Author Question: Surgical Spleen Removal

Amanda Asks:

I have a character who was shot in the side, not life threatening, but he had to have surgery to remove his spleen as well as the bullet because some rib fragments damaged his spleen.

My question is how long would he be in the hospital after surgery? I’m sure when he first comes home he’ll be getting around in a wheelchair or something while he heals and gets his strength back. When could I plausibly have him on his feet slowly walking around? I don’t want any dramatic complications with his injury or anything. He’s going to heal up great and be perfectly fine afterward.

Jordyn Says:

I ran this question by some of my nursing cohorts who focus in adult surgery.

Having your spleen removed would require a couple days stay in an intensive care unit. This would be due to risk of post-surgical bleeding and concern for infection.

The surgical nurse I spoke to said these patients are up and walking by the time they come to the floor so there would be no need for the character to use a wheelchair.

Once research point that is helpful with this question is that you can Google search for discharge instructions regarding many kinds of operations. For this one, I searched for Home Care Instructions after Spleen Removal. This document gives excellent information that can be translated into your novel.

For instance– how long the patient should expect to have pain. Driving and lifting restrictions which can help determine what they would physically be capable of in your novel.

FYI– patients who have had their spleens removed are at more risk of serious infection. Your spleen is part of your immune system. So some infections that would normally not be a big deal for the general population can be life threatening to those who have had their spleen removed.

New Medical Device: NAVA

Breathing on a breathing machine is not like you or I breathe. One time, when I was doing an ICU rotation, they allowed us to put the end of ventilator tubing inside our mouth and attempt to breathe as the machine delivered a breath. All of us spat that thing right out.
We breathe via negative pressure. We activate our diaphragm and when it contracts it pulls air in via negative pressure. A ventilator delivers a breath via positive pressure– by basically shoving air into your lungs.
Although at times a patient needs a ventilater– just being on a vent adds a whole other set of potential complications which is why some of these other “bridge” strategies have become more popular (like CPAP and BiPAP) which are positive pressure but delivered via mask. It is not uncommon for patients to wear these at home.
One of the problems with ventilators is getting it to deliver breaths when the patient breathes. This allows patients to be more comfortable without requiring a lot of sedation. Ventilator manufactorers began developing different modes of ventilation to achieve this goal.
What was available to patients up until now was synch mode but it basically waited until a patient triggered a breath and then would force the breath in after that. The patient and the vent were more coordinated but still not perfectly synchronized.
What’s new is a system called NAVA (Neurally Adjusted Ventilator Assistance) which uses a cathether passed down the esophogus to sense when electrial impulses are travelling down the phrenic nerve (which is what stimulates the diaphragm to contract) and delivers a breath at that time– which is much closer to the timing of when a patient would naturally breathe. 
I know– perhaps this is just exciting for medical nerds like me but keep this technology in mind if you’re writing an ICU scene in a big-metro hospital. They are likely using this technology already.

Lisa’s Story: Part 2/2

Today concludes Lisa’s story– a story that likely happens every day– nurses advocating on behalf of their patients to save their lives.

You can  read Part I here.

Welcome back, Lisa!

I instantly had a suspicion of what I might be dealing with and finally called the pulmonologist. Lucky for me, it was a doctor I was quite familiar with and someone I trusted. He could sense the urgency in my voice, as I relayed the information to him. And he started dictating a number of tests that he wanted done. I had to get firm with him, and finally told him to stop.

“She just returned from India 2 weeks ago, she’s been in and out of 3 hospitals and 4 urgent cares in the last 2 weeks.”
 He stopped dead in his tracks, and said, “Lisa, what do you think this is we are dealing with?”
I was shocked he asked, but I had a gut feeling. “I think she might have malaria.”
His reply was a barrage of orders and ended with a “Holy . . .”
 
“Wait,” I replied.
He stopped and asked what was wrong. I then relayed that she had taken her 2 year old daughter with her.
Here’s the thing. I had heard about malaria and we had touched on it in nursing school, but I had never seen a case of it, so I had truly no idea if that was right. His mind was racing too. This was South Carolina! We don’t see cases of malaria here. He said I needed to call the hospitalist back and make sure he told the husband to take the little girl to the children’s hospital.
I called the hospitalist back and had to argue with him on the phone. I remember as clear as day telling him that if he didn’t let the man know to get his 2 year old daughter to the hospital, her death would be on his hands not mine. I remember arguing and even cussing at him, I was so angry and he seemed to care about was that I was interrupting his 3 am sleep.
Fast forward . . .
The lady ended up being transferred to the other hospital where in fact the 2 year old had been admitted for also having a case of Malaria. The husband had not traveled with them so luckily he had not contracted it. My patient was transferred to the other hospital on her 30thbirthday. What a way to spend your birthday!

In the end, both she and her daughter were treated and were fine. But that story still warms my heart, because of my stubbornness and persistence I truly believe that I was responsible for saving not one but two precious lives.

The following day I was leaving the floor and heading home. For some reason I decided to go through the ICU to take the stairs instead of the elevator.
As I walked past the nursing station, I heard a man’s voice saying, “Are you Lisa?” I stopped to see the face of an unfamiliar doctor. “Yes, I’m Lisa.”
“The same Lisa who called me last night and chewed me a new orifice, and demanded I call Mrs.X’s husband?”
I sheepishly replied, “Uh, yeah, that was me, guilty as charged.” I said holding up my right hand in admission of being the woman who had made his night a living hell.
He bowed and said, “You may have just saved not only 2 lives, but my career.”
He reached over and kissed my hand in a bowed position with one knee on the floor. I was to say the least shocked and embarrassed. The entire ICU staff started smiling at me. I left with the biggest smile on my face and my heart filled with joy.
Those are the moments that make nursing truly worthwhile.
Shortly after this happened, have you traveled outside of the country was added to the admission forms.
Here is a link to Malaria and its signs and symptoms: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001646/
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Lisa was born Lise Amanda Forest on November 19, 1966 in Ontario. She has 2 children, and 1 grandchild. She currently, lives in SC. Lisa speaks French and English. She graduated from College and worked as a flight attendant for a Montreal based airline. Lisa is a world traveler, having been to South America, Caribbean, and all over Europe; Lisa has been employed as an RN for the last 18 years. Lisa has moonlighted as a realtor and interior designer. Now she’s a writer and her debut novel Oracle is in editing. You can visit Lisa at her blog www.lisaforest.blogspot.com.

Lisa’s Story: Part 1/2

I wanted to share this story of a fellow comrade in arms– a nurse working in the trenches that likely, only through her efforts, did a patient not succumb to death.

There is so much of nursing that goes unnoticed. What nurses do every day. The battles we fight on behalf of patients and their families that likely are never known by those we care for.

I also like first person accounts because they allow writers to “live in someone else’s shoes” for a moment and might make writing from that person’s position much more authentic.

Part I will be today and Part II will conclude on Wednesday.

Welcome, Lisa!


I am so happy to share this story, as this is one of my favorite moments as a nurse.

I typically worked the Baylor shift of 7pm to 7am at one of the local hospitals. Even though the story I am telling you happened about 7 years ago some of the details are still so very fresh in my mind. I have always believed there are no such things as coincidences. And this story truly emphasizes that.
I had arrived to the floor, received my change of shift report and was settling in for the night.
Shortly, thereafter we got a call that a young 29 year old woman was being admitted to the floor. I had no empty beds and my co-worker was a male nurse. This young woman was brought up to the floor with an admitting diagnosis of urinary tract infection and possible respiratory alkalosis.
Immediately, the diagnosis just seemed off to me. When the woman arrived I also noticed she was from India, she felt very uncomfortable with the male nurse so I asked him to switch off with me and I would take the admission. I really didn’t understand why she was being admitted to my floor. We were the IICU, intermediate intensive care unit. We essentially took the overflow from the ICU, with the only exception that we didn’t taker arterial lines. We did everything else, from vents, to trach’s, to PICC lines, and countless drips, and we rarely got anyone under the age of 50.
At first glance the woman really didn’t seem that ill. I was rather confused by her admission to my unit. After a few questions, I returned to enter her information into the computer system. I had barely sat down and the bell was ringing. I got up and headed towards the room. I had never seen anything like it. She was ashen, diaphoretic, and trying to make her way to the bathroom due to nausea. As I reached over to help her up she felt like she was on fire. I told her to sit still. I had just checked her temperature not 15 minutes prior and it had been slightly elevated around 99.8. But this time when I checked it, it was over 103. I was shocked and terrified for this poor woman.
I helped her up to the bathroom and helped her get changed and settled her back into bed. I took a look at all the new orders, returned with some Tylenol for her and began looking at the history. Something in my gut was telling me we were missing something. I read and reread her admission paperwork trying to find a clue. I called the hospitalist on call and related my story. He essentially blew me off and said I needed to contact the pulmonologist. Before I had a chance to call, she was ringing the bell again, and this time she looked even worse. Her body was writhing all over the bed, almost convulsing and she had no control over it. I looked at her and asked a simple question.

“Have you traveled outside of the country in the last few months?”

Her reply was “yes”, she and her daughter had just returned from India 2 weeks prior.
 I looked at her, and asked, “How old is your daughter?”
The reply, “She is only 2 years old.” 
Hope you’ll join us for Part II on Wednesday to see what this patients mysterious illness is. What might your guess be?
**************************************************************************

Lisa was born Lise Amanda Forest on November 19, 1966 in Ontario. She has 2 children, and 1 grandchild. She currently, lives in SC. Lisa speaks French and English. She graduated from College and worked as a flight attendant for a Montreal based airline. Lisa is a world traveler, having been to South America, Caribbean, and all over Europe; Lisa has been employed as an RN for the last 18 years. Lisa has moonlighted as a realtor and interior designer. Now she’s a writer and her debut novel Oracle is in editing. You can visit Lisa at her blog www.lisaforest.blogspot.com.