Saturday, January 28, 2012

Day 11: Losing the Dear Hickman

I better keep this moving so I don't fall asleep.

They pulled the Hickman Catheter, which folks up here on 11 North call a "central line." They did this because one more blood culture turned up positive, and they're scared that some of them may stick to tubing and be difficult to eradicate.

That brought up a host of questions. Do I just immediately go back to eating after a week off, and how are my stomach, intestines, and hemorrhoids going to handle that! And if it's bad, and I can't stay on the regular IV pain meds, then am I going to be able to handle this?

The answer? For me it was to realize that I don't actually know any of those things. I don't know that I have to go back on real food right away.

So I just passed the afternoon getting a new PICC line inserted, then getting the catheter removed.

Getting the Catheter Removed

Here's how she told me the catheter would be removed. Well, first let me let you see the catheter:

You can see where it goes into the skin. It's not a tiny tube. Then it runs along under the skin, curves over the collar bone and down into the jugular and subclavical to get to just above the heart.

All the striped areas are just reactions to the adhesive. They were changing the bandage that day.

If you have trouble placing the picture, my neck is draped far over my left shoulder. In the top right corner is my neck.

So this catheter tunneled under about three inches of skin before wrapping over the collarbone.

The lady expained that they put some sort of matrix around the tube to help it adhere to the inside of the skin. She was hoping, however, that since it had only been two weeks, mine would not have adhered much.

I closed my eyes and prepared for whatever I had to face.

She gave me lidocaine shots over a lot of the course of the tube. Then she started pulling.

I don't how long it lasted. I don't know how much pain I bore or didn't bear. I tried to be quiet, be myself, and no one complained about me later. I was already so tired from being awake for hours and so dazed from being on pain meds for days, that I wasn't thinking clearly. I took advantage of that, and I kept telling her, "I'm fine." Though sometimes I was sucking in my breath pretty hard. She patched it up.

My wife may have to correct that description tomorrow. She was there.

Wife's note: I'm inserting a short video here of the procedure.  You will see the doctor inserting scissor tips to separate the tubing from any organic material that has grown around it.  There is no sound, though Paul's face speaks for itself a bit, until Paul is told to take a deep breath, at which time the catheter is pulled out.  The procedure did not take long at all.  Here's the video:

Dazed and Confused

I haven't had Dilaudid in large doses. I understand that the Dilaudid I get, all by IV, is about 500 milligrams per dose. I've heard of people getting 30 grams, or about 60 times what I get.

I try to be careful with it, but it's started building up. The most noticeable side effect, for me, is that you start dreaming as soon as you close your eyes, and I seem to dream the entire time I'm sleeping. Worse, it's not that hard to open my eyes, see all the people around me, then close my eyes, and see an entirely different set of people.

So this evening Jerry was visiting, talking to me about something, and in my exhaustion, I closed my eyes a little bit. I was watching something on TV in my dream, and I started to comment on it. Well, on Dilaudid, you can still move when you're dreaming, so I raised my hand, pointed at the TV, which was off in the real world where Jerry and Rayette were sitting, made a comment about what was on the news. Realizing that silence was not the appropriate response, I opened my eyes, and there were Jerry and Rayetta, looking at me with bewildered, soon to be laughing eyes.

In fact, just now, I heard someone make a wisecrack about Benayah's coffee not being served down on the 3rd floor. I heard it! With no one in the room except the nurse. Since it sounded like a wisecrack, though not one the nurse would actually know, I said, "yeah," out loud. Fortunately, the nurse just figured I was talking to my computer and went on.

Anyway, I'm off the Dilaudid. So far, so good on the pain, and hopefully my thinking is clearing up.

There's a lot of funny things that have happened. I'm not going to write on those until I think I can do so intelligibly, though there's probably little hope of remembering things in any order.

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