In my previous post I shared some of the post-op photos after undergoing robotic assisted peritoneal vaginoplasty with Dr. Marissa Kent and Dr. Peter Chang out of Beth Israel Deaconess Hospital (BIDMC) in Boston, MA.
This post will be a more detailed account of my experience with BIDMC, Dr. Marissa Kent, & my surgical recovery.
I also am including my day 10 picture.
BIDMC experience:
There were some very competent providers at BIDMC, specifically those who were apart of Dr. Kent’s team. However the overall care I received from BIDMC as a whole was felt like the standard care most trans women can expect to receive from a medical institution.
I was intermittently misgendered by nurses, overnight staff were not familiar with the procedure, or assumed it was a simple orchiectomy, and my pain was undermined.
The largest issue that I had was my partner, and medical proxy, was not allowed to stay overnight with me. He was able to stay the first two nights before the nursing director informed us he could not stay any longer, and that his prior overnights were exceptions to inflexible hospital policy, a relic from the “peak” of COVID the hospital has opted to maintain.
Having a medical proxy present those two nights was integral to ensuring that my pain was taken seriously, especially as the surgical team had neglected to put in a standing order for pain medication, and the overnight staff had no specialized training in post operative care for SRS. Having my partner there ensured there was a person sensitive to the needs of a trans patient to advocate for pain management and appropriate treatment. When we requested to speak with a social worker to create a plan for sensitive and trans friendly care, we were unable, and weren’t able to reach them till Saturday, a day prior to discharge.
Pre/Post op notes
Pre-op:
I had specific dietary restrictions for the day before surgery. 24 hours pre-op I was only allowed to eat light foods such as rice or toast. At 12 hours I was restricted from having anything other than clear liquids. At 8 hours I was not allowed to ingest anything, including fluids.
I also had to clear my bowls using Milk of Magnesia. - If I was unable to clear my bowls using Milk of Magnesia by 6pm the day before, I was required to get an enema, though this was ultimately unnecessary.
Day 0:
I went into the hospital at 6:00 AM, and was brought up for pre operative vital checks and meeting with the surgical team around 7:00 AM. I met with Drs Kent and Chang, as well the plastic surgeon, medical students, and anesthesiology team, including a nurse anesthetist and the supervising anesthesiologist. The surgical care nurse met with my partner and parents and provided updates throughout the procedure to them. My surgery began around 8:00 AM and lasted six hours. After surgery I was brought to the PACU until a bed opened up in inpatient care. My partner and parents were able to visit me one at a time in the PACU.
I was nauseous and disoriented coming out of surgery and due to anesthesia I don’t have many memories, though I do remember I was in a lot of pain.
The best way I could describe the pain was it felt like my legs were being ripped from my pelvis & my urethra was on fire. During the first day I was not really able to move my lower body or tense my abdomen due to the pain and weakness post surgery.
After the surgery I started a 14 day course of oral antibiotics, Cephalexin, taken 4 times a day. I began twice daily anticoagulant, Heparin, which I was maintained on until discharge. Until Day 2, when I began walking, I had inflatable ankle cuffs intended to promote circulation and prevent blood clots.
For initial pain management I was placed on an IV Dilaudid drip, which was discontinued as I got moved to inpatient, and from then was only administered a single dose of oral Tylenol & IV Toradol until 10pm, approximately 8 hours post op. At 10pm I was given my first dose of IV dilaudid after advocating with the nurse and moonlighting physician.
As aforementioned, the lack of opiate pain medication was due to not having scripts after being transferred from surgery to my hospital room & the covering doctor thinking the procedure I had was, in his words, “a simple orchietemy”.
Day 1:
I was more mobile than the first day and was able to shift/bend my legs and somewhat elevate my upper body by inclining the hospital bed, however I was not able to do this for long periods of time due to the discomfort.
I started taking a stool softener to help prevent the constipation caused by opiate medications. I also had a small reaction to the tape pictured in the pressure dressing I previously posted, making it extremely itchy, so I was given an oral antihistamines.
The pain was much more manageable & I was switched from IV dilaudid to oral oxy, and increased the dosing from 5 to 10mg. However, most of the pain felt like it was caused by the catheter in my urethra & the bladder spasms. The medication that I took which reduced my pain the most was Pyridium, an OTC medication recommended by the nurse the day following surgery to treat bladder spasms.
Day 2:
This was the first day that I was able to walk for short distances in the hospital. Dr. Kent’s goal for me was to walk 5 times a day without assistance, other than having someone else hold my catheter bag and assist in transferring in and out of bed, which I was required to do without sitting, to avoid putting the incisions and stitches under any strain.
At first it was quite difficult to transfer out of bed or walk due to the tenderness in my abdomen, it felt like I had done a thousand crunches the day before. It was also difficult to stretch or bend near the pelvis due to the feel of tightness of the stitches.
Day 3:
Due to the energy that I needed to not only walk through the hospital upon my discharge but to transfer in and out of a car and to walk to my hotel room I was in bed most of the day relaxing.
The car ride was a bit difficult due to the fact I am not cleared to sit down for 4 weeks post op, unless it is on a toilet or a donut pillow to avoid putting pressure on my stitches. This made transferring in/out of the car difficult due to the angle I was at, however the pain from the ride was very minimal.
Days 4 - 6:
These were my first real days outside of the hospital. I felt better mentally, physically, and emotionally & felt that I had more energy throughout the day. I was slowly able to gain more mobility & independence throughout these 3 days, from being able to dress myself to being able to transfer in and out of bed unassisted. I was unable to successfully have a bowel movement until Day 5, with the assistance of laxatives and stool softeners.
I burst into tears the first time I was able to stand outside in the sunlight unassisted or was able to see myself fully clothed in front of the mirror. It truly felt so good to be out of the hospital.
The pain gradually decreased & by the end of Day 6 I was no longer taking opiate pain killers & was managing my pain mostly through Pyridium.
Day 7:
This was my most physically exhausting day after being discharged from the hospital.
In the morning I was driven to the follow up appointment with Dr. Kent where the internal gauze & my catheter were going to be removed. I was a test dummy, for lack of a better term, for a new method of packing the internal gauze inside of a condom.
Both the condom with gauze & the catheter were painless to remove. Before removing the catheter they used a syringe to fill my bladder with water through the catheter to make sure I was able to pee.
After my stitches were inspected & I was shown how to dilate by Dr. Kent which was also a painless process. Because of the swelling I was not able to feel the dilator inside of me.
After the appointment I was driven home & spent the rest of the day in bed recovering from the long day.
. Should I start freaking out?
