My Hospital Stay: Pre-Op, Op, and Post-Op Days

I really had no idea what to expect for any of these stages (which was partly a good thing), so even though everyone's experience will be different, I wanted to describe mine in as much detail as I could so y'all could have at least one very detailed data point of what recovery can look like. The TL;DR is everything went so so so much better than I expected.

Pre-Operation

Monday

10 AM

I had my pre-op appointment where they took my vitals and blood and performed the following tests:

• aPTT (activated Partial Prothrombin Time): blood clotting test that examines the intrinsic pathway of coagulation 
• CBC (Complete Blood Count) with differential: test that checks the total number of all cells in the blood like a regular CBC (red blood cells (along with hemoglobin and hematocrit), white blood cells, and platelets), but also examines the levels of the specific white blood cells in the body (like basophils, eosinophils, lymphocytes, monocytes, and neutrophils) to further gauge immune function 
• Prothrombin and INR (International Normalized Ratio): blood clotting test that examines the extrinsic pathway of coagulation 
• Type and cross: test done to see what blood types a patient is compatible with in case they need to be given blood during a procedure (since I had never had surgery before, we didn't know my blood type yet (I'm O positive in case you're wondering))

They also told me to not take any ibuprofen from this point on until after my procedure since it can increase the risk of bleeding. 

The anesthesiologist who met with me at this visit seriously set the standard for the kind of doctor I want to be. She answered every question my father and I had and was incredibly warm and attentive. She even came by on Wednesday morning when I was waiting to go into my operation to check in on me!

10 PM

I had my appointment for an MRI focusing on my cervical and thoracic spine without contrast so my doctor could see if I had a syrinx (we all know how that went). 

• To prevent any artifacts in my MRI from trace metals on my body, I am a dork and play it too safe, so I showered beforehand to get all my perfume, deodorant, lotion, and leave-in hair products off.
• Surgeons also don't care about this part, but I shaved, took off my nail polish, and trimmed my nails so I could feel clean going into my surgery without doing all this the morning of.

Pro-Tip: I am not claustrophobic, but this MRI took about 40 minutes and as someone who really struggles with sitting still, this MRI was legitimately more unpleasant than surgery for me. So if you also get restless easily or struggle with being still, I recommend letting the office know before your visit so you have a more relaxing experience.

Tuesday

I woke up from the phone alert that my spine MRI results came in and once I saw the scans I just sat with the diagnosis for a bit. I waited a few hours before telling my family because I wanted to let more of the emotions settle out before I talked about it. The main thing I kept telling myself after seeing my syrinx was how lucky I was to be getting surgery within a few hours, and how lucky I was that nothing serious happened leading up to my procedure from my syrinx. 

We purposely didn't make any plans for the day so we could spend quality time together and get really familiar with the hospital (I bought a little merch, you (hopefully) only get brain surgery once). We rewatched the lecture I linked in my "What is Chiari I malformation?" post to re-familiarize ourselves with the procedure and so I could pay better attention to the explanation of syringomyelia (I zoned out a little during that part the first time I watched the lecture because I thought it didn't apply to me (oopsie)). 

In the evening, I ate four different types of pasta at dinner and we walked around the city a little more. I could not have asked for a better Last Supper.

Before dinner, I got a call from the neurosurgeon's office providing me with additional instructions for my procedure, which was set to start at 7:30 AM (I felt very special being the first case of the day). My instructions included:

• No food after midnight
• Drink a lot of water leading up to 3 AM
• Drink 20 oz of non-red Gatorade/Pedialyte/Powerade from 3-3:30 AM and then nothing else until the procedure so I'd be full of electrolytes
• My sister and I turned this into a drinking game and I downed the entire thing in less than 4 minutes, highly recommend
• Shower and brush teeth the morning of, but do not put on any deodorant, perfumes, or lotions
• Wait to pee in the morning until they can get a sample in the pre-op holding area (to ensure I'm not pregnant, this does not apply to everyone obviously)
• Be at the hospital by 5:30 AM 

Operation Day (aka POD 0- Wednesday)

I woke up at 4:15 AM, took a shower, blow-dried my hair, and then had my sister put my hair in two braids separated down the middle (which we ended up taking out before the procedure so I wouldn't unbraid my hair post-op and have chunks falling out).

Since our hotel was right on the medical campus, we were able to walk to check-in which was a very cool experience, since I didn't know how soon I'd be walking again after my procedure. We got there before 5:30 AM and they informed me that since my neurosurgeon specializes in pediatrics and because of my body habitus, my operation would take place in the pediatric OR, but that I would be in prep and recovery on the adult floors. With that knowledge, I finished getting checked in, and prep started!

Figure 1. Me getting ready in the pre-op holding area

First, they had me change out of all my clothes, put them in a clear bag, and fully wipe myself down with six 2% chlorhexidine gluconate cloths to prepare my skin. Then I changed into my surgical gown and grippy socks, put on my bouffant cap, and went back to my spot in the pre-op holding area looking like a lunch lady who was one gust of wind away from being arrested for indecent exposure.

From there, I got a nice warm blanket, they placed a PICC line in my arm, and the neurosurgeon and anesthesiologist reviewed all the pre-surgery paperwork with me. Around 7:30 AM, they were about to wheel me into the OR and asked if I wanted some midazolam in my IV before the procedure to help me relax. I actually felt very calm and ready going into surgery (my hands weren't even sweating and they'll sweat all day for no reason), but I figured I may feel more anxious all of a sudden once we hit the OR so I said yes. They told me it would feel like I just had a couple cocktails, but a couple cocktails have NEVER felt that awesome. They wheeled me into the OR and within 4 minutes of them administering the midazolam before anything was even set up for anesthesia, I was knocked all the way out until about 3 PM. 

The procedure ended up being more invasive than we originally expected, but I let my surgeon know that my biggest goal was to have the best odds at a "one-and-done" surgery. I figured I'd have no idea what recovery would look like for myself anyway, and I am at a unique point in my life where I am young and have time to take a pause in my career to fully heal, which is a luxury I will likely not have again.

We went into surgery planning for a suboccipital craniectomy, C1 laminectomy, and duraplasty using an AlloDerm graft, all of which went very well (my surgeon did note that I have a thicker skull than he was expecting though, which checks out). He (thankfully) also opted for cerebellar tonsillar reduction via cauterization when he saw how much my cerebellar tonsils were compressing the surrounding soft tissue, and how compressed my right tonsil was by my left. 

My procedure ended around 3 PM and then my dad came to sit with me in the PACU while I was waking up from surgery. When I woke up, I was in a lot of pain but it was shockingly in my arms and due to my Foley catheter, not my head at all. I also remember trying to wiggle my toes once I was awake and thinking that I couldn't move them, luckily I was very wrong about that. Due to my pain, they gave me 0.4 mg of Dilaudid a couple of times. I don't remember being on anesthesia at all, my guess was that I'd be a crier or a laugher, but my dad said I just acted like I always do. 

In the evening, they wheeled me into the neuro wing's more intensive monitoring unit just to be aware of any changes I experienced. I was very nauseous waking up (Pro-Tip: have a handful of alcohol prep pads on hand and keep one under your nose when you get nauseous) and had tingling in my fingertips, toes, and face (but luckily this was normal due to the way my body had been positioned in surgery for so long and this subsided after a few hours). I was also NPO until the morning but took a little sip of water with my meds and had the occasional ice chip every few hours which tasted like the most delicious thing in the world at the time. My lips were also probably the driest they have ever been (Pro-Tip: ask a nurse or loved one to put on a glove and apply some Vaseline to your lips).

I was considered a high fall-risk patient (due to all the work they just put in on my spine and cerebellum) so I was also told to stay in bed until at least 5 AM when they would remove my Foley, in the meantime, they gave me SCD leg wraps (which for someone who, like I said, gets super restless, these were so awesome). This was the toughest night in the hospital for me but I had the most amazing nurse that night, if she doesn't get the DAISY Award I will start a petition. 

Post-Operation

POD 1

I got my Foley out (one of the best feelings ever) and when I got up to look in the mirror I shocked myself. The color had come back into my face in a way that I hadn't seen in months, it looked like a plug had been pulled that brought the life back into my face (which, I guess, is kind of exactly what happened).

My dad fed me some delicious pancakes for breakfast (I did not expect hospital food to show out like it did), and he also fed me lunch (pot roast, rice, and macaroni) and dinner (pepperoni pizza and orange sherbet) like an absolute boss. I couldn't open my mouth very wide for the first few days, so soft foods and patience were definitely the strategy. I already had a way bigger appetite than I did pre-surgery, and my entire recovery has been that way so far (except when I've actively been sick).

I got up and walked a lap around the neuro wing in the afternoon holding my dad's hand for stability, and I realized what a privilege it is to able to walk (I've been doing a lot of it since). I also had a little bit of a wet cough so my nurse gave me Robitussin to keep me from coughing, which was a huge help.

For pain, I was on a lot of meds including Tramadol and steroids to help minimize swelling that were first given to me via IV. A couple of the things that I found the most interesting regarding IVs that I never learned in med school:

• IV sites can "go bad"- I thought I was being dramatic when all of a sudden the medications all started to hurt when going in, but the nurses just placed another IV and the pain went away 
• IV Tramadol stung- so Pro-Tip: ask your nurse to push it slowly 

In the evening, they moved me to the neuro wing that monitored less intensively since my vitals were all looking good. Since I was no longer using the SCD boots but still not moving as much as I usually do, they started giving me heparin shots every six hours which continued until discharge. 

Figure 2. The nighttime view from my room in the more intensive monitoring neuro wing

The sleep mask and earplugs were game-changers once I was off most of the anesthesia. I noticed I was very easily overstimulated while I was in the hospital (I never even turned on the TV throughout my entire stay) so being able to make everything dark and quiet, even if it was the middle of the day, was just what I needed at some points. I did not need a neck brace after my procedure which also helped with comfort, but sitting upright to sleep took some getting used to.

POD 2

This was the first day where I felt like I was with it enough to know what medications I was on and what my care plan looked like. I started taking most of my meds by mouth and spent a lot of time out of bed by sitting in chairs around the room and taking walks around the floor which felt great. The care team let me know I technically could be discharged that evening, but I liked the idea of staying for one more night to be fully ready to leave since I was excited to get home and wanted to make sure I felt ready enough for the 7+ hour drive on the day of discharge. I had also been getting a POC glucose fingerstick every few hours to check my blood sugar due to my medications (which didn't feel great), and since all my readings had been in the normal range, after I found out I was cleared for discharge I started opting out of these.

I took a lap around the neuro wing every few hours and my neurosurgeon visited me and removed my bandage from my incision site. Before surgery, I asked him to take off as little hair as possible (because even though my hair is long it's pretty thin) and he totally delivered, you can't even see my incision site when I have my hair down. The site was closed with dissolvable sutures (which rocked) so beautifully that it looked like a delicate little robot had done it (see Figure 4).

I had also noticed a bump by each of my temples which hurt initially, and the one on the left was a bit larger and had some dried blood. My neurosurgeon let me know that these were from the skull clamp used to stabilize my head during my procedure and that the swelling should go down with time. I was unable to feel either of the bumps by POD 14.

I ran the breakfast and lunch routines from yesterday again, and for dinner, I had salmon, rice, macaroni, and chocolate ice cream. To celebrate my last full day in the hospital, we took a nice long walk around the floor and very cautiously stopped to dance before returning to my room.

POD 3- Discharge!

Figure 3. Sunrise from my hospital room on the day of discharge

I took a couple more walks around the neuro wing to complete 12 total laps for my stay (11 laps was a mile) and my walk was already starting to become less of a shuffle. I had pancakes again, changed out of my gown, reviewed my discharge instructions thoroughly with my nurse and physician assistant, and we were out by 10:30 AM.  

When we got to the car and started moving, I immediately felt like the biggest idiot on Earth because I felt like I had sat down in a rocket ship and was pretty sure I was going to make my dad check us right back into a hotel 30 minutes up the road. But I just focused on my breathing, took a Valium, and was able to sleep through more than half of the drive.

I started feeling occasional tingling in my left thumb, but it was painless and went away on POD 11. I also noticed on this day that due to how my body had been positioned the last few days, I could not fully extend my arms, so I started gently extending them and holding them there for a few seconds at a time to loosen my muscles.

My care team let me know before discharge that I was finally cleared to shower (just no baths), so I took my first shower at home using my shower chair and it felt phenomenal to finally be home and get clean. We took a progress picture of my incision site and I could not believe how awesome it was looking. 

Figure 4. My incision site POD 3

Glossary

Artifacts: unintended distortions or patterns in a medical image that do not accurately represent the area being examined

Body habitus: a medical term used to describe the shape and size of a person's body

Cauterization: a medical technique to remove tissue using electricity or heat to minimize bleeding 

DAISY Award: a nationwide program that recognizes and celebrates nurses who go above and beyond in the incredible work they do

Extrinsic coagulation pathway: blood clotting pathway activated by external trauma (like a broken blood vessel)

Foley catheter: flexible tube that drains urine from the bladder into a collection bag when a person cannot urinate on their own

Intrinsic coagulation pathway: blood clotting pathway activated by internal damage (like inflammation or blood cell damage)

PACU (Post Anesthesia Care Unit): a hospital area where patients are monitored and treated after surgery before being discharged or moved to another room

PICC (Peripherally Inserted Central Catheter) line: a thin, flexible tube that is thicker and more durable than a regular IV and is inserted into a vein in the upper arm to administer IV medications without the need for repeated IV placements

POC (Point-Of-Care) glucose fingerstick: a portable tool that pricks a patient's finger to measure their blood sugar 

POD: abbreviation for "post-operative day"- in the hospital, we count the day of the procedure as POD 0, the day after as POD 1, and so on

SCD (Sequential Compression Device) leg wraps: leg wraps that inflate and deflate in a repetitive pattern to improve blood circulation in the legs and minimize the risk of blood clots when a patient is not able to get out of bed