Sarah Klein

My name is Sarah Klein and I am 39 years old. I live in Israel, though I grew up in America. Here is my story... I had an inguinal hernia (left groin) that needed fixing (my personal goal was to be able to have another pregnancy, without the painful hernia). I went in for out-patient one day surgery on April 26th, 2007. When I woke up, I was told by my surgeon that he had also removed a large benign tumor (called a "lipoma") from my left thigh that had been located behind the hernia, possibly causing the pressure that made the hernia. He said it was filled with lymph nodes, but that there was probably nothing to worry about. I was not given antibiotics upon release, even though it was known that this tumor had lymph nodes in it, notorious for holding infection. I went home that evening with pain from the surgery. The next morning I awoke and noticed that the whole bandage was soaked with blood. I called the surgeon and went in for a check. He took off the bandage and told me everything was OK and I could go home. I asked "don't you want to put another bandage over the incision?" and he said "nah- it's air tight at this point- nothing can get in there". Those were his exact words. Four days later the pain was getting much worse. I put ice on it as I was told, and took over-the-counter pain killers which didn't really help. The night of the 5th day after surgery I wasn't feeling well at all. I tried to get into bed with ice on my incision, but the pain was unbearable. I had shakes and nausea like a fever, but no fever. I tried to get to sleep with pain killers, but I just felt worse and worse. I went to the bathroom at one point and needed to throw up, and did, and then I fainted there on the bathroom floor. My husband helped me after I came to, and got me back into bed. He called my surgeon (1am or so), and he was told that nothing could be done at that point, and that the surgeon would be on duty at 7am. We tried to wait it out. I still had the shakes, and fainted again in my bed- the pain was completely unbearable. Still, though, the area didn't look particularly red or swollen more than it had been since the surgery. At around 2am, my husband again called the surgeon and said I fainted again, and then he called an ambulance to take me to the ER (the surgeon said he'd see us at 7am when he came on shift). I felt intuitively that something was wrong in a big way. It is unclear to me how I got to be on the phone again with the surgeon, - but mid-conversation I fainted again with the phone in my hand. All I remember was the searing unbearable pain. The paramedics came and had to get me down our two flights of stairs in writhing pain, in their chair. We had called my friend to come and sleep at our house and get the children off in the morning (4 small children ages 8 to 1 year). I fainted a few more times getting into the ambulance, and also in the ambulance. I wanted pain killers so badly, but they wouldn't give me anything until I was checked thoroughly. The one who wasn't driving kept squeezing my neck by the shoulder blades to wake me from fainting (think "Spock"). At the hospital they took blood tests and checked the incision from the hernia surgery. I had no fever, and my pain was actually located more toward the hip, though, and the incision looked OK. The blood tests all checked out OK; that was the strange thing. My white blood count was normal. That is one of the reasons I am writing this to post on the site- in hopes it can help someone else recognize nf without classic symptoms like fever & elevated white blood count. After what seemed like years, they finally gave me pethidine for the pain. It took the edge off and I could finally stop screaming there in the ER. They thought it was a virus or something- nothing else checked out. Still no fever, my blood work-up was OK, and there was no obvious inflammation of the incision. At 7am, as promised, my surgeon came on duty. I was still in the ER, no antibiotics, and on pethidine for the pain. Advice had been given by the head of the department to start antibiotics, even without knowing the nature of the problem. My surgeon decided not to start antibiotics because the nature of the bug wasn't known, and he felt it wasn't wise to give a broad spectrum antibiotic. If I had received antibiotics then, I wouldn't have had to go through what I went through with the NF. He couldn't figure out what was wrong, but admitted me to the surgical ward for observation. At the time, the idea of referred pain (to the hip from the groin incision) didn't occur to anyone. For three days of constant morphine and pain, I went through tests - X-rays which showed nothing, endless doctors poking and prodding me, I can't even remember what else - it is all a blur to me. Still no antibiotics, though. After the third day, my blood pressure dropped significantly to 66/46. It was only then that the doctors and nurses started getting scared. My surgeon decided to take me in for exploratory surgery. That showed up nothing, surprisingly, but while on the table my vitals dropped significantly, and my kidneys started to shut down. Only then was it decided to take me to CT scan. In the CT is where they clearly saw the underlaying patches of necrotic tissue from the incision to my hip. From the CT, I was taken back into surgery and the debridement surgery was started. My first post-op blood pressure was 50/30 (with medication), kidneys still not functioning, and nobody was sure if I'd make it or not. I woke up in the ICU 4 days later. The reality I woke up to was a gaping hole in my belly & upper thigh and more unbearable pain. I couldn't move. I was taken off life support, and, thank Gd, slowly regained my functions. On the 5th day after debridement, I was transferred out of ICU to the surgical ward.Ten days after debridement, when I was just beginning to walk again, I underwent the skin graft to close up the wound. I was so scared I'd wind up again in the ICU, I prayed hard beforehand. Thank Gd the skin graft went well, and after 3 more days completely in bed, it was announced that the new skin took, and that it looked good. I want to write here something also that happened on the third day after the graft surgery that was unnecessary and traumatic. When the doctor came to check how the graft was doing, it was first thing in the morning. I hadn't yet even opened my eyes until they came, and had no pain killers in my system. He declared that the graft took, and wanted to check the donor leg. He asked the resident who was with him to open the bandage. This was the original polyurethane bandage that goes on at the end of surgery. The resident started to open it, and I was screaming in pain. He stopped, saying that he couldn't go on if it hurt me so much. The surgeon continued to rip it open himself with me screaming; no pain killers at all. Once it was off, in 2 seconds he said it looks fine, and told the nurse to re-wrap it. There were bandages and sheets stuck to the donor leg all over the place, and I was in so much excruciating pain, and I had to use the bathroom (I had just been woken up). I couldn't move because everything was stuck to my leg- entire bed sheets were stuck like glue to fresh drying blood. The nurse finally got me into a shower chair and wheeled me (with sheets and bandages and all) to the shower where the warm water helped to remove the sheets from my leg. Once back in bed, the nurse re bandaged the leg (with antibiotic cream), with more horrific pain- like a blow torch going up and down the donor leg. The whole nightmare ended only about 4 hours after the time I had been awakened. I later learned that the polyurethane wrap that they put on the donor site at surgery is supposed to stay on until either it falls off by itself, or when it is no longer painful to remove. It can remain there for weeks. I feel I was unduly traumatized from this. Again, I am writing this to help others hopefully not suffer unnecessarily as I did. I went home a week later. I am writing now 5 months later, still in a process of recovery. I am a birth assistant (doula) and have a birthing couple I help once a month or so, but I am not back to work regularly, and don't know when I will be able to be. We also have a nanny we had to hire (out of pocket expense) to help with taking care of the children, which I also can't yet handle myself; physically *or* emotionally. The main physical hardship of my recovery is dealing with the pain I still have with the donor leg, where they took the skin for the graft. The scars on both sides turned hypertrophic, and are very painful when I stand. I wear silicone sheathes on them, and keep them wrapped in pressure bandages to limit the pain. I am also still dealing with pain from the wound site, also wrapped in silicone and pressure wrappings. The emotional side of this ordeal is no small matter. I have been in therapy with a trauma therapist for 4 months now (also an out of pocket expense). I have suffered sleeping problems on many levels - nightmares, insomnia, fear of falling asleep (this came from waking up in the hospital with the effects of the morphine worn off and horrific pain; after I was given a PCA (Patient Controlled Analgesic) machine, I realized that if I didn't fall asleep, I could keep the morphine pump button pressed). The insomnia is the worst, but slowly getting better. I also have to come to terms with this disfigurement- the left side looks mutilated (see picture), and the right side (donor leg) looks weird, but I can deal with that better. As for plastic surgery to fix this horrendous looking scar, at the moment I am against it. As much as I feel mutilated and it is hard to live with, fixing it will take at least 3 more surgeries, I was told last time I was at the out-patient plastic surgery clinic. I am now at the 5 month mark- 5 months after the skin graft. They said it could be done at 6 months afterwards, but the appearance of the hypertrophic scars would probably push that time line off. Anyway, I am leaning toward learning to live with it as a permanent feature. I haven't gotten there yet, but I can't see putting myself through all that surgery. It depends on how life is after the hypertrophic-ness heals and I no longer have to wear bandages. Then I'll be able to see if I can wear all my regular clothes (at the moment I can't) and live a normal life (meaning emotionally as much as physically). I don't aspire to be a belly dancer, anyway, and my husband only wants for me what I want. He said he would only want me to fix it if he knew that was something I wanted. There are so many aspects of my life that have been affected by this - I venture to say every aspect. Some aspects are intimate and personal, and some are obvious and just reality. Above all, I am grateful to Gd that I got to survive this, to be a mother to my children, and live my life with my wonderful husband. Anyone who wants to write to me personally is invited to do so: Sarah.specialdelivery@gmail.com