Episode 4: ICU Week Two

My home in ICU with the machines continually feeding me drugs Id rather not take. Photo by Dr Carlien Wassermann

By way of a disclaimer, this post contains graphic images which some may find grotesque. I would encourage you to view them however, they are part of what life is and facing these things will only make you stronger. The same is true of the contents, these next few posts expose a side of life which isn’t easy to face but again you would be diminished for not doing so.

Monday 22/07/19

After some rest over the weekend, rest being a relative term, it was back to theatre on Monday evening to have the dressings changed. At this point my left leg was basically held on by my calf muscles and the ex-fix. It would have been too painful and too much risk of infection to open the leg in the ICU so all dressing changes would be done in theatre. Although I came out of theatre feeling drained, it was at least a small compensation that it wasn’t as bad as the last weeks oppereations. Dr Bischof had also cautiously mentioned that they were more confident that they could save the left leg, something which was by no means certain at this stage.

Tuesday 23/07/19

Tuesday brought more emotions, I can’t tell you why it hit me so hard that day but it did. There were so many things that seemed to happen during the day as well. The Anesthetist came to place a new epidural catheter, they need to change them every few days for risk of infection. The placement of the epidural is unpleasant to say the least, a large hollow needle is inserted between the vertebrae and into the area surrounding the spinal column and the catheter is then fed into that space, to find to exact spot the doctor needs to move the needle around a bit and it feels like someone is literally scraping your spine from the inside. the process was further complicated by me not being able to sit forward, usually epidurals are used for child birth and are inserted in a seated position. I needed to roll over and stay in that position for some time, a painful situation for me which was again accompanied by an increase in drugs to compensate. The dull high of the morphine and the reality separating feeling of the Ketamine is a combination I would never get used to. Its as if you fade away from reality, reality becomes dull and feels like its breaking into whatever smaller parts it consists of. It felt to me as if I was being pulled by death’s scythe out of reality and it was out of my control if I came back or not.

The discomfort in my bowels had been growing for days now and with laxatives I finally passed movement again. I had to use the bedpan twice that day and both episodes were amongst the worst experiences of my time in hospital. Not only was turning, lifting and positioning painful, but the actual act of shitting was as well, follow that with the inability to clean oneself and having to have the nurses roll me off the pan and clean up the mess. Each episode left me broken and drained.

I did see Nick and it was comforting to chat to him. I also got new Magic cards which helped to take my mind off what was a very emotional day. The ever elusive fits of sleep with their strange and very real Precedex dreams would flit bout me like ghost of healing, as ethereal as they were important.

Wednesday 24/07/19

Although I had gotten through the emotional rollercoaster of the day before, today would see me in theatre again, looking back on this week I can liken it to going round after round with the devil in an MMA cage. Monday, theater; Tuesday, rest; Wednesday, theater; Thursday rest; Friday Theatre; and Saturday was like judgement day and judged I would be. The operation today was by the orthopaedic surgeon to reconstruct the Tibia head which had broken into three sections. He would open the knee up on the side and manually rearrange the pieces before fixing them together with two castellated screws which would go right through the Tibia head from side to side. The surgeon was encouraging post-op, he said that there was more bone contact than he expected, exactly what that means I can’t tell you, but he seemed to think that the operation went well. My family came to visit again and I spent a long time talking to them and then to the anesthetist, Dr Carlien Wassermann, who had kept me alive in the first operation. Despite the operation, the day passed quicker than the day before and it felt that there might be a bit more light ahead. The day merged with the night in that same way, without ceremony or sunset, in the ICU the only thing that really changes is the hue of the light. It’s just as bright at night and it’s just as busy.

Thursday 25/07/19

At least I got a bit more rest in today between surgeries, by all accounts tomorrows surgery would be a big one and as events would later transpire, I really needed all the rest I could get. I had another bowel movement which was painful, the rolling and the lifting to get on and off the pan were quickly becoming some of my worst memories of my hospital stay. But beyond that the day was more peaceful, it felt for the first time that there was a bit of space for me to think. I thought of the future, the distant and now unknown future, the chances of saving the leg were growing with each day the doctors had told me. But what did that mean, what kind of functionality would I be able to get out of the leg, would I be able to walk again, or climb again? My entire life had been changed to centre around climbing and it would seem that that was no longer an option. Although these thoughts were heavy and the chaos thick, I did at least have time to think them and the anxiety they provoked only seemed to strengthen my resolve further. Although i didn’t know what the future held, I knew what must be done to engage with it. Having opened some new Magic cards the day before and my continued fascination with stories of mythology, I was perhaps not hopeful but certainly had a better understanding of what may be necessary to move forward: Pick up your Spear and go conquer the dragon that assailed you. The Dragon was life and the only spear I had left was my mind. It may prove a futile journey in the end but that’s irrelevant, the only honorable course of action was to fight. I didn’t know how valuable this day of introspection would be as things took a more dire turn during the night. During the afternoon I received more blood ahead of tomorrow’s surgery. Unbeknownst to me, tests had been returned that showed my infection markers had begun to rise.

Friday 26/07/19

The night was terrible, I managed to drift off to sleep early after a quieter day but awoke shortly after midnight with increasing pain the the right leg stump and left knee. It began by feeling sensitive and I could feel more pain with the tiny movements i would do, by morning it had built to an intense pain in the right hand side of the knee. I could also feel I had a temperature, which was confirmed at first light when the nurses did the rounds. Somewhere infection had taken root and Dr Bischof was visibly concerned. She ordered blood to be taken and cultured to try to isolate what type of infection it was. I was put on further antibiotics, these ones they apparently use to treat Tuberculosis but they used them because they have a good bone penetrating effect. The antibiotics were delivered intravenously and the drip bag was kept in a thick silver liner to prevent exposure to light, it was unnerving to say the least. The trauma doctor brought in an orthopaedic surgeon to assess the knee clinically and they decided that if the went through with the surgery, they would literally cut the knee open on the side and go in and manually clean it out to try to stop the infection from eating away at the cartilage in the knee. In the end the doctors decide to proceed with the surgery despite the infection and at 15h30 I went under again, this time for 5 hours. The orthopaedic surgeon opened and cleaned the knee whilst Dr Bischof and her supporting team performed what is called a gastronomicus flap and grafted skin taken from my thigh onto the gaping hole in my flesh.

During the final surgery to close the hole. Photo by Dr Carlien Wassermann

The gastronomicus flap involves cutting a part of the calf muscle out but leaving it attached at one end, then rotating that flap of muscle around to the front of the leg and suturing it in place. This bulk of flesh serves to close the hole in my leg where the rock had gouged out tissue and further tissue had later been removed as it died off. This large hole left the bone exposed. The bone would not regenerate if not covered by flesh and skin to provide an infection free area with good blood flow.

The muscle flap from my calf clearly visible. Photo by Dr Carlien Wassermann

I would be missing a large chunk of my calf muscle but at least the bone would have a chance of healing. After 5 hours under anesthetic with my body already taking shots, I awoke feeling broken once again. Not for the last time did I have this feeling of being a conscious passenger without agency traveling through this Hell which seemed never ending and tomorrow would prove no different as the source of the infection was brought to light.

Post surgery but before dressing, the skin graft held in place by staples to avoid over tensioning the skin. Photo by Dr Carlien Wassermann

Saturday 27/07/19

Yesterday’s operation had tired me out completely and I actually got some sleep, it was patchy but it helped. I felt a bit recovered when I awoke in the morning but today would prove to be one of the hardest and lowest moments of my stay in hospital. I later looked back at this period and thought about the ebb and flow of a kind of vital life energy during this ICU period, it was as if each operation took all the energy I had and I was barely able to recoup enough energy to be able to make it through the next operation. It was brutal, knowing each time that Id come out feeling broken again but still having to just hold on as the rollercoaster rose and fell, with my consciousness on board, a passive bystander.

The anesthetist came to change the epidural around midday and was surprised to find the epidural site infected. She decided to avoid placing a new line for fear of further infection. She and Dr Bischof were concerned, an infection penetrating into my spine was a dangerous and unneeded complication. I was given a stronger flow of the IV drugs before rolling onto my side so the doctors could cut open the area and disinfect it. Reality once again cracked and distorted, blurring around the edges as the morphine, ketamine and precedex dimmed the flame of consciousness in a most unholy way. I could still feel the cutsa and scraping as the doctors worked but at least there was minimal pain.

Without the epidural controlling the pain sent up my spinal cord and only the IV drugs to dull me, I was far more aware of the sensations in my legs, I would have to ride out the rest of the ICU stay with more pain, and there was heaps of it to come. The anesthetist did inject local anesthetic around my femoral nerve in both legs although i can’t say this helped much.

Dr Bischof wanted to assess the extent of the infection and whether it had moved into the spinal cavity itself. She arranged an MRI scan to determine this. Without the epidural movement was much more painful and I would soon be wheeled into the MRI room and transferred first to a stretcher type bed which could be wheeled into the NRI room (there can be no metal in the MRI room so the normal hospital beds aren’t allowed inside) and then onto the MRI table itself. Both painful transfers after an already pain filled day. To add a further complication, the machines which regulated the flow of drugs into my body were also made of metal in places and I was detached from these stemming the drugs which deferred the pain.

Inside the MRI was tight, hot and claustrophobic with a hard thin board to lie on, add to this the loud alien sounding noise that the MRI makes as it spins and moves and the resultant experience was truly nightmarish. I lay corpse still, alone with the sound, heat and terror of infection. The pain increased as the drugs faded. In total there were three scans done, each lasting an eternity as I waited to be pulled out of the MRI between each. The nurse attending to me administered a dose of drugs buy hand when I was pulled out. Each time she did the pain reduced but so did reality, slipping away into that strange escher drawing like state typified by the ketamine high. It was all I could do to keep my mind from splitting apart as the nightmarish cycle of pain, desperation and mind altering drug trip coalesced. All the while the over loud alien whooshing sound of the MRI threatened to fully derail my sanity. Again I was transferred to the stretcher bed before being transferred back into my hospital bed, this time there were fewer drugs in my system and the pain lanced through me and consumed my conscious field, there was nothing but pain in those few minutes.

When I returned to the ICU I was finished, my head spun and my breathing was erratic. I am certain that the MRI ordeal was as much as I could take. there was no escape and reality was truly too much for me to take. but alas there was more coming, the constipation caused by the drugs was ever present and the discomfort was again growing, my abdomen distending from the pressure within, despite the activity of the day I would find sleep almost impossible due to the discomfort

The only salvation that day was when the head nurse came to offer me some comfort and told me that they had found no evidence that the infection had spread from the surface deeper into the spinal cavity. It is uncertain to me that I would have had the will to fight that too.

Sunday 28/07/19

I did manage to get a few hours of sleep in the morning before Dr Bischof made her rounds. she reassured me that the infection had not spread and it seemed that my infection markers were dropping in the blood test results. The anesthetist came to change the Main Line from the vein in my right shoulder to my left. They change these IV points frequently to avoid infection, in my case though my body seemed to reject the intrusions faster than most and the site would become clogged or inflamed and would have to be moved. Each day I would have at least one change or blood sample taken, I looked and felt like a pincushion for the storage of doctors needles. The intrusions into my body were a norm but I would never grow used to them.

I did manage to have a bowel movement again, as uncomfortable and distressing as that was, it did bring some relief to the discomfort. However, a new problem emerged when they removed the catheter for the first time since I arrived. The drugs mess with one’s ability to control bowel and bladder functions and the muscles had also not been used for two weeks, despite the build up of pressure, I could not urinate at all. Most of the night was spent trying to re-learn how to pee. Initially my efforts were useless, a terrifying feeling as one as can imagine. Later, I succeeded in passing small amounts of urine which relieved the pressure just enough to be able to find some light sleep. Only to wake minutes later and begin the ordeal again. Moving to place a pee bottle between my legs was painful each time, again and again I fought the muscles needed. After a full twelve hours of effort and distress I managed to urinate and although I would still have difficulty with this in the future, the battle had been won.

The first sequence of surgeries were over and the left leg had been saved, so it was time to start preparing me for transfer to a lower care ward where the wounds could heal before the next phase of the journey began. These first two weeks had taken me beyond what I believed i could bear, but even with the emotions and the drug trips, the journey was mostly rooted in physical experience. Something which would change drastically as I was moved out of ICU. The next battle would be one of sadness and loss. Like Atreyu in the Swamps of Sadness I would know what it was like to lose my Artax.