VATS pleurectomy: Day one post-op

Tuesday 12th May 2015
Recovery from a pleurectomy and bullectomy to treat reoccurring spontaneous pneumothorax.

The night

Aside from the morphine drip beeping at me and refusing to cooperative on multiple occasions, the night was a pretty uneventful one.  

Waking up

I had a had a great nights sleep, thanks to the drugs and anaesthesia, but that didn't mean I woke up this morning feeling refreshed. In fact I was quite the opposite. 

I remember being thirsty and weak (remember I still hadn't eaten), despite the IV and remember asking for some water and some help propping myself up. This was the next hurdle I found, actually sitting up. This was the first time I really became aware of the fact that I had a drain in my side, until then it was not something I had thought of at all or even felt. But sitting up requires upper body strength, and the tension from attempting to do so made me very aware that there was a foreign object in my side. I won't say it was really painful, it wasn't, but it was uncomfortable. In the end I was helped hugely by the nurses and I was required only to bend in the middle whilst they lifted me up and propped up my pillows. 

Getting up attempt one

The next thing I remember is thinking I should try to get out of bed and eat, and so again I asked for the help of the nurses to get myself out of bed and into the very comfy chair next to me. This was much harder, and was a bit painful. Shifting my weight to turn in the bed and lift my legs over the side required strength that I was lacking, and caused pain that I didn't wish to feel. Nevertheless I eventually found myself sat in the chair and looked up to see the doctors, surgeons and nurses on their rounds by my bed. 

It was at this stage that I felt the immense nausea and dizziness come over me. 

I called out as loud as I could that I was going to be sick and a cardboard tub was somehow immediately placed in my lap. I focused on my breathing to reduce the nausea, the thought of being sick with a painful chest and chest tube was not something I wanted to experience and frankly scared the hell out of me. So I breathed away, but to no avail. A darkness began to creep over my eyes and my body felt heavy and not my own. I have never passed out before but I knew this was what was happening, and so once again I called out to the masses around to "Help me, I'm going to pass out." 

A doctor from the rounds quickly appeared by my left side and began massaging pressure points around my shoulder, I can't say whether I was given anything else as well, but I found the dizziness began to wear off and within a minute or two I realised I had managed to avoid passing out. Thank god! 

I was quickly placed back into bed and told to take it easy. The blood pressure monitor was once again squeezing my arm, and continued to do so all day. I decided food wasn't an option just yet and promptly fell back to sleep. 

Getting up attempt two

Thankfully this was far more successful than attempt number one. I awoke to see my partner beside my bed, ready with the water, asking me if I was OK. I was happy to realise that I felt much better than earlier in the morning, and once again requested that I be sat up. Baby steps this time!

After about an hour or sitting and talking and a few nibbles of toast, I felt a sensation that I hadn't felt in quite some time. I needed the loo. So now it wasn't an option, either get out of bed, or pee in a bed pan. I am 25 years old and had my boyfriend by my bedside...I did not want to be peeing in a bed pan. So up I got, and this time with far more success. 

The Comode

Well this was something different. I had been told by a nurse in my pre-op that I would not need a catheter or a comode as I should be up and able to use the toilet. Well this is lies!! Due to the delightful chest tube sticking out of your side and the suction tube that attaches this to the wall, you are in fact confined to the small area surrounding your bedside. And so to my dismay I was informed I would be peeing into a comode. Put simply... a wheelchair with a bucket. 

To make matters worse I was unable to bend and so required help lowering the god awful surgery knickers I was wearing. In addition to this I was also so weak that I couldn't lift myself onto, or off of, the comode and practically clung to the nurse for support. 

Still, despite the comode, my boyfriend standing in the corner and the god awful surgical knickers and gown....it felt really good to pee. And so I found myself back in bed with a little less dignity than I had had before, but grateful for the love and support I had from my partner and nurse that made this seem like it was no big deal at all. Even now looking back, it still makes me a little emotional as you realise just how much this meant at the time. It might only be a comode, and there are worse things in life, but for me at the time it was a big deal, and they made it far less so. Thank you. 

The rest of the afternoon consisted of a little more talking, but mostly just sleep. I declined the offer of more visitors...I was far too zonked, but was once again reminded of how much I love my partner who simply sat by my side whilst I slept for hours. He must have been bored stiff, but it was so nice to wake up knowing he was there :)

I was also more aware at this point of the magical morphine button, especially when it began to beep incessantly to tell me it didn't want to work. Thankfully it was fixed fairly quickly.  

Warfarin

The first dose of Warfarin was given to me this evening to thin the blood and prevent clots. It is a small injection into the stomach and is not very pleasant. It stings only a little at the time but for me the sensation of stinging seemed to get worse and radiate a little for about 20 minutes after the injection. I was told this was normal and since then spoke to others who felt the same way. Also be aware that it will leave a little bruise and a lump in your belly for a period of time afterwards, I still have one now. I have read that the closer to the belly button the injection the worse the lump afterward (apparently two inches away is ideal).

Moving Wards

I was deemed to be well enough in the afternoon to move to a smaller ward where I was told it should be a little quieter in the night. So my things were packed away and I was transported to a ward of just four beds and no nurses station buzzing in the middle of the room. 

Physio attempt one

Whilst on the new ward I was also paid my first visit by the physio. I was introduced to a spiroball contraption which was designed for me to breathe through in order to help expand my lungs and measure the lung volume. It is fair to say my first attempts at this were awful and on a scale that went to 4000ml I was only able to reach 1500ml at the most. The physio will sit there and tell you to "keep going, keep going, keep going" but you cant....it's not like I wasn't already! I was told I should continue to use the device every half an hour, with 5 breaths each time and follow with a cough to help rid my lungs of any mucus. This is to prevent pneumonia. My coughs at the time hurt quite a bit however and were pretty pathetic. I did use the device continually though which I think surprised the physio...apparently most people don't bother, but I really recommend that you do. It definitely helps and gives you confidence that things are improving, or at least not getting worse :)

The spiroball! Your new best friend.

In addition to the breathing exercises I was also given arm exercises to do in order to prevent frozen shoulder and open up the chest. I was meant to do 10 sets of three exercises but think I roughly managed only two or three of each. We put this down to the morphine making me feel dizzy and lethargic when I stood and decided to try again the following day. 

New neighbours

That afternoon another lady arrived on the ward to presumably have an operation. She was met by the surgeons and doctors throughout the afternoon and in the evening was finally visited by the anaesthetist. It was during this time that my boyfriend had come to visit, yet we sat quite quietly due to the fact that I was pretty tired. As a result of this and the fact the curtains had not been closed, I could hear some of the conversation this lady was having with the anaesthetist. I obviously won't divulge what I heard, but the gist of it was...don't have the surgery, it may not be easy to wake you up. I just remember laying there, exhausted and in pain and wishing someone had said that to me. Why didn't someone tell me not to have it, to just go back home and save all of this pain and exhaustion!? This only intensified when they left, they actually left...they were gone within a few hours of arriving and not a cut in sight, whilst I was laid in pain feeling tired and sick and sorry for myself, trying to fall to sleep.

(Please note that with hindsight I am glad I had the surgery...I just really wished I hadn't at the time.)