Amputation Puns and Drug Delirium

When Steve got back to his hospital room after his Below-the-Knee Amputation on Thursday, he looked, well - "perky." He was relieved, lucid; he greeted friends with ease. When our kids, Brita and Tim, delivered an oversized pink "contented cow" balloon, he was cordial and "appropriate" - if such a thing exists for a man who has just lost a leg.

He had had a spinal anesthesia, and wasn't keen on the experience of hearing the reciprocating saw and smelling the aroma of full-on cautery. But he was mentally "there."

The next day brought plenty of narcotics - necessary, of course, to dull the intensity of bone pain. But we have all learned that Steve doesn't do well - mentally - with narcotics. He gets delirious. Fortunately, it's an entertaining delirium; he's never mean or cantankerous. And it's temporary.

In the early hours of Saturday, Steve was not only delirious - his temperature was climbing. He has demonstrated florid mental status changes in the past with sepsis (infection in the bloodstream), so this was clearly a concern.

Therefore, I understand why the doctor-on-call ordered Narcan - the medication which reverses the effect of the narcotics. It was important to know if Steve was loopy because he was drugged or because he was getting really sick with an infection.

The Narcan popped the fluffy cloud of relief on which Steve had been floating, and slammed him into a wall of screaming pain. It was awful.

Furthermore, Dr. "Narcan" had then ordered Dilaudid - a drug on which Steve has had notoriously bizarre behavior. I asked to have the order changed to morphine, but the doctor couldn't be reached. After an hour, I couldn't take it anymore. I said, "Give him the Dilaudid."

Two years ago, after Steve's failed kidney transplant, Steve got Dilaudid.

"Are there salmon swimming up my back?" I remember him saying. Later, his friend George's head was completely replaced by the head of George's cocker spanial, Lady.

Like I said, they were entertaining little hallucinations, but bothersome nonetheless.

As soon as the Dilaudid was injected this time, Steve grinned instantly.

"Is that a salmon?" he asked.

The rest of the day and night was spent in various degrees of awareness, as Steve's drugs were manipulated.

His response to it all? "I'm on a wild goose trail. I'm taking a monkey out of a can."

Steve, my brilliant raison d'etre, is clearly at his best with a mind. I'm waiting for it to come back.

We'd already started on the bittersweet amputation puns. "Steve's landed on his foot once again!"

And, after all, I'm still in love with this man - head over heel.

Take care.
Linda Gromko, MD
see also http://www.rowingthroughthewinter.blogspot.com/