The day began with the surgeon’s team doing their rounds at about 7am. There were about 5 or 6 of them all at once, and I still wonder how so many people can fit in this tiny room. There is only a foot of space at the foot of the bed, 3 feet to the left of the bed, 2 feet to the bathroom door, and another 3 feet to the recliner where my wife has been sleeping and staying by my side 24/7.
I probably wasn’t making a lot of sense at that point between the pain and the dilaudid bursts, but I remember being clear that breathing was still really painful at the base of my right lung after drawing only about 500ml of air, so I was kind of panting like a puppy dog at summer high noon, EXCEPT I must draw the distinction that I was not short of breath as I consider it; I never had to struggle for enough oxygen. Technically my breaths were short, which to me is a subtle difference that was totally lost on everyone else, who seemed to think I was struggling for air.
This breathing status, noted on day #1, immediately led to blood tests, incentive spirometery, a chest x-ray, then a CT scan. They were pleased with the results of the CT, saying that there was no internal bleeding, just a pleural effusion that was collapsing part of my right lung. So now on day #2 I was sent down to get another chest X-ray, and that showed improvement of the junky right lung, an encouraging sign. So today’s plan was to remove the foley catheter, after which I had 8 hours to pee spontaneously. I learned my lesson the first time that I can’t pee lying down, so I needed to be able to stand as soon as possible. I desperately did not want to experience another straight cath so at the 8th hour I dosed myself up with dilaudid, raised the back of the bed to about 90 degrees so I was folded up like a painful taco. I grabbed the bar above my head, carefully swung my legs off the right side of the bed, and with a little pulling from my wife and pushing by the nurse, I had my feet on the floor facing my walker. These walkers are a life-saver and I am not too proud to say I love them. I was able to pull up onto my feet and shuffle to the bathroom, where after about a minute of my bladder trying to remember how to operate, I was able to empty my pee into the hand-held urinal. What a relief! Then, the chore accomplished, I scooted back to the gurney and lowered myself down. There were a few minutes of payback while the adreneline wore off, but I lowered the bed back to a 45 degree incline and relaxed. I think I took a goodly long nap.
This exertion dropped my O2 saturation levels into the 80s which alarmed the nurses so I was put on a cannula with 2L of oxygen. This didn’t have much effect as when struggling through pain I’ve learned I revert to caveman mouth-breather mode, and unless the cannula was pressed into my teeth somehow, my O2 levels weren’t changing much. So the nurse turned up the O2 to 4L, and I learned to breathe through my nose to make them happy. Every time I fell asleep on my back though, I would forget myself and breathe through my mouth again, which caused panic and another 1L rise in the oxygen level.
I was also put on EKG telemetry so my pulse and Sp02 could be sent to the nurse’s station at all times. Though they say a watched pot never boils, my pot got to boiling a great deal and every aberration in my breathing now got an instant response from a team of nurses. So by the end of Day #2 I was now on 5L of oxygen, most of which I probably didn’t need, and I had to be sure to breathe with the incentive spirometer 10 times an hour.
They also brought a respiratory therapy team who connected me to a BIPAP, a positive airway pressure system that I could wear for only 4 hours at a time unless I was in the ICU, and I felt like escalating to the ICU would cause more panic than ever. I had never done a CPAP or BIPAP befrore so I had to get used to a machine breathing for me, which was surprisingly easy and either it was a long day or the BIPAP was relaxing, in any case I crashed into a very deep sleep for 4 hours.
I woke up sort of hyper-aware that 4 hours had already passed, and I was waiting for my BIPAP to turn into a pumpkin, or at least for someone to show up and disconnect it. My mouth and throat were drier than the Sahara and I rang the nurses, who were confused by my request to remove the BIPAP and wanted to have a long discussion about it, which was impossible because any attempt on my part to make speech was met with instant lung-filling pressure, and I had trouble figuring out the timing. I ripped the mask off. The nurse was of the opinion that anything that worked good for 4 hours was worth doing for 8 hours, and had never heard of the 4 hour rule the respiratory therapist mentioned. But they shut the machine down and put me back on cannula oxygen, and I took a well-needed tiny sip of water to rehydrate my mouth, which was like astronaut freeze-dried ice cream at this point. Very soon I realized my lung pain that I experienced after drawing in 500ml of air, was now happening instantly and all the time, so I was approved for another bolus of dilaudid which helped make the pain tolerable but didn’t reduce it lower than a 4.
That was pretty much the end of day #2, as the dilaudid clouded my brain and I slept very soundly from then until morning.