The Accident, Chapter Four: Surgery and Beyond

By that Friday afternoon I was scheduled for an open reduction/internal fixation of my four-part proximal humerus fracture, to be done as a same day surgery at a local surgery center. That comforts me a little. Just a surgery center. Well, it couldn’t be too bad then. The MS was not a complicating factor that would have it done in a hospital. So it would be simple. Sort of like having a tooth pulled or an ingrown toenail taken care of. My biggest concern was that I might have to have a urinary catheter. I am so shallow. Oh, and stupid. As a result of my ignorance, even as a nurse, I am completely and utterly unprepared for what I am in for.

The craziest part is when I called the center to find out what time I had to be there on Monday, the girl turned around from the phone and called to someone “What time is the Open Reduction on Monday?” Open Reduction. She said it. Right into my ear. And “open” means just what it sounds like. I know what an open reduction is. And it still never registered. I was primarily irritated that I had been demoted to a procedure, not a name.

My daughter Mary Kate brings me to the surgery center bright and early Monday morning, nine days after my fall. I am relaxed and cheerful. I am certain I will be sufficiently medicated to be comfortable and that this will fix my arm. Better in a few days, I’ll be. So I have no qualms. What a moron.

The staff is very nice. The nurse anesthetist shows me one part of the anesthesia they are going use, an interscalene block. A catheter will be put in my neck and medicine will go in there that will completely numb my shoulder and arm. With that I will only have sedation for the surgery, not general anesthesia. So I need neither intubation nor catheterization (yay, I can leave on my knickers!). An attached pump will go home with me, pumping medicine to the blocked area for four days, by which time the pain will be reduced. Well, that sounds great!, I think. I am still cheerful and relaxed. Especially since I still have my knickers on. They will give me a little something to relax me while they insert the catheter in my neck. And to be honest, except for a brief memory of being wheeled into the operating room, that is the last thing I remember until I am offered ginger ale in the recovery room. According to my parents, this is six hours later.

Dr. Wonderful appears in the Recovery Room with copies of my x-rays. He proudly shows off his work: a plate and about a billion screws that are holding my arm bone pieces together. I look at it as though it belongs to someone else. “Wow” I say while sipping ginger ale. I feel no connection to that hardware whatsoever. I had no idea there was going to BE any hardware, so it doesn’t sink in.



This is not my actual arm, but it's what the inside of it pretty much looks like now.

What I don’t realize has happened, and won’t until days later when I look it up on the internet, is this: I was placed on the operating table and put under conscious sedation, meaning I was heavily sedated but not completely unconscious. Because of the drugs used, I wouldn’t remember anything. The operating table was then raised into a seated position. Every bit of me, except for my right shoulder, the area to be operated on, was covered in surgical drapes, including my head and face (Can we talk about my claustrophobia? I practically need to be sedated just typing this.).

My right lower arm is swathed in sterile wrappings. With a scalpel, Dr. Wonderful makes a cut from the top of my shoulder six inches down my arm, which is then spread wide open and held in place like that with metal surgical retractors for the extent of the surgery. Muscles and blood vessels and nerves are pushed and/or cut out of the way to reveal the bone. The broken pieces of the head of the humerus were fitted together and fastened.


Dr. Wonderful then decided on the size of the plate needed and number of screws. Holes were drilled into my arm bone with an electric drill, the plate was fastened onto the bone and broken pieces with the screws until everything was nice and put together. Throughout the surgery the surgical site is continually flushed and suctioned to keep blood out of the way. Additionally, my arm was repeatedly manipulated and x-rayed during each step of the operation to make sure everything was fitting together as it should. At the end, I was sutured up and sent on my way.


Alrighty then. Not quite like having a tooth pulled. No wonder it freaking hurts.


I go home. My arm is numb and I have plenty of pain medicine. I sleep off and on over the next day and I feel…ok. Then a few things happen. First, my legs swell up like two giant slugs attached to my body. To the extent that anyone looking at them gasps. There is no delineation from my thighs to my ankles and my feet look like giant marshmallows with little dots where the toes are. Add the fact that my skin is as white as paper, this is not a pretty sight. I look like the Michelin man from the waist down.


I call the surgeon’s office. They tell me to call the surgery center. And to keep my feet up. Which is what I have been doing since I fell, but whatever. So I call the surgery center. They tell me to call the surgeon. And to keep my feet up. I call the surgeon back. They tell me to call my regular doctor. And to keep my feet up. I call my regular doctor. His office is closed for a few days. I am surprised the answering service does not tell me to keep my feet up. I call the surgeon back. They are not pleased that the hot potato has landed back with them. “Ok, well, keep your feet up and I’ll tell the doctor. We’ll call you back.”


And I also now realize that my arm isn’t really numb anymore. The pump was supposed to be effective for four days. This is the third day, but there should be another 24 hours plus to go. Then I notice the neck of my t-shirt is wet. Right where the catheter is. As a matter of fact, the catheter is leaking. The numbing medication that is supposed to be going into my arm is now dripping down my chest.


I call the surgery center about the catheter and they tell me to come in, the anesthesiologist will adjust the catheter for me, and he fastens it with surgical glue. He also gives me a nice bolus of analgesia, which numbs me for a blissful couple of hours. The nurse anesthetist says, “You know, I thought it looked a little out of place when you left the OR.” Oy vey. Maybe THEN would have been a good time to adjust it? But I keep my mouth shut, because otherwise everyone has been so nice to me. She points out my swollen legs to the anesthesiologist. “Hmmm.”, he says. “They weren’t like that on Monday.”, she says. “Hmmm.”, he says, “Keep your feet up.”


At home the surgeon’s office has called back about my legs. Get a pair of Jobst stockings. These are stockings that are about two inches by two inches and you have to get your whole leg into them and they perform miracles. However, the real miracle is getting them on. What no one has taken into consideration, including me before I plunk down $85 for the stockings, is that it is hard enough to get them on with TWO hands. With one, it is impossible.


Before I can even get too upset about the legs, like magic they go back to normal. The interscalene block catheter comes out. And then I settle into my routine of the next four weeks. Living from pain pill to pain pill, completely incapacitated, unable to drive, unable to dress without assistance, unable to lie down to sleep, sleeping in a chair. It will be seven weeks before I can sleep through the night. The pain and the stress have a terrible impact on my MS symptoms, ramping them up, causing major issues with walking, cognition, tremors and numbness. My daughter has to help me put my underwear on and does my hair. My mother and friends and church cook for me. I can’t even spread butter on toast!


The six inch long incision is breathtakingly ugly. Gradually it sinks in that I have had major surgery. That this is going to take a long, long time to recover from. And I become extremely depressed. I feel as though my body has let me down by breaking. I feel as though life has let me down by throwing me this incredible curve when I am already dealing with so many disasters, MS and being out of work. I feel like Dr. Wonderful let me down by not telling me what the surgery entailed. But, to be fair, I asked no questions either. Part of that may be because I was demented by pain, narcotics and lack of sleep, but…they could have given me a clue. The picture of my face in the waiting room that morning should be next to the definition of ‘clueless’ in the dictionary. But here’s a scary fact: according to my daughter, who was with me, Dr. Wonderful did explain exactly what was entailed when we were in his office that Friday morning before the surgery. I just couldn’t hear it.


I have home physical therapy ordered. Janet, who comes to the house three times a week, is wonderful. She is cheerful and no-nonsense, patient and kind. She is tolerant when Bella the Maniac Shih-Tzu jumps all over her like, well, a maniac. She manipulates my arm gently to get back my range of motion. She is relentlessly encouraging and supportive. She tells me to rest and take care of myself and how to manage my arm and pain better. She worries about me and my blood pressure. She scolds me when I do too much. She is a major contributor to my healing process. I love her.


Gradually I start getting out a little, but a simple trip to the supermarket exhausts me. My sweet father drives me everywhere, doctor’s appointments, the supermarket, even a job interview. Yes, I went to a job interview two weeks post-op in a sling. (I didn’t get the job :(). We go to the supermarket and can’t find a parking spot, so we park in the designated “Parent with Child” spot, at 76 and 53 years of age, giggling like two little kids. I do have to say it is a treat spending that time with my father, like I was little again.


After eight weeks, the incision is completely healed (although still hideous). And so are the bones in my arm. Dr. Wonderful gives me the good news: I can drive again! It has been two months since I fell. My life screeched to a halt that day and is very, very slowly creeping back to normal. I am not there yet. I now go to out-patient physical therapy three times a week (Mike is a great therapist, but I do miss Janet!). My arm is gradually, painfully getting strength and motion back. I can dress myself now and sort of do my hair.


It is going to take me a long time to process this experience. There has been a lot of bad, a lot of craziness but much good as well. Many people came through for me, supporting and encouraging me, telling me they loved me and thought about me and were devastated for me. Dr. Wonderful was wonderful. He put me back together. I am trying to focus on all that instead of how hard it was to get appropriate care, how horrifyingly brutal the injury and surgery turned out to be, how this accident impacted my sense of safety and how long it is taking me to return to my interrupted life.


I am getting better every day. And that’s the story!