The first few days after surgery were an opioid and pain filled fog. Immediately after surgery I woke up in pain, confused and blind. Not literally blind, but as a person who wears contacts and has a strong prescription, not wearing glasses can make one feel blind. I remember calling out for help, saying I was in pain. I knew I was in the recovery room when this happened. I could make out a person sitting just beyond the foot of my bed, sitting, typing on a mobile computer station, what we in the industry call “COWs,” which stands for “Computers on Wheels.” At the hospital where I did my residency we had to call them WOWs (Workstation on Wheels) because the patients thought we were being derogatory to the nurses when we were heard walking around the wards asking where the COWs were.
At the time, I felt like my needs were not attended to, but now looking back I think they were. It was just that every time I called for pain meds, I likely got them and went back to sleep so all I remember was the waking pain part. At one point I woke up and heard the nurse giving report to the floor where I was being transferred to and they said I had received 100 mcg of fentanyl and 4 mg of dilaudid, which in laymen’s terms is a lot pain meds to get in a short amount of time.
The following days were increasingly filled with consciousness, but also with an acute awareness of the pain. At some point I realized I had a Foley catheter (a tube inserted into the bladder to drain it of its urine). It had been placed while I was under anesthesia, since I had no recollection if it getting put in and I assume getting a Foley is not one of those things people forget having done to them. The physician part of me was irritated they left the Foley in after surgery due to the increased risk of infection associated with indwelling catheters. The patient part of me was elated they left it in because it meant I did not have to get up out of bed and try to go to the restroom. Doing so would have caused a lot of pain and discomfort.
The doctor/patient dichotomy also translated to my use of pain meds. I initially was going to try to tough it out and not use very many narcotics because I know they cause constipation and oh, you know, addiction. I also knew I wouldn’t be sent home with many because of the changing environment surrounding narcotic use in the Opioid Crisis Era, so I wanted to not be dependent on them when I left the hospital. I did this “holding out thing” for about half a day and then gave up. I was miserable. I couldn’t even move to lay on my side without a horrible somewhat unrelenting sharp abdominal, not unlike labor pain, minus the uterus. With the pain meds however the pain was muted to a tolerable dull ache.
Post operative day number 1 (POD1) was not entirely pleasant, but POD2 was the worst. My friend, who is an RN, told me it would be the worst day, as did the nurses on the floor who had undergone laparoscopic surgeries. At this stage the bowels were still not working the way they normally would having been slapping around and reconnected during surgery; all around in general traumatized. My bowels needed time to relax and wake up, so to speak, before they they could get back to the business of moving food and gas through the system. The biggest issue on POD2 was that to undergo a laparoscopic surgery your belly gets filled like a balloon with CO2 gas. After surgery the CO2 is reabsorbed by the body. Some of it is exhaled, but some of it goes into the bowels. This causes an incredible amount of bloating, added to the fact that I had been eating some clear liquids to keep up my nutrition. The end result of these two convergences was a gut traffic jam causing an insane amount of gas in a bowel that was still asleep at the wheel. I had insane bloating and since I could not pass gas, this increased the pressure in my belly thereby causing increased pain. I literally tired everything to get gas to come out. I walked. I sat up in a chair. I chewed gum. At one point, like a drugged contortionist, I tried to put myself into child’s pose in my hospital bed making it easier for the gas to exit my body all to no avail.
My friends and family who came to visit asked “Did you pass gas yet?” Every time a nurse came to my room they would ask the dreaded question. “Did you pass gas yet?” Every time I replied with a disappointed “No.” Never in my life have I wanted to fart so bad. The problem was, my bowels have never been one for performance art. They have always considered themselves the polite sophisticated type, waiting for the appropriate time and place to sing their swan song. Farting in the hospital in the company of my dearest family and friends, despite them saying it was okay, was not something my bowels wanted to do even if my brain told them it was okay. Passing gas was the one thing I needed to do to be discharged, so the pressure was on. No pun intended.
After three days in the hospital I was discharged home and much to the chagrin of my nurse, it was before I passed gas. He said, “It’s because your a doc, isn’t it?” I said “Maybe.” I then went on to explain to him the rationale as to why it was a safe discharge because I had a normal white blood cell count, no fevers, was tolerating my diet well, and no signs of perforation or other issues that would be concerning enough to keep me hospitalized. He merely nodded his head with a sideways grin that said, “Yeah okay lady, whatever you say. You’re still getting released early.”
I got home, and by home I mean to the vacation rental my family and I planned on staying at for two weeks to recover before going home home. One of the first orders of business was a hot shower since the last one I had was the night before surgery. I carefully tested the water and stepped into the steaming stream. It was amazing. As the hot water rolled over my body washing away antiseptic solutions and hospital germs, my body began to relax. My stomach churned and I knew what was going to happen. I leaned over slightly to ease the passage of the gas that was so desperate to escape. In a faint staccato, gas stuttered from my body. I could feel the tension in my belly give way and relax as the pressure released. It was at the same time painful, but pleasurable. I did it. I passed gas. My gun shy bowels needed to be at home and in the quiet, familiar and relaxing environment of the bathroom to be at ease. With this I was at ease, and in my mind I told the nurse who doubted the validity of my discharge, “I told you so!”
After taking a very long hot shower, I delicately dressed myself and combed my long tangled hair. I left the bathroom and entered the kitchen where my family was seated. I made the announcement.
The room erupted in applause and cheers of joy as this was the moment we had all been waiting for. Who would have ever thought my passing gas would have made so many people so happy. I never did.