Expert: Dr Ian Jackson - please note UK based - 1/31/2009

Question
18 months ago I had a hysterectomy, less than 24 hours after the surgery I stopped breathing, I was on a morphine pump and have sleep apnea (yes they knew this).  They did not stop the morphine.  For 3 days I was in and out of it.  I knew my kids, by name and would call their names and plead for help with my eyes and moan. (so I am told, as I have no memory of those 3 days).  I was in ICU and intubated.  My daughter kept asking them to take me off the morphine but they wouldn't.  My son flew into town and apparently coached me to say I was allergic to morphine the next time they asked me.  So he had them ask me and I said yes.  They stopped the morphine and within 24 hours returned to myself.  

I am normally an easy going peacemaker personality. During these 3 days I was combative, would spit pills out at the nurses.  They had to tie my wrists to the bed, had alarms on the bed, was on a catheter.  I don't remember much of this, only at the end when I came to and they untied my wrists.

Second part of this is that I ran a "head fever" during this time.  My face was beet red.  When I got home from the hospital my face had several layers of skin that kind of looked like chicken leg skin.  It took several days of "scrubbing" to get the skin peeled off.  It was ok ujderneath.  I think it was BOILED skin.  Side note, on a normal daily basis before and after the surgery, when I get nervous or too hot or work hard my face gets RELLY red all over and my head sweats to the point of water running down my face and neck.  So I think it was the stress of the situation that caused this but would like your thoughts on this too.  

The doctors did not offer an explanation and I was too fried to ask many.  My ability to spell has been affected.  The part of my brain that knows whether to use "hear" or here" type words is no longer automatic, which is was before this situation.  My short term memory has been affected.  Those first 6 months were hard to function at work.  I did, but it was a struggle.  Thankfully my employer could see it was post surgery problems or I would have lost my job.

Please comment on the reaction to the morphine as far as my  behavior, semi-conciousness, the red face fever and the skin.  They ran test after test after test, cat scans, mri's and said there was no stroke.   

Thank you.

Answer
Hi Lenore
I am really sorry you (and your family) had such a distressing time after your operation. However I have lots of questions to ask before I can really comment fully.

It is not clear to me if you have nasal CPAP for your known sleep apnoea?
If it is known again I assume it was evaluated by sleep studies and proven this way?
If this is the case were you on your nasal CPAP the night you 'stopped breathing'.
You say you were on a morphine pump - again I assume that was a pump you had control over i.e. Patient Controlled Analgesia?
Where were you being nursed on that first night - was it a routine ward or a high dependency unit where they could monitor you closely?
It would also be interesting to know if you just had a respiratory arrest or if you had a cardiac arrest also? however I suspect you would have to ask those who looked after you about that.

In the meantime I'll give some comment on your questions and if you are happy with that then you don't have to come back to me with the answers to the above.

One would have to suspect that the morphine contributed to your respiratory arrest (stopping breathing) The question is how long was it before this was noted?
I suspect the symptoms you describe afterwards were caused by a mixture of the drug in your bloodstream and to a degree by a period of brain hypoxia (lack of oxygen reaching your brain) during the respiratory arrest.
I suspect you were put on the ventilator after the 'arrest' to optimise the oxygenation of your brain and to minimise any possible brain swelling which can happen.
So I reckon there were plenty of reasons to explain your agitation.

I'm not sure about your red face and swelling of the skin but it sounds like you developed marked subcutaneous swelling/oedema either as a reaction to one of the drugs you were given or to any tapes used on your face to hold tubes in.

The symptoms you describe in the subsequent months sound very much like you had a period during the respiratory arrest when there was a lack of oxygen going to your brain.

My advice is to read the above carefully and then ask the hospital for a full explanation of what happened. Agree to a meeting with them (take any family member you wish to be present) and go through what happened. Often it is the not knowing that effects us most and I believe we (as in clinicians) are not very good at getting patients back once they are sufficiently recovered to go through what happened to them.

I hope this makes sense to you and I commend you on the way you have dealt with the after affects of this.
Kind regards
Dr Ian Jackson