Journey into an ACL Reconstruction Surgery

So Friday (June 4) I went in for an ACL Reconstruction surgery performed by Dr Shirish Pathak, at the Deenanath Mangeshkar Hospital, Pune.

Mangeshkar Hospital is right up there with the best in Pune city – their efficiency, courtesy, and patient-care is seamless. Safety protocols are clearly visible and everyone (right from Administrator Sachin Vyavahare to reception staff) is accessible and prompt in addressing patient needs.

This is a diary of my notes from Day 1.

5 am

Up and fresh and dressed. Have to get to the hospital by 6 am to get admitted. My younger brother, Shaikhspear, is going with me. He’s been with me throughout the tests and hospital visits the last week. He is very good with processes, paperwork and working in sync with the institution and ensuring we are always adhering to COVID-appropriate behaviour.

8 am

ShaikhSpear has just completed the admission procedures and we have been assigned a room. It has a patient room and attached relative room. I have changed into the hospital gown-dress, exchanged my masks for the hospital provided masks.

My hospital room with its bed and sanitiser.

8.25 am

I am in the wheelchair now. The attendant has arrived to take me to the Operation Theatre (OT), Shaikhspear has to accompany me – he has all the reports, permissions, imprints and historical files handy. Apart from all the ECG, blood tests and MRIs etc, there are three test reports (that should be negative) that are critical requirements without which I wouldn’t be allowed into the Operation Theatre (OT) – COVID antigen test report, the Hepatitis B Test report and HIV Test report.

I will handover the phone to him and hopefully type out my further notes after I am back in the room after surgery.

Notes from Memory (8.30 am – 1 pm)

Pre Surgery Waiting

I am lying on my back, prone, on a wheeled-bed and being wheeled down some corridor. It’s odd whenever you see people stretchered in movies or tv serials, it’s always someone else’s view. It looks grim or glamorous or grimly glamorous. Let me tell you what I, the patient, can see: The tiles and lights on the ceiling. If I crank my neck a bit to the side, I can glimpse a bit of the walls. But that’s what I can see as I am wheeled on and on- the ceiling mostly. So if I have to navigate here in the future, I know the rights and lefts up on the ceiling.

My bed has now been been wheeled onto a waiting area. Nurses are asking me questions (my name, what surgery, which side of body) and getting ready to hook me up to IV tubes (those intravenous tubes that has some fluid or the other drip-dripping down into the patient).

Two nurses came and one held my left arm, patted a spot on the back of my palm, just above the wrist, just below the knuckles. The other agreed and took a fresh razor and shaved the hair around that area. Then they washed the area with some alcohol-based solution and then took a fresh needle and before I knew it, I was hooked to the tubes.

“What’s in the plastic bag?”

“Saline water.”

“What does it do?”

“It’s for hydration, during procedures or treatment.”

“Ah.” Duh or tube light moment for me.

There is no sense of time as I lay on the wheeled bed. Could be 5 minutes, maybe I have been here 15 minutes. But they are keeping me informed. I closed my eyes and drifted away.

When I opened my eyes, a lady with kind smiling eyes was standing by my left side.

“Good morning. I am Dr Manjiri Ranade. I am your Anaesthetist.” She asked me some questions and informed me about the procedure. I had so far had all previous surgeries under general anaesthesia (GA). She kindly said that they would go with whatever I am comfortable with. She explained that for ACL reconstruction surgeries, the surgeon usually recommends spinal anaesthesia since along with a pain management block, it provides a longer pain management duration. There are no adverse risks nor any pain of administration. She asked me to think about it and let them know at the OT.

I had clear convictions about GA due to experience. Just then the surgeon Dr Pathak came in and told me I would be taken in to the OT in 10-15 minutes. We discussed the anaesthestic matter and he confirmed that he recommends spinal for this kind of surgeon and that it is safe.

Did I tell you that all doctors are in dark but bright blue and all nurses are in deep pink? The dress they wear is the same: a comfortable pyjama-trouser and a comfortable half-sleeve top. And hair is in a whitish plastic kind of cover. My hair is also covered with one of those.

Operation Theatre

I have just been wheeled into the OT and I can see Dr Ranade smiling at me. There were many nurses and doctors at hand. Everyone seemed to have a clear role. Someone placed several nodes on my chest and stomach and told me it was to hook me to a monitoring system so all my vitals were being checked at all times. Someone checked the tubes and hooked those up to IV. A curtain was drawn across my chest so that the doctor could operate.

Dr Pathak came in and Dr Ranade asked me about the anaesthesia, I smiled at both of them and said we will go with spinal.

Dr Ranade talked me through each step as she performed them. They gave me a medication to make me feel good (as she put it) and then they helped me sit up and a tiny injection was administered, didn’t feel anything more than a cool pin prick. Then they lay me back down and I started floating. I could make out my left leg was being raised but didn’t feel a thing. I was floating in and out of consciousness, like being fully alert one minute, flying on a cloud the next and then out like a light. And back again for the whole round trip. Somewhere in between, I remember wondering what happens if I die today, like now. My life insurance would take care of the family’s financial security for some time. Will I get to say goodbye to my children from the beyond, like they show in the movies? Would there be a holding area between life and death? I made up my mind that no, it’s just over. No communication beyond the here and now. I didn’t see my father after he passed on. So it’s really the unsaid things the living carry that makes them think there’s something on the other side. I have no unsaid matters. There’s no other side. It’s just now.

Then another me reminded me: this is an ACL reconstruction surgery, stop being dramatic. I think I was laughing, because someone said I was smiling. Then I was out again.

I could see bright lights overhead but to the side, from time to time. No idea how much time went by till I heard someone say it was 40 minutes. I kept drifting in and out. Dancing. Floating. I remember looking down from the window and seeing a lot of fluffy white clouds. I think I had the window seat. Some time after Dr Pathak said, “Sanjay we are done. You are all good. They will take you to the recovery room.”

Recovery Room

I don’t remember being wheeled out of the OT but I remember opening my eyes to a different ceiling. I remember bouts of severe shivering, uncomfortable, uncontrollable shivering. The nurses put blankets on me and it subsided to an occasional shiver. It reminded me of being in Kaza, in the dead of winter at -20 degrees. But there was no snow and no ice here. Why was I shivering like so? I soon saw Shaikhspear next to me and was glad to have him in sight.

I think it was close to a couple of hours in the recovery room and then I was taken to the room. Though I don’t remember the ceiling lights go by or anything else really, till I woke up in the room.

1.30pm

I close my eyes and fall asleep immediately. The slightest noise wakes me but wakes me rested and alert. This is how most of my life had been till the past few years. I could fall asleep anywhere, always coming awake when there was a change in my immediate vicinity. I didn’t have to sleep in my own bed or house. I could sleep anywhere literally. And wake up rested. This surgery might help me reconnect with some of those old, simple but healthy habits.

2.05 pm

The nurses have been setting up the IV tubes and telling me what medicines they are injecting in. Everyone seems worried if I have passed urine or not. Apparently that is one of the difficulties post surgery.

2.15 pm

Dr Sunil Mane just dropped by to check on me. He gave very few but very clear instructions. Have a few drops of water at 3.30; if there is no nausea or vomit, have some more water and then have tea with a biscuit; if that goes down well, have soup and a soft-diet dinner.

Regarding the urination, he explained that the bladder may be full due to saline but since there is no sensation waist down, I won’t know if susu happens or won’t be able to generate normal pressure.

3.30 pm

Just had two sips of water. All good. Nothing coming out. No nausea. So I had a few sips more. Feels good. I also feel very hungry.

3.45 pm

The nurses have been coming and fussing, worried if I need a catheter to pass urine. Thinking on what Dr Sunil had said, it suddenly occurred to me to check if I had passed urine and I found that the gown was a bit wet. ShaikhSpear checked and confirmed. The nurses told me it’s alright, nothing to be embarrassed about since it’s common after surgery. The good thing is you are passing urine. Many patients have difficulty and pain. So I told them I am not embarrassed, it just occurred that if they gave me a pot I could try pressing from my abdomen and stomach. ShaikhSpear gave me the pot and sure enough, the stomach pressure helped me relieve myself but couldn’t feel a thing. 500 ml. A hygiene caretaker came, sponged and changed my gown and sheets.

Everyone seems relieved.

6.23 pm

A dull ache along my left leg is increasing in intensity ever so slightly. It’s like a thrill and an indication about what’s to come. I guess this is why there are injections in my room and why the nurses and doctors have repeatedly reminded me to let them know if pain increases.

6.39 pm

Just passed urine without any incident and with sensation returning to pelvic region and legs. 720 ml. That is very good the nurse said.

Nausea, vomiting and difficulty in urination are common post-surgery after effects to the anaesthesia. I have followed the doctors’ and nurses’ advise to the T and so far, no nausea and have managed to relieve myself properly into the bed pot thrice already. This is what little kids feel like when they learn to do susu on their own – a sense of achievement.

6.50 pm

ShaikhSpear just spoke to the dietitian to figure out what I can eat for dinner. Khichdi, which I love. So am waiting for dinner, which is still an hour away. I remember our paediatrician, Dr Pandit, always says if the child is active and hungry, he’s fine. That should apply to adults too I guess. I am hungry so I have to be on the road to fine.

7.25 pm

Dr Khurana was just here. He knows how to destress you. Very informative and a stern guide and a great storyteller. I always feel relaxed around him. He was happy with my progress.

The pain is also progressing.

Just finished dinner. Simple, no stress to the digestive system and delicious. Khichdi, lentil soup, slice of lemon, salt and a sweet kheer. Seemed just like what I needed.

8.35 pm

Did I tell you that I love hospital food and airline food? I have heard so many people crib and complain about airline food and hospital food. I love whatever food I get wherever I get it. In my own house, I may be picky and choosy, but outside of that, I am grateful for what I get especially if it is given with kind intent and under difficult conditions. The meal I just had was truly wonderful. Simple and satisfying.

The nurse is here and she’s injecting antibiotics and then she will inject pain medication into the IV. I will probably drift off soon.

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