The Root Won - Part 2
After the urgent care visit, I tried getting back into somewhat of a normal routine. Sleeping sucked, as did trying to get comfortable on the couch. I needed five pillows behind my back sitting on the couch or I wasn't able to lean forward at all to stand. Even trying to lay on the couch was hard and so painful. As a PT, I know exactly how to move and what motor planning is required for going from laying on my back to on my side or for going from sidelying to sitting upright - but implementing? As Nick put it, there was plenty of whimpering every time I tried moving. Of course, I was also trying to be stubborn and do it all myself. I never said I was smart!
Sunday - four days since the crash, I decided to try my first "workout." Nothing fancy, just 30 minutes on the trainer. Shouldn't be too hard - after all, I'd pedaled that 30 minutes back to Cam's house after the crash! First few minutes felt great. Then it got progressively worse and worse. I barely made the 30 minutes and my breathing and ribs felt like crap when I finished. I had to sit on the couch for an hour after the ride to get my breathing under control. The next few days were easier when it came to workouts, but not improving at all. Monday I walked to the library and back, noting that it felt harder walking then it had right after the crash. My whole right side ached and my breathing was really ragged. Tuesday I took another walk and did another 30 minutes on the trainer. The walk was worse then Monday, but the trainer ride felt better. Wednesday was another 30 minutes on the trainer and that felt even better then Tuesday. Maybe things were now on the upswing! Except...
The nights were miserable. I couldn't sleep on my right side at first due to pain, but Monday when I tried laying on my right side I had an uncontrollable coughing fit. Coughing fit with broken ribs? Yeah, wouldn't wish that on my worst enemy. I also couldn't lay on my back. At night trying to sleep, I to elevate my head almost into a sitting position due to decreased ability to breath. Tuesday night was intermittent wheezing, gasping and not being able to breath out well at all. I felt like I had a slight temperature, but never checked it. All the symptoms went away when I got up Wednesday. But Wednesday night? I could not breath out. I'd take a breath in and then feel the air just rush out of my lungs without any control. I was wheezing, gasping and feeling like I was starved for air no matter how hard I tried to slow down my breathing. I was also feverish - intermittent bouts of sweating between shivering. This time I did get up and take my temperature. 101.3. Something was majorly wrong. I told Nick we were going to ER, gathered a few things and off we went.
The good thing about going to the ER at 4:00 AM on a Thursday? There was nobody else there! It didn't take long to get triaged and back into a room. Once again, I felt like they were looking more at the numbers then just me. My heart rate was 82, my pulse Ox was 91 and my BP was 94/58 - mostly normal numbers. I tried telling the ER doc that yes, those were normal numbers for most people, but that wasn't MY normal! The words all all jumbled out in the rush of breathing. It wasn't until after then x-ray results that things changed. You know it's bad when the doc returns to the room and says "well, your x-ray results were rather interesting. I think we are going to admit you." You know it's even worse when the ER tech is wheeling the cart with the chest tube kits over to the door. Yes, I know what those are... The ER doc wanted to wait for that though - get a chest CT and go from there. So shortly after 7:30, I was heading up to the Cardiovascular Unit.
Step one - Chest CT. That would let the doctors know what was really going on and how bad things really were. Then more waiting. Finally, the pulmonlogist came in and started going over options. Talk about timing - I actually had Nick on the phone when that happened! I'd broken more then one rib. The CT showed fractures in ribs 6-10, so five ribs in all. There was also large hemothorax - blood in the space between my lungs and rib - taking up most of the right side of my chest. It would need to be drained, but they couldn't tell how much was liquid blood and how much was clotted. Finally we decided that we'd start with the least invasive procedure - a thorocentesis to try to drain the fluid. That procedure pulled over 1.3L of fluid out of my chest. And there was still more fluid showing up on the X-ray. Time to schedule for Step 2.
Which was a VATS to clean everything out and then have a chest tube placed to ensure things drained. This was full OR surgery. At 11:00 Friday morning, I was rolled into the OR and positioned on the table. The next thing I remember was waking up in recovery, coughing a little, trying to catch my breath and having the worst dry mouth I'd ever had! I hung out in recovery until about 2:20, trying to convince the nurse that I could hold the cup of ice chips and not try to eat them all at once. As anticipated, I had a chest tube coming out the right side and was on oxygen. But I could breath! And even though it hurt, it was the best I could breath in a week. Once I was back in my room on the CVU, I wanted out of the bed. Good thing the nurses were willing to tolerate me cause I guess "jumping" out of bed to sit up right after returning from recovery isn't normal.... There would be a lot of not normal patient behavior to come!
It's amazing how much we take for granted with our health and independence. Because the chest tube was on suction, I was severely limited in my mobility. The first night after surgery, the nurse even put the bed alarm on me! I wouldn't have gotten up without help, but it was a good reminder. I definitely wasn't steady on my feet the first time I got up that night. I had to have the nurses get a cardiac walker with a portable suction for any excursion outside my room. I did get an extender to the suction tube, so I was still independent in my room during the day. But every movement had to be planned between the chest tube, the oxygen and the IV pole. I think the fact that I'm used to untangling all of the above made it a little easier for me. I also knew the importance of getting up and moving. In fact, the nurses had to remind me that I'd just had surgery and might want to take it a little easier when I was cruising on my 15th lap of the CVU on Saturday...
With the chest tube in place, it was a waiting game. There wasn't much coming out on suction and my x-rays were looking better all the time. I took advantage of the time to complete a few CEU classes, listening to courses between laps of the CVU. I got off the oxygen on Saturday after noon, when I was able to do a nice walk without dropping below 90%. I might have slept better Saturday night if I'd had them put me on one liter, but that's hindsight. Sunday morning, the x-rays looked good enough to take the chest tube off suction. Step one in going home! I figured I would have the chest tube for at least one more day, to make sure things were going well and they would pull it Monday. Just having the increased freedom of being able to walk whenever I wanted was great. I racked up 20 laps of the CVU on Sunday! But with no signs of increased drainage and pressure, the doctors decided to pull the tube Sunday afternoon. Even closer to getting home! The x-rays four hours after the chest tube was pulled looked good. I wasn't having any pain really - but the ribs were finally starting to be noticeable again. The x-rays Monday morning looked "practically normal."
Freedom!!!
From literally the brink of death to walking out five days later. I didn't realize how close things were to going over the edge on Thursday until I started texting my dad. As an ER doc, he's seen all kinds of things and he knows the numbers. More on that later.
Sunday - four days since the crash, I decided to try my first "workout." Nothing fancy, just 30 minutes on the trainer. Shouldn't be too hard - after all, I'd pedaled that 30 minutes back to Cam's house after the crash! First few minutes felt great. Then it got progressively worse and worse. I barely made the 30 minutes and my breathing and ribs felt like crap when I finished. I had to sit on the couch for an hour after the ride to get my breathing under control. The next few days were easier when it came to workouts, but not improving at all. Monday I walked to the library and back, noting that it felt harder walking then it had right after the crash. My whole right side ached and my breathing was really ragged. Tuesday I took another walk and did another 30 minutes on the trainer. The walk was worse then Monday, but the trainer ride felt better. Wednesday was another 30 minutes on the trainer and that felt even better then Tuesday. Maybe things were now on the upswing! Except...
The nights were miserable. I couldn't sleep on my right side at first due to pain, but Monday when I tried laying on my right side I had an uncontrollable coughing fit. Coughing fit with broken ribs? Yeah, wouldn't wish that on my worst enemy. I also couldn't lay on my back. At night trying to sleep, I to elevate my head almost into a sitting position due to decreased ability to breath. Tuesday night was intermittent wheezing, gasping and not being able to breath out well at all. I felt like I had a slight temperature, but never checked it. All the symptoms went away when I got up Wednesday. But Wednesday night? I could not breath out. I'd take a breath in and then feel the air just rush out of my lungs without any control. I was wheezing, gasping and feeling like I was starved for air no matter how hard I tried to slow down my breathing. I was also feverish - intermittent bouts of sweating between shivering. This time I did get up and take my temperature. 101.3. Something was majorly wrong. I told Nick we were going to ER, gathered a few things and off we went.
The good thing about going to the ER at 4:00 AM on a Thursday? There was nobody else there! It didn't take long to get triaged and back into a room. Once again, I felt like they were looking more at the numbers then just me. My heart rate was 82, my pulse Ox was 91 and my BP was 94/58 - mostly normal numbers. I tried telling the ER doc that yes, those were normal numbers for most people, but that wasn't MY normal! The words all all jumbled out in the rush of breathing. It wasn't until after then x-ray results that things changed. You know it's bad when the doc returns to the room and says "well, your x-ray results were rather interesting. I think we are going to admit you." You know it's even worse when the ER tech is wheeling the cart with the chest tube kits over to the door. Yes, I know what those are... The ER doc wanted to wait for that though - get a chest CT and go from there. So shortly after 7:30, I was heading up to the Cardiovascular Unit.
 |
| This is not what a chest x-ray is supposed to look like.... |
Step one - Chest CT. That would let the doctors know what was really going on and how bad things really were. Then more waiting. Finally, the pulmonlogist came in and started going over options. Talk about timing - I actually had Nick on the phone when that happened! I'd broken more then one rib. The CT showed fractures in ribs 6-10, so five ribs in all. There was also large hemothorax - blood in the space between my lungs and rib - taking up most of the right side of my chest. It would need to be drained, but they couldn't tell how much was liquid blood and how much was clotted. Finally we decided that we'd start with the least invasive procedure - a thorocentesis to try to drain the fluid. That procedure pulled over 1.3L of fluid out of my chest. And there was still more fluid showing up on the X-ray. Time to schedule for Step 2.
Which was a VATS to clean everything out and then have a chest tube placed to ensure things drained. This was full OR surgery. At 11:00 Friday morning, I was rolled into the OR and positioned on the table. The next thing I remember was waking up in recovery, coughing a little, trying to catch my breath and having the worst dry mouth I'd ever had! I hung out in recovery until about 2:20, trying to convince the nurse that I could hold the cup of ice chips and not try to eat them all at once. As anticipated, I had a chest tube coming out the right side and was on oxygen. But I could breath! And even though it hurt, it was the best I could breath in a week. Once I was back in my room on the CVU, I wanted out of the bed. Good thing the nurses were willing to tolerate me cause I guess "jumping" out of bed to sit up right after returning from recovery isn't normal.... There would be a lot of not normal patient behavior to come!
 |
| My daily to-do list! Getting the minimum number of walks wasn't an issue. |
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| My new best friend. When I first got the IS, I couldn't even get the indicator between the arrows. |
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| Might as well take the time to learn! |
With the chest tube in place, it was a waiting game. There wasn't much coming out on suction and my x-rays were looking better all the time. I took advantage of the time to complete a few CEU classes, listening to courses between laps of the CVU. I got off the oxygen on Saturday after noon, when I was able to do a nice walk without dropping below 90%. I might have slept better Saturday night if I'd had them put me on one liter, but that's hindsight. Sunday morning, the x-rays looked good enough to take the chest tube off suction. Step one in going home! I figured I would have the chest tube for at least one more day, to make sure things were going well and they would pull it Monday. Just having the increased freedom of being able to walk whenever I wanted was great. I racked up 20 laps of the CVU on Sunday! But with no signs of increased drainage and pressure, the doctors decided to pull the tube Sunday afternoon. Even closer to getting home! The x-rays four hours after the chest tube was pulled looked good. I wasn't having any pain really - but the ribs were finally starting to be noticeable again. The x-rays Monday morning looked "practically normal."
Freedom!!!
From literally the brink of death to walking out five days later. I didn't realize how close things were to going over the edge on Thursday until I started texting my dad. As an ER doc, he's seen all kinds of things and he knows the numbers. More on that later.
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