- Hip Surgery
- Return to Work
- Moffitt Follow-Up
- Upcoming Travel to Germany
Hip Surgery
After two weeks of non-stop work and prepping my Simulation Lab for my two-week (or more) absence, my labral tear repair surgery day was finally here. On June 17th, 2021, I reported at 8 AM to the Outpatient Surgery Center at Orlando Health. It was already a difficult morning because Ralf’s’ strict morning routine usually prevents him to leave the house before 10 AM. Outpatient surgery is a very different experience and reminded me of the countless spinal injections and the two endoscopies I had endured years ago. Overall, the process was very organized, staff was welcoming, and the nurse, who started my IV (in my hand, of course) did such an amazing job that I didn’t feel much at all. After my pre-op workup was done, Ralf was able to sit with me until it was time. I am very thankful that the Delta variant hadn’t hit the hospitals in Florida yet, so he was allowed to be with me.
Now, post-op was a wholly different story. I remember waking up, Ralf was there, and the nurse asked me about my pain. As was trying to evaluate the different sensations that I was feeling, I realized that my right hip/thigh was getting pretty uncomfortable. It was hard to gauge, and it kind of intensified by the seconds… “um, I am not nauseous, but my right thigh hurts – it’s about a 5….no 7…actually make that a 9!!!”. Thanks to the opioid crisis movement, I was getting only “homeopathic” doses of Dilaudid, 0.2mg at a time! I know for a fact that the lowest dose comes in 0.5 mg syringes, so I assume that the nurse diluted 1 mg of Dilaudid in a 10 mL normal saline syringe, giving me these minuscule amounts each time. That doesn’t work, just FYI… after a couple hours of this, I realized the pain wouldn’t get any better with this, so I decided to get dressed and get home. Poor Ralf had to witness my ordeal, and while he hurried out to get the car, the nurse transferred me into a wheelchair and parked me near the back door.
After we got home, I took a Percocet and went to bed. That actually helped me a lot better to control the pain, and I wished I had gone home much sooner. I was pretty messed up, falling asleep while chewing some bread, just to snap awake again with a little confusion. But at least I wasn’t nauseous, and I even managed to hobble to the bathroom on crutches. I realized two things: if I didn’t engage the abdominals when the right leg came off the floor, I was punished with VERY sharp pain in my groin. I was also very happy that I had the raised toilet seat installed – it would have been a nightmare without it.
I slept all throughout the night, and when I woke up, Ralf was there with my meds already lined up. Then I made a pretty disturbing discovery: because my iliopsoas tendon was inflamed and super-tight, the surgeon released it (by slicing my tendon in the middle). I was told during a pre-op appointment that my right leg would be “weaker” for the first couple of weeks. But as I was laying there in bed, trying to abduct my right leg, nothing happened. I mean absolutely nothing. I looked like a failed magician, trying to levitate an object. My brain was screaming “leg: MOVE”, and my leg was like “what? Did you hear something? Nah…”. In fact, I couldn’t lift my leg up for several weeks to come. It slowly improved, but I admit I was freaking out a little at the beginning.
I spent the first two weeks in Ralf’s armchair, learning how to get up and move without violating the “no-past-90 degree-bending” rule. Ralf was also having increased abdominal pain and related issues, which was not surprising, considering the stress and messed up routine. But we managed, and he took good care of me, helping me getting dressed and making sure I get my meds on time. Another thing I learned during those two weeks was that crutches SUCK! Especially if you are non-weightbearing on one leg. Boy, my hands were so bruised and tender from the repetitive pressure, it was pure agony. But overall, I was getting better.
Looking at that big dressing that covered my right upper thigh, I wondered what was underneath there. I had to wait 3 days before I was allowed to take it off and shower (with waterproof bandages). To my relief, I only found the three small incisions, and they looked good. I invested in a good supply of Mepilex dressings, since they are very gentle to the skin and stay in place for a few days. That harsh tape already caused some irritation, so after my first shower I changed them for the Mepilex.
I was so touched by the many well-wishes and gifts I received during this time. My friend Geraldine, with whom I graduated from UCF in 2014, sent me a lotion and pamper set. I also received a box with fruits and nuts from some friends from work, and a variety of other helpful things from Erika, Bonnie, and Bergie, who all visited me at home.
I was very eager to get my recovery going, so I started PT five days after my surgery. I was lucky to have found the Lake Nona Sports and Rehabilitation Center because it was not only 4 miles away, but the therapists Danny and Chris are also amazing.
On July 2nd, I finally had my follow-up appointment, and I was determined to get off those despicable crutches. And I really needed to be able to drive, at least short distances to work and PT.
The PA who saw me was very happy with my progression and the way the incisions looked, so I was now allowed to walk without assistance. I was also cleared to drive if I felt confident enough. After the stitches were removed, I happily walked out with Ralf carrying my crutches.
Well, here is another fun fact about tendon release effects: once I was behind the wheel and had my right foot on the pedal, driving was very easy. I had full strength pushing the breaks without any pain, and I also could move my foot side-to-side. However, I was still not able to abduct my leg, which resulted in me having to physically pick up and lift my right leg into the vehicle… I hope nobody witnessed that, since it probably didn’t look very competent to drive (looks can be deceiving, lol). In any case, I was now able to go back to work and look after my Simulation Lab.
I had been doing my routine PT exercises every day at home, and I continued PT, mostly with Danny, which I credit with my current level of progress. I have to say, though, recovery from this procedure has been very different from ADR back surgery. I have had huge fluctuations in pain, with a major set-back two weeks ago when I was in a lot of pain. But overall, I have been trending up – every week a little better. I am on light duty at work, but I am still pretty active there, so that may have contributed to the ups-and-downs. I am now about 6 weeks post-op and even though I am not pain free yet, my ROM has much improved and I am ready to tackle the flight to Germany that is coming up tonight.
ICE ICE ICE!
Return to Work
During the first 10 days post-op, I was able to telework from home. I took some hours of sick leave on short notice, based on how I felt.
After I was cleared off the crutches, I went back to work in person the following Monday. Since I still don’t have a Sim Tech yet, there was a bit of chaos (as expected), so I started to clean up and prepare the place in snail-mode. Not being able to lift heavy manikins or even walk at my usual fast pace was testing my patience, but I promised myself to not jeopardize my recovery by doing too much too soon. But I still got a lot done, updating and maintaining my manikins and help the new nurse educators to implement consistent staff training.
I got really lucky when the Education Department assigned me a Pathway intern to be with me for three months, and Casey has been a huge help so far. In fact, having her around has been a nice preview of what how it could be with permanent help in place. And as it turns out, the timing was crucial….
As the Delta variant started to spread like wildfire among the unvaccinated in mid-July, it became clear to me that we were heading into another pandemic crisis. I had various training events already scheduled in advance, but my gut told me to start looking into tightening Covid restrictions again. Ironically, I received an email from leadership the very next morning, asking me to do just that and provide a list with activities, along with group sizes, ect. That same day, I had a pretty elaborate central line catherization class going on, involving 21 students plus instructors. The CVC course was divided into parts 1 through 4, which I separated into four skills stations. But it was still a lot of people…
So, imagine me trying to figure out how to coordinate and manage future simulation-based activities moving forward, freaking out a little about the buzz that was currently unfolding all around me (even though I just got the email that morning, but still…). With my mind back in acute pandemic mode, I finally listened to my bladder to use the restroom. Since there was a bunch of folks in the front part of the Simulation Lab, discussing “common complications”, I decided to slip by the “what’s in the CVC kit & sterile field set up” station and exited through the back door. As I was rounding the corner to go to the bathroom, I suddenly stood in front of my boss (Chief of Education), the Chief of Staff (second in command of the hospital), and a guy with a camera. Mind me not, we are all standing in front of the main entrance to the Simulation Lab. It took me at least 5 seconds process what was happening: I won the 5S Quality Improvement Award of the facility, and Dr. Zacher was presenting me with the certificate! Right then and there! I clearly remember my thoughts, going from “oh, ok, I guess we are doing this…”, to “How am I going to explain what is happening behind the closed door”…. It was inevitable, they wanted to tour the Sim Lab, and I knew it was coming. When I look at the picture that was published in our newsletter, I can clearly see the anxiety in my eyes.
Again, in reality, I didn’t do anything wrong, especially since everything was so calm for a while, with no COVID patients at all in the hospital, just before Delta hit. But still, things had changed rapidly, and when I opened the door, there was such an energy and buzz going with a gazillion people everywhere (or at least that’s how I perceived it). To my relief, Dr. Zacher was very impressed with the high-quality training we just recently put in place. Needless to say, I didn’t get to pee for another hour.
A week later, I got another visit in the Simulation Lab: Dr. Zacher (twice now in one week!), the Medical Director, and a lady I didn’t know. Casey and I were actually busy with planning the skills stations for cross-training nursing staff to be detailed to inpatient care units to buffer the lack of staffing. I was just setting up the “IV insertion” practice station (complete with fake blood) when they arrived, asking for a tour. I was like “sure, come on in, pardon the dust”… I found it odd that the Medical Director was asking me all these questions about the Sim Lab and my Virtual Reality innovation projects, so later that day, I did a Google search to find out who that lady was. Well, as it turns out, I was paid a visit by Dr. Clancy, Deputy Undersecretary of Health from Washington! I guess the Simulation Lab has now morphed into an asset to our hospital and staff education, which really makes me happy and a little proud.
As I mentioned earlier, I was busy with setting up skills stations to train nurses to cross-train for inpatient care. That means that nurses, who usually work in areas, such as mental health, PACU, primary care, ect., get prepared to support inpatient care in existing and newly-created patient care units. Yes, we are back to that, just like last year. Since I already had my flight to Germany booked, I needed to make sure all stations were set and operational, resources were in place, and the nurse educators were able to trouble-shoot when necessary. I do feel a little guilty leaving right now, but I am also relieved a bit. With so many people (including healthcare providers!) unwilling to get vaccinated, we haven’t seen the worst yet.
But before I even go there, the last week at work also included Ralf’s follow up visit to Moffitt. The anxiety and fear were indescribable, and especially the days leading up to this appointment were very difficult for both of us. In addition, we lost a dear friend, Mikey, just the week before. He was very unexpectedly diagnosed with stage 3 colon cancer six months ago, underwent emergency surgery, and had been declining from that point on, despite all the fight. My heart also goes out to his wife, Fay, who barely left his side. She was fighting with him to the end, and it was because of her that Mikey was able to go on his terms, at home in their Airstream, with hospice service in place. It just all went so fast in the end, and even though it was also extremely taxing and scary to drive the two hours in the car, Ralf and I were able to make it to Tampa to say good-bye. It was so emotional when Mikey recognized Ralf, a smile forming, and saying “Ralf, you came!”. I left the two alone for this moment, and I was sitting with Fay, a soul I can relate to so much, as I have had my own share of “what if” thoughts and emotions. Mikey passed away three days later, on August 7th at 9:35 AM.
It still feels so surreal, so unjust. And with our heart still heavy, we had to shift gears to face Ralf’s own follow-up the following Monday. The good news: the cancer appears to be stable, with some “waxing and waning” here and there. He will never be cancer-free, and the repercussion of this brutal surgery, along with the fact that sheaths of cancer still encase some parts of his organs and intestines, explain some of the chronic GI issues and pain. This will likely be with him for the rest of his life, but Ralf is determined to find the best “new me” version he can be. Also, there is no prognosis: the cancer can be stable for decades to come… or not. Nobody knows, but my gut is telling me that he will have many, many years to come! The next follow up is not until next year February, and hopefully we can then go on an annual schedule.
Upcoming Travel to Germany
I have refrained from posting anything about the current Delta surge and vaccination issues. This has become an ugly debate between the proponents of the vaccine and antivaxxers. My own mental health has been pretty affected by everything that has happened. I didn’t want to become a target of people who refuse to get vaccinated for various reasons. I have lost precious friendships over this, which I never thought would be possible. But I realized: I AM angry. And since it is ok for others to voice their opinion, I decided that I also have the right to get this out of my system:
After we started to finally get more and more people vaccinated, the numbers of infections and hospitalizations dropped during the spring. I started to feel somewhat safe again, and Ralf and I went out to meet with vaccinated friends in restaurants a couple times, and going to the grocery store was much more relaxed. However, we both kept wearing our masks inside buildings. I even got to go to Universal Studios the end of May, and it was such a liberating feeling. But then came the Delta variant, fueled by the huge number of people who refuse to get vaccinated. This variant is much more infectious than the original strain, so now we see this sharp increase in Covid infections – again! Do you know that my hospital is now so overwhelmed that they took stretchers out of the Simulation Lab because we are running out of beds? We are back to emergency tents in the parking lot, trying to create more space! This affects all of us, and I feel betrayed by the people who decided that they rather take their chance with this deadly virus than taking this “experimental” vaccine!
Here is how I see it:
The only reason why we were able to come up with a vaccine at all this fast is the fact that mRNA vaccines are NOT new. They have been researched for a long time, which is the reason why this vaccine could be customized to this virus so quickly. It works, it is safe, and we have massive amounts of worldwide data to back that up. Sure, we can try and reach herd immunity over the next several years to come, exposing ourselves to potentially even more deadly mutations along the way. Well, this virus is nothing we have seen before, and with the vaccine, we could have prevented this massive surge.
It is not just “your choice”, since this affects everyone, no matter what. The fast majority of hospitalized Covid patients are the unvaccinated. Since we now have no more ICU or other hospital beds, other people with medical emergencies are dying because there are not resources. Chronic diseases, heart attacks, accidents…. All those people can’t get the care they need because we have, yet again, overwhelmed the hospital systems. Oh, and did I mention the significant amount of healthcare providers who are out sick? Overrun with patients and understaffed – and the virus keeps spreading and spreading…
Sure, we now see a percentage of vaccinated patients who get infected regardless. It’s inevitable by the massive spread of this virus, but the vaccine still does what it is supposed to: it prevents severe disease and death from happening. No severe disease, no tying up a hospital bed. In my mind, getting vaccinated is the least anyone can do to help end this madness! I don’t like the idea of the government forcing people to get vaccinated. But then again, they shouldn’t have to!
Am I selfish? I guess I am because I want to be able to go to a restaurant with my husband without fear. I want to be able to go grocery shopping, go to the movies, or a theater. I want to be able to travel to see and take care of my family without being petrified of getting infected and potentially hurting my family. The higher the virus load is out there, the higher the chances of getting infected even with being vaccinated. The main fuel for this virus is provided by the unvaccinated, and until that changes, we will continue on like this, from one wave to the next.
I am getting ready now to go the airport, in fear, and travel to Germany to take care of my family. It’s not a vacation, it’s a necessity. I did my part and got vaccinated, but that is all I have control over at this point. Rant over.