pacu

I will never work in the PACU. Let's just make that clear right now. But probably after this is all said and done, I will be able to! Today was miserable. Not really, but still a little bit. Jason went back in for surgery. When they say surgery, I really don't know what that means, and that drives me crazy. Some docs say it's for wound cleaning, some say they're working on his fingers, left, and right leg, others say it's both. I just don't really know. They did replace his wound vacs, so that's good. I think they might've shaved a tad off his bone so the skin will be able to cover his right leg. Either way, he was in there for 4 hours. And when he came out, it was scary.

I left here around 2 am - this seems to be my routine - stay late, and get in late, because other family want to visit. So, I left him, (mind you I felt like I was leaving my child all alone on the side of the road not able to fend for themselves) around 2, and fell asleep trying to find I Love Lucy by 3 (no hallmark channel on the navy base apparently). The phone started around 7am, but I ignored it for a while. There comes a point when you just have to. Maybe my point is earlier than others, but still. I just ignored it.

Finally woke up around 11 - his friend Kyle was here from his old unit in Germany. He has since gotten out of the Army and lives in New York. When I told Jason a couple of days ago he was coming, he said "I know." I was like how?! He said "I just knew he'd be here." Battle buddy camaraderie I guess :) So he brought me some pizza rolls and dr. pepper from the shopette - thank goodness, I was starving, and still no food in my new little 'home'.

By the time we got to the hospital, Jason had come out of surgery and was in the PACU. When we got there, he was completely normal. Out of it, but acting normal. His mom and Ged left for a while to get some lunch since they got up early to be with him when he went to surgery. Kyle and I stayed with him, and that's when things got a little weird.

I don't deal with postop patients - so this freaked me out, and more so because it was my husband, and I've never seen him do anything weird (unless he's been drinking). His pain was out of control to begin with, so that didn't help. His blood pressure was 200s/110s, and then he started involuntarily twitching his head, but saying "I'm not doing that on purpose, make it stop!" And then, "No, no, no, etc - don't take my head too!" (I think he was referring to TBI, he was afraid he is going to have permanent brain damage, although he hasn't exhibited any symptoms of it yet) The nurses asked him his pain level - he rolled his eyes and said "160". "Well what kind of pain?" Again, the eye roll, "It feels like I'm stepping on that fucking land mine over and over again." I can sympathize with the pain scale question - it's a requirement - but god almighty they asked it like every 2 minutes, and I'm not even lying. So obviously you need to do something about this pain. They pushed dilaudid and fentanyl I think. No relief.

At this point, the weird stuff started happening. Stuff I'm not used to seeing, because where I work, everyone is coherent, and virtually healthy. As his head was twitching, his pupils got completely constrict, and he started stuttering and whispering all at once.

"Can you tell me your name?"

"Jason Graham Searles" (all whispering and stuttering and twitching)

"Where are you?"

"Hospital"

"What country are you in?"

"Afghanistan"

"No, you're in the United States. Who's that lady beside you?"

(after a minute of trying to turn his head to look at me)

"The most beautiful girl I've ever seen. But I'm not Jason. This is Cooper."

I said, "Cooper is what you wanted to name our baby, is that who it is?"

"No, I'm Cooper. The baby is Owen. Jason isn't here right now. Jason will be back in 25 seconds."

And he fell asleep.

And literally, 20ish seconds later, he woke up, and was completely normal. Talking normal, not whispering, not stuttering. And he remembered saying all of those things. To date, the weirdest thing I've ever witnessed. I almost started wondering if this was going to be a permanent side effect too.

The anesthesiologist was super nice, answered all our questions, (and gave him the drugs we've been asking for) although I think I need to start bringing the computer with me everywhere to write everything down. I've asked so many questions, and they've tried their best to answer most, but then I don't remember a day later.

I asked if he was going to get an IV BP med - that blood pressure was freaking me out a tad. She said "well, we'll give him his normal dose that he takes every day" I said, "He needs an IV med, his blood pressure is too high right now, the pill isn't going to work fast enough" She said "Well it will all absorb the same." Ha. No it won't. Then I saw the anesthesiologist pushing labetalol, although I'm not sure why because his heart rate was never high, so I was a little worried that would bottom out, but it was ok. Then they gave him his regular dose a little later. I asked if he could have that switched to taking it at night, and they said no because your blood pressure normally drops at night. But, I'm thinking, he always takes it at night, and never had problems - granted he's never been on 3 pages worth of meds - but if he's going to be in surgery every M/W/F and then NPO from midnight the night before - he won't get his morning dose regularly - and then we'll have this blood pressure issue every time he comes to the PACU. Annoyed.

Complete sensation in both legs - all the way down to his toes. This isn't normal, yesterday he could barely move his left leg because he was so numb. That is the goal currently, with the epidural. They checked his dermatome levels a bunch, duh, it's not working. Fix it. They tried a local block - that didn't work. It made it worse. Finally, they pushed a higher concentration of Lidocaine in the epidural to verify placement, and that seemed to help.

So now his pain is finally controlled with the lidocaine epidural bolus, and the morphine. The anesthesiologist finally switched the PCA to morphine for him since that's what he's been asking for. Although right now, it doesn't seem to be helping. So then he starts deserting, forgetting to breathe, blue lips, all that fun stuff. We play incentive spirometer for a while, and have to try to keep him awake. He eventually gets down to 1L NC but can't tolerate room air. So he's still on the O's, but I prefer that over blue lips.

Right now his right leg is bothering him the most. He is knocked out - and totally falls under that stereotype that we laugh at at work - passed out asleep, and when I wake him up to ask him his pain level, he's a 5-6. Ironic! But, he is my husband, and I don't think he's making this shit up. He said the morphine just knocks him out and makes him feel great, but the pain is still around a 5. He was at a 2 last night. And all day yesterday it was his left arm. So I just don't know how to keep on top of all the different pain locations. I'm wondering if his right leg is hurting more tonight because of the surgery though. I think I heard they shaved the bone down a little, to have more skin to make the 'flap'. I'm sure if they manipulated that, it's going to be pretty painful. He's also got 2 JP drains in that leg now. Maybe tomorrow it will start feeling a little better?! But then something else will start hurting :/

It's like a never ending sick game of whack a mole. But we're not really whacking anything.

I'm that wife. I ask for a print out of his meds. Ha. So tonight when he woke up and said he was a 5 - I asked if he wanted the IV push - yes - And of course when the nurse comes in, he's sound asleep. I said "I know it doesn't look like he's in pain, but I swear he just woke up and told me he was a 5!" I know what they think.

He is finally on an air mattress though. And I hope they'll start his PICC line this weekend. Sometimes I wonder what it's like for people who don't know anything about the medical field. I wonder if he'd get these things if I wasn't here. Not tooting my horn by any means, but most people just don't know what to ask for. I'm sure they'd get done eventually, but probably not as fast as I'm making them happening. Hey, I'm just saying...now's a good a time as ever to practice being assertive - these people don't know me - and I'm sure they'll be happy to see me go :)

In other news, Mom came up tonight briefly. She brought me a ton of food which will be a Godsend when I get back at 0200 and am starving. Baby is mostly awake at night too. I saw him move from the outside last night when I was lying in bed. I can only feel him kicking or punching when I'm lying or sitting which is a bummer because I really want Jason to be able to feel him. Mom and I and some close family friends that took the time to drive her up here since she just had a knee replacement, went out to dinner at Ruth's Chris - I had never been. Holy Lord. Ahhhmazing! We'll have to get Jason some take out for his birthday from there :) He did eat 3 pieces of pepperoni pizza and some cheesy bread tonight I was told, so that was awesome. That's the most he's eaten since I've seen him. He also got a roommate which is a huge bummer. Selfish, I know, but it was so nice to be able to take over the whole room. At least he has the window view. The other guy is 24 as well, a marine, and got shot 4 times I believe, in the abdomen. But he looks like he's gonna be fine. And he still has all four limbs. Which makes me a little annoyed because I feel like they're thinking "Wow, they have it way worse." And they'll most likely go back to the way they were no problem and in no time, and the entire public won't know the difference unless he tells them. And then I tell myself that is not very nice.

Everyone says they're so shocked at how I'm handling this. And they all think I am so strong. I don't really think so, I just know that I get up and do it every day because this is my role now, and I have no choice but to handle it. I will be his primary caregiver. This will be my life for a long time. (Sometimes I even wonder if this is the reason I went to nursing school. Has this been in the plan all along? Did someone know I would need this background in order to keep myself sane through this process? Clearly, I'm no surgical nurse, but I at least have the basic knowledge...) I don't think my brain is still letting me process it - if it did, I'd be in a padded room, no doubt. I think it takes a long time for anyone to fully accept something like this. I suppose everyone knows me to be an extreme worrier and I am. But when you are thrown in to a situation like this, you have no choice but to just do it. Just get through it. What else is there to do?