Recovery Stage II
Settling In, 12–24 hours post surgery

Seeing the wound for the first time was both startling and encouraging.

Prepare yourself for an emotionally turbulent 24 hours post-surgery. While your initial reaction could be mild elation as you gaze down upon your well-wrapped leg, especially if you are relatively pain-free, this feeling of comfort and security could be short-lived. Your relief that the surgery is over and comfort in anticipation of your recovery could rapidly give way to a cauldron of other emotions. You could be depressed, on edge, a bit confused, or ebullient.

Just as no two knees are alike, each recovery is also unique. One thing all recoveries have in common is a lack of awareness of how truly incapacitated you, the patient, are at this moment. Lying in a hospital bed attached to multiple medical instruments, you may feel aware of what is happening around you. It is difficult to accept that your body has been subject to a significant physical shock. It will take weeks, if not months, to recover from this surgery—particularly if you don’t feel much pain.

For me, this was the period of the unsettled mind as I cycled through various mental states. Don’t expect to remember much from this stage of your experience unless you write it down. I was still a bit dizzy 6–18 hours post-surgery and still under the effects of anesthesia, but I found social interaction—with family, visitors and hospital staff—restorative. Some people, however, don’t feel up to socializing at that time, and those feelings are equally valid.

The nurses in the orthopedic units are well-trained to assist you, but in order for them do their best, they have to know how you are feeling. What information is your body giving you that you need to share with them?

• Is your pain medication working?
• Are you drinking enough water?
• Are you able to sleep?

To help me take charge of my recovery, I tried to learn the names and responsibilities of the various people I saw throughout the day. They provided the Caring, and I provided the Cooperation—both critical aspects of healing.

When I reached my room, I immediately asked for my notepad and pencil and began my journal. I noted the names of my nurses and my goals for this period:

• Get my pain management under control
• Be able to get to the bathroom on my own
• Work successfully with my PT.

Now all of the habits I had created in prehab, such as drinking enough water and doing controlled breathing, became essential parts of my recovery. Drinking an adequate amount of water was particularly critical. I learned that urine is measured during this period because the patient must produce sufficient urine to receive certain pain medications. Hydration also helps prevent constipation, a natural consequence of pain medication. Making sure I drank enough water became my responsibility. I also learned to request ice if my leg started to ache before I was due for more pain meds.

Other ways in which I could act as my Guiding Hand during this period included:
• Keeping my kneecap pointed towards the ceiling
• Resisting the temptation to put a pad directly under the knee itself
• Keeping a pillow between my legs to relieve pain
• Remembering to move around in bed periodically
• Rolling onto one side if I started experiencing pain in my glutes.

Of course, I continued doing whatever exercises I could, including ankle pumps, quad squeezes, and leg slides. Listening to music would have helped, but I had neglected that part of my preparation.

Seeing my leg unwrapped for the first time after each surgery was a shock.

Fortunately, it didn’t feel as bad as it looked. As a physician’s assistant gently unwrapped the layers of bandages to check the condition of the wound, I took the pictures above. The wound was healing appropriately; it did not have signs of inflammation. This was significant because of the vulnerability of the new knee to a bacterial infection. See Prehab Ideas Part II.

Warning signs of infection include:

1. Persistent fever higher than 101 degrees
2. Sweats or shaking chills
3. Increasing redness, tenderness, or swelling around the wound
4. Separating edges of the incision;
5. Wound drainage or discharge that is bad-smelling or thick
6. Increase in pain, especially with activity
7. Increasing warmth around the wound

Being a good patient is an active, not a passive role. As the person in charge of my recovery, I needed to collaborate with my caregivers to promote my healing. I refer to this interaction as the Dynamics of Report and Support, i.e., reporting my need for assistance and receiving support and appropriate care in return. Report and Support became crucial as my pain level began to increase after surgery when the medications used in surgery to suppress pain, including the nerve block, were wearing off.

Next: P.R.I.C.E. Part I