Palmer House

Renovating and Restoring Our 1880 Folk Victorian

DISCLAIMER: This isn’t going to be the usual home improvement post…more an explanation as to why it isn’t a home improvement post . So if you came looking for before and after photo’s of a bathroom or living room or something, and talk of surgery and body parts makes you queasy, skip this post and head to the next one!

Oh my goodness it has been a minute since I posted anything! To put not too fine a point on it…I had a combination of writers block, no time, and honestly – a lack of desire. But at the moment I have a PLETHORA of time! I am currently home for two weeks on a strict “no lifting, no driving” protocol after emergency surgery on Halloween night.

Oh my gosh that sounds so dramatic and somehow cliche…

But seriously, it was quite the day, and it seriously disturbed my plans for the blog in that I wasn’t able to post about one of my favorite Palmer House holidays! I was so looking forward to doing an in-depth blog post on Halloween around here – what I decorate with, how I decorate, my DIY projects…all the deets! I had started the night before by getting the porch 80% of the way decorated. I had planned the day before Halloween, Halloween itself, and most of the day after Halloween to be off from work – all for the purposes of decorating, cleaning up, and getting an awesome post up. That morning at 5 AM, one of the cats woke me and I noted that I had some pain in the lower right quadrant of my abdomen (forgive me, the nursing language is going to come out a bit here, but I’ll try my best to keep it easy to understand!). Hubby was just getting home from work at that time – I told him about the pain and he told me to try to go back to sleep and that it was probably just gas pain. Well, at 5 AM I wasn’t about to get out of bed and argue the point! I found relief by pulling my knees up to my chest and went back to sleep.

The next time I woke up was around 8 AM. I got up and started getting ready for the day. As I was about to get into the shower, I noticed the pain had quickly come back, was slightly worse and that I wanted to sit down. So I went downstairs to sit in my PJ’s for a few hours, ate some breakfast, and the pain went away. At this point, I thought that it probably was gas pain as it was coming and going. Once I felt better, I got up and started going about my day again. I got through a shower just fine, but the minute I got out, the pain came back even stronger. On a scale of one to ten, with ten being the worst pain you could ever feel, this was probably an eight. I was doubled over on our bed (Chris was up by now), and I told him that I thought we needed to go to the emergency room for me to get checked out. I had texted some of my nursing friends and even called a doctor friend of mine and they all agreed – minus the coming and going of the pain, it sounded like appendicitis. Chris and I were torn on where to go – we didn’t want to waste hours with me in pain in an ER waiting room, but the Emurgent Care that we really liked was about 45 minutes away. Upon the urging of my ER nurse friend, we decided to drive to the ER. Chris jumped in the shower quickly and I stayed in bed in pain. Finally, the pain escalated to the point of causing nausea. I ran to the bathroom, knelt in front of the porcelain throne – and the pain left. Poof. Gone. Quicker than it came.

What the heck was going on? My (neonatal) nurse brain couldn’t understand what was going on in my adult body. I made up my mind that if the pain came back, we were going to the ER no matter what. We both went back into the family room and sat down for another few hours. By this time it was lunchtime and I had something to eat – still no pain. So we both finally got up with plans to go visit our newest kitten, Millie, in quarantine for an upper respiratory infection in our upstairs bedroom and then to finish decorating for Halloween. I think we were in the bedroom with the kitten for a total of ten minutes before the pain came on – raging! Ten out of ten! I am talking doubled over, moaning in pain with a dash of screams anytime I needed to vomit. This time, there was no “driving” to the ER – we called the ambulance. Something was wrong. Very wrong. And I knew it. And I needed pain control.

The ambulance came and I could barely answer the EMT’s questions due to the pain. I couldn’t move. I couldn’t walk. I could barley talk. The rebound pain when I let go of the pressure over that right lower quadrant was unbearable. They had to carry me out of the house in a special chair lift and physically put me onto the stretcher. I got two doses of morphine en route to the hospital which did nothing for my pain. Didn’t touch it. The only slight measure of relief I had was keeping myself in a fetal position with my knees to my chest.

At the hospital, I went two hours without pain control. The reason? There was no doctor assigned to me, therefore the nurse had no orders. Two. Hours! At a pain of ten out of ten. Me moaning – begging! – someone, anyone to give me some sort of pain relief. Well finally my knight in shining armor – the hubs – pulled my nurse out of our little curtained cubicle and told her that if she didn’t have a doctor looking at me in ten minutes, he was going to take me and leave. I had orders within five minutes! An ultrasound was ordered and “a dilauded for the road.” Now, if you have never had the pleasure of  being in enough pain to need narcotics, you probably have never heard of dilauded. But I would bet that you have heard of morphine! Well, dilauded is seven time more powerful than morphine and still did nothing to ease my pain.

No. That was not a typo.

That was the most agonizing ultrasound of my life. First an external ultrasound to look at the “surface” structures in my pelvis, and then an internal ultrasound to look at the organs that were deeper (i.e. my uterus, et.). I give that little ultrasound tech and my husband credit. The ultrasound tech – because she was positively methodical. She took tons of images and dealt with my squirming and yelling at the same time. Poor girl…at one point during the internal part of the ultrasound I yelled at her “GET OFF THAT SPOT ALREADY!!”.

I am a nurse. I don’t yell at my interdisciplinary colleges when they are just trying to do their job. I apologized, don’t worry.

And poor Chris got the life squeezed out of his hand throughout that ultrasound. He helped move me from stretcher to table to bathroom (to pee…which I couldn’t do at the time (morphine can cause urine retention)) back to the table and back onto the stretcher at the end. All while keeping my vomit bag close.

knew something was wrong at the end of that ultrasound when the tech looked at Chris and said “Can you get her back on the stretcher? I need to take these to the radiologist to read.” In case you don’t know how a hospital works, it’s basically a “first come first served” type of environment – unless you have a condition that moves you up in the pack. Therefore, the sicker you are, the quicker you’re served. So the next time you are in the ER and you have to wait for hours, be comforted in the knowledge that your problem isn’t urgent enough (ie loss of life and limb always outranks everything else) to be seen emergently. The fact that this tech had to leave before she even got me back on the stretcher safely said that something was very, very wrong. Little did I know I was about to fall under that “loss of life and limb” category.

Chris got me back on the stretcher in the hallway outside of the ultrasound exam room and the radiologist was there almost immediately (Another good thing to point out…an ultrasound tech/radiology tech performs the test. In order to do that, they need to know how to recognize the anatomy on the screen (of course). However, the radiologist interprets the ultrasound images). Again, first come first serve in the line of images, and the radiologist had read my images in the ten or so minutes it took Chris to get me from point A in the ultrasound exam room to point B in the hallway. He asked me if I was using medication for IVF therapy. I told him yes, that I had taken injections the past month and that I was currently on progesterone. He said that often, the follicles in the ovary (the little chambers that hold the egg) can become “irritated” by the hormone therapy. I had no idea what that meant, and at the time, I didn’t care. The pain was still excruciating.

The transporter came to my waiting spot in the hallway of the radiology department and took me back to my bay in the ER. About fifteen minutes later an ER resident came in and said that the ultrasound images didn’t make sense…that my anatomy wasn’t in the correct area.

WHAT?!

He said that the radiologist read the images as a possible ovarian torsion and that the gynocoligical surgical team had been called. Translation: My ovary might have twisted around itself, cutting off blood to the organ and I might be going to emergency surgery to try and save the organ – if possible.

In the meantime, I got another dose of dilauded that finally brought the pain from a ten to a nine. Not a big difference, but at this point I had been in pain for hours, so any relief was welcome relief. The labor & delivery (L&D) attending and her team showed up just in time for the effects of the dilauded to kick in – which was wonderful because it took enough of the pain away that I could focus on what they were telling me, give consent for surgery and ask questions regarding the surgery. They. Were. Wonderful. I will always sing the praises of the people who took care of me from this moment in this story on. The attending (aka, the head honcho on the labor and delivery floor that night) explained that her team had to call the surgeon in from home, and that they had initiated a conversation with my IVF doctor to try and figure out what the best course of action would be. Do we go to surgery? Nothing on the ultrasound confirmed a torsed ovary, but my anatomy wasn’t correct on the ultrasound either so something was going on. So should do we wait and just work on pain control? The L&D attending explained that she doesn’t do the gynocological surgeries…just C-sections, so until the surgical attending showed up, she wasn’t 100% sure of a plan.

That changed when her chief resident (also an amazing person – anyone who will hold my hand while I am crying in pain is an amazing caregiver) bumped my bed and I screamed in agony. The attending looked at me and said “Have you gotten any pain medication?” Through tears I answered “Yes. Two boluses of morphine en route and now two doses of dilauded.” “What is your pain on a scale of one to ten?” “TEN!!” She looked at her chief resident and said “We’re going to the OR. Get the consents ready.” Two minutes later I was signing paperwork and the surgical attending showed up at my bedside. The procedure was explained to me along with all the risks – the biggest being hemorrhage, infection, and loss of my ovary.

Terrifying.

I signed the paperwork and they had an OR ready and me rolling in fifteen minutes. The danger now was that every minute we delayed, my ovary was potentially being starved of a blood supply, which meant it could die.

Right before I went into the OR, I met the anesthesiologist and signed consent for them to put me to sleep. I had never been under general anesthesia before, I remember trying to crack a joke through the tears and told him “Just don’t break my teeth!” (Yes, that is an actual risk when being intubated. Translation: when the breathing tube is put in, the metal tool, called a speculum, that both opens your airway and helps guide the breathing tube in, can break your teeth!). He laughed and said that he didn’t anticipate any problems.

I remember being rolled into the OR with my little blue hair net on, an oxygen mask being put over my face, and getting really light headed and sleepy. I remember looking at the IV in my left arm and seeing that the medication to put me to sleep was being put in.

Next thing I knew I was in the recovery room being gently woken up by the post-op nurse. The time is foggy in my memory, but I remember feeling great! The pain that I had from the three incisions (one near each hip and one in my belly button – this was done laparoscopically, thankfully!) was maybe a four out of ten. Maybe. I remember knowing that I was feeling the effects of pain medication and the anesthesia, but I had almost no pain! It. Was. Amazing. Chris was there, and I was (apparently) very chatty as I woke up – not my usual. Traditionally, coming out of anesthesia I cry. I could be laughing up a storm, but there would be tears streaming down my cheeks. Not this time! I think this time having relief was so wonderful that there was no way I could cry! Other memories from this time was that my throat was sore and dry from the breathing tube and that cranberry juice never tasted so good. I also remember the nurse putting chapstick on my lips for me when I complained they were dry – something that moved me to tears later on…so maybe I got my tears out after all. I know that Chris and the nurse told me what happened during the surgery, but I don’t have a concrete memory of that until the next day.

I was transported upstairs to the observation/post-surgical unit for labor and delivery. Since this was a gynocological surgery, that is where I was slated to stay for the next few days. The surgery went from approximately 10 PM to midnight, and I was up on the floor by 2 AM. By the time my admission assessment, vital signs, pain management protocol and walk around the nurses station (Yup. That’s right. My fantastic nurse, Donna, got me up out of bed just a few hours after surgery and walked me in a loop around the unit while the pain meds were going strong!), it was 4 AM. If you have ever gone through surgery and wondered why the nurses want to get you up out of bed so soon, it’s because sitting/laying in bed does a few things to you that you don’t want post surgery: 1. You become a high pneumonia risk because you don’t move your lung secretions like you should. 2. Anesthesia and narcotics basically shut off your intestines. When you have had surgery, particularly abdominal or pelvic surgery, the last thing you want is to have a hard time bearing down to have a BM. Pain! Pain! Pain! 3. Within three days of sitting/laying in bed or on a couch, you will have muscle wasting. That’s right. In just three days, you will start loosing muscle mass. So the sooner you get up and move, the better! It hurt to get up and walk, but I was so thankful my nurses pushed me to do it. (PS, I still ended up with a cold when I got home because I didn’t move enough and coughing HURT!).

I got two hours of sleep that night before I had a little gremlin, aka a second-year resident, wake me up to do an assessment. Now, this hospital is the hospital that I work at in the NICU. I’m used to dealing with residents, and this one got on my nerves quickly. I was not 24-hours post op…I wasn’t even 12-hours post up, and this little dingus had the gall to look at me in the face and say “Well we’ll send you home later on today.” I remember looking at her and saying “Are you serious? I can’t even get to the bathroom by myself, let alone lower myself down onto the toilet – and that bathroom is three steps away from my hospital bed! Do you know how far away my bathroom is in my house? At least four times that distance! Who is going to help me to the bathroom when I am at home? My husband has to work! I’m having urinary retention from the dilauded I’m on and my pain is nowhere near under control. There is no way on God’s green earth that I am going to agree to or sign any discharge paperwork this morning.”

Yes, you CAN say this to your “doctor”. You are allowed to advocate for yourself.

I put doctor in quotes because the residents don’t have an actual say whether I can go home or not – they are at the hospital to gain clinical experience and finish their education. Yes they are “doctors” – they have completed medical school and earned their MD, but a second-year resident (residencies are different depending on the specialty they choose to go into) is nowhere near competent enough to make a call like that – only an attending can decide if a patient is ready to go  home. So often, it falls to the nurse to get the resident to lift their heads out of the black and white – the lab results, the x-ray results, the vital signs, the textbooks, et. and get them to realize the reality of the situation. Now, in a perfect, textbook world…yes, I would go home “the day after a laproscopic surgery.” This resident wasn’t there overnight to see me roll up on the unit four hours earlier, so to her, it was the next day. So, understandably, she was working from the textbook. But we all know that not every patient – in fact, MOST patients – are not textbook.

Luckily my surgical attending, who performed the surgery, agreed with me and said I could stay as long as I needed. A perk to being a nurse is that the doctors trust your educated judgement enough to say such a thing…some people would take advantage of that and treat it like a vacation. “Free” food, “free” clean clothes, warm “free” bed…yeah…some people definitely look at a hospital stay like a vacation.

When my attending came and spoke with me the next day, she showed me the pictures she took of the inside of me during surgery (SO. COOL!). The long and short of it: When the team got into my abdomen, they found a half of a liter of blood and clot just chilling in my pelvic cavity. This can cause a lot of irritation and probably had a hand in the amount of pain I was having. My right ovary was indeed twisted – one and a half times, to be exact. The reason my pain kept coming and going throughout the day was because my ovary was literally twisting and un-twisting itself throughout the day. What was making the ovary move? A cyst the size of a baseball. To give you further idea of the size of this thing, it stretched from my belly button to my right hip bone – essentially, the entire right side of my pelvis. This made my ovary “top heavy”, which caused it to twist on itself. The most distal (farthest away) third of my ovary from the blood supply had already begun to die, so the surgeon needed to remove that part of my ovary.

The question I have had from many family and friends was “What caused the cyst?”

Anatomy time! The IVF meds did. The whole point of the medication you take before an IVF cycle is to stimulate your ovaries to make lots of eggs. More eggs = more chances to conceive. In a woman’s normal cycle, one ovary releases one egg every cycle and the ovaries usually take turns – one egg from one ovary this month, one egg from the other ovary the next month. When you are on IVF meds – all hell breaks loose! The medications force the ovaries to produce more than one egg and they are not discriminatory! So both ovaries will turn out several eggs at once. You think you have bad PMS now? Oh boy…wait until you’re on IVF meds! The egg develops in a little house in the ovary called a follicle. Each month you have multiple follicles, but usually one big boss follicle takes the lead and releases an egg. With IVF meds, you make multiple follicles at once before the eggs bust out of each of them and leave the ovary to meet the sperm in the fallopian tube to make a baby. Once the eggs leave, those follicles don’t just go away. They basically shrivel up and become a hormone factory, pumping out progesterone to maintain a pregnancy, should one occur. If one doesn’t, you get your period, the follicles stop producing the hormones for pregnancy and your cycle starts all over again. Being on a supplemental progesterone as part of IVF therapy can stave off your period and keep those little hormone factories running. Mine basically got out of control. At some point, a vessel popped and started bleeding into the cyst (actually, once the egg leaves the follicle the correct term for that little hormone factory is, in fact, “cyst”) and it didn’t stop growing. Eventually the cyst started to leak into my pelvis, hence the free blood in my abdomen. The fact that they found clots in the blood in my pelvis suggests that this had been bleeding for some time.

Now, if you have had the luck to never need help from an IVF clinic, you wouldn’t know that ultrasounds are part of routine care throughout the cycle. However, between your IVF procedure (ours ended up being an IUI procedure – aka, the “turkey baster” method with five eggs released), there is no point in having a ultrasound to look at anything because, quite simply, there is nothing to look at! Between your procedure and the seven week mark, you won’t see anything “baby-wise” on an ultrasound, so you don’t get any ultrasound. So, no – before you ask – there was no way to catch this before it happened. My ultrasound of my follicles before our IUI procedure were all a healthy, normal size – nothing out of the ordinary. It’s no ones fault. Very luckily, I walked away with most of my ovary.

So that’s the way my Halloween ended. Four days in the hospital and two weeks of no lifting and no driving. Hopefully, I’ll be cleared by my surgeon in a few days and back to work shortly. I never through I would miss going to work, but I am going positively stir crazy and I am ready to get out of the house and back to normal life!

Hope you forgive me for the lack of a Halloween post…I guess we will have to wait until next year!

“Always believe something wonderful is about to happen” – Unknown

 

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