Wednesday, September 26, 2012

Almost Everybody Loves Their New Shoulder

Katja, looking remarkably cheerful before her anticipated journey to the After-Life

Dear George,
Katja had her shoulder replacement surgery on Friday.  It was hard to believe since she’s still recovering from knee surgery.  However, Dr. G said there weren’t any options, and they decided to move ahead.  Dr. G is a jovial, middle-aged man with a sense of humor and an unquenchable optimism.  Though Katja had gotten some cautionary advice about the risks of shoulder replacements, Dr. G didn’t have a qualm in the world.  He explained that it’s 99% successful and that all his patients love it.  I asked Dr. G about pain, and he said some patients have no pain at all.  Others might be uncomfortable for months, but there’s no way of telling beforehand.  In any case, Katja would be up and around in a day or two, he said; would be driving soon after; and would have a greatly improved range of motion in her arthritis-plagued shoulder.  All in all, it sounded terrific, and Katja was eager to get it done.

The operation took place in a suburban hospital.  Just beforehand the nurse explained to Katja that she would be under general anaesthesia for three hours.  Katja was taken aback by this news, and she whispered to me that she didn’t think she’d ever come out of it.  As they wheeled her out, she gave me a goodbye kiss that had an air of finality about it.  Aside from signing a form acknowledging that death is one of the known side effects, Katja hadn’t worried much up to that point, nor had I.  I waited in her hospital room, reading Dave Barry to keep my mind off more serious matters.  After three hours Dr. G came in and said that the operation had gone perfectly and that Katja had been an excellent patient.  A while later the nurse brought in Katja’s bed with her in it.  She was out like a light.  The anaesthesiologist stopped by and tried to speak to her, but, despite poking and nudging and speaking loudly in her ear, he got no response at all.  He said that everybody’s different and that it wasn’t that uncommon to still be unconscious.  He added that her vital signs looked good; then he left.  I thought about Katja’s fear that she’d never wake up, but I didn’t ask about it.  In fact, Katja did blink and open her eyes about half an hour later, and she seemed amazed but happy to have returned to the living.  I stayed around for a while, then returned to town to get the doggies.    

Dr. G had said that everybody likes to get out of the hospital as quickly as possible and that Katja would be discharged on Saturday morning.  When I returned, the nurse went over the instructions about home care, doing exercises, danger signs for calling the doctor, etc.  She said it was imperative for Katja to begin doing exercises right away to prevent a frozen shoulder and permanent loss of use of her arm.  That caught our attention.  She said to call the doctor in case of persisting high fever, excessive loss of blood, undue swelling, signs of infection, dizziness, nausea, etc.  They left a catheter in her shoulder which would continue to feed a pain-reducing numbing agent to the incision area for two or three days.  Then they brought Katja out to the car in a wheelchair.

On the way home we stopped at our neighborhood Graeters to get an ice cream cone, but Katja was too dizzy and unsteady to walk.  Once home she got into bed and fell into a deep sleep.  Hours later Katja woke and I suggested that she try her exercises, but she was too exhausted.  Visions of a frozen shoulder flashed before my eyes.  Later in the evening her temperature started rising, I noticed that her arm was swelling and turning purple, and a moderate amount of blood has leaked from the catheter site.  Katja needed help sitting up or getting out of the bed, and she felt sick and nauseated.  She said she should still be in the hospital, and I wholeheartedly agreed.  We were doing a sort of make-believe hospital at home, but it was a pretty amateur operation.  I thought about calling the doctor, but I didn’t know if Katja’s symptoms were acute enough and I didn’t want to bother him on Saturday night.  Finally we called our own son J (who, to our good fortune, is a physician), and he gave us helpful, calming advice.  

We were taking care of our friend Donna’s sheepdog, Sophie, while Donna was out of town, and I’d created a barricade of boxes and chairs around the bed to keep the three dogs off and avoid any harmful bumping and jarring.  Katja felt sad about depriving the dogs of their favorite bedtime spots, and the dogs themselves were distraught and confused, sitting motionless at the edge of the barrier, looking soulfully at me and begging to be allowed in.  By early morning the dogs had started stirring, and, just to be on the safe side, I got up to take them out for a pre-dawn walk.  Katja was feeling a little better by Sunday noon, and I was very relieved when she got up and did her pendulum exercises (leaning over and swinging her arm in different directions).  Then she went back to sleep.  I let the three dogs in the bed with her and monitored them while I watched the Bengals game.

By Monday morning Katja’s catheter apparatus had run out of medication.  The nurse had given me instructions about removing it.  She said it would be easy, and I it was, sort of.  I pulled away the tape and then began pulling the catheter tubing out of her shoulder.  It seemed to go on forever – maybe an inch and a half – a very unappealing experience.  The nurse had said that occasionally the black tip of the catheter comes off inside the patient’s arm and that I should bring her back to the hospital if that happened.  I didn’t see any black tip on the tube that I pulled out, though I didn’t know what it was supposed to look like.  All in all, I decided that I was totally unqualified to be a home care nurse.  I chatted later with a physical therapist who said that the primary emphasis in medicine today is on limiting benefits.  That seemed to explain Katja’s inordinately brief hospital stay.  Katja vowed that this would be the last surgery she would ever have.  Apparently she didn’t love it as much as Dr. G’s other patients had, at least not so far.  The long-term outcome, of course, should be very positive, and it’s just a matter of toughing it out through the recovery phase.  We saw the surgeon this morning, and he said Katja was progressing excellently.  She is definitely doing much better.  Now we’re ready to skip ahead a couple of months. 

G-mail Comments
-Linda K-C (10-2):  Liked letter about the shoulder surgery, glad she is doing so well!

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