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Surgery Day to ICU (Surgery + 1-2 days)

So, you get there at 5:30AM and see basically everyone with a first slot starting time surgery. I saw at least one super young kid there which was a bit sad, but hopefully wasn’t for anything too major. People are checking in to both in and out patient surgeries.

You bring only your license and your insurance card to check in. Your loved one takes everything else back including those things. They must be there with you! They get issued a pager and info for how to get updates on the surgery.

Also note that the hospital itself issues all your medications. You don’t ever bring in any of your own. Medications ordered by any doctor, including Dr. Movahed, are for when you leave the hospital.

Finally anyhow, it was my turn to go. They buzzed my pager and they went ahead and walked me into a prep room. I got to talk to all the doctors ahead of time including the anesthesiologist, technicians, and nurses. It was a really good calming prep experience. They had me change into surgical scrubs and made me comfortable.

Remember this face. It’s the last you’ll see of it

Finally, I gave my last hug to my wife and they wheeled me away. I remember them wheeling me into the operating room. I remember them tapping an extra line in my arm. And then nothing. Nobody said count to 3 or anything. Just blank.

Surgery was reported to be 11 hours and went successfully. When I finally woke up, I was in the ICU, as per plan. My head and chin were wrapped with bandages, and because of the rhinoplasty, I had trumpets inserted inserted into my nose to keep it open to help with breathing. My wife said I looked pretty frightening, so I’m going to spare you the pics.

My time there was pretty hazy to me initially. I was in some amount of pain, mainly sore throat from the trache tubes, but some numbness as well in my lips and cheeks. I was swollen like a watermelon head for sure though. Apparently I got the oxycontin dose only once a night for the first two nights because I said my pain was high. I was definitely more conscious in daytime but in and out for sure, especially for the first day. Pain was tolerable without much of any pain killers in the daytime.

There were several difficult things that happened during my initial ICU days:

1. I found out I was allergic to a common anti-swell drug, specifically a steroid. Most people would not have this allergy though. However, two episodes of projectile vomiting with tightly rubber-banded teeth is absolutely no fun. Causes vomit to shoot through the nose. Didn’t know vomit could do that…

2. Because of the complex work from both ENT and OMS surgeons, they had put in something called nasal trumpets, which are essentially tubes that keep your nose open and holds structure. Those things coming out were less than pleasant; ended up, again, vomiting from all the blood and fluid that flowed back into my throat from pulling those things out. I don’t think it’s that bad for everyone but those were two episodes I wouldn’t care to repeat.

Sleeping in general was very easy because it was so early on. My body was beat.

By the second day post-op, I was awake enough that they were really pushing for me to start working on eating and drinking protein. You can’t put liquid in your mouth initially with a cup. Instead, they hand you a syringe with a catheter attached to it to pump liquid into your mouth. I tried a few drops through said syringe flat out couldn’t swallow. This goes to the first of many things that needed to get removed: the head wrap. It’s a wrap which goes around your chin to the top of your head. They wrap it tight just after surgery to keep your jaw together. Unfortunately, it also sits right at the point where you swallow.

This is the point where I have to repeat: If I didn’t do myofunctional therapy beforehand, I would’ve been completely toast. You will not be successful swallowing with a tongue thrust. Not happening. However, with myo therapy in my back pocket, I knew exactly how to swallow properly and I understood what was blocking me. You need to know where the throat muscle is that swallows. It was still disturbed and sore due to the trache tube during surgery.

They also insisted that I start walking in order to get discharged from the hospital safely. I couldn’t do it in the ICU. I was too tired and it was too hard even after the 2nd night.

Besides for that though, I got nothing but praise for the Mercy St. Louis ICU staff. They took great care of me and I am very thankful for them.

Then they transitioned me to the TCU (Transitional Care Unit) next.

This was around the time we switched up our plans with our kids. My wife pulled off the logistical coup of the century planning from half way across the country, enlisting help from friends and relatives to care for the kids, to arranging kids’ camps, to flights, to lodging. My only input was, “Okay, whatever, you figure it out.” That was the mental capacity I had in the ICU.

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