Confuzzling Anesthesiologists

I promised I would write up one of my weirder experiences with anesthesiologists and here it is. This story is from my wrist surgery.

There were 3 of them. Anesthesia Residents, young and eager.

Their goal? Do a nerve block via the armpit.

They doped me up by pushing something in the IV and and proceeded to fumble the nerve block.

The kind of fumble I imagine no doctor wants because it was public and the patient knew about it.

The three of them huddled in the corner, whispering with worried looks on their faces. I was high, but not deaf so I heard that they hadn't hit the nerve.

Keep in mind, I was out of my gourd on happy drugs so I was not acting rationally. Speaking up was not on the radar because 00000 Look! I have toes! On my feet!

Despite the drugs, a dark fear began swirling in my stomach. I was afraid I was going to be one of those people who would not only be awake, but feel every cut of the scalpel during the surgery.

So they wheeled me into the operating room. No one said anything. Everyone was pretending everything was fiiiine. Plus, did you know, toes wiggle?

More happy drugs via IV with the intent of inducing twilight sleep.

Except I wouldn't go to sleep.

I was petrified if I did, I would not be able to tell the surgeon when I could feel the scalpel. Keep in mind, this was all in my head. Not once did I say anything to anyone. I can only blame that on the narcotics.

More whispered conferences and worried looks among the anesthesia team. I distinctly heard them saying, "Why isn't she sleeping?"

So they pumped more happy drugs into the IV.

And then more.

Followed by even more.

I resisted and stayed awake. It wasn't that hard actually.

It ended up being a good thing, I think. Because the fumbled nerve block did wear off mid-surgery and they had to use general anesthesia.

However, by the time I could feel anything, I was so doped up I could only moan. I couldn't form words, but I remember the surgeon instantly stopped and asked what hurt. I gurgled out a narcotic laced interpretation of the word shoulder and next thing I knew, the mask was coming down over my face.

I had a hell of an anesthesia hangover the next day. Very sick.

I wish someone had just taken me by the hand and said 'it looks like the nerve block is only partial, so here's how we're going to manage that yadda, yadda, yadda.' That's all I needed. Nothing more than that and certainly not more narcotics.

Instead, I think the residents may have glossed over their fumble? I don't really know, but my impression is that it was swept under the rug. Or maybe everyone knew and it really was okay, but no one explained it all to me? Often as a patient, I notice that everyone else knows what's going on but me, so that could've been the problem. No one stopped to fill in the patient.

Or maybe the pieces parts I saw/heard were out of context. I have no idea, but it was definitely a bizarre experience. Stressful too.

Hey docs, don't let the patients see you sweat and don't be afraid to tell them the truth either. All we want is to be taken care of as patients, a flub is okay as long as there's a plan and the patient isn't left in the dark to assume the worst.

The Surgery that Almost Wasn't

At the age of 14, I sustained a serious soft tissue injury to my (dominant) right hand. It used to be broken bones I was afraid of (my first break was at 4), but I rapidly learned that serious strains and sprains were worse.

If they are severe enough, they don't heal well.

Bones get 'bed rest' via a cast, they get set. You can have surgery if you need it where they'll pin the bone in place or give you a steel rod. Bone regenerates. A break will heal very fast.

Soft tissue injuries don't have as many treatment options and they aren't immobilized as well as a broken bone, so they don't get much 'rest' to heal. You're left with R.I.C.E and a nifty collection of ace bandages. Soft tissue tends to develop a chronic inflammation response and pain. It heals at the speed of a paralyzed glacier.

Worse, doctors don't really know what to do for soft tissue injuries that become chronic. (Massage therapy can help in many cases, but I didn't know this until it was far too late.)

So my hand doubled in size from the swelling and stayed that way for months. I had problems with it from that point forward. It truly was a bad injury.

By the time I was 25, I had literally lost my grip. I couldn't hold a cup. Couldn't write. Couldn't make a fist and squeeze. Push-ups were out as was carrying grocery bags. Forget opening jars or even stirring--when I baked the hubby would have to stir the cookie batter for me. Handwriting was incredibly painful as was typing. I used the computer mouse with my other, non dominant hand.

I had over a dozen ace bandages and I wore one every day. The pain was constant and it eroded my emotional reserves, wearing me down to the point of tears on a regular basis.

But my primary care physician wouldn't give me the referral to a surgeon or any place else (like physical therapy). I asked. She said no. I asked again. She said no. We did this dance for a year.

Which was incredibly frustrating.

Then my husband happened to need surgery for an avulsion fraction of his finger -- the result of a tag football game gone wrong. I was impressed with the surgeon and wanted him to fix my wrist/hand. (This is a great, albeit unusual, way to vet doctors.)

I went back to my PCP and listed out all the ways I couldn't use my hand. Then I begged, "If it's like this at 25, what will 30 be like? I am going to completely lose the use of my hand at this rate. We need to do something. Please."

I got the referral.

The surgeon ordered an arthogram-- they inject dye and see how much of it 'leaks' through' tears in the muscle (at least that's how it was explained to me)--and it showed nothing.

I was crushed.

I thought the negative arthogram was the end of the road. Especially after having been ignored and poo-pooed by my PCP for so long--maybe she had been right. Maybe I was a big faker too--this is always my default assumption in these situations, that I'm an idiot. Yet oddly enough, I'm the one who is usually right and it's the docs who are missing things. Weird.

Thankfully, the surgeon really was as good as I thought he was. He spent several long minutes palpating my wrist, popping bones in and out of place (everything was loosey goosey in there) and said we should do the surgery anyways. He told me arthograms miss things about half the time.

I was SO relieved. There was still a chance to get my hand back.

They allotted an hour for the surgery, but ended up needing three. For my little wrist! I am kind of tall, but I have teeny tiny hands. So how they found anything to do for three hours in my teeny wrist is amazing to me.

There were some issues with the anesthesia team during surgery (another post for another time) but the surgery went well overall. The surgeon told me I would probably need more surgery in the future because the damage was much worse than he'd anticipated. He'd run out of time to do everything that needed doing. However, more than ten years out from the surgery I have NO complaints. My right hand, on a good day--of which there are many--is at 90-95% which is amazing.

I have no plans to seek additional surgery. I'm good. Also, enough high medical weirdness has happened since then, that I am not anxious to do anything I don't have to, you know?

While my bum wrist was a major factor in my inability to continue with massage therapy, the surgery made a huge difference for me. Let me count the ways...

-I can mostly open jars--I'll always be little weaker than someone with a regular wrist.

-I can carry a full cup without spilling.

-I can carry grocery bags as well as a baby in an infant carrier.

-I can do push ups, although there's arthritis in the wrist and sometimes this doesn't go over well.

-I can cook, but also use a Kitchen Aid mixer to spare my hand. Kneading bread is hard and used to require the hubby's help, but now that I low carb that's not an issue.

-I still sometimes have to switch the mouse to my non-dominant hand and watch how much I type, but that's a minor quibble.

-Handwriting continues to be painful, avoided and illegible anyway because I can't control the fine motor movement very well. Computers allow me to compensate pretty well.

-Breastfeeding was hard because of how much the hands are used to support the baby (and also an anesthesiologist screwed up my other hand during labor-which is another story). I was able to work through that using massage for the muscle tension and the My Brest Friend pillow --which makes breastfeeding ergonomic and takes the strain off the shoulder girdle and arms, much better than the Boppy.

-The overall pain level has been reduced by 95%. It can still flare up at times and there are problems with all the muscles in my forearm up to the elbow, but mostly, I have my wrist and hand back.

It was scary to ask for surgery, but I am so glad I did. This one had a happy ending.

Now I should write up the story about the anesthesia team because it was actually kind of funny. They had a really difficult time knocking me out. All they need to do was say 'it's okay' but somehow they thought the answer was more drugs.