Day 27 - Surgery day - shorter than we thought?

This morning Daniel is resting and getting ready for his 2nd autografting surgery. Not counting in-room procedures, daily wound cleaning and other "routine" tasks; this will be Daniel's 6th surgery. We had heard various plans for this upcoming surgery from nurses and interns, but Daniel's chief surgeon Dr. Wi. just stopped in and briefed us on his plan for today.

The new plan for this surgery is to debride any dead skin on his chin, throat, neck. Depending on what they see they may stop and just clean it up and hold off until tomorrow or so to begin grafting. They've left some of the area from his chin down to his clavicle or thereabouts alone until now. Some of the skin might be necrotic, but many times it's not. So we hope that the burn area here has healed some and since it heals quickly like the face does some of it may not require grafting - of course the doctors won't really know until they begin the surgery. Once they've got the area all set then they will either:

• go for it and precisely harvest skin from his scalp, OR
• stop, give a day or more to let it heal and do the grafts then.

So today's surgery will probably be like an hour or so with two surgeons working: Dr's. Wi. and Wa. along with a team of support staff, anesthesiologists, nurses and burn techs.

His OT arrived and worked with him this morning. Starting with fingers, hands, wrists then moving to elbow and shoulders. He moaned a few times when the stretching got to be too much for him. That's about the first time we've heard Daniel use his voice to express pain in the ICU for the past 27 days. We know that the stretching movements he needs to start making will cause pain in the joints, muscles and his skin too. Basically moving hurts a lot everywhere for burn patients until they get used to activity again. Some people have issues with pain after they've returned home, but we hope Daniel isn't one of them.

The OT was pleased with Daniel's range of flexibility in his wrists and elbows. He was more resistant in moving his shoulders today, but she didn't push him too far. It's the elbow stretching where we heard the moans. We're saddened to see him express pain and it's sort of a new development. Part of him being more alert when he's conscious will bring greater awareness of his pain. As we begin to move towards him being more ambulatory and building back his strength Team Daniel will push him more out of his comfort zone. They will be looking for signs of pain as a signal for how far they can work him and try to take him just up to that limit.

During morning rounds the staff reviewed his progress (like every day) and felt he was strong and ready for surgery. His lungs have cleared up mostly; he's showing few signs of infection and his white blood count is stable, though elevated still. A few tweaks going on here and there, but all normal I'd say. During surgery they want to get him back on a catheter for a few days to help keep him drained and flushed. I don't necessarily agree with this action as it seems like a step backwards, but we want to be sure he's healing optimally and flushing out toxins is important through this stage.

Good luck Daniel on your surgery today and we'll see you on the other side late this afternoon. 

In the meantime I've created a word cloud generated from the first blog post I wrote almost four weeks ago. (The larger the word the more it's used in the post.) The word cloud reminds me of all the crazy deer-in-the-headlights feelings I had that first day!

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With some time on my hands while waiting for surgery I've tweaked the blog a bit. It will now:

• accept comments from anyone (anonymous too),
• played with the template a bit,
• added a new gadget o track usage,
• in the footer I set up other ways to allow you to subscribe and track updates.

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The following section may be too snarky or bilious (new word for Mason) for some of you... I apologize in advance and I partially blame the redhead (ale)!
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Engage Snarkiness Font now...

Every time it's different when Daniel goes off to the OR. This time the surgical team invited us to walk along with Daniel to the surgery pits (didn't even know we could do that). The operating rooms are on the 2nd floor. Burn ICU is on the third. So I headed off with Daniel and his handlers (sounds like a rock star huh?) through doors, secure access hallways, a special elevator, more doors and bumps along the hallways to the surgery waiting "pits". Once there handler2 plugs him all back in with all his monitors and IV systems. Handler1 gives me a tracking number so I can rot, I mean wait in the OR waiting room... NOT!

Daniel and I wait there in the pits and go through a fairly exhaustive check list with handler1 which is kind of weird since Daniel's done five surgeries already without any of the extensive interrogations. They did ask us a few of these questions the first time he went off to surgery, but that was up in his room before they rolled him off. Well anyway, this time plus all the times before they couldn't ask him any of the questions in the pits that they asked me since he doesn't talk. ...Whatever - follow the procedure... at least what I begin to appreciate is MANY checks and rechecks to be sure they have the right patient for the right procedure - I guess that's comforting on some level.

Several surgery people stop in and ask me what the procedure is, that my story jives with what they've been told he's doing. Then the anesthesiologist comes in, asks all the same shit again, do I have any questions, where can they contact me, blah blah blah. On one level I'm thinking WTF - is this an omen? Why are they asking me with all this seriousness when it didn't seem like it was such a big deal all previous five times, but okay then, on the other hand it's good to know that everyone takes their job seriously and there's no question what the surgery is going to be all about.

Okay so then Dr. Wi. (the surgeon) comes in. At least he's cool with the whole scene. He's already talked to us this morning so it's on to idle chit chat... how did the burn occur (I tell the story - I've got this down to a refined art by now), how do I reach you after we're done, reassure, reassure, "I've got this," "We'll be fine", "how are you and your wife doing through all this"... 

TIME OUT FOR TODAY'S WORD:  Platitude - 

noun [ C ]

 US ​ /ˈplæt̬·ɪˌtud/

​

a statement that has been repeated so often that it is meaningless

TIME IN
So anyway instead of rotting in the OR waiting room I'm going to the library... 
CRAP... the library is closed for president's day...
       okay there's Ursula's - perfect! 
               Please be open, Please be open, Please be open... 
                    YES! Bar's stay open on president's day - I wonder why?

So now I'm sipping a nice redheaded ale and will then go on a nice long march (quickstep) and return to the OR waiting room to read...
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Snarkiness FONT disabled and back to normal again...
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Daniel is back in his room with us. The surgery went as planned - to clean and debride his chin, throat and upper chest down to about his nipples. That left his body skinless in this area so that they can graft using his scalp tomorrow morning - first thing.

We were waiting in his room and when he arrived he seemed pensive at first. Then the surgery team began to hand him off to the Burn ICU nurses. His handlers were asking us if he seemed in pain to us. The anesthesia was starting to wear off at this time, then it hit! He started to moan, he furrowed his brow, he started to really look like he was in MAJOR PAIN - OFF THE SCALE PAIN!>>!

The anesthesiologist was ready to give him something immediately for pain (hydromorphone), and he continued to moan a meek cry, he even raised his arm to hit his leg which is something he does when he's upset at home. We helped hold his hand, showed him how to breathe through the pain. He cried out a little and breathed and moaned some more. We moaned along with him so he could understand that we were helping ease the pain. The nurses delivered more pain meds (fentanyl and half his hydrocodone dose), then shortly after more hydrocodone/tylenol to prep him for wound care for his chest and back and arms.

Now that it's been about 45 minutes he's started to relax a little more. His brow is less furrowed, he's not looking quite so pained, he's stopped moaning. He seems a bit calmer, but is still holding Dawn's hand. It was rough!

Up to now I have not seen Daniel express his pain much at all. He seemed to be enduring all that's been thrown at him. He finally topped the CPOT chart - it was obvious to anyone in the room that he was IN EXTREME PAIN! It was very hard to see my son hurting so. Once we get this graft tomorrow he will be in so much of a better way to start healing. Tonight may be a hard night to get through for Daniel. We'll be here for him until he drifts off to sleep I think - can't feel right leaving him if he's scared from all the pain. Dawn is singing to him now and soothing him.



His arms are really looking good. They were grafted two weeks ago. But his shoulders are all exposed now - all red and horribly raw looking. It's hard to look at them without feeling the pain that he must be enduring! That's all I can write tonight.