Cuts You Up

My surgery was a little over a week ago and I'm up to writing about it. I was the first surgery of the day for my urologist so I had to get there very early (5 am, we literally waited outside the hospital doors until they opened). While I'm not a morning person and probably got a couple hours sleep the night before, the good news is that there were no delays for me since there was no time for things to get backed up. Before going in, I drank the energy/carb drink they gave me which was, surprisingly, not bad. I went in on a Friday morning which was also convenient because, since I primarily work from home, I only had to take 1 day off of work. Obviously other people's situations may vary based on the physical location and the amount of physicality of one's job. If you work a desk job but need to go into the office, you will probably need 1-2 weeks out for reasons I'll get into later. If you work involves physical labor, it could be longer.

I will probably say this multiple times but I cannot commend the staff at the hospital were I had my surgery enough. From beginning to end, everyone was fantastic and did everything they could to help me through this. I sincerely hope any other men out there reading this have the same experience because it really makes a difference. I start with usual hospital check-in things, showing ID, insurance information, etc. Then they gave me the ID wrist strap with the QR code that would be scanned a crazy number of times during my stay as well as a “Fall Risk” wrist strap because I was going to get anesthesia. Not 15 minutes later I was called back to pre-op work. This is where they get basic vitals, get you into those lovely hospital robes, and then all sorts of folks come through to ask you all sorts of health questions. Again, very standard stuff, similar to when I was there for my biopsy several months ago. I meet with the various team members (anesthesiology, nurses, and of course, my urologist) all of whom explain their role and what will happen. One of the things I was told is that I would have a tube down my throat to help me breath during surgery but that it would be out before I woke up. I was quite glad to hear this because the idea of waking up with that sounded quite frightening. Finally, I get wheeled into the operating room where I move over to a very hard, cold, and not particularly comfortable table. But this is fine as I'm not going to be conscious for very long anyway. And the next thing I know ....

I wake up in recovery which looks very much like the pre-op area. A nurse is there to get me acclimated and asks how I'm doing, pain etc. I do have a large amount of abdominal pain. When she asks me to rate it on a 1-10 scale, I guessed and said 6. Later I decided that was too low, it was probably an 8, but I didn't have much of a basis of comparison yet. She adds some Dilaudid (aka hydromorphone) to my IV which is an opioid but really did help with the pain which was strong enough that I was doing breathing exercises to get through it before the medication took effect. The other thing I realized was that it was very cold in that room. Every time I would exhale on the breathing exercises, my feet would shake. I didn't realize that was the cold until they took me to my room.

Once I reach my room, I had to stand up to move over to the hospital bed. This was really the only time I was truly a fall risk as my balance was horrible. But I had multiple people there to help me and I settled in well. At this point, my wife as able to join me in the room as well (she was with me right up until they wheeled me into surgery which was great). It's at this time that I would first notice my urinary catheter which was new for me but something with which I would need to become familiar for a while. More on that later. I also notice the time, it was about 12:30 so my surgery was about 3-4 hours which what I was told to expect. I was then introduced to the first nursing team of my stay (the day shift). There was a male nurse who was training a newer female nurse as well as an assistant. I didn't see the male nurse again until the shift change, but the nurse in training was very good and everyone has to learn sometime. But the male nurse described and wrote down on the whiteboard the three main objectives of my stay there:

I had 2 IVs, one in each hand, but only my left hand was active with the right being there as a backup. Both were well secured and I didn't have much restriction of movement. These were mostly basic fluids as the medication I got while there was oral. The other thing of note is that I had a Leg Compression Device on each leg. Think of these as wraps around your lower leg that inflate and deflate almost like a blood pressure cuff (but not as tight). The goal of these is to prevent blood clots from lying in bed for a long time. They didn't bother me much, but I think it's worth mentioning.

Soon I get a visit from “Dietary” which was someone who wanted to get a lunch order. They had a small but decent menu and I was not on any dietary restrictions so I could pick anything I wanted. I know the stereotype is that hospital food is horrible but, honestly, it wasn't bad. A bit bland for my taste but overall the menu had something for just about anyone and, overall, it tasted good. Not 10 minutes later the food arrives. To be entirely honest, I was never particularly hungry during my entire stay so I didn't eat a lot, but I thought it was a good idea to get something in my system to start the healing process.

Then the normal process started. About every hour someone was coming in to do something with me. Sometimes it was just checking vitals, other times it involved giving me medications, checking my urine, and just generally checking in on me. This is why no one gets good rest in hospitals, but I understand why they need to do what they do and everyone was very nice and careful. A couple times a day, they would check my incisions. I had 6 of them, each about 2 inches (about 5 cm) long across my lower abdomen, which was noticeable swollen (and would remain that way for quite a while). There were no traditional stitches, rather they were held closed by surgical glue. I was told that over time the glue would simply flake off so there was no need to have any follow-up outside of checking for things like infections. The other thing that would happen a couple times a day is that my catheter site would have to be cleaned. Let me say that if you have modesty issues, this will likely get you over them. The process is that the nurse would clean around the tube in my penis with some towels in a disinfecting solution and would finish by putting some antibiotic gel around the site. Now what makes this a little bit worse is that if the tube shits a bit, it sends you a small shock of pain. Nothing horrible, but enough to make you flinch for a second. Unfortunately, this won't be the only time this happens.

As far as medications go, it was difficult to keep up with everything they were giving me but they did explain each one and what it was for. That and by using the medication list with which I was sent home I think I can recreate it here for those interested:

If there were other things, I may have forgotten them, but these are what I remember and have found on discharge papers. On most nurse visits, I would be asked to rate my pain on the 1-10 scale. The idea behind pain management is to try to catch it before it gets really bad because if you let it go too long before treating it, the pain medications may not work and you have to go to something stronger which they (and I) would like to avoid. So my line was around a 5-6 I would alert them and they would give me something based on the schedule of what else I've taken. I've always been a minimalist when it comes to medications so I wanted to keep the pain under control to avoid going to heavier drugs.

There was one thing that I thought was being missed. I was told by my urologist that I would be up and walking the same day I had the surgery. It was nearing the end of the day shift and I hadn't done that yet. I asked the nurse if this is something I should be doing and she agreed and set up a time shortly after to get me up and get me walking around. I say this because I think it's important for patients to understand what should happen and to speak up and ask questions if you think it's not happening. She actually seemed a bit surprised that I would ask for this, but was enthusiastic to get it going. My guess is that not a lot of patients want to do this. But, to me, my job there is to heal and improve so I want to take an active part in that just as everyone around me is doing so as well.

The first walk was, let's just say, difficult. The nurse's worry is, of course, that I might fall (and remember, she's still in training) but, by this point, my head was clear and my balance was fine, even though she insisted I use a walker. What made walking difficult was the catheter. Keeping the whole contraption with me wasn't that bad. In fact, for this first walk the nurse carried the bag for me. The problem was that all I was wearing was a hospital gown. There was nothing to stop my penis from moving as I was walking. This caused a lot of irritation from the tube as it would move. So with each step it hurt. After a few steps, I'd have to stop and make sure I went very slowly to try an minimize the movement. I will say the first walk was the worst..it actually got better later. However, because of this I only made it about 1/3 of the way around the floor before I went back to my room. But I took it as a small victory. I then sat up in a chair instead of going back to the bed. This is also preferred as sitting up helps prevent pneumonia. At this point, I get to order dinner and eat in the chair. Then before the night shift comes on, I moved back to the bed for a while.

Before day shift ended, my urologist who did the surgery came to see me and said that everything went very well and that the inside of my pelvis was “textbook” and made her job easier. That's kind of a strange compliment, but I'll take it.

At this point, there was a shift change and I was introduced to the overnight shift. As I've stated before, everyone was great and I noticed no change in my level of care. However, the process is very much the same with someone coming in about every hour to do something to me. By this point, my wife had gone home to take care of our pets and get some rest. I came prepared to entertain myself in the case I had trouble sleeping. I had my iPad with me where I could watch videos, read, and listen to music. Along with the iPad I had some noise cancelling Blu Tooth earbuds as well. My thought here was to be able to block out the floor noise even if I wasn't listening to anything. But, to my surprise, the floor was very quiet that night and I didn't have an issue. Still, I suggest bringing something like that in your case. The nurse on this shift was impressed with how my urine had cleared up. It had gone from quite red, to pink, to a clear light yellow by this point in time. I was producing quite a bit due to the fluids they were pumping into me through my IV in addition to the amount of ice water I was drinking. I typically drink a lot of water during the day anyway, but in the hospital I really kept it up. First, because the air is quite dry and, second, because it helped to keep my throat wet as it felt slightly scratchy likely due to the tube they had down my throat during surgery. I do think that it also helped clear up my urine quickly so I strongly suggest making sure they keep water (cold or room temperature depending on your preference) near you all the time and that you drink as much as you can.

I had two things that I didn't expect to happen during the night shift. First, it felt like I had pulled a muscle around the right side of my rib cage. Moving really hurt. I asked the nurse about this and she said it wasn't that but that it's very common when they do arthroscopic surgeries since they pump air into the area to give them more room to work. That air eventually has to work its way out. I had actually read about that before the surgery, but it had slipped my mind. The other thing was that I felt like I really had to urinate which seemed odd since I had a catheter. She checked my bag and urine was flowing fine and that it was likely just inflammation. She gave me a dose of Tramadol which helped both of the symptoms. I bring this up because as much as you research before having a surgery, you can still get something unexpected and the best thing you can do is ask. Be your own advocate. Sometimes just knowing what it is can help along with addressing the problem, of course.

I, again, request to get up and walk once during the night shift. Hey, if i can't sleep I can at least do something to help myself. Again, the nurse was enthusiastic and set up a time to do so. This time it wasn't great but a little easier. My guess is that the inside of my urinary tract had gotten a little tougher since my last walk. It was still quite unpleasant and I had visions of living entirely on the first floor of my house until it was out. But this time I made it ½ way around the floor before getting back into bed. A small but important improvement.

The rest of the night was getting 20-45 minutes of sleep at a time in between check-ins with the nursing staff. This went on until about 7 am or so when the lab tech came in to get blood draws for the day. A little later my wife returned as the plan was to send me home sometime that morning. I was introduced to the new day shift of nurses, and had some breakfast. As I was going home with the catheter, we got instructions on how to change out the bag without making as mess as well as a way to change to a smaller bag which attached to my leg which could make walking easier. As I mentioned before my wife spent 15 years as a Registered Nurse but has been away from the field for over 10 years. Still, having her there as they explained things to me and, more importantly, having her at home with me was invaluable. They can throw a lot of instructions at you when they send you home and she is able to ask more medically intelligent questions than my engineer brain ever could. And, although it's been an while, she's actually done this stuff before. This was all new to me.

While we wait on the long process of discharge, I ask to take one more walk this time with my wife here (she was gone for the first two). Again, they were glad to accommodate me. I bring this one up because it was actually a critical juncture for my mental state. This walk was much easier. Not pleasant to be sure, but much less painful and I wasn't using a walker and was carrying my catheter bag. It was this walk that made me think that going home with this was going to be possible and it really helped change my outlook on the upcoming week. I made it about 2/3 around the floor. I could have done more but I would get plenty of time to get up later that day and just knowing that I could do it without being in agony really lifted my spirits. I say this to encourage other men who go through this. Make sure you get up and walk early and get the bad walks out of the way. Get used to how to do it and let you body get used to it while you have the most help. It will never be great, but it can get better. At this point, I even felt better about taking stairs at home.

While my urologist wasn't there in the morning, I did get a visit from another urologist on staff along with a resident who checked everything one more time and gave me an opportunity to ask any further questions.

Finally, discharge time arrives. I am sent home with 7 prescriptions. All of the ones listed above plus a laxative and the antibiotic ointment that the nurses used to clean my penis around the tube as I'll need to take over that job at home. They wheel me out and my wife gets me home where the next phase of recovery begins.

Sorry if this post is too long and had too much detail but my goal here is give men some idea of what to expect if having prostate surgery. It's a big deal and not knowing can really cause one to worry. Obviously, everyone's experience will be different and there will be men who have more difficulties than I had. But I also wanted to show that things can go smoothly. Hopefully I have given you some idea of what will happen and can help others prepare for this part of their journey. That's the overall goal of this entire site but I think that it was very important for this post in particular. If you made it this far, thank you for your indulgence.

Please note: This blog is based on one man's experience and is for educational and support purposes only. Nothing in this blog should be considered medical advise. Always consult a physician to properly evaluate your particular health issues.