THE Ordeal

Things never go as planned do they? Ok, well typically, they do, but this time, far from it... this is an email I sent to my MFM for the boys pregnancies. I was looking to get his opinion on "THE Ordeal" as I'd like to call it...

WEDNESDAY --- On Wednesday morning I had a laproscopic assisted vaginal hysterectomy. Dr. Gala said that my uterus and bladder were really stuck together due to scar tissue and adhesions and that he had to manipulate my bladder quite a bit more than expected. He also stated that I had no significant blood loss. By late night Wednesday, early Thursday morning, I began feeling pretty bad. I started vomiting bile (twice) and afterward, I had a few sessions of dry-heaving I was given phenergan via IV but that did nothing to help, so they started zofran via IV, and that helped tremendously.

THURSDAY --- Lab came in around 5am. When Dr. Brunet (she assisted Dr. Gala) came by to make morning rounds, I was informed of my low H&H and that they wanted to do a transfusion. I was again informed that I had no significant blood loss during surgery. They thought maybe I had some venous bleeders from where the adhesions were removed. I still had the foley catheter because they wanted to give my bladder time to rest - my output was very low. They said my kidneys were shunting off to other vital organs. I was very pale, weak, tired and I felt listless. I received two pints of blood. They checked my H&H approximately one hour post-transfusion and my levels had risen. I felt better post-transfusion - had a little more coloring in my face, attempted eating (but was unable to), and had more energy.

FRIDAY --- The next morning, my levels were lower than they were before the first transfusion. Dr.'s Gala & Brunet came in and said that clinically I appeared to be doing better - still had a hint of pink in my lips and cheeks. I told them that I didn't feel as good as I felt the night before. They gave me the option of having the second blood transfusion - I opted for it seeing as how my count was lower that day than before the first transfusion. They told me they were only doing it to "bulk me up" so that I could go home to my little boys and that once the transfusion was finished, I would be discharged. I received an additional two pints of blood. During the second pint, I was spiking fevers throughout. When it finished, my temp was 100.9. I asked my nurse if they ordered an H&H and she said no and that she thought it was odd. She called "the doctors" three different times and told me that she didn't understand why they were so adamant in not getting it done. She was also concerned that they were going to discharge me with fever. My nightshift nurse came on and I voiced my concerns with her. She called Dr. Rodrigue (according to notes I've read) and informed him of the 100.9 fever and everyone was still okay with me going home. She called him again and he finally said that if I felt better staying one more night and having my H&H checked again in the morning, he would authorize it.

SATURDAY --- The next morning my levels had gone up. Dr. Wax came in and said that I was being kept until 5pm because of the fever I had the night before. I asked her why everyone was so quick to send me home with fever the night before and now today, I had to be kept for observation - it just wasn't adding up to me. She was giggling when she told me that my levels "were good" (this really offended my mom because in her non-md opinion, 8 and 23 are not "good"). Not only were we rubbed the wrong way by her but I was given a male nurse who acted like I was a serious inconvenience to him. Dr. Peresi came in because I was questioning why I lost so much blood and needed two transfusions and the idea of the venous bleeders. She told me she couldn't answer my questions. Dr. Gala called me later and said that he thought it was still the venous bleeders idea. I informed him of the immense pressure I had in my abdomen. He said it was most probably from the bleeding post-op - that it most likely formed a hematoma and that once it re-liquified (within 48-72 hours) that I would feel a release of pressure, my appetite would increase and my bowels would begin functioning. He said that he was going to call the nurse's station to discharge me instead of keeping my until 5p. I went home.

SUNDAY --- The morning started off nicely. My bleeding had gone from light pink spotting to red and a little heavier. I decided to get on the computer to see what to expect/what was abnormal post-hysterectomy. As I was sitting at the computer I could feel myself bleeding more and more. I went to the bathroom and I had a steady stream of blood coming out of me with moments of gushes (it reminded me of when my water broke with B). I was soaking pads in under 10 minutes. I spoke to Dr. Harrington (on-call) and she told me to go to ER. I was in tears and I honestly don't know if I've ever been that scared. I just kept praying that nothing bad would happen to me. I got to the ER and was triaged and told to go back to the waiting room. About 15 minutes later, Daddy asked the nurse why having a hysterectomy on Wednesday and severe vaginal bleeding was significant enough to get a room. A nurse came and spoke to me and it wasn't until she saw how soaked my pants were (and the towel that I was sitting on) that things started to move a bit faster. About 5 or so minutes passed and I was brought to a room. A student nurse came in to ask me questions and look at my incisions. I told her that I had an LAVH and showed her my incision sites (1 supranaval [from my gallbladder] and the other 2, in my c-section incision) - she said "wait did you have a c-section?" and I said "no, a hysterectomy." A few minutes later an actual RN came in and started an IV and the ER doctor. He told her what type of bloodwork to do and we waited for Dr. Harrington. She came in and did a pelvic exam. She said my cuff appeared to be intact, as well as the sutures; she believed that I was bleeding through the cuff, not from it. My counts had risen slightly from the day before so she said that it wasn't new bleeding. I went home and my bleeding was getting increasingly worse and I was starting to feel more weak, light-headed and dizzy. I held a 16ounce cup under me and filled 12 ounces of it in 7-8 minutes. Daddy was disappointed in Ochsner's ER so he took me to East Jefferson (by far worse). I sat in the waiting room for over 1 1/2 hours after being triaged - heavily bleeding. We left. I decided that I would just go home and monitor myself because at least I was in the comfort of my own home. My aunt in Nashville (a surgical RN for over 30 years) was less than thrilled with it all. Her friend is Richard Bracken, CEO of Columbia HCA. He called us and said to head to Tulane Medical Center - he called them personally and rounded a team to see me. We arrived and met with a doctor. They did a CBC, coagulation study, urinalysis and pelvic exam. The doctor said my cuff was intact and stitches looked good. He said that he could clearly see me oozing through the cuff. I also had a UTI so he gave me a prescription for Levaquin.

While admitted, my heart rate was a bit tachychardic - I pretty well maintained 108-123. My blood pressures were normal, for me, most of the time (110s/60s) - I had a few low ones (104/46, 88/68, 96/52).

My H&Hs were:
6/17 - 12.6 hgb 38.4 hct (pre-op)
6/24 05:08 - 7.7 hgb 23.4 hct (pre-transf #1)
6/24 18:23 - 8.6 hgb 25.1 hct (post-transf #1)
6/25 05:16 - 6.8 hgb 20.3 hct (pre-transf #2)
6/25 08:50 - 7.1 hgb 20.8 hct
6/26 04:20 - 8.2 hgb 23.7 hct
6/27 - 9.4 hgb 27.3 hct (ER#1)
6/27 - 8.8 hbg (ER#3)
6/29 - 10.2 hgb 30 hct (follow-up)

And that ladies and gents, is a brief snippet, without all of my opinions, on how things went... check back later this week for my opinions.