Tag Archives: Surgery

Surgery Update

It’s been nine days since P’s surgery, and all seems to be going well. The day of his operation the poor kid was more worried about making it up the six flights of stairs to our apartment after the surgery than the surgery itself, but everything seemed to have worked out.

We arrived at the hospital around ten in the morning, two Tuesdays ago, and P changed into the required hospital garb (as seen in the pic). We kind of assumed that shortly after prepping him he would be going in for the surgery, but various medical staffers (nurses, surgeon, anesthesiologists) kept checking in and saying, “another half hour…” “perhaps another half hour…”

One of the anesthesiologists looked kind of Indian, and I tried to catch a glimpse of his name badge, but before we could say anything, he made note of P’s name on his paperwork and said, “Do you mind if I ask where you’re from?” When P said “Nepal,” the doctor said that he was originally from Punjab. His last name incorporated the popular Sikh name “Singh” and he asked, “Do you know what that means?” I think he expected P to answer and was surprised when I blurted out from the corner, “lion.”

“Yeees, that’s right!”

After waiting almost three hours the Punjabi anesthesiologist came back to wheel P away. I was told I could see him in about 2 hours—about an hour for the surgery and about an hour for him to start waking up from the anesthesia.

While P was gone I drove over to a store to buy a new thermos. P’s mother had been very adamant that in Nepal once a patient wakes up from surgery it is important that he has a cup of black tea right away.  She seemed alarmed to hear that doctors in the US don’t give patients black tea right away and gave me the task of being ready with it in the hospital.

I found a nice thermos, bought it, and took it to the bathroom for a good cleaning. Then I went to a nearby café to have them fill it with black tea and to have a little lunch. I was back in the hospital waiting room with time to spare before I was called back to the recovery area.

When I saw P, his color looked a little off, a little greenish gray, so I figured he wasn’t feeling good from the anesthesia. A few years ago my mother had a surgery on her abdomen and when she woke up from the procedure she felt nauseas and vomited. He said his stomach was fine, but he still felt disoriented, and he was most worried about the stairs. He looked so fragile in the hospital bed, with a small oval thermometer sticker attached to his forehead, his leg wrapped in an ice “cryo-cuff” and brace, and his grayish coloring. I told him not to worry about the stairs yet and asked the nurse if I could give him some tea. I wanted to fulfill the duties that Mamu charged me with.

As the medicine wore off P became more coherent and more nervous about the stairs. “There is no way I’m going to make it up there!” he kept fretting. I wasn’t sure what to do, since I didn’t want to push him, but I also felt it would be better to be home and have him resting in his own space.

My mother had called me the night before arguing with me that we should either go to my sister’s apartment in Rhode Island because “at least she has an elevator!” (never mind that she lives in a studio and is a student whose schedule wouldn’t be conducive to having a surgical patient sleep over, or that it was almost an hour away so it would be impossible for me to check on him during the day or help him at lunch) or a hotel. “Don’t be stubborn!” she scolded me, “What if he is permanently damaged because you insisted he goes up those stairs, and he never walks right again!” Thanks for making me less worried mom.

We had arranged that if need be we could stay in an extra bedroom at our friend S-di’s place, and if he struggled to even get up the few stairs to her porch to get into the apartment I kept the option of a hotel open, but I still felt home would be best.

As the nurse was prepping to move P out of recovery and back to the room we were waiting in before the surgery she asked if we had many stairs at our apartment.

Do we have stairs? Big time.”

When I told her how many I asked what her honest opinion was of what we should do. I told her about the options, and how P and I had even practiced having him slide his butt backwards up the stairs, and leaning on me and hopping, but that even in a good condition, going up all that way on one leg would be exhausting.

She agreed with me that home was probably the best option, since a patient feels most comfortable in their own space. She said that she could give him a shot of a heavy duty pain killer that might help get him up the stairs. She took me to the hospital staircase and we played with the crutches until we found the best way to make it up on one leg and I felt a little more confident. As we walked back to the recovery area she said in a hushed tone, “I shouldn’t tell you this but, just try your best to get him up, and if you can only make it half way, call the fire department, they can carry him the rest of the way.” It was nice to have a fall back “plan B” although I was afraid I’d be charged for calling the department for a non-emergency.

After about an hour and a half in recovery it was time to make the trip home. Two friends had agreed to help me and as per the nurse’s instructions our plan was to get P up the stairs one flight at a time with someone standing behind him and someone standing in front of him in case he got woozy from his meds or exhaustion and started to fall. My plan was to put a rolling desk chair at the top of each flight so that he could sit and catch his breath, and we could wheel him to the next section.

Even though P was worried, he took each step in stride. I showed him how the nurse recommended he use the crutches, and our friends stood close by to catch, although luckily it didn’t come to that. Slowly he made it up each section of the stairs. I was so relieved when we got to the top; we had him sit in the computer chair one last time and we wheeled him across the hallway down to our apartment door, then onwards to our bedroom. We got him propped up in bed, and he seemed okay. Whatever wonder drug the nurse gave him seemed to work magic wonders because he said he barely felt any pain in his leg.

The next day was a totally different story. P seemed to be in excruciating pain. His whole leg was throbbing and even the slightest movement made him grimace and writhe in pain. I thanked our lucky stars that we got him up the stairs the day before, because he never would have made it up the second day. He could barely sit up in bed, let alone get up and go to the bathroom.

Before going to work I made a thermos of tea, brought him fresh cut fruit, a large bottle of water, pain medication and ice packs. I bought a small styrofoam cooler to store ice packs in so he could manage changing the ice while I was away. I came back at lunch to make food and check on his status, refresh his ice packs, drinks, etc., and then by the time I got home from work the poor kid was sitting in the dark because he was in too much pain to get to a light switch—so I pulled a lamp over so I wouldn’t forget the following day.

The past two weeks have been busy helping him out. One day he even said, “You are really working your wedding vows aren’t you? ‘In sickness and in health…’” But he has been a pretty good patient, and he is definitely getting stronger. He has been moving around the apartment a lot more on his crutches, and the past few days I’ve even noticed he fixed himself some stuff in the kitchen before I got home for my lunch break.

It has also been nice to have good friends around. Our Nepali friend from P’s academic program offered to come over during the day that first week and work from our apartment so that he could help P when I was at work. Our friend S-di cooked Nepali comfort foods like kwanti (bean soup) and Nepali style chicken soup (meaning there were large chunks of chicken, not just chicken broth). Other friends would come for visits to check in and lift his spirits.

His first post-operation doctor’s appointment is tomorrow, so it is his first time out of the house since last Tuesday. I’m hoping the stairs feel more manageable this time around.

P’s Ready for the Knife

Knee Surgery

What’s the latest news in the AmericaNepali Household? Tomorrow P is going to have knee surgery…

Back in June I mentioned in this post (“Weird thing #1”), that P had done something to mess up his knee. At the time we didn’t really know what it was and our primary care physician assumed P had a ligament issue. Since then I’ve mentioned P’s leg problem here and there.

His knee problem was almost cyclic. For a few days he would feel pretty good, even gaining confidence to walk around a bit on it, and then he would have days when he was in a lot of pain, and barely wanted to put weight on it. Luckily he felt okay during our wedding weekend, but plenty of other times during the summer he didn’t, which kept him fairly homebound. Most days he didn’t feel well enough to walk to his office, but on the days he did feel okay he was too nervous to push his leg and stayed home anyway. In Nepal we wouldn’t go anywhere unless he could take a taxi from point A to point B with minimal walking effort.

P is a really active guy. For most of his life he has played soccer at least a few times a week. Being housebound all summer has been a real psychological blow. His leg problem cascaded into a series of other issues related to a lack of exercise—a pinched nerve in his neck from sitting in a computer chair working too much, headaches, his legs have lost a lot of muscle mass and are smaller than I’ve ever seen. For a while he was in a real mental funk. He was thinking that his leg would never be the same, and he might have to give up soccer, or not be as active, for the rest of his life. This isn’t the case, but it was tough seeing P in such a low mood when he is the one in our relationship who is always consistently “okay.”

Before we went to Nepal P’s physical therapist finally ordered an MRI, and after months of speculation (he had an x-ray early on, so we knew it wasn’t broken, but the doctors insisted on physical therapy to see if his knee would “improve” on its own before ordering an MRI) he was finally properly diagnosed—a torn meniscus.

What’s a meniscus? I certainly didn’t know either… The meniscus consists of two connecting pads of cartilage at the knee joint in between the thigh bone (femur) and lower leg bone (tibia). The cartilage helps prevent friction in the joint between the two bones.

Image from Wikipedia with my yellow highlight of the meniscus

The doctor gave P a copy of the cd with his MRI images. He and I would look at the images like they were ancient hieroglyphic texts; they didn’t make any sense to us. Of course the American doctors explained the images to P at an appointment, but it wasn’t until we met up with one of P’s high school friends in KTM (who happens to be a leg surgeon) that we had the images fully explained. He came over and sat in P’s family’s living room, and while Mamu supplied him with cups of chai and bowls of nuts and sweets, P’s friend went through the MRI images on P’s laptop, slice for slice, and showed us exactly where the tear was located and how the surgical procedure to fix the problem would be done.

Apparently cartilage doesn’t receive a lot of blood flow, and for body tissue to properly heal it needs to have a flow of blood to help bind the tissues together. The outer edges of the meniscus have blood, but the inner portions have very little. Thus a small outer tear can heal, but if the tear is too deep or long, then it might not properly reconnect.

P’s tear was straight through (of course, we are the bad-luck-juju family!), and the pain he was feeling was from the broken meniscus flap moving. When the flap was out of the way P felt pretty good, but if the flap wedged into the knee joint, he wouldn’t feel so hot. Additionally a small cyst formed near the injury which also caused pain when the joint moved back and forth.

P’s friend explained that during the surgery the doctor would probably shave a bit of the meniscus to see if it bleeds. If it does, then he might try stitching it to see if the edges will re-attach. This procedure takes a lot longer to heal, but protects the knee joint longer into old age. If it doesn’t heal after a month or two, then P might need a second surgery.

If the meniscus doesn’t bleed during the initial shaving, then the tissue would most likely never rebind, so instead of stitching the doctor would simply cut off the torn “flap.” The healing time on this would be much faster (since he only needs to recover from the surgery itself, not the tissue rebinding), but then P would be missing a chunk of cartilage in his knee joint, leaving him more susceptible to arthritis issues in the future.

Obviously procedure #1 is probably best if it is successful, but P’s friend said due to the extent of the tear the doctor would probably have to do procedure #2. We won’t know until the doctor opens P’s knee up and checks out the situation.

“But if you do procedure #2, don’t worry,” P’s surgeon friend reassured us, “If you are missing that chunk perhaps you would get arthritis at age 60 instead of 65. It’s not that big of a deal, even I don’t have a meniscus anymore.”

So tomorrow I’m taking a personal day from work and I’ll be at the hospital with P. I’m not that nervous about the surgery, I’m more nervous about getting P home. We live in a building that used to be an old three story Catholic school. The apartments are converted old classrooms with 12 foot high ceilings. That means that even though we are on the third floor we have to walk up six flights of stairs, and there are no elevators. I’m not sure how I am going to get P up all those stairs with crutches and a cast.

When we moved into the apartment a year and a half ago, while huffing and puffing it up the stairs with heavy boxes of books and kitchen paraphernalia, I remember thinking, “I hope neither of us breaks a leg, we would never make it up these stairs.” Oops.

Meanwhile P’s family is worried in Nepal. They have called every day this week to check in. Last night P’s dad asked if an ambulance could bring him home and paramedics could bring him up all those stairs on a stretcher. P explained to him that ambulances can only be used for “medical emergencies” and insurance wouldn’t cover carrying a post-surgical patient to his apartment because there was no elevator. Meanwhile P’s mom wanted me to make a long list of things to bring to the hospital including black tea (in Nepal after someone wakes up from surgery they are supposed to drink black tea) and extra blankets.

So, hopefully all goes well. I’ll keep you updated.