The Big Day

The day is here at last. We woke up early so we would get to MGH by 9:00 am for my 10:30 am surgery. I took my second Hibiclens shower and put on my second set of clean clothes. No breakfast!

We left the Liberty Hotel and entered the back of the Yawkey building. From there all the way to the Pre-admission Testing Area (PATA) on the third floor of the Wang building without having to go outside. The PATA is only one month old and quite beautiful. I was called in and my wife was told she would be called in later. I was told to undress, put all clothes in a bag and put on a johnny and a robe. They inventoried my clothing in the bag and sealed and identified it with my name and MR number.

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My wife was called in and I gave her my wedding ring, my wallet, and my eyeglasses. They made sure I had no contact lenses and no removable teeth, bridges, or other body parts. The iPhone I was going to use for audio recording was eyed with concern. They didn’t want me recording private information about other patients.

And then we waited. My surgery was scheduled for 11:30, not 10:30 as I had been told before. Finally I was put on a gurney and moved from the PATA on Wang 3 to PeriOp on Lunder 3 where I would be staged before surgery. We went through a hallway between the Wang and the Lunder building which is quite pleasant. It goes over the main entrance to the hospital and has a glass wall which looks out over the chaos at the main entrance and up North Blossom Street to Beacon Hill.

I was quizzed by a nurse who asked what procedure I was having done. She also put a sticker with my name and MR on both the iPhone and the carrying pouch. I discovered at that time that it was difficult to see whether my iPhone was recording or not without my glasses and with the brightness turned down to conserve battery. I upped the brightness.

A hairnet was placed over my head. I was asked to take my arms out of the robe. Dr. May came by and asked a few questions. He used a marker to write “yes” on my right hip. The anesthesiologist came in. His accent was difficult to understand but he was patient with my poor hearing. We agreed on a spinal with full wakefulness and full memory. I was reminded that general anesthesia was plan B if the spinal didn’t work. He was happy to see I have a large entry to my windpipe so they would have no problems putting me under if necessary. The anesthesiologist put in an IV in my left arm near the inside of the elbow. It was uncomfortable to bend my left arm. That would be an issue for the next two days until it was removed. The assistant anesthesiologist was introduced to me. It turns out she would do all the work and would be supervised by the main anesthesiologist.

Finally I was wheeled into operating room 65. That journey was also quite pleasant with a glass wall on one side looking out over various parts of MGH and the adjoining Mass Eye and Ear.

The operating room had lots of modern equipment:20130402-093006-2388

I was transferred to the operating table, wired up to an EKG machine, and a cuff was put on to take my blood pressure almost continuously. I sat up, placed my hands and head on a table in front of me, arched my back, and the spinal was done. I didn’t feel the spinal being inserted. The numbness came in a few minutes. The assistant anesthesiologist tested the spinal by pressing a sharp pin against my skin. Above where the spinal took effect,  I could feel the pinprick. Below it just felt like someone touching me with their finger, a little weird because I could see it was a pin, not a finger.

They placed me on my left side and I tried to get comfortable. They put a few padded vertical bars up by my stomach and my back to keep me in that position. Two armrests were placed so I could rest my arms. A lot of green (Tyvec?) sheeting was taped around me and clipped to stands so I felt like a dog with a cone on.

The monitor was turned on and placed in a position where I could see it. More of the paper sheeting was placed over my left leg, privates and abdomen and taped into position. The only part of me not protected by this sheeting was my right hip and my upper right leg. It was similar to preparing for a paint job. In a paint job, drop cloths and masking tape are used to keep the paint from contacting other surfaces. Here it was to protect the area of the surgery from  bacteria, dust, hair, etc. that were elsewhere on my body.

The surgeons were in full protective gear. Face shields, green hoods covering their heads with dry air blown in so the shield didn’t fog up, surgical gloves, head to toe green gowns, even booties, I think. The cuffs of the gown wer taped to the surgical gloves. Any bacteria on the surgeon was going to stay on the surgeon.

Another liberal Hibiclens wash of all exposed areas, which were scrubbed then towelled off. The surgeons poke and prod and mark my hip with a pen. They are marking where they will be cutting, I think, or maybe where they think my femur is.

You know those dish mops with the hollow handle you filled with soap and a sponge on the end to clean the dishes?

soap-dispenser

I haven’t seen one in years, but what they use to swab me with the iodine based disinfectant looked just like it. They swabbed that stuff over everything that was exposed. Then they placed a sheet of what is like thick clear plastic over the area to be cut. It was impregnated with the same iodine based stuff.

I’m putting the description of the operation including photos and audio on another page. I’m doing this because some of you might not want that much detail. Some of the photos are a little gruesome.

From the time I was rolled into the OR until I was ready to be rolled out was about three hours. But they didn’t have a bed for me yet in the Post Anesthesia Care Center (PACC), so I wait for more than an hour in the OR. They give me some pain medications and they take an x-ray.

Dr. Tomford says it was an easier surgery than my last hip replacement on in 2004. He said it was a little difficult moving the muscles out of the way because I am a big man and the muscles don’t completely relax with a spinal. It did look like they were working hard to move my leg so the femur was in position. One of the assistants showed me the saw. It looks more like a little battery operated drill than the big SawsAll that I remember hearing in 2004. I got the DVD containing the video of the operation.

Finally I was transferred to the PACC. Lots of attention. Vital signs taken automatically quite often. Still getting fluid and antibiotic via IV. I expected they would call my wife, but they didn’t. I think visitors are not routine in the PACC but since there is no bed in the orthopedic ward, I’m a longer term visitor than they are used to. I finally asked if they would call my wife, and they did. My wife said I looked much much better than I looked after the last hip replacement in 2004. We chatted for awhile. My dinner was served, and I ate pretty much everything. My wife and I were both tired so we called it a day. She went to her hotel room for some sleep and I closed my eyes

Some differences from last time:
No blood taken pre-op for possible auto transfusion.
No pre-op exercises.
No urinary catheter.
No Hemovac to pull fluid out of the wound.
No pressure cuffs or stockings.
No abduction pillow.
Anesthesia eliminated pain but not all sensations. I could wiggle my toes while they were stitching me up.
I ate my first meal 4 hours after surgery instead of 3 days.
Blood thinner was by injection rather than oral. (Very unpleasant.)