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So, I had another surgery today. My left implant seems to be encapsulating slightly. It’s certainly not terrible, but the changes have been noticeable over the past few months, prompting me to see my plastic surgeon. When I saw her she agreed that it looked as if there was some encapsulating going on and told me to wait , and come back in a few weeks to see if things seemed to progress, and they did.

So today I had a revision done to my reconstruction on the left side. Dr. Otero took out the implant, removed some skin, made a revision to the dent (seriously a dent developed around my armpit), and then popped the implant back in. I don’t think I realized that the implant would be taken in and out so I’m feeling a bit more rough than I expected to. And I have a drain, which I was hoping not to have but Dr. Otero said there was a lot of fluid in there, so better safe than sorry. Certainly better than an emergency drain insertion as I’ve had before and it can come out first thing Monday, which is great. Essentially one of my fake boobs needed a lift. WTF?

I didn’t have to spend the night, so I’m home. Joanna is on a prescription run. I feel pretty rough and am in more pain than I expected, but I’m hoping the recovery will be speedy and the pain will dissipate quickly.

Tonight I’m going to watch Wife Swap, eat matzo, drink diet ginger ale, and pill pop. I’m hoping for a weekend of movies and bad tv on cable. Pedestrian as it is, I am okay with that.

In December I blogged about my less-than perfect experience at Washington Hospital Center, during my stay after breast reconstruction surgery. Since then I’ve received 2 letters of apology, including one from the pharmacy that took a bloody decade to dispense my drugs (why the drugs have to be dispensed by the pharmacy and aren’t more readily available to the nursing staff to be administered quickly to patients in the hospital is completely beyond me, especially when the drugs have been prescribed by your doctor.) Some responses sounded more sincere than others, but overall I’m pleased at the response and genuinely hope that improvements are made so that someone else doesn’t have the same lousy experience I was treated to.

That said, the nicest response came from the head nurse of the ward that I was in. Not long after my surgery, I received a call from her. She apologized, talked to me about my experience, and said that she was looking into the matter in the attempt to make sure that it didn’t happen again. It was a nice thing to do and she sounded genuinely concerned.

Ultimately, I’m glad I sent the letter. I would encourage anyone else in a similar position do the same. It doesn’t hurt to send praise to an institution where you’ve received exceptional care either. Up until the point that I was admitted to my hospital room, my experience in recovery at WHC was so good, I was already composing the letter in my head, between injections of pain killer and nausea medication.

To whom it may concern,

I am writing to relay my experience at Washington Hospital Center on the December 20th-21st.

I was scheduled to have the 3rd step of my breast reconstruction with my plastic surgeon, Dr. Susan Otero, after being diagnosed with breast cancer in 2006 and undergoing two mastectomies at another hospital in 2007. Prior to my surgery date the WHC staff called me for my pre-op check-in and were also very attentive during the check-in process at the hospital. I was very pleased with the treatment and care I received prior to surgery and post-op during my recovery. Three nurses in particular, Birdie, Claudia, and Joan provided me with very high quality care. I was very pleased with the treatment I received in recovery.

However, the first major problem came when my initial recovery nurse, Birdie, called repeatedly to find me a room. My surgery was over between 2-3pm, and I recall being fully awake and able to be moved to a room around 5pm. Around 8pm I was moved to a different, larger recovery area and put under the care of Joan and Claudia, and told that I would be moved to my own room soon. After over a four hour total wait, I was finally transferred to my own room around 9:30pm.

By this time I had missed all the meal times and was hungry and tired and wanted to be in my own room, which should have been much quieter than the hustle and bustle of the recovery area. When I finally got to my room I was checked in and asked about getting food of some kind. I was told that the meal times were over. I pressed the issue as I was very hungry, not nauseous in any way, and definitely feeling up to eating a small meal. I was told that a boxed lunch could be ordered for me. In the interim, my nurse brought a large cup of juice.

Around midnight no food had arrived and it had been about four hours since I had received pain medication. Around 12:30 when my nurse, Jillian, came into my room I told her that my pain was increasing and asked for more pain medication as well as lozenges for my throat which was very sore after being intubated. She said she would order the medication and told me that no meal had been brought. She eventually found some cereal and milk for me, which was kind of her, as the food that was ordered apparently never arrived.

At approximately 1:30 I received throat lozenges. Around 2:30am I still had not received any more pain medication and my incisions felt like they were on fire. It was almost impossible for me to rest. I had not been seriously uncomfortable post-op until around midnight when I had asked for the medication and as I stated before, had been very well cared for. In recovery I was asked about my level of pain and the nurses responded appropriately. Therefore I went from being very comfortable to being in an unacceptable amount of pain for an extended period of time even though I knew that my surgeon had ordered Vicoden for me during my recovery in the hospital. I paged my nurse. She said that the drugs hadn’t arrived from the pharmacy yet but if they didn’t arrive in 10 minutes she would go check on them herself. About 15 minutes later she came with the pain medication, apologized and she told me that it would probably take me two cycles of drugs to really feel better since the drugs I had received so much earlier were almost completely out of my system.

Around 6am my surgeon arrived and told me that I would be discharged that day, which I had expected. My nurse followed shortly thereafter and brought another round of medication. I was feeling much better by then and was awaiting breakfast since I had yet to really eat anything. When breakfast did arrive, I discovered chicken broth, jello, and more juice even though I had already eaten solid food and had requested a vegetarian meal. I was not able to eat any of the food that was brought for me. I paged a nurse and a tech arrived. When I told him about the problem, he got the person who was delivering the meals and explained the situation. The delivery person said that he had an extra breakfast and would bring it to me. It never arrived. By this time I wasn’t surprised and simply wanted to get out of the hospital so I could recover properly.

I am amazed that I was able to receive both the best and the worst care I have ever had in a hospital at the same facility in 24 hours. My diagnosis has necessitated six surgeries in the past 14 months and I have never had to wait so long for medication or food in any hospital – especially things prescribed for me by my doctor and/or things that I could have had at home. I would have fared far better if I had left the hospital and gone home after my time in the recovery area, which is unacceptable. I am at a loss as to the reason why I was not able to get the medication prescribed for me, in the hospital. Considering that during previous recoveries in other hospitals I had serious issues with nausea and required far more pain medication, my experience at WHC does not make me feel confident that it could provide me with a level of care that would keep me well and comfortable. If it was so difficult to get the medication specifically prescribed for me, I can only assume that if I became nauseous or needed a non-prescribed drug right away there was no way I would have gotten it.

While I appreciate the kindness and dedication of the majority of the WHC staff which I came into contact with, overall I am appalled by my experience there. As portions of the WHC were rated among the US’s best this year, I have to believe that I experienced huge flaws in an otherwise well-functioning system. Nonetheless, I consider my experience to be unacceptable and I feel I would be remiss if I did not relay the details of my situation in the hopes that the system can improve and others can enjoy at least a modicum of good quality care that was missing in the majority of my experience at WHC.


nick & nora cow slippers

Originally uploaded by l@in.
After my second overnight stay in the hospital this year, I think I’ve figured out what I need to make myself comfortable without over packing the way I did for the first mastectomy. I thought I’d share just in case someone else needed to make similar plans.

  • trash magazines. – lots of pictures and and little written content is best. this time i think i took curve, the fall fashion issue of elle, northern virginia magazine, venus zine (for the MIA article), and bust. i just wanted something to glossy flip through. as the time went on, i was able to do a little reading, but very little.
  • ipod – i didn’t end up actually listening to it this time, but last stay when i was overwhelmingly sick, i don’t think i could have done without the distraction. the important thing is to attach it to something since they’re so small so they don’t get lost in the sheets, fall on the floor, etc. i used an athletic strap to attach it to a stuffed animal which also served as an arm prop. it worked rather well.
  • lip balm – being intubated left my lips incredibly dry. one kind nurse even applied vaseline to my lips in recovery. i used the lip balm a lot while i was in the hospital.
  • slippers with treading – the hospital usually provides slipper socks with plastic treading, but i usually find them ill fitting and scratchy. this time around i got cute little slipper sock things kinda like these with rubber tread that were nice and soft and warm and made me really comfortable. the nurses all loved them too.
  • snacks from home – last time i was so sick i didn’t eat anything until the next morning which, i think, was some sherbet. this time i actually felt like eating, at least a little but was never given any menu selections so every entree was meat, meat, meat, which just made me feel ill, especially the smell of it. i think i ended up eating sherbet and squash one night and some frightening wonder-like wheat bread for breakfast. i had packed joanna some snacks – nuts, seeds, dried figs and crackers and ended up eating some of those, which made me feel much better. pete also brought me a 2 liter of diet ginger ale, the contents of which i drank almost all of before checking out the next morning.
  • This may be mastectomy specific, but for the trip home, a button or zip-up shirt to wear as well as pull-on pants and slip on shoes were invaluable. For the car ride a pillow was essential to put between the seatbelt and the foob (fake boob). it still hurt, but certainly lessened the impact, especially over bumps, around sharp turns, and at abrupt stops.

It should go without saying that it’s important to develop a nice rapport with your nurses and nurse technicians if possible. That said one shouldn’t be afraid to ask for things that you need – that’s why the nurses are there. I will say that most of my nurses were kind and attentive, especially the night nurses who happily untangled my IVs from my pole when I returned from late night bathroom trips, poured me endless cups of ginger ale over cups of ice they supplied, and brought me extra blankets.

Just a little food for thought for making it through a hospital stay without losing your mind.

Today has been spent lazing around for the most part. I’m still feeling pretty good but the pain management gets trickier. The pain is constant and present even with the vicoden and valium. Last night I had a brief meltdown while trying to go to sleep, it seems no amount of pillow arrangement would do the trick and no matter how I laid it felt as if my left pec muscle was being ripped in half. As a result I’ve upped the medication dosage to just a little more than prescribed, and am just trying to distract myself until I fall asleep. This usually entails falling asleep to something on TV. All in all it’s still not bad, but my goodness, moving around, is certainly an exercise.

I think I mentioned before that I was very upfront with my anesthesiologists before this surgery. I let both of them know that I was in an unacceptable amount of pain after the last surgery and had a completely unpleasant experience in the recovery room where, according to my dim recollection, I had to practically beg for pain relief. If this little discussion didn’t help, I’d be shocked because my experience this time was completely different. I felt as if I was taken very seriously in recovery and treated very, very well. One of the recovery room nurses recognized me, fed me ice chips, and provided me with vaseline for my dry, post-op lips.

I find the approach to pain medication by different medical professionals fascinating. My surgeons have always taken my discussion of pain seriously and have never denied me pain killers when I’ve requested them. My anesthesiologists have always behaved in a similar manner. That said, in my last hospital stay it was interesting to get the reaction of various nurses to my telling them I was in more pain than I wanted to handle. A few times it was explained to me that I only needed to click on my morphine pump when I needed it and the drugs would only be released every 20 minutes. I thought it curious that someone who had just underwent major surgery was expected to watch the clock and click appropriately and/or wait a little while to see how the pain was before clicking. My strategy was to click the button when I remembered. Morphine really doesn’t make you the sharpest individual, so I clicked when I could.

Later, after my doctor gave me the go-ahead to leave, I asked the attending nurse about my prescriptions just to make sure that I had what I was told I would get – an antibiotic, vicoden (for pain), valium (as a muscle relaxer for the tissue expanders). First she said no valium – but she’d double check. Then when she did find the prescription for my valium, she 1) assumed that I was taking it regularly pre-suregery, and 2) couldn’t understand any reason why I’d be taking it other than to put me to sleep. At which point I had to explain the tissue expanders, and the muscle spasms which result in trying to get your muscle and tissue to make room for a foreign object.

There were other instances too with various nurses who didn’t seem to have a clue as to why I was there and what I needed. I was asked to hold things, which I couldn’t really do. I was given a monitor on a pole whose wheels didn’t work properly so it was almost impossible to move by myself (I requested and received another). Finally when I left the technition who “helped” me get to the car, grabbed on to my left arm tightly to maneuver me around the wheel chair foot holders which she placed in my way. When I asked her to please not touch that arm, she watched me struggle with the car door.

This is less a rant against nurses and more of my amazement at a system that permits those providing immediate care to those who are almost wholly dependent on them to have a very limited knowledge of the situation of each patient. I had some wonderful nurses each time I’ve had surgery (5 times in the past year in fact). The night nurses that I had this time around were especially attentive and sweet. Overall my hospital experience was good, but there are aspects that make me a little nervous, especially if I were less coherent than I’ve been while staying in the hospital.

That said, I’m still enjoying sex in the city, and playing the sims 2. Joanna went on a bagel run this morning so I’ve had my weekly lox and bagel fix. yippee!

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