cancer – day 20

So technically this story is about day 19 of the cancer life, but the surgery day got me a bit off in my journaling. But this is one my parents will never forget, and I can’t very well leave it out of the journal, so I’m going to tell you about the day after surgery in the hospital.

Overnight at the hospital I had a wonderful aide, Amy, and a fantastic nurse, Robyn. My nurse was actually the charge nurse who usually runs the floor but that night she was working the floor because she needed more nurses. They were great. Amy made sure that I ate, and she came in to check my vitals on a schedule, and she would chat with me a little bit about what she does and what kind of patients they get, you know, small talk, but she and I have the same opinion of stuck-up doctors and people who think they’re better than anyone else (apparently many people treat hospital aides with about the same level of respect that executives treat the mail-room clerk). And since I couldn’t sleep, Amy would check in on me and try to get me to eat some crackers or soup whenever I got a shot and we’d chat now and again. She even came in to say goodbye to me in her street clothes in the morning as she was going home.

My overnight nurse Robyn was amazing. Somehow very caring and amazingly efficient at the same time. I suspect this is what my mom was like as an RN. Robyn talked with me early on about how much pain medication Dr. Thayer had approved per hour (up to 10 milligrams of morphine per hour, wowee would that have been a druggie trip or what?) and how she is perfectly fine with giving me the full amount per hour though she prefers to dole it out in smaller doses more frequently so we can adjust the medication to how the pain shifted during the night. This made perfect sense to me, and so whenever the pain started to be too great, I would push my little call button and Amy would come on the speaker to see what I needed and Robyn would come in a moment later to talk about the pain and we’d decide the dosage (usually two to four milligrams) and she’d be back a moment later with the shot and administer it with some saline to help prevent nausea from the morphine. Robyn is from New Zealand, and her accent was amusing. Same sort of thing as with Amy, since I was up most of the night, Robyn would check in on me sometimes between patients and if I was up we would chat a little. With Robyn in charge and Amy aiding, I felt safe and protected, and completely trusted their care. I also really empathized with their rational for working nights . . . the workload is more calm and controllable, and very little of the daytime hospital politics or attitudes seep over to the night shift.

Their shift change was at 7AM, so I had my last shot from Robyn at about 6:50AM. She told me they needed to get me switched over to oral meds in order to let me go home, so we decided to up my last dose to six milligrams. She was encouraging it, which I didn’t completely understand at the time, but an hour later it was obvious that the day staff is very different from the night staff at Mercy Medical.

My new aides come in at 7AM to take my vitals. There are two of them, because one, Cheryl, is in training. Cheryl has been an aide in convalescent care for many years, but has only been at the hospital for two days, so she’s new to how the hospital does things. The aide training Cheryl, Arynne (pronounced Erin), was very busy telling Cheryl what and how to do things, and when she asked me what my pain level was, she apparently didn’t hear me say “5” because she wrote zero on the chart. Zero, HA! What I wouldn’t give to remember what it feels like for pain to be at a zero. Anyway, the aides seemed too busy to actually take care of me, and I didn’t ask them any questions.

A few minutes later my day nurse came in, Susan (Sue P.). She and I butted heads almost immediately. The first thing she said was “I understand you’re in a hurry to get out of here.” Which shocked me, because, aside from asking someone the night before if there’s a typical time they release patients that I should have my parents be back at the hospital by the next morning, I had never suggested to anyone that I thought I didn’t need the pain shots or that I was anxious to go home on oral meds. So I told her “No, not at all, I just asked if there’s a time I should tell my parents to be here because we live far away. I definitely prefer being where I can be cared for and have my pain controlled.” She asked about my pain and I said it wasn’t too bad at the time because I’d had six milligrams of morphine just 30 minutes ago but that we’d been dosing it in smaller more frequent doses all night. She poo-poohed that, like it’s just a hassle to do small frequent doses.

But morphine wears off after about an hour, and so just 30 minutes or so later, I was ringing the call button for Sue to come in and give me my shot. It took her about ten minutes to show up, but she went straight to it and gave me four milligrams without asking how bad the pain was or how much morphine I thought I needed. This women was clearly not the care-giver Robyn is. But, hey, she did bring my shot, and an hour later I rang for her again, and so on through the morning.

At ten o’clock she brought me pills instead of morphine and said we needed to get me onto orals so I could go home later. It was Darvocet. I took it, but I told her that I had been given Darvocet after the last biopsy and that it had started causing me stomach problems and not working very well after I’d had it a couple of days, and that the nurses yesterday in post-op had said I was going to have Tylenol-3 with codeine instead of Darvocet or Vicodan (which also has made me sick in the past). She was annoyed by this, and flipped back in the chart saying that Darvocet is what Dr. Thayer ordered so that was what I was going to get. I tried to ask her when that order was written because the Tylenol decision hadn’t been made until late in the day yesterday, but she fussed about having to call in a different prescription and left the room. Not long after that my parents showed up. I told them about the Darvocet thing and that I was worried about getting sick from the med when we got home, and they told me to make sure that Sue changed the prescription so we wouldn’t have to worry about that. When Sue came back in (while Mom & Dad were with me), I mentioned again the conversation the nurses and Thayer had while I was in post-op and that I was supposed to have Tylenol-3 because Darvocet hadn’t worked well for me before and caused me stomach trouble. She snapped, “well, how do you feel now?” I told her I felt about the same as when she gave me the pills an hour earlier, a six on the pain scale. And she said the pills were obviously working because the pain hadn’t increased since I took them. I pressed her on the prescription thing anyway, and she said she would have to call Thayer to get the Tylenol-3 prescription approved and I told her “well, yes, I think you need to do that then.” And she kind of stomped off, obviously annoyed that I had increased her workload by requiring her to make an extra phone call to my surgeon and call back the pharmacy to change the prescription she’d just called in. Mom and Dad agreed though, I had to push her to do it, we couldn’t go home with Darvocet knowing it doesn’t work for me. It would take Dad 90 minutes to go get another prescription if the Darvocet didn’t work and we had to call Thayer from home to change the medication. So it’s about 12:15PM now, and we’re waiting for the aides to bring me lunch and then wait to make sure the pain pills work before I can go home with Mom & Dad. They’re hungry too, and Dad’s getting antsy, and I suggested they go ahead and go downstairs to get lunch, so they went. I was trying to rest and snooze a little, but not long after that the pain started going up, because the Darvocet wasn’t working.

So as usual I push the call button, get the aide station, and ask them if I can get some pain medicine please. They say the usual “ok, I’ll let your nurse know” and I waited. The pain goes up from a bearable six to a muscle-tensing seven. No nurse. Ten minutes go by. I page again. Slightly more agitated voice this time, “can I please get some pain medicine?” They say they already told my nurse but would tell her again. I wait. The pain goes up to a nauseating eight, ten minutes go by. My phone chi-gongs with a text from Mark “still drifting?” I text back “almosrrt aa 9 waaiitng 4 nurrrse” my hands trembling so much I can’t type into the blackberry properly. Pain rises to the face-wrenching crying nine, and still no nurse. I’m alone in my room. I press the call button again. I can’t control my voice, I’m crying and m voice is hoase and I beg them, “Please, I need some pain medication, Please!” They start to tell me they’re looking for my nurse and I croak out, “I don’t need Sue, just send in a nurse, just send in anyone’s nurse, Please!” They start babbling about how Sue is my nurse or something as she enters my room. “Nevermind, she’s here” I gasp, and collapse back on the bed. I can’t even look at Sue, I can’t even see through the tears, and my whole body is shaking uncontrollably. It’s been 35 minutes since I first pressed the call button. Sue says something about having been on the phone calling in the new Tylenol prescription and I just scrunch my eyes closed and try to stop trembling. She administers 4 mg of morphine and disappears.

I can’t imagine how awful it would feel being a care-giver and finding your charge in that state from your neglect.
Mom and Dad came up about fifteen minutes later and the morphine was working, I was back to a 7-1/2, tears still drying on my red cheeks. I didn’t tell them everything right away, just that it took Sue over 30 minutes to bring my pain meds and I was hurting. As you can imagine, my Director of Nurses mother and Hospital Administrator father have an opinion about the minimum quality of care one should expect of nurses in a hospital.

The next time Sue came in the room it was to confirm the Tylenol-3 prescription and make sure the morphine was working. Her tone had changed completely, and she was almost meek in her efforts to be helpful now. Later I told Mom and Dad how bad it had gotten and I told Dad I couldn’t tell them at first because he would have gotten her fired then and there if he’d known. After all, he’d just been downstairs chatting it up with the Mercy Medical hospital administrator, who was cooking for the hospital barbecue my parents ended up having lunch at. Dad and the administrator hit it off, go figure. And apparently one of my nurses from the day before remembered my parents and came over to tell them they hoped I was doing well, which had made Mom feel good.

Anyway, we got me out of there around 2:30PM or so, and now I’m thankful to be home even if the pain isn’t down to a 3 like the first nurse told me it should be for going home.