Getting Back On Track, Again

A kind soul on Facebook finally gave kick in the seat of my pants that I needed to get this blog going again. Let's see, where were we...ah, yes! The nightmare during surgery.

I've been trying to figure out that dream for a couple of years now, but a description still eludes me. Suffice it to say that I dreamt, either during surgery or in recovery, that I was being operated on in a wood-paneled room in something that seemed like a room in, of all places, Hell!. I can't remember if I was in hell, going there, or if World War III had just broken out and everybody was headed there. Either way, I dreamt that I was trying to warn the surgeon (in mid-operation) that he shouldn't be operating on me with the end of the world imminent.

My wife says I really did say this next part during recovery. Apparently, I told a nurse that I had accidentally created a MIDI controller (musical device for non-techheads) that would launch all of the world's missiles if someone programmed it to play a certain song. Don't ask me what the song was - I can't remember.

The whole hallucination was probably due to the length of the operation. I was under for two or three hours. Not long when compared to an organ replacement, but plenty long when you consider just how much ankle hardware the doctor had to insert in order to repair bimalleolar fractures with complete dislocation on both feet.

Suffice it to say that I was under for more time than I've ever been. I also woke up in EXTREME pain.

Not to end the story, but just a quick status update: I'm now on long term disability leave from my job due to a laundry list of problems that keeps getting longer. I have a heart condition called PVC (Premature Ventricular Contractions) that can strike without warning, and the electrocardiology specialist who verified these (along with another heart problem) says there's nothing he can do, mainly due to the operation I had which put the Greenfield mesh filter into my vena cava. I won't go into the other problems since they're most likely not due to the gastric bypass, but next update I will go into the real hell that is called Spending Time in a Crappy Hospital.

Watch this space for the next installment, and thank you for reading.

But First...

I'm still having some problems getting my thoughts sorted out on the nightmare mentioned in the previous post; just thinking about it brings up some degree of post-traumatic stress. So, until I can deal with those demons, I figured I would put this online for your perusal.

What follows is the text of the Operation Report from December 17th, 2009, the day on which my ankles were fixed. I just received this after asking for a copy of it during a follow-up appointment I had on Tuesday. Certain portions have been omitted to keep swarms of lawyers from descending on my family. Also, a few reformats have been done here and there to make it more readable, and I've added a few explanations of some of the more technical terms, trying to limit those so that I don't defeat the goal of improving readability.

Here we go:

OPERATION: 12/17/09

PREOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.

POSTOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.

OPERATION:
1. Open reduction internal fixation (a.k.a. ORIF - fixing a fracture after incision into the break site - ed.), left bimalleolar ankle fracture.
2. Open reduction internal fixation, right bimalleolar ankle fracture.

ANESTHESIA:
General.

ESTIMATED BLOOD LOSS:
50.

COMPLICATIONS:
None.

DRAINS:
None.

TOURNIQUET TIME:
Left 25 minutes and right 27 minutes.

INDICATIONS FOR PROCEDURE:
The patient is a 46-year-old male who suffered significant bilateral ankle fractures after a fall 5 days prior. He was eventually medically cleared and due to the displaced subluxed (dislocated - ed.) ankle fractures bilaterally was indicated for ORIF. He understands risks and benefits of surgery and consents for the procedure.

SUMMARY OF OPERATION:
Following successful induction of general anesthetic, both ankles were prepped simultaneously. Ancef 1 g (an antibiotic - ed.) was administered prior to start. Calf tourniquets were applied. The left side was done first.

Following exsanguination (I assume this means either free bleeding or some removal of blood from the site - ed.), toruniquet was inflated on the left. Lateral incision was made through skin and subcutaneous tissue. The fibula was dissected down to and underwent reduction. There was minimal comminution (breakage into a number of pieces - ed.) but somewhat softened bone.

Fracture site was irrigated of hematoma and a curette was used to remove any loose bony fragments. It was then reduced anatomically with a bone-holding clamp, and a single compession screw AP (anterior/posterior - ed.) was placed to hold the reduction. A 6-hole 1/3 tubular locking plate was bent to conform and placed along the lateral aspect. Initially, 2 compression screws, cancellous (i.e., into spongy bone material - ed.) was placed distally (at the far point - ed.) and cortical (dense bone - ed.) placed proximally, followed by 3 locking screws of appropriate length.

We then moved to the medial side and made a small curvilinear incision over the medial malleolus. Opened the deltoid ligament to identify the fracture, irrigated it, and reduced it anatomically and held in place with a bone clamp. Two 50 mm 3.5 partially threaded screws were then placed in parallel through the medial malleolus obtaining good compresion and good derotation (stability - ed.).

X-rays confirmed good hardware placement and anatomic ankle mortise reduction on AP and lateral images. The limb was then wrapped snugly with an Ace wrap and the tourniquet deflated.

We moved to the right side and performed a similar procedure after tourniquet inflation; first the fibula and then the medial malleolus in similar fashion. We used a 7-hole 1/3 tubular locking plate laterally with a single AP compression screw for this similar short oblique fracture. Anatomic reduction was achieved on both sides. Final X-rays confirmed good hardware placement, screw length, and mortise reduction.

Both ankles were then irrigated thoroughly and closed with 0 Vicryl (absorbable sutures - ed.) for the deeper tissues including the deltoid ligaments medially followed by 2-0 Vicryl for the subcutaneous tissue. The wounds were then dried, Mastisol (an adhesive - ed.) and Steri-Strips were applied to all 4 incisions, Xeroform (gauze - ed.) and sterile dressings followed by a soft roll and boots placed bilaterally.

The patient was then reversed from general anesthesia and taken to recovery in stable condition.

The aforementioned nightmare happened either during the operation or during recovery. I'll never be sure which, but from what my wife tells me I'm guessing it happened in recovery.

I promise it'll be up soon. It scared me, but it might give you a good laugh once you've read it. Go ahead, if you can't laugh at the walking wounded, who can you laugh at? (Hawkeye Pierce, M.A.S.H., if memory serves.)

More Omens and More Operations

So, here we are, four days following my re-admission to Hospital X. According to my wife, I've since had several pints of blood transfused, had several more pints of other fluids and nutrients infused, and now have a piece of titanium permanently wedged into a major blood vessel to keep clots from killing me. The internal bleeding appears to have stopped and my blood pressure is up a bit, so I'm finally out of ICU and am being given morphine for the pain. Meanwhile, both my ankles have been somewhat re-set after sustaining both dislocations and multiple fractures and are now wrapped, awaiting an operation to put everything back in its proper place.

Things would appear to be getting better, right? Well, you've probably guessed it - another bad omen popped up earlier in the week, this time involving the doctor scheduled to fix my ankles. He had a death in the family and had to go out of town for the rest of the week, meaning his associate would be performing the surgery. (Someone upstairs apparently took notice and showed a bit of mercy, though, as my employer told my wife on the same day that the company was willing to put me on FMLA leave until I was physically able to return to my job.)

The ankle repair surgery took place Thursday afternoon. It was supposed to last around three hours, but after a four hour wait my wife has still not heard from the surgeon. She says she got someone to call and check on me at that point and was told that I was already on my way back up from the recovery room. The surgeon didn't even bother to stop by and talk to her about the operation. I heard about this from her later on, and she was supremely pissed with the whole situation. Our relationship with this doctor would not improve until much later (after I'd left the hospital, in fact).

Up to this point I'd been going in and out of consciousness and lucidity, thanks to my physical condition and/or whatever drugs or anaesthesia was being used on me at the time. Aside from feeling goofy at times and at other times thinking that I was in Austin instead of Dallas (see the previous update for info on the latter), I hadn't had anything disturb me mentally other than the sheer pain of the situation. Something different happened during the ankle surgery, though - I don't know if it was in the operating room or in recovery - but I had some kind of dream that scared the hell out of me for a while. It was disturbing enough that I apparently felt the need to describe it to the recovery nurses, who then told my wife so that she could have a good laugh at my expense.

I'll describe what I saw in the next update and let you be the judge.

The Operation

The gastric bypass operation took place on Friday, December 11, 2009.  Pre-op was pretty uneventful.  They put an IV in me, and I told the anaesthesiologist about problems I'd had before with nausea and with surpressed breathing response during recovery.  My wife came into the pre-op room and checked on me, then the nurses wheeled me away.

I don't remember anything about the operation, and I don't remember much of the recovery room.  I remember being groggy, and I remember having a urinary catheter and some other tubes sticking out of me.  Everything else is a blur, until some point later in the day when I found myself in my hospital room.

The uneventfulness continued through Saturday until a couple of hours before my discharge from the hospital.  I was still in pain, but I didn't feel like it was unusually bad pain.  I remember telling a nurse that I felt like I was about to have an anxiety attack.  They gave me something for it, and I calmed down shortly afterward.  No one thought that anything out of the ordinary was going on.

The problem is that something very bad was happening inside of me.  Things would get much, much worse within the next 24 hours.

Introductions Are In Order

Hello - my name is Lee Jackson, and I have a bit of a story to share.  It involves a bit of drama, a bit of comedy, a touch of cruel irony, and a huge chunk of physical pain.  It's complicated, to the point where it could be considered by some to be embellished or even made up.  Nevertheless, I swear it is true, from the start to wherever the finish may happen.

I will be changing names here and there to protect the innocent (especially myself and my family, mainly from lawsuits), but I will not be changing any of the facts to the best of my knowledge.  Granted, I may be a bit hazy on some of the facts, but on those points I will bring in my wife to confirm what actually happened.

The story begins on December 11th, 2009 at a certain hospital in the city of Dallas, Texas, where I had what was supposed to be a routine gastric bypass operation to help me lose weight.  What followed was anything but routine.

(To be continued...)