The other side of the fence
By Joan Wilson, RT (Orthopaed)

I recently underwent surgery for arthritis of the first CMC joint (CMC arthroplasty, ligament reconstruction, tendon interposition). With 33 years working in health care under my belt, I figured I had a clear understanding of what patients must be going through when they are injured or have surgery. I was mistaken.

I experienced, firsthand (so to speak), the joy of wearing a cast. I felt more concern over how I would cope with the cast than the surgery itself. Knowing ahead of time that I would be casted for six weeks and then splinted for six more gave me a sudden appreciation for how patients cope when their immobilization is due to trauma. I had time to get my spring cleaning done and other tasks I knew I wouldn't be able to do "one-handed", as well as time to ease my husband into the idea that he would be assuming some new duties around the house. Many patients who suffer trauma and become immobilized don't have the luxury of advance notice. It must be difficult for many patients, especially the elderly.

The thought of being away from work for four to six months was disconcerting. I had a number of thoughts ranging from, "How will they manage without me?" to "Will I have forgotten how to do anything when I return?"

Day-of-surgery protocol has changed quite a bit since I was last in the day surgery unit. Gone are the days of: a private cubicle, curtains drawn, and a few quiet moments to spend with your family. Now it's: change into the blue party dress and back to the packed waiting room wearing your housecoat and fuzzy slippers. I actually wore shoes. I figured I could run faster in shoes in case I chickened out at the last minute and needed to make a quick getaway.

When the anesthetist visited, I requested a regional block rather than being given a general anesthetic. I got the impression the anesthetist would like me totally asleep. Perhaps my surgeon had already given him a heads-up thinking I'd be less trouble asleep. I chose to be wide-awake so that a) I could be sure the surgeon was actually present (rather than off somewhere texting someone on his Blackberry), and b) there would be no peeking under the blankets. The anesthetist laughed at my suggestion of this. I was dead serious.

I could tell which nursing staff had worked forever by how they spoke, "You need to move over to the table and when you get to the spot that's uncomfortable, you're there" the OR nurse said, as I moved from the stretcher to the OR table. It often helps nurses to have a slightly warped sense of humour to help them through their day.

The downside to being awake was that the two tourniquets­squeezing the life out of my arm-were painful. The anesthetist tried to counterbalance that pain by running the IV wide open, which caused a tremendous amount of bladder pain. Perhaps it was payback for refusing the general anesthetic.

I had thought there would be a red flashing light outside the OR saying, "Keep out-Surgery in progress". Apparently, this is not the case. The operating room seemed to have a revolving door. There were two visits from an orthopod operating in another suite with some time between cases. He came to "entertain me", as he put it. There was also a visit from a general surgeon who happened to be in the neighbourhood-with something to discuss that couldn't wait. I spent the next half hour thinking about infection from visitors to the OR. At that point, I could suddenly feel the scalpel where a tendon was being removed and needed some local anesthetic. The block was wearing off. Apparently, local anesthetic is usually injected at the surgical site once the surgery is finished to delay the pain for a few hours. I hadn't realized that.

Every orthopaedic technologist must receive calls from distressed patients with post-injury or post-operative concerns. Over the years, I have heard complaints about all types of odd sensations under a cast or splint. I never really believed there could be so many feelings of pain, burning, tingling, etc., until I was in a post-op sling myself. I now regret (anytime I may have been busy and feeling overworked) answering one of those calls and, while giving helpful advice, thinking, "Get over it, it will pass." Being a patient has cured me of that.

The post-op pain was slightly more than expected, but Percocet, being the drug of choice these days, seemed to keep the pain at a minimum. Other than the crazy itchy rash it gave me, it worked great.

I was relieved to see that the wounds looked fine considering the odd sensations I had felt under the splint. I looked forward to having the cast, rather than the splint, so I would have more finger freedom. However, wearing a thumb spica cast certainly restricts hand function. We all take for granted that 50% of hand function that our thumb provides. Wearing a cast made me realize how important it is to have the synthetic casting tape end at an area of the cast that won't rub against the patient's clothes. After the cast picking at my clothes and bed covers, I was determined to find something to smooth the edges. A rasp out of the toolbox did the trick. A piece of stockinet pulled over the cast at night seemed to help cover the roughness. I highly recommend the use of a purchased cast bag for showering. It was well worth the money.