Thursday, March 21, 2019

Medical Snafu

I write this post with one request in mind: please no Monday morning quarterbacking, second guessing or unsolicited medical advice. I am well and without going into prurient details in a public space my groin feels much better since the IVC filter was removed. I write this post as part of the series about my long drawn out recovery. Shit happens in the world of medicine and it happened to me on Monday. Of all the operations I’ve had Monday’s simple filter extraction was easily the worst and the most painful. I was awake for the entire three hours I was on the operating table and I could feel everything. 

The Inferior Vena Cava filter looks like a shiny umbrella frame without the cloth. It is inserted in the groin to catch blood clots that may form in the legs of bedridden, non ambulatory patients. It saves lives by preventing those clots from traveling from the legs to the heart lungs and brain and paralyzing or killing you. They have been around for almost 20 years and the early models were fixed like mesh strainers and had a tendency to break and formed their own danger to the patient. That’s why you see lots of advertisements from bottom feeding lawyers looking for clients. Modern IVC filters fold like umbrellas and are slotted into a tube and extracted through a cut in the neck. Very simple and very clean.  Takes an hour from start to finish, at most. 

My appointment at Jackson South was at nine for surgery at ten. My paperwork went wrong in some manner and then they discovered I had been told mistakenly I did not need to fast as I was not going to be unconscious. That pushed me back to 2pm when the surgeon found out I had breakfasted. Even being awake I might vomit from the effect of the drugs that were supposed to make me drowsy. (I did copiously in recovery) and if I aspirated on the operating table it would be a problem. Score one for Dr Toro he called that right. 

Eventually the paperwork got sorted and we went to pre-op. I’ll tell you this: everyone was incredible at Jackson South. They were kind and thoughtful respectful and shared a few jokes with me. I would go back any time for medical work. They treated me well. 

It had been stressful waiting and it gave me too much time to think. Paula my nurse was wonderful keeping me relaxed and talking me through my nerves. I disliked the idea of being cut in the neck while awake but she said it had to come up going up through my body because if they tried to pull it out backwards it would open and jam. Brr I thought to myself. And you can’t knock me out? Not necessary she said. It would take longer for recovery than for the operation. In retrospect that was ironic. I was in recovery for five hours. We didn’t leave the hospital till ten that night it ended up being a thirteen hour day. 

I got my IV inserted into the back of my hand. I had drunk a lot to make my veins easy to find, I know that trick by now and where once I had a dread of needles not anymore. I had to get rid of the water as I waited for my operation so I ended up wandering the halls to and from the loo numerous times as I waited. Another reason I’m delighted the filter is  gone. It seemed to make me need to go often and I think it pressed on my full bladder in a way that made it hard to hold back. When I had to go I HAD TO GO! Awful stuff. 

The next photos are post op, just so you know. I was wheeled into the operating room and my head was turned to the side and half my face covered so I could only see out of my left eye. I must have been naked I guess but I felt nothing of that. I never saw DrToro during the three hour operation but I heard him and as restrained as he was I knew when he was getting frustrated. Opening my neck hurt. I felt a thump and a sting as they applied a local anesthetic and that pain drifted away as they started giving me lesser painkillers to dull my consciousness. That didn’t work and I could feel the wire winding through my torso like a train following my arteries to my groin. It was creepy but it didn’t hurt.  It took some effort but they got the filter into the tube to general sighs of relief. Then the return journey began. Which is when everything started to go wrong.   

The filter got hung up. I heard the surgeon say it’s in a wall and I can’t get it over. This went on for ages. They started on the dilaudid which sent me to la-la land but only briefly. I kept waking up. He was tugging the wire and I had the distinct sensation I was being stabbed in the chest. There was a thump followed by a jolt of electricity and a stinging sensation as he struggled to move the filter.  It was lodged tight. This went on for a while. I got more dilaudid. I was groaning in pain. 

Eventually they opened a hole at the top of my thigh and inserted a balloon to grab the stuck filter from below. Paula had told me the longest extraction they had lasted two hours and eventually that patient was sent to ICU for a full on operation to get the filter removed. I was facing that prospect and I prayed the balloon would work. Finally it did and the filter came out untrammeled. It came out so easily I could feel it sliding across my chest in the artery but I had to ask what happened when all action ceased. It’s out they told me. Cheer I said. Clap lets be happy. They indulged the patient. At my insistence the doctor went and spoke to my wife who was in tears in the waiting room. After one hour had passed she knew something was wrong. After two hours she figured I was in trouble. When Dr Toro came in looking somber she thought I was dead. He was just tired after the worst extraction he had ever handled. He said the filter was wrapped in a vein which complicated things. 

They had to clean up gallons of my blood all over the floor,  I had been bleeding for three hours after all. I was rolled into recovery where the loss of blood left me feeling freezing cold. I huddled under five blankets (three photos up taken by my wife) and started projectile vomiting my breakfast coffee and bagels some into the bucket some on my long suffering wife and some on the floor. My excellent nurse Lehaney kept ice on my wounds and chased my vomit like the pro she is and monitored me closely for five hours. Like all the other nurses and staff she was wonderfully compassionate and caring and minimized my embarrassment at the mess I was making.

Carlos rolled me out of the silent darkened hospital to the warm Miami night.  Drizzle was in the air but I was so glad to be leaving it all behind.  I was spent through stress, loss of blood, and vomiting. 

I could walk a bit and when my wife stopped at Publix to get dinner - I had an irrational but understandable craving for a moist meal of cereal- I walked slowly to the bathroom using my cane and without the filter I had plenty of time and no urgent sudden need to urinate. It felt fantastic!  You have no idea. 

The picture above is of handicapped driver at he hotel being an asshole blocking van accessibility. Everyone has the capacity to become an asshole in Miami. Anyway I feel tons better now the filter is out and I am over my drugs. I think the filter was put in badly in the first place because it always felt odd and caused me pain and numbness in a place no man wants to feel those sensations. It was like I had a urinary infection or something and all that nastiness went away the minute the filter was removed. 

Kudos of course to my ever patient wife who drove me up and back and took care of all the administrative stuff. She was very smart to schedule this nightmare during her week off in spring break. Not a great way to spend vacation time but it was one less thing to worry about as we came home 24 hours later than expected. Our friends took care of Rusty who was delighted to see me and shared my recovery next to me on the bed. Never did I expect this routine operation to force me to take my first night back off sick. But it did! I hope you learned something from my experience: not least that we are all capable of dealing with more crap than we think we are.