I am pretty comfortable today and making great progress.  The last few days
are somewhat of a fog, and a mix of good and bad memories.

Here are some rambling thoughts on some of my experience.  Most of this is
fairly fresh in what little memory I have and might fill in some of the
murkier expectations of anyone who is headed for surgery.

The Surgery took place on Tuesday.  Started at 9:30am. Finished about
2:00pm.

I woke up in recovery and saw a large clock hanging from the ceiling,
reading 2:30.  My recovery nurse was really nice.  She is a cook and says
that her ribs are the best around.  We swapped recipes and so forth until
about 3:30 when they took me up to my room.  I don't remember the recipes or
her name, but she was very pleasant to have around...

I spent two nights in the room; pain was pronounced enough to keep me from
sleeping on Tuesday night.  I had a sleeping pill on Wednesday night...
That was a real treat since I was so exhausted.  Violet stayed in the room
with me.  She was sleeping on the roll - around when the nurse came in at Oh
dark thirty to get vitals on Wednesday night.  I was wearing my headphones
and apparently could not hear him call my name.  Violet says he became very
concerned very quickly.  He thought I was unresponsive for some other
reason, like death, maybe.  We had a little chuckle over it.

The doc didn't want me walking on Tuesday.  Bed rest.  Wednesday I took my
first walk about noon.  Sat in a chair for a while.  Took another walk.
Then another.  Then crashed hard with extreme pain.  The evening nurse
firmly but kindly lectured me on over doing it.

I developed gas over the two days in the hospital and continued to be a
painful problem until Friday.  Changing pain indicators and sites throughout
the stay made it difficult for me to make the call as to "pain level" and
what I thought was the cause...  The intestinal distension was masking some
of the surgical pain, I think, and there was a specific place in the right
abdomen under the drain which was really sore.  The combination of percocet
and morphine did abate the intensity of that particular pain as long as I
did not move.  Movement fired it up (as well as the other site - specific
pain, but that was not as pronounced by a long shot) to the point where I
was getting very concerned that something was wrong.

I saw a number of doctors over the period, and each pronounced that I was in
really good shape and that the surgery went perfectly.  I was having some
doubt though, until Wednesday evening when I was able to articulate exactly
what was going on with the pain to my nurse and doctor, and was reassured
that the sort of migratory, transitional, intermittent, constant localized,
gassy, bloated pain was perfectly normal for my situation.  It seems to me
that there is a tendency to gloss over some of the expectations when
discussing the aftermath of surgery with the patient, because of the
subjective nature of the issue.  Basically, no matter how crappy you feel,
or how unique your situation seems to you, it is probably familiar to the
doctors and nurses, but you don't know that, and they cannot tell what is
really going on if you cannot clearly express it.  This is a problem
considering you are distracted by pain, exhausted, and stoned.

I couldn't believe the amount of gas I was producing in the bowel.  The doc
said that the body absorbs the carbon dioxide they inflate the abdomen with
when working.  That it is released back through the gut.  No fun at all.
Note that the conventional pain killers do not help reduce the pain of
abdominal wall distension or bladder seizures, although enough oxycontin and
morphine will cause you to not care too much about it.

In discussing the particular pain in the right side that was a concern, the
doctor said that it could be caused by bladder spasm and that I could have
an anti -spasm drug to take care of it.  Well, I was due for a couple of
hits of oxy and they were willing to give me another morphine shot at the
time, so the discussion turned to the question of whether I should do one or
the other of these drugs.  The reason presented by the doc (all of these
references are generic in the sense that unless I say Dr Koeneman I am
talking about either the floor resident or the fellow who was working under
Koeneman ) was that they would not know which one was helping if I just took
them all at once.  After the fact, Violet and I were laughing about it,
because, in reality, who gives a rat's a.s which one helps as long as it
works...

The pain management program in this case was based on the patient asking for
meds.  Instead of scheduling the meds for specific intervals they waited
until I told them that I wanted pain medication.  So, there were a few times
where the delay between the call for meds and the delivery was over thirty
minutes.  One time was over an hour.  When entering the room, they asked me
about  my pain, and I told them what seemed right at the time.  I would have
specifically requested the meds get scheduled, which we did do the second
day when one of the nursed actually recommended it, if I had known how it
worked at the outset.  The nurses were quite good to me and there were a
couple who were super - duper nurses.  They did their best to keep me
comfortable in every way as far as I could tell, but they had this
procedural glitch in pain management.  So, it would be a good idea to tell
them straight out that you want the meds on the most effective schedule
right off the bat, and if you are doing really well, taper off.

More to come.

God Bless,

Steve