Day Two - 10/25/07

The first night of sleeping was not bad at all. My friend Patsy told me that during the couple of 2-3 hour periods between nurse interruptions I actually looked like I was sleeping peacefully. I had one short period (less than 5 minutes) where my O2 sats dropped to the high 80’s but I didn’t stop breathing during this time. The next morning I actually felt that I slept – not the fitful apnea stuff that has been the norm for the last 12-13 years – but actual restful sleep. Now don’t misunderstand me – the fatigue from being through my surgery was still with me, but the been-run-over-by-a-truck-hangover feeling wasn’t! I had a long way to go with recovery but it was the first positive sign I had seen that maybe this surgery wasn’t a mistake.

My day continued to cruise along with a few visitors stopping by to see me. The swelling in my face was continuing to increase. Dr. Hudson stopped by to check on me and told me that he was pleased with the surgical outcome. He was able to get 4 mm advancement on my maxilla, at least 12 mm advancement on my mandible and an additional 3-4mm genioglossus advancement with my chin osteotomy. He told me that the swelling would peak at around 48 hours. After that it would be the slow descent back down to my new face. Pain was always present, but manageable with the PCA boluses. I was tolerating clear liquids fine, actually able to use a cup even though my bottom lip is totally numb. Yea! I was stoked that I was going to be able to manage nutrition without having to use a syringe. Later that afternoon I started feeling itchy and flushed. I thought that maybe I had gotten too warm. Then within minutes it seemed that I was itching everywhere! I looked in the mirror and my face and neck were breaking out in a rash. I got a throbbing nasty headache on top of the surgical pain I was feeling. We called the nurse immediately. As it turns out Ancef, the IV antibiotic that I had gotten in surgery and three more doses since surgery, I was allergic too. I questioned the nurse about the Ancef – reminding her that I am allergic to Cephalexin. She said she saw the allergy and had called the pharmacist about it. The pharmacist had also questioned the order knowing that that both Cephalexin and Ancef are both in the same cephalosporin family of antibiotics. The pharmacist had been told (by my doctor? the anesthesiologist? I don’t know who) that I had been given Ancef in surgery and did okay. So, since I didn’t have an allergic reaction no one saw a problem giving me a medication that I am allergic to! This really ticked me off! For every damn piece of paper that I had signed for the hospital, in the pre-admission interview, the anesthesia interview and on my chart it was noted that I am allergic to Cephalexin yet I was given a cephalosporin anyway! So much for fail-safe policies and procedures to prevent medication errors! I was started on IV Benadryl immediately. My antibiotic was changed to Cleocin that afternoon.

After school my kids came by the hospital to see me. They took the way I looked pretty well. They came right up to me and gave me a very delicate hug, being careful not to bump my face. I was so glad to see them. As much worrying as Allison had been doing preop I was concerned that she might be upset seeing me. She seemed to actually be okay with the whole situation once she knew that I was done with surgery and wasn’t going to die. Ben has been fairly trusting that I would be fine all along. After a short visit, Mom took them home to get homework and dinner done.

Following the allergic reaction and with the addition of Benadryl to my medicine regime I started having my O2 level drop when I fell asleep – which happened often because Benadryl + Dilaudid = sleepy Anne. O2 by nasal cannula was added. I was already wearing a humidifier mask to humidify room air to keep my nasal passages moist. During night shift my nose was really starting to get sore because the nasal cannula was rubbing against the newly-trimmed nasal spine. The respiratory therapist switched the humidifier mask over to O2. Well, to get 2L/hr flow of O2 through a humidifier mask you have to turn the flow up really high. I found myself with uncomfortably cool air blowing in my face. The evening continued to be less than optimal with the nurse I had been assigned that night. I wound up with a slow Eyore-like LPN in charge of caring for me. I have nothing against LPNs. I have worked with LPNs in the past that could work circles around anyone else, but this chick wasn’t great. My PCA ran out of med and it took one hour to get it back up and running. Being an LPN she couldn’t do anything with my PCA so I had to wait for the RN on the floor to become available to reset it. I am a fresh surgical patient who would have been in ICU had it not been for Patsy and I am assigned the LPN with one speed – slow. Not a stellar night.