Session 4: Back to the Hospital or Gosh I'm a Gripy Lady

I'm not really sure where to start with this. I think I have probably already discussed how I thought that because my pregnancy was so incredibly perfect that I had this feeling like something would eventually go wrong. Maybe I messed myself up- walked right into a self-fulfilling prophecy. It started with the C-section and then escalated from there. Let us please note, though, that since it seems that something just had to go wrong I am SO eternally grateful that it was me and not Davy. I hope that it can always be that way.

**For anyone reading this blog- I do apologize for the lengthy and overly-detailed posts. Bear with me, though. I am trying to work through this stuff so I can be a more pleasant person in all other aspects of life.

Maybe the best way to do this is with a sort of timeline:

Friday, December 26, 2008: All three of us go home from the hospital for the first time. My mother and my sister, her husband, and his daughter are all in Birmingham. I'm still in a lot of pain from the C-section so my mom picks up my prescription for Percocet from Target as well as supper for her, Robby, and me. In the meantime Robby, Davy, and I get settled into home. We decide to camp out in the living room since I can't quite lay flat on my back to sleep in the bed just yet. The evening and night go great. We are so happy to be home. I swear, the heaviest thing I lifted was Davy- all 6.5 lbs of him.

Saturday, December 27, 2008: I wake up and even after being awake for a good part of the night, I don't really feel tired (oxytocin still at work I think). But something is definitely wrong. My eyes feel hot. I normally run around 97.7, temperature-wise, so I can almost always tell when I have a fever, even low-grade. I check it and it is high enough to call the doctor (the on-call doc). She asks how my incision looks- just the same, no redness, it's just fine. I have no other symptoms so the doctor posits that it could be my milk coming in and that the situation doesn't seem dire enough for me to go to the ER unless I just want to (who the heck wants that if they don't have to do it?!). I ask if I should take Tylenol to help keep the fever down and she says yes. We monitor the fever throughout the day. It goes as high as 101 at one point, and only a little while after taking the fever-reducer. My mom and Robby encourage me to take a cold shower. Ugh. I start to cry because I am chilled from the fever and in a bit of pain from the whole milk-coming-in inevitability. I do it anyway because I don't want to end up in the hospital. I cry through the whole thing, but Robby helps me through it. Finally the fever starts to hover around 99- still high for me, but low enough that it isn't an issue from a medical standpoint.

Sunday, December 28, 2008: My fever is still down for the most part. I check in with the on-call doctor. She says I seem to be doing well, just to check in with my regular OB on Monday. My mother goes home since my fever seems to be doing better.

Monday, December 29, 2008: The fever is low in the morning. I don't feel fantastic. I am starting to notice puffiness in the area of my incision, but no redness. We take Davy to his first pediatrician's visit. Poor guy gets a heel-stick, but handles it like a champ. After his visit we go see my doctor. My fever is up in the 100 degree range again in the office. The doctor looks at my incision and says he thinks there is a hematoma beneath the muscular fascia (a thin layer of connective tissue covering the muscles). He says that he is worried about me, prescribes antibiotics, and says he wants to see me on Wednesday if my fever will stay down. If my fever doesn't stay down, I will have to be admitted to the hospital for at least three days for IV antibiotics. I also need to stop taking Tylenol because Percocet has acetomenophin in it already, so I switch to Motrin. When I left the office, I was in tears...again. At this point I am terrified of having to go into the hospital and not having Davy with me. The idea of three days without your one week old baby is excruciating. [Even now, I don't think I could handle it very well, but certainly better than I could have then.]

Tuesday, December 30, 2008: I don't remember the events of this day. I think my fever stayed down for the most part. We must have taken it easy. It might have gone up again in the evening, now that I think about it. I remember looking down at Davy and crying, thinking that I was going to have to leave him. It could have been any one of these nights, though. I'm pretty sure that was a nightly routine for me during this time.

Wednesday, December 31, 2008: Back to the doctor. I'm doing ok. My fever is has been down in the morning for the past two days- even as low as 98.3- but as the day progresses and I start to move around it goes up, though not as high as 101 again. The doctor seems pleased, but says we aren't out of the woods yet. He is going to tell the on-call doctor about my situation so that she is knowledgeable if I have to call. But, praise the Lord we find out that if I have to go to the hospital then Davy can come too as long as there is always another person present to look after him, since he is no longer a patient. My father and his wife and their children come over for New Year's and to see Davy. It is nice to see them, but I am not feeling well and I know that it puts a damper on everyone's holiday. Sorry.

Thursday, Janurary 1, 2009: My dad and family go back home. Fever is mostly down. I spend most of the day on the sofa. A friend of ours has a birthday today and stops by since we can't join her and other friends for dinner. Around 9 or 9:30 I start to feel the tell-tale chills. I try to take my temperature discreetly. It reads 102-point-something. OH crap- sorry, there is no other more polite way to say it. I take it again. Same thing. I have to tell Robby. He says we have to call the doctor. The doctor says I have to be admitted through the ER and I should pack a bag. We hurriedly pack and bundle Davy up and leave. Thankfully, there are only a few people in the ER and we sit as far away from them as possible in attempt to keep Davy from catching any germs that might be floating around (he didn't thank goodness!). After 20-30 minutes they take us back. It is probably close to 11pm at this point. The nurse takes my vitals, we go to a private ER room. The ER doctor comes to look at me. He assumes that I have an infection as my fever is now 103.7. He tells us that the on-call doctor wants to start me on two or three different antibiotics. He asks if I am breastfeeding. I say yes. "You probably won't be, " he says. This statement is devastating. He leaves. I cry. A lot. I don't care what I have to do- I am going to feed that baby when all this is over. The doctor comes back- my doctor says I can breastfeed on these antibiotics. Despite everything, I am elated. So is Robby. Poor guy was convinced Davy wouldn't eat for him. Doctor leaves, comes back. I am going to have surgery. My doctor thought it over and with my fever as high as it is, she wants to open up the C-section to see if there is any pus in it (I secretly think the ER doc called and told her to do this. He didn't seem satisfied with the hematoma theory.). Sigh. Ok. I think I'll start using past-tense now...

The whole surgery bit was quite unexpected. During pregnancy I didn't do very much research on C-sections, so I had no idea that they sometimes were opened up again. The doctor on call arrived to tell me what was going on and what to expect. She said that she had thought it over and called my personal doctor- who was going to come up and help- and together they decided it was best to do the surgery. She said they would have to leave the wound open and that I would have to have a Wound VAC to help close it up. I think Robby and I might have chuckled at this point. Our choir director has had a Wound VAC for the past...geez, at least four months, maybe even five. He lovingly calls it "Etheldrita." She also said I would still be on the antibiotics, through which I could breastfeed but they were going to use general anesthesia for my surgery and I likely wouldn't be able to nurse for several hours following that. The anesthesist came in to discuss what we were going to do. He said that generally it was best to wait until I was well awake from the anesthesia to breastfeed, but that they were ordering me a lactation consultation and lactation would know what was best. **An aside: The lactation department at Brookwood is absolutely fabulous. They are nice, knowledgeable, and always follow up to see how you are doing.** He also said that they usually give patients a preliminary injection that helps them relax before the general anesthesia and surgery and it could stay in my system longer, causing problems for nursing, BUT since I seemed fairly relaxed that he thought we could go without it. The ER nurse came (lots of people coming in and out as you can see) to start my IV and to draw blood for a CBC (complete blood count). I think she stuck me twice for the CBC and twice for the IV- again, lots of bruising. At this point I think my bruises had bruises, haha. She put the IV in a terribly awkward place- right in the crook of my right arm. I could barely bend it. After all this...or maybe even through it, I can't remember...I nursed Davy one last time, taking in as much of him as I could. **A note on Davy: He was the absolute best baby through all of this mayhem. I can't even think of a time that he cried except when we gave him a sponge bath a few days later.** Also during all this, we were very concerned about what was going to happen with Robby and Davy. We had all our bags, plus Davy, and Robby was going to have to somehow transport all this somewhere on his own. If he was going to be in a waiting room somewhere, he might have needed help and we had no idea who to call who could get there in time. I had already been admitted, so we kept asking if our room was ready. Finally, after I changed into my gown and the OR nurses had come to transport me to surgery, we found out where our room was. Someone brought a large-person wheelchair for Robby to put all our baggage on and we all started off down the hall.

I had elevated the back of the hospital bed so that I could get better support while Davy was nursing in the ER; however, this was not a pleasant position as they were rolling me down the hall. I was starting to get anxious. I couldn't see Robby and Davy. I knew they were behind me, but I had no idea how they were faring. All I could think about was that if they needed me then I couldn't help them. I really can't even explain what I felt as they wheeled me through the dark halls. I guess it was anxiety- it's not something I feel often so I'm not sure I recognize it when it pops up. Maybe it was a combination of things- anxiety, frustration, disappointment, maybe even a little bit of fear. Something that had crossed my mind in the ER was "what if my uterus is infected and they have to give me a hysterectomy?" So much for being calm, but I tried to keep my brave face on. Robby and Davy parted ways with us at the elevator in the women's hospital. It was so surreal rolling through the hospital in the dark. All I could think about was whether Robby and Davy would be ok. I felt alone. My breaths started to catch in my chest a little bit. Rock music was playing as we arrived in the ER. They helped me onto the operating table, then went through the same routine of applying O2 and strapping my arms down. Ha, I'm not sure how I might react if I ever have to have my arms strapped down again. I might put up a fight next time. It's horrible. You feel utterly powerless during a time when you are already feeling vulnerable. The anesthesist and one of the doctors arrived. I remember the anesthesist saying that I would go to sleep and then what felt like several minutes passing before I lost consciousness. I don't think I dreamed. When I had my wisdom teeth taken out I had a dream that I was in my own mouth jumping from tooth to tooth, but I guess that anesthesia is a completely different beast.

I woke up in pain. I didn't expect that, either. With the C-section I didn't feel anything in recovery because, of course, I was totally numbed. I can't remember exactly the nature of the pain I had upon awakening, just that it was present and urgent. I don't think I made a lot of noise, but I had to do something so I started to moan softly. I think I remember the nurse saying, "She's awake and she's in pain." Then there was talk about starting my PCA pump. Haha, I started to try to breath through the hurting like I breathed through my contractions. I think the nurses got a little bit of a kick out of that. I guess an hour passed and they finally brought me upstairs to my room. I think it was around two or three a.m. Evidently the room was difficult to find because they had to stop once to ask for directions. It was on the same floor as post-partum, but on a different hall. I was pretty much lucidly awake by the time we arrived. I had to push myself over onto the bed in the room. Robby was feeding Davy. They had already gone through the expressed breastmilk and had had to start using the pre-mixed formula the hospital had given us when we went home the first time. I remember aching to be close to them. We had a wonderful nurse that night. She helped me with the pump that was sent up from lactation and brought me water. I had O2 on well into the next day and it severely dries out your throat and mouth.

Later in the morning...I guess it was around 5am because there was a shift change-our new nurse was Shelby, who was very nice but a little bit airheaded...lactation came and told me I could breastfeed as long as I didn't take the sleeping pill that was ordered for me. Apparently my blood count was low because the doctor ordered for me to be transfused with two units of blood. I've never had a blood transfusion before. It was strange. I think the transfusion was finished by the time my mom arrived and I only had the O2 on. Oh, right. Also early in the morning the ostomy nurses (wound care nurses) came to outfit me with my Wound VAC. First they had to remove all the dressing from my wound. Ow. Robby was very good about reminding me to press my PCA pump every six minutes during this time. It still hurt like...I don't know what. It's so hard to describe this pain. They always ask you to rate your pain on a scale of 1-10, 1 the lowest and 10 the highest, but what is the point of reference. The most intense pain I have ever felt was the pain of labor, but that is so different from the pain I experienced with the wound. I think you have to categorize. Anyway, they kept pulling piece after piece of gauze out of the wound. Then they measured it. I think it started out on that day at 14cm long, 2-3cm wide, and 1-2cm deep. Then they "installed" the Wound VAC. Here's how that works:

1. Cut a piece of this special foam to fit the shape an size of the wound.


2. Drape this special tape around the edges of the wound so that the foam doesn't come into contact with the skin after they...


3. ...jam the piece of foam into the wound.


4. Put more special tape over the piece of foam, then cut a hole in it.


5. Put another piece of foam on top of the hole in the tape and cut a hole in that. (This is called "the bridge.")


6. Fix a long tube over the top of the hole over the second piece of foam.


7. Attach the long tube to the the tube coming out of the Wound VAC.


8. Start suction.

The way the Wound VAC works- and I probably am not explaining it exactly right- is that it creates a negative pressure inside the wound so that the body wants to send cells there to repair a perceived trauma. This way it helps the wound to close without leaving an incredibly deep scar. Plus (I looked at the wound about a week later) there is all kinds of stuff just hanging there (I saw my fat layer and everything) so it covers that and all the layers can heal together rather than just being healed over. If that makes sense. The piece of foam they put in gets progressively smaller until you no longer need the VAC and everything heals over. Initially, the worst part of the VAC is having it changed. The first changing was....well, it was excruciating. They gave me a shot of Nubain beforehand....Nubain doesn't do anything for me. It doesn't even make me dizzy. No help there at all, kind of like Loritab for me- nada. During the first changing the nurse got most of the tape off (this tape is like...devil tape- after it was all finished my skin looked like it was made of plastic then peeled like a really bad sunburn) then just ripped it and the foam the rest of the way. It burned like crazy. Also after that first changing, my doctor came to remove a drain that had been put in during the surgery (This little thing was a major pest whenever I got out of bed to go to the bathroom. It would fall and jerk when I stood up, so I had to make sure I held it and lowered it gently when I did so.). It was stitched in place, so I thought it couldn't be terribly deep. Wrong! He pulled about five inches out. Stopped for a beat. Then kept pulling! All I can say is that I didn't scream, though I wanted to. Ah, I wish I could remember the name of that little thing so that this can be a warning to anyone of you who may have one of those some day.

Well, this has gotten out of hand. I'll end this Session here with the basic experience and get into the emotional aspects of that hospital stay and living with a Wound VAC in a separate Session.

This is the kind I had in the hospital. Luckily they have much smaller ones for toting around!

You can see the track here. That black thing in the pink bag is the VAC.
A side view.
The red dot is from the surgical drain.

It looks like a mouth