Sleepless

My sleeping pattern has deteriorated over the past few years. Acid reflux problems started sometime in my mid-30's and worsened as I took less care of my diet and exercise. Early on I would keep a bottle of Maalox tablets on the beside stand. Usually at around 3:00AM I would be awakened by a burning esophagus, sit bolt upright, chug a pint of water to dowse the flames, chew up a couple of Maalox tabs, usually lemon cream flavored, chug more water to wash down the chalky tablet remnants and then struggle back to sleep propped up on pillows keeping my torso inclined.

As I slid down the ramp of pillows, in my sleep, I would wake in the morning with a sore neck and back. This in turn led to dizziness and more sleeping difficulty. Then came my hip deterioration and associated pain which caused me to toss and turn. I went from a solid 8 or more hours per night to 6 or 5 or less hours of broken sleep. Somewhere in the midst of the above problems I started to snore pretty heavily, loud enough to wake my wife who then jab me with an elbow to get me to roll over. This usually worked, for her. Often I was left awake. She would immediately fall back to sleep and begin snoring softly. I would often get up and turn on the TV.

Work and financial stresses added up for a while and I went through a long period of sleeping 3-4 hours per night. This is OK once in a while, but when it's every night, for weeks, the body starts to suffer. The dizziness worsened. When weeks turned to months I was reduced to a shell of my former self.

I don't like going to the doctor. I was falling apart, I got quite sick and told the doctor about my sleeplessness. He prescribed Ambien. A lifesaver. I slept every night for months. I would take a pill and 20 minutes later I needed to be close to the bed, because I was going to sleep. I know there's some addictive properties to sleeping medication but I didn't care I was sleeping and my body started to recover. I had energy.

My hip got progressively worse and the Ambien became less and less effective. I think I now have a resistance to it and will often not fall asleep until 3:00 or 4:00AM. I've been off work for a few weeks, so staying up late isn't too big of a problem. I can nap during the daytime if I need it, but I seem to be on the verge of a problem. It was every once in a while that I couldn't sleep, then it became more frequent and now it's often on back-to-back nights.

Sleep is critically important to overall health and cognitive ability. When my sleep problems were at their worst I was very ineffective at work. I made lots of mistakes and forgot lots of important details. Even my normally good note taking became difficult for me to transcribe into meeting minutes. I became very reactive and not a good planner which is a critical handicap for a project manager whose responsibility is to drive project schedules.

I'll be going back to work in a couple of weeks, hopefully, and will need to get this situation in check before the cycle repeats. I like to sleep and I like to be productive and sharp-witted. In the meantime I'll have more time to post here.

A New and Hipper Host

Three weeks ago Wednesday, on Valentine's Day, I had a new hip installed. My right hip had degenerated from osteo-arthritis. This condition caused me nearly constant pain for the past 3 years. My doctor commented after the surgery that the condition of the joint was worse than he expected, so it was probably good that I had it worked on before becoming immobile.

I have some minor post-surgical stiffness and reduced flexibility, but overall I feel remarkably good. Let's hear it for modern medicine and particularly pain medication. I had repeated advice from doctors, nurses and technicians to "stay ahead of the pain". Thus expecting a freight train of agony to bear down on me, I erred on the side of caution and asked for pain relief at the slightest twinge.

Day One - We had to be at the hospital at 5:30 AM, two hours ahead of the 7:30 start time. It was breezy and a little cool that morning. I was anxious but determined to get this over with. How bad could it be? It had been hurting for 3 years.

When we arrived at the hospital it was a ghost town. There was no one to check me in at the desk. We wandered around until I interrupted a nearby hospital administration employee who arrived early to apply a coat of Pledge to her office furniture. She seemed very disinterested at first, but was pleasant enough and got the check-in process started. It wasn't long until I was ushered to a private area to change. Cindy had to wait in the lobby. I had a to put all my valuables in a green plastic bag for security. Boy that green bag sure made me feel better.

I got undressed and climbed on the bed with the requisite open-backed hospital gown on and was administered an IV and given a sedative while I watched wake-up TV news. I was asked my name several times, had a couple more wrist bands attached and had to mark the word YES with a Sharpie on my right hip. Cindy was allowed to see me before I was wheeled into surgery. I remember the ride to the OR, lying flat on my back with the view of ceiling tiles and fluorescent light fixtures rushing overhead. I don't remember arriving in the OR.

Three hours passed.

The next thing I recall was waking up in recovery, weighed down by multiple warm blankets with a flurry of nurses leaning over me to examine my eyes and telling me to wake up. It's a peculiar feeling when you wake up after sedation. Hours pass and you have no idea. The time is simply lost. There is no recollection of the subconscious or of dreams. It's just a black spot with no time element.

The initial hours after the surgery are mostly lost to the blur of intramuscular morphine injections every 4 hours and the after effects of the general anesthesia. Doctors orders were for pain meds every 4-6 hours as required. I opted for 4. Apparently that much morphine makes you swear like a sailor. I treated my visitors that day to a barrage of expletives.

Day Two - More morphine after a difficult first night with little sleep and mean nurses poking me with sharp things in the middle of the night. I threw up shortly after the first two meals. The effects of the general anesthesia. I dozed a lot, finding a comfortable place at the edge of consciousness with my eyes closed but my other senses taking in the scene. Visual input seemed to be a sensory overload. I was thirsty, very thirsty.

"OK we're going to get you up!" was the rallying cry of my nurse and physical trainer. I was rather dubious laying in a very comfortable pit in the middle of the bed made by my heavy-with-morphine body. Moving me was certainly some sort of ruse or distraction to get at my green plastic bag. "No." said Cindy the bag was safe in the car. Somehow I drew myself out of the depression in the bed, slid my ass over to the side, hung my leg over the edge and pushed up off my elbows so as to not break any of rules leading to a displacement injury. Warnings for this were second only to the ones about pain. Don't cross the right leg over the left, don't rotate the right leg inwards and don't bend at the waist more than 90 degrees, and by all means don't do all three at the same time or you hip will certainly dislocate. "Now get in that chair!"

With great effort I made it off the bed and into the chair. While I sat collecting myself and gripping the arm rests of the chair with white knuckles, several things happened. Cindy gave me a sponge bath...lovely. The technicians changed my bedding and then a cute, young nurse-in-training asked me to take a deep breath while she pulled out the catheter I had been fitted with in surgery. Taking a deep breath was not sufficient preparation for this eye-watering procedure. I was glad when that was over, but now I'd have to take some action when it was time to pee. Fortunately they have the jug. It's a plastic bottle with a flip-top about the size of a half-gallon milk container with a slightly angled spout. This is a great and simple invention. Once back in the depression of the bed with clean sheets and fresh injection of morphine I wasn't too motivated to get out of bed. I used the jug for a day or so before I had to get up and walk to the toilet. It was also handy at night when I was just too tired to attempt a bathroom foray.

That night the Czech nurse from hell didn't want to give me my pain medication, citing her personal beliefs about the speed of the recovery process. I was confused by this contradictory approach to pain management. Cindy straightened her out and I got a shot in a few minutes.

When you're immobile, for several days after a major surgery, there are risks of bed sores, pneumonia and blood clots. To counter this I had a bed with moving pressure points, a breathing apparatus to ensure deep breathing and inflation boots placed on my legs to alternately squeeze the lower legs and feet. With all this going on there is little time for extended sleep. Nighttime consisted of drawing blood at 3:00AM, the booties dislodging and sounding an alarm every 30 minutes and the IV alarm sounding to alert the nurse that flow was interrupted. The iron curtain nurse ignored my calls for help so I hardly slept. I complained to the nurse in charge of the floor in the morning but was tired and irritable for much of the next day.

Day Three - Propped up on a walker I shuffled to the door of my room but felt really insecure and light headed and needed to get back to the safety of my bed. Physical therapy was exhausting. Lots of calls and visitors. The dressing over my incision had been intact since the surgery. It was a monstrously huge astronaut diaper of a thing taped across my butt crack. When Kevin the PA removed it I experienced the equivalent of a Brazilian waxing. A smaller bandage was applied.

I was now able to eat but the hospital food wasn't doing it for me. Cindy went out and got sushi for us. I wanted to, but couldn't eat much.

Day Four - In order to be released I had to demonstrate an ability to go up and down a few stairs with the walker. The physical therapist was urging me to walk down the hall to the therapy room. I still couldn't break the psychological constraints of leaving the relative safety of my room. Looking down the hall was like a scene from Vertigo. The hall seemed to grow longer and wider as I focused on my destination a hundred feet away. I asked for a wheelchair. When we rolled into the PT room it was really cold and I was surrounded with hard angular surfaces. Wooden steps with 2x4 handrails, linoleum tiled floor and various exercise equipment. The therapist was a petite bundle of energy. She wheeled me over to the steps and said "Let's go!".

I got up from the chair just fine and stood there swaying for a moment to get my bearings. I told her that I was afraid she was too little to catch me if I fell and was very apprehensive about climbing the stairs. She said "Yeah, you're probably right". Instilling little confidence in my already shaky self, I struggled up the four step contraption and turned at the top to survey the room. I was too high up and the ground was too hard. I need to be down, right now. I hustled down and slithered into the wheelchair completely out of breath but exhilarated at my success. I was thinking that Cindy would be really upset to miss this and asked the nurse to look for her down the hall. She came in with a Starbucks coffee in hand and I was energized by her to demonstrate my abilities. It was easier with her there. I knew she could catch me if I fell.

Shortly after returning to my room the discharge papers were drawn up and I was sent packing. Mom and Dad came to drive me home in their van. I wouldn't have been able to lower myself into our car.

I was home! I shuffled the walker to the bottom of the stairs hoisted myself up the 14 steps and made my way to the bed. While I was in the hospital we had new carpets installed. The house had that new carpet smell, but how nice to have cushy new carpet underfoot. Cindy and I worked hard in the weeks leading up to the surgery to paint and decorate the bedrooms. This was the pay off, a new bedroom. If I was going to be staring at the walls I wanted it to be nicer.

David, my at-home physical therapist showed up the next day and worked with me every other day for the next 10 days. He removed the staples from my incision after 12 days and determined that I was ahead of schedule in my recovery and left me to care for others in greater need. Cindy gave me Fragmin injections in the belly for the first six days and fed, clothed and bathed me for a week before returning to work.

I've been on my own for most of this week and am starting to get a little stir crazy. Mom and Dad have taken me out for lunch a couple of times and Cindy comes home for lunch when her schedule allows. It's been just over three weeks now and the incision is nearly completely healed. All of the bruising and swelling is gone and my strength is slowly returning. I don't have much stamina. A few hours of time out of the house and I need a nap.

My employer's health coverage has provided me with 100% of my salary. This has been a tremendous relief. I've been able to focus on healing and not worry about finances. While I've been at home I've received a couple of nice bonus checks from work and we have invested a portion of that money to have 14 tall pine trees removed from our back yard. Our house is now bright and open and serves as a nice metaphor to my bright new start. I am eager to drive and walk and run and ride and travel and be a whole healthy person again.

Thanks to everyone who has provided support and prayers. My success so far, can in great part, be attributed to the kindness and generosity of others. Many thanks to all of you! But especially Cindy who has been my light, inspiration, strength and comfort.