Back on the ward

Once I woke up after my endoscopic transsphenoidal pituitary adenoma resection surgery (that's what they called it on the forms!) I had half an hour or so in the post-surgical recovery area to rehydrate and have regular neurological checks. I had these throughout my time in hospital, with decreasing regularity. They ask you where you are, what year it is etc (it usually takes me until at least February to readjust to a new year so I had to concentrate for that one), then there are physical tests; squeezing hands, pulling and pushing with your hands and feet etc. to check that nothing weird's going on in your head.

The last time I had pituitary surgery, I was pretty perky afterwards, probably because I had a whole bunch of morphine when I woke up. This time however, my head barely hurt when I woke up, so no morphine, so I was rather more subdued... Which I think everyone else was probably thankful for. I was taken onto the ward and my parents arrived not long after. A nurse brought me a yoghurt to eat and then a tuna sandwich - I only managed about a quarter of it, but it was really nice to have some food, and when the tea trolley came around I was practically in heaven.

At first I had to have observations taken every half an hour for the first six hours, then once an hour for six hours, then every two hours, and so on. Observations involved measuring blood pressure, blood oxygen levels, heart rate, breathing rate, pupil response to having bright light shone in them (usual response: argh, get that light out of my face), and the aforementioned neurological tests.

I was really not in much pain at all, I had some paracetemol and that was all I needed with regards to painkillers - I was up and walking to the loo within two hours of waking up, so I did pretty well I think. They start you on hydrocortisone, a steroid medication, immediately after surgery (via IV drip initially) because there's always a risk that your body will stop producing steroid hormone after the operation, which may be temporary or permanent.

The most exciting thing to happen was a ninja nosebleed, which suddenly appeared from out of the blue. A nurse ran up to the neurosurgical theatres to grab a selection of bandages wrapped up in bandages, to tie around my face like an attractive surgical moustache and catch any unexpected oozing.

Anaesthetime

Going Under

So I was wheeled into the little anteroom by the operating theatre; the connecting doors were open so I could see into the main theatre room, which was a bit weird. The first thing they do (reassuringly) is to check you're the right person, both by asking you and by checking the ID tags on your wrist and ankle. Then it becomes a bit of a flurry of activity really; you have to untie the hospital gown so it's basically just an extra blanket, make sure your glasses are labelled before they take them off, etc etc. The various anaesthetists and nurses and assistants are really lovely; both times I've had a general anaesthetic, they've done a stellar job of distracting me and keeping me feeling pretty calm about the whole thing.

I had a mask with some oxygen flowing to breathe while they put a cannula in my left wrist. The anaesthetist warned that I might feel a little sting as the anaesthetic was administered, but it was actually surprisingly painful as it moved up my arm. Upon waking up I discovered that at some point the vein had blown, they'd taken that cannula out and put one in my right wrist instead, so I don't know if that would explain why it hurt more than I expected. Equally possible I guess is that it always hurts like that but most people forget once they've been knocked out?

Incidentally, common misconception about cannulae; they're little flexible plastic tubes that sit inside the vein, they don't have needles in - the needle is just used to insert it and is then removed.

Waking Up

I woke up gradually and was fully awake by about half-past twelve; there was a clock opposite my bed. Immediately I took this to be a good sign, as I knew I'd had the general anaesthetic about nine. Given that it would have taken some time to get me into and out of the theatre, that vaguely indicated an operating time of around three hours, which implied there probably hadn't been much in the way of complications like, say, a cerebrospinal fluid leak. Lack of complications is good.

The first thing I noticed, of course, was pain: I didn't have much of it. The second thing I noticed was: there were no bandages in my nose! Last time I had transsphenoidal surgery, my nose was packed with rolls of wadding afterwards, and having it taken out was a pretty unpleasant experience. This time? Nothing. My nose was a little delicate, but it was bandage free and, remarkably, not even oozing at that point. A lovely nurse explained they had filled the wound with a kind of foam, which sets hard and then dissolves slowly. Occassionally over the next few days I would feel it creaking slightly in my head and sinuses, which was an extremely weird sensation but happily caused no actual pain.

As expected, I was really thirsty and my throat was sore from the tube they put down it. The very nice nurse came and asked me my name and where I was, and brought me a cup of water. With a straw. On reflection, maybe I should have remembered that you're not supposed to drink through straws after pituitary surgery, and in hindsight the three cups of water I proceded to drink using said straw may have contributed to the epic nosebleed I experienced some time later once I got back onto the ward. But it's hard to think straight when you've only just woken up...