Perioperative nursing is an absolute joy. Oh yea, like any job, it is frustrating also. Budgetary constraints get in the way of patient care all the time. We as nurses have to stand up for what is right and necessary for proper patient care. Healthcare is a business, but there are times when you have "to spend money to make money". It is often hard to make the "bean counters" understand that, but we have to keep on trying. As nurses, we have to keep an eye on the cost, but the total patient outcome should be our main concern. Often, as specialty nurses we loose sight of the total patient. Try not to do that in your daily patient care, no matter what your area, OK?!!

The past few years or so have been a challenge for me as a nurse. I have had to be a patient for not one, not two, but a total of four surgeries, rehab, treatments and radiation therapy. I can't decide whether it is better to have the knowledge of what is wrong and what is being done, or to know nothing more than the average lay person. At least my doctors tell me I have a wonderful outlook for all I have gone through. Hey, what more can I do?

First I had my left total knee done on 8/28/02 and Jennifer and Patty were there to take care of me. I had epidural without sedation so I was awake through the whole thing. Just listened to my cd player and answered the occasional question. Jen was a doll, came in to work at 7am just to circulate for my 8am case (of course they had her scheduled to come in 11am-8pm that day!) and Patty was my fantastic scrub tech. Everything went well in surgery and was good until I got the Dilaudid PCA in PACU. No matter what medication they gave, I kept on vomiting with each successive push of the button. Hmmm, decrease pain or puke - what a choice! The hospital stay was OK (fortunately only 3 days) and then I was transferred to rehab under the care of my primary physician at another of the system hospitals. The left quad shut down and went into severe spasm. Now that was a "thrill", didn't work for almost 5-1/2 weeks so I spent a lot of hours in the CPM daily both in rehab and once I was home. The joint didn't have much pain, but the ineffective quad surly did! I spent 12 weeks in outpatient rehab before I was ready for the right total knee. The left one has done great and I have a range-of-motion of -5 degrees extension to 127 degrees flexion when I work it. Not bad for someone with an implant.

Then on December 4, 2002 I underwent my right total knee replacement. Again they managed to have Jennifer on the 11am shift that day so she came in the 4 hours early again to do my 8am case. This time she circulated with Frances being the scrub nurse. Again, an epidural without sedation and listened to the cd player. Surgery went well, but gosh all mighty did I have bruises on the leg. The right one has had numerous surgeries in the past so the retraction and old adheasions popping did a very colorful number on my leg. Joint did well, the quad shut down again, but this time there was no spasming and pain so I was much happier. Quad started responding within 2 weeks and by 4 weeks post op I already had a range-of-motion of 6 to 95 degrees. My surgeon was very pleased with himself! When all was said and done I had 0 to 125 on that knee.

I'm "young" for total joints - but my knees were "old". I am so pleased that I did it. I was off work for 7-1/2 months and have done great with the knees upon return to work. I can stand to scrub cases, walk around the OR, everything (well, as long as I remember to take my 1pm 800mg Motrin that is). They get stiff and a little sore when I do a lot, but no severe, stabbing, debilitating pain - so I am more than happy!

Was only back to work about 2 weeks when I had to be off again for a few days for biopsy surgery on 4/26/03 for the breast cancer that was found on my annual physical mammogram. Three weeks later on 5/14/03 I was off again for 5 weeks after having re-excision of the biopsy area and removal and study of axillary nodes. I am lucky that UH has the Ireland Cancer Center which has designation by the National Cancer Institute, does all sorts of clinical trials and is on the cutting edge of cancer detection and treatment.

Then, ended up being out again from mid December '03 to mid January '04 due to an infection that occurred in the old seroma sac which had collected some of the radiation necrosis fluid. Since it couldn't be absorbed by the body and was basically in a "balloon", it festered until it swelled up and had to be aspirated. First day had over 50cc of thick tan pus. Next day was another 50cc, but since I had started on antibiotics it was not as thick. The next day it was incised open, packed and left to drain and close on its own. Has healed OK, but the nice tiny scar is now a wide thick one since it had to granulate in.

I have been through whole body bone scans, liver scans with and w/o contrast, MRI (with and w/o contrast) from top of my head through mid femur. I have been poked, prodded examined over and over. After the second breast surgery I went through 5 months of the "seroma from hell" that just love to fill-up. I have never spent so much time taking off my tops to have people examine me over and over. Had to have the seroma aspirated about every 10 days until it finally collapsed and then I got to start radiation therapy. Was originally scheduled for 28 whole breast treatments and 7 boosts. I developed 2nd degree burns with "lovely" tissue sloughing around 20 whole breast treatments in. The radiation oncologist decided to decrease the boosts down to 5 thank goodness. The boost area was where there was no intact skin left. Very painful, but is healing nicely. Surgeon, medical oncologist and radiation oncologist are all pleased with things so far. I have infiltrating ductal ca so this is something that we have to continually watch out for metastatic disease.

You know, I've been an orthopedic patient for years, but this has been a whole new experience for me. I would have treatment at 9:15am and be at work from 11am - 7:45pm daily. Didn't miss a single day due to the treatments. I was lucky, Heather (a PRN nurse) was always looking for extra hours so many of the weeks she worked on Wednesday for me so I got to rest a bit more. I'm a couple years out of radiation now and on Taxoxifen twice daily for a full 5 years. All scans remain negative and my oncologist is happy, so I am too.

The total knees are doing great. It was odd, but at over 3 years out I gained lots of strength, range of motion and ability to do things I hadn't done in years. Don't know why it took so long, but I'm happy with the results. No pain - just occasional stiffness at the end of a long day. I'm back to doing remodeling around my house by myself - something I love to do and missed doing for so long.

I've added some links below. OrthoWorld has a site developed for surgeons, patients and companies can search stuff out. The patient site map has links to all sorts of things like - what is Orthopedics, anatomy, surgical and non-surgical therapies and stuff. I've also added a link to the American Academy of Orthopedic Surgeons - you can search a variety of educational topics that have been presented at various annual conferences. Very informative.. a different perspective from the nursing end of Orthopedics. Of course, one of my favorites is still the Antique Surgery site - it's fun. Unfortunately for the patient I've killed them more than once!

Hope you like my Operating Room cartoons. I got the "Totally Lost" one from Mary, a nurse who used to work with us in the operating room. She left us to become a Nurse Practitioner at another institution (see what happens when you have someone go on to further their education - way to go Mary!), although she did stay on PRN, occasionally working on the weekends. A year later she returned to our hospital as a NP so we do get to see her a bit more often. She even took care of me in PAT for the first surgery. The other cartoons I came across in one of my print programs.

I got tired of the music from Quincy so I have gone back to the "sentimental" theme from St. Elsewhere (used it in our pinning ceremony many years ago). I tried using the theme from E.R., but it just irritated me. And, Chicago Hope's was too dull. Anyway, I hope you like it.