Post-Op Battles
- Cristine
- Mar 31, 2024
- 7 min read
After mom's surgery was declared a success, there is a sense of relief that takes over. However, what nobody ever warns you about is the new normal that establishes itself ... and the new normal took us a very long time to accept.
Even though my knowledge on neurosurgery was limited (I had never worked in neurology or neurosurgery and I had no interest in working anywhere near surgical units), there were still some general post-operative complications/symptoms I knew to look out for: infection, pain, malnutrition, deep vein thrombosis, atelectasis, urinary retention, constipation, muscle atrophy, etc.
After surgery, my expectations were that we would be discharged a week later ... but with the set of unexpected complications that came along, that wish was impossible.
Here are the set of battles that mom has had to overcome during hospitalization:
When I first saw mom in the Neuro ICU, one thing I noticed was that she held on to a Yankauer (device used for suctioning) for dear life. Every few seconds or so, she would suction herself as she had difficulty swallowing her own saliva. When mom would speak, she was very soft spoken, and certain words were difficult for my cousin and I to comprehend. From what the medical team has told us, it appears that mom's right vocal cord was paralyzed. "It could be temporary and last six months. Anything past that period, we must assume it will be permanent", said one of the doctors. This complication then lead to another: dysphagia (difficulty swallowing).
Because one of mom's vocal cords wouldn't budge, every time she swallowed something, there was a big risk that it would enter her lungs rather than her oesophagus. Already, management of her own saliva was difficult as she seemed to be choking if she tried to do it without the Yankauer. The decision to insert a nasogastric tube (a tube from her nose leading directly to her stomach) was made to prevent aspiration pneumonia.
Eating is something we take for granted. One of the pleasures of life is being able to fill our palates with different textures and flavors, to explore uniques tastes and savor different cultures through food. For many months, that privilege was taken away from mom. For those who do not know my mother, she is a passionate cook. Seeing her receiving nutrients (Ensure was her enteric feed) through a tube was disheartening. Over the course of the next three weeks, it was difficult to find a feeding regimen that fit her needs. The caloric requirements, in my belief, vary from country to country. Given that mom grew up mainly in a Canadian lifestyle for more than the past half-century, the calories calculated by the nutritionist in the Philippines were deficient. Hence, uncomfortable digestive symptoms + insufficient caloric intake = major, MAJOR weight loss.
With poor oral intake, there is no question that mom may have had electrolyte imbalances. To put things into perspective, try answering the following question: Have you ever done any intense physical activity for a long period of time without sipping water? If so, what do you suppose tends to happen? I've had quite my few shares of experiencing muscle cramps in my case. Now, imagine feeling those cramps in your legs for the majority of your days. Imagine your body recuperating and adapting to major neurosurgery and the complications that ensued from it. Imagine being bedridden and nearly voiceless. How on Earth do you expect to relieve such constant discomfort? When mom experienced such pain, mom would tap on the side rails to get our attention. She would point at her lower extremities and gesture for massages. And that is what my cousin, my brother and I did in rotation. Was it exhausting? Yes. Did it deprive us of rest? Absolutely. What kept us going? The hope that one day the pain would alleviate completely.
TOV. Trial of void. This is a term coined in healthcare to describe the act of removing a urinary catheter in a patient in hopes that they pee within the next few hours. It is common after surgery for such assessment to be done. However, in the Philippines, the way it was done was very different. Even to this day, it is hard to wrap my head around the way they perform TOVs over there. Mom's first TOV was done in ICU (I did not have the chance to see what exactly they had done). When she was transferred to the neurosurgery ward, I watched as the nurses explained how it would go. "Ma'am, I am going to clamp your catheter. If ever you feel the urge to void, please call us and we will unclamp it." In my head, I was shouting blasphemies. "How the f*** is this accurate?, Why not remove it instead?".
Side note: I had never mentioned to any members of the team that I was working as a nurse in Canada. I was simply a daughter asking many questions. But, there came a point where I could not understand how things were done and so, my professional identity was revealed as my questions became more healthcare related.
When the nurse came back, I figured I would ask about such procedure. I had approached her and simply stated that in Canada, our TOVs were a bit (OR MUCH MORE) different. I questioned her about the rationale behind leaving the catheter in, and how it was possible to know if a patient would be able to void without it. From what I can recall, she had mentioned vague studies done in the field of urology and how it was shown to be more effective. I was not happy with the answer. After 6-8 hours of the catheter being clamped, I remember being anxious that mom would fail once again this weird TOV. Me: "Do you feel the need to pee?"
Mom: "No"
Me: "Move from side to side in bed, maybe it will help"
Mom: "I'm tired"
Me: "Come on ma. Otherwise, you'll have that tube in for a longer period of time"
Mom didn't feel the need to pee unfortunately, and thus the catheter was unclamped and we were back to square one. As I was fed up of this setback, I had urged mom's primary nurse to simply remove the catheter and see what happens. Initially reluctant to do so, she said she would check with the doctor. After pushing and pushing, finally the catheter was out. As time kept ticking, I kept asking mom the same question over and over. I'm sure she was annoyed. "Do you need to pee?" over and over until she finally said yes. As mom was not permitted to get up (that's a whole other story in the last section of this post), the nurses had asked mom to try and urinate in the diaper she was wearing. She did not want to, and I understood her completely. I advocated for them to bring a commode, but because of the IDIOTIC mobilization restriction imposed, many of the nurses would shrug off my suggestion, except for one nurse.
To my surprise, he had brought the commode to her bedside. From what he told me, he had to get the commode all the way from the lower floors of the hospital and bring it all the way to her room. He assisted her to the commode and a few seconds after being placed there, we heard the noise we all wanted to hear: a stream of urine. We (my brother, my cousin and I) shouted with so much glee, you'd think we were celebrating the win of our favorite sports team (LOL). Trial of void officially succeeded.
Finally, the last and possibly most impactful complication acquired from surgery was the severe muscle atrophy from being bedbound for several days. Mom was always petite (90lbs at baseline). Despite her small stature, prior to the operation, she was strong for her size. Small but powerful, as they say. It is common post-op knowledge that early ambulation creates better outcome for patients. To my dismay, I remember when mom had her first physiotherapy session in-hospital, I was not pleased. In fact, out of all the services, it was the service I was most upset with due to the uncalled for slow progression they made with mom.
This is how the sessions went:
Session 1: They would only perform "passive" range-of-motion (ROM) exercises in bed; they would be moving her limbs for her rather than her activating them herself. I remember asking them why they would not try to get her to sit to the edge of her bed given that she had already spent 3 days in ICU. Their answer: "She is at risk for seizures, we have to go slowly". Looking back on this, and now working in the neuro field, I call BS.
Session 2: "Active" ROM in bed.
Session 3: Passive transfer to a wheelchair and active ROM in there.
Session 4: Sitting at the edge of the bed.
Session 5: Standing up with the help of a walker.
You may ask yourself why am I so discontent. Well, session 5 occurred on post-op day 7. That is SEVEN days in bed. They say that ONE bed bound day takes approximately THREE days to recuperate the muscle loss and strength. Mom had at least 21 days to try and gather her strengths.
At the end of her hospitalization, and upon returning to Canada via repatriation, mom weighed 66 lbs. Five years later, she is now around 82-84 lbs.
I've learned the hard way that little progress is better than none, that setbacks are often needed to come back stronger, that certain battles only resolve with patience, whilst others can be won through advocacy and persistence.
Whether you're fighting your own battles now, or helping another fight theirs, I pray that your resilience will be rewarded with peace of mind, and strength anew.
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