Karen has been pretty nauseous since the surgery. She hasn't been able to keep anything down, and the heaving from vomiting really hurts her stomach. That said, her pain level has come down. She woke up from her surgery with a pain level of 8 out of 10, but after a couple hours was around a 4 or 5. They were able to get it down to around a 3 today, but heaving always bumps the pain level back up to a 5 or 6. She has recently had a little bit of broth and that's stayed down. So hopefully things are starting to turn around. Her resting heart rate is still in the 90s - I'm not sure what that's about.
As they have done previously, they have Karen on a PCA pump - a Patient Controlled Anesthesia pump. It is set to administer a small amount of painkiller - hydromorphone in this case - once every 8 minutes, but only if you hit the button. The issue we had with this before was once she would finally get her pain level low enough to sleep, she'd soon be woken up by the pain. Last night her pain level was settling around a 5 or 6 when she didn't push the button, and once they stopped taking vitals the pain alone wasn't enough to wake her, so she was able to get some sleep. Today it's settling around a 4 or 5 when she's not hitting the button. We're now at the point where she can get her pain under control fairly quickly after waking, with just one or two doses from the PCA pump.
But I did want to rant about this for a minute because this was one of the most frustrating things for us in the past, and I don't think I ever succeeded in fully explaining it. After falling asleep, Karen would be woken up by her pain, which was around an 8 out of 10. Then she'd have to play catch up, 8 minutes at a time. And with pain medication it's always easier to stay ahead of the pain than try to bringing existing pain under control, especially when you can only take it slowly in small increments. And when she'd get really tired and fall into a half awake state, she could get to a point where her pain level was still pretty high but low enough to sleep. So she would only miss hitting the button once or twice before the pain would wake her up again. She would go all night and into the day with completely broken sleep, awake for a button press or two, and then asleep for 10 to 20 minutes. And they'd come in during the day and tell her she should be sleeping at night, not during the day! We had complained about it but it was suggested she couldn't sleep at night because she was half asleep during the day and got her day-night cycles reversed. We were also told if they used a constant drip with anesthesia this strong, she could easily overdose and stop breathing. The PCA pump prevents that because you'll knock yourself out before it gets to that point. (But aren't all these machines monitoring that? Surely they wouldn't have to wait until you stopped breathing before adjusting it?) I'm not sure the problem was at all related to her day-night cycle, and I see the advantage to the PCA pump when your pain level is settling in a range that won't wake you from your sleep, but when your pain is anything more, it just functions like a sleep deprivation torture device.
