WARNING: THIS POST CONTAINS GRAPHIC PHOTOS OF SURGICAL INTERVENTIONS
Recovery from surgery is no fun. There were a couple of temperature spikes, which are scary. They often produce vomiting and just an altered mental status that thankfully now, allows me to not even remember them. But at the time, I guess I was in rough shape. Actively cooling me with ice in my armpits and anti-nausea medication, but not before the awful feeling of throwing up and the chills and the sweats and all that. Fortunately, the staff is well trained in dealing with these flare-ups and they got me under control quickly. You just have to be careful what the cause is…is there an infection and is it minor or something major having to do with the surgery itself, deep in your abdominal cavity. Luckily, the couple of fevers I spiked were nothing too serious, just scary. But when it comes to recovery time, every little setback means 3 or 4 more days of observation.
So, I think I had about 6 CAT Scans while I was there. Most of them, were of course, focused on the lower abdomen. But with a high pulse rate over a number of days, my fantastic surgical PA, Meg Parker, had the inkling to do a full set…the abdomen, all the way up to my chest. With great thanks to her, this test found a Pulmonary Embolism, which was basically a blood clot in my lungs. Fortunately the clot itself was not too serious, the doctors were confident that it would dissipate on its own and not travel to anywhere dangerous. However, the priority immediately shifted to the prevention of further clotting. After all, I had been lying in a hospital bed for more than two weeks at this point with very little walking or exercise and the risk of clots forming in the legs and traveling to very dangerous places was a serious consideration. My condition was contraindicated for blood thinners, so therefore, the course of action would be the installation of a vena cava filter to catch any would-be clots that might want to travel up to my heart or lungs.
The procedure is not painful really, but a bit unnerving. You lie awake on a surgical table with your head turned to the side. Local anesthetic is injected into your neck, so that the interventional radiologist can then make an incision into your Jugular Vein (yes, just knowing this is going through one of the largest veins in your body is a bit disconcerting). With image guidance, he inserts a catheter through the vein, down through the heart and into position in the Vena Cava, the largest vein the the inferior section of your body, carrying all the deoxygenated blood from your lower extremities back to your heart. There’s a lot of pushing and prodding at the site of the insertion point in my neck and the specialist guides this catheter into place before deploying the filter itself, which attaches to the inner walls of the Vena Cava and helps to block any large clots from moving upward.
A bit scary to think that this antiquated looking device is the only thing standing between me and a potentially life threatening blood clot, but I guess it’s the standard of care and I should trust it. Apparently, it can come out in about 5 or 6 months. So, again, another procedure that warrants a few days of observation before considering discharge. Here we are over two weeks post surgery and I’m still waiting patiently for all the stars to align that will lead me home to my family.
The biggest frustration is the ileus. Ileus is defined by Wikipedia as a disruption of the normal propulsive ability of the gastrointestinal tract. Although ileus originally referred to any lack of digestive propulsion, including bowel obstruction, up-to-date medical usage restricts its meaning to those disruptions caused by the failure of peristalsis, the normally symmetrical contraction and relaxation of muscles that propagates in a wave down a tube, allowing food materials to travel through the bowel in a normal, one-way pattern, toward the exit. So, when the bowels are significantly rested from lack of food, and certainly man-handled as in surgery, they fall into a state of ileus and are just not capable of doing their job yet…so you wait.Yet another thing you have to observe for days before going home.
So, the nurses come in every so often and listen to your bowel sounds. You’re hoping and praying that they hear something, ’cause you’re not going anywhere until they do! And the GI tube up your nose doesn’t come out until they hear something – can’t have food and fluids in there if they’re not moving. Finally, a little gurgling, finally the idea that we can try some clear liquids to see if they travel your tract properly. At first, it’s very uncomfortable. You’ve been in IV nutrition for almost three weeks now and none of your insides are used to anything being in there, so it doesn’t exactly feel normal as the process winds up again. Gas pain, you’re taking it very slow, just hoping that things stay down. The food TASTES amazing, but you’ve got to be careful to not over-do it. Finally, with success, they decide it’s time to take the GI tube out and try some more normal, yet soft foods. You get the idea, nothing happens fast…so it’s a process of waiting and trying and praying that your body gets back to normal as soon as possible.
Three weeks was about my limit! People constantly asked me how I didn’t die of boredom while I lay there so long. For the first few weeks, you have very little time to actually get too bored. There’s a lot of desire to sleep, and the way the nurses are these days – or at least were for me – they were very good at not waking me up just to take a set of vitals. In the past, it was an every few hour thing that you got woken up to get poked and prodded. I felt thankful that my nurses let me alone when I was sleeping, for the most part. When you’re not sleeping, there’s always some procedure you’re mentally or physically preparing for, or meeting with the doctors that you’re looking forward to. Then there’s the watching of the clock to request your pain medicine at regular intervals. You don’t want to miss that, so that keeps you occupied too. And when it comes, the next hour or so is lost to space and time because you feel so good and relaxed. The time eventually drags a bit, but you know you’re there to heal, so I tried to embrace the rest and just let my body relax. A little bit of TV here and there, but mostly rest and reflection. Then, there’s the guests. I had at least a couple guests every single day, which meant the world to me. So, was I bored? Not really. But at the three week mark, I started to get EXTREMELY bored. Like I said, that was about my limit and I think it probably had more to do with knowing that going home was just a day or a few hours away and I just couldn’t wait any longer for that culmination of excitement to ensue.
And finally that day came. All the IVs were disconnected, I was eating regular hospital food, and getting visits from the case worker, who coordinates my home care – the visiting nurses to change my dressings every couple days. I saw a nutritionist, who provided some guidance on what foods to stick to and avoid. Some last minute visits from doctors to wish me luck and send me off, expecting to hear from me for follow up appointments. A couple of quick procedures: One to pull out the triple lumen (also called a picc line, or central line). This is the IV port that the surgeon installs during surgery into your mid-clavicular area, that goes almost straight to your heart. Think about it, a single IV in your antecubital space (the opposite side of your elbow, sometimes called the “elbow pit”), is not very practical for a three week hospital stay. You’re constantly moving your arm, so as to irritate this area and compromise the site’s integrity. Not to mention, when you’re on the amount of IV fluids and medication that I was, you need more than one site, so the triple lumen allows for three semi-permanent ports to be used to hook you up to all the stuff you need to be hooked up to. Not only this, but they were taking blood almost every single day. Can you imagine being poked for three or four vials of blood in a different vein for three weeks? The triple lumen makes it easy, they unscrew an IV, pop in a blood collection vial and grab the blood they need over and over from that same site, painlessly.
So, anyway, that central line has to come out. It’s a funny feeling, but doesn’t hurt. Though anything that you know is directly aimed at your heart is a little disconcerting to think about. You just hope nothing goes wrong – and nothing almost ever does – but it’s just one more thing you pray about…and follow directions very carefully. The worst part about the going home preparation was the removal of the tension sutures on my incision. This was the last thing to be done, but certainly the most uncomfortable. Here’s what my incision looked like at this point:
I know, I’m sorry, it’s disgusting. But it is what it is. Eighteen years ago, after my first surgery, they simply sewed me right up the first time and after that second surgery, stapled me up all nicey nice, so what you have appears as a completely closed up incision…no redness, just closed skin. Apparently, over the past 20 years, what they’ve learned essentially from the battlefield, is that it is much more effective to let an incision heal in the way you see here. Closing it up completely was leading to more infection right under the surface of the skin and concerns with fluid discharges, etc. Instead, now, they leave what looks like more of an open wound, and allow it to heal up from the inside out, exposed a bit more to the oxygen in the air. This is supposed to create a safer healing experience and healthier skin growing over the incision eventually. But, before going home, these sutures come out. So Meg, the surgical PA, arrives to do this and these are not thin pieces of suture thread. They are thick wires, wrapped in a rubber tubing to protect the surface of the site. They have to be tugged on to snip in the right place, the tubing cut off, and then pulled out over the width of this scar…underneath the surface. This did NOT feel good. It wasn’t necessarily painful, but it made me lightheaded and close to fainting as she pulled out the first two, because it is so disconcerting to feel the pulling and tugging through what you consider a very sensitive area. Fortunately, my triple lumen wasn’t out just yet and she called for my nurse to push 1 mg of Dilaudid pain medicine through the IV to help me through this process. That was heavenly. It only takes a minute or two to take affect and then pulling the other four was a breeze. I thanked Meg for her gentleness and expertise and I was off to the races. I’ll spare you the picture of what it looks like without the sutures. It’s not pretty, but they said it would be closed up and skinned over in 2-3 weeks. Until then, regular dressing changes by the visiting nurse and I’d be on my way.
Dad drove me home from the hospital after gathering all my things. All the pictures that had donned the walls, colored by my nieces and nephews and sons. I know they brightened the day of every nurse that ever walked into that room. I was so grateful for their empathy. I met some incredible people over those three weeks and as I rode the wheelchair down the hall to the elevator, I got lots of hugs, kisses on the head, even some nurses who teared up and a big round of applause. How special is that? Then, my buddy Yvonne ran out from the nurses station, calling out to me as I rolled into the elevator. She jumped in and gave me a big hug. It was a heartwarming experience and I hope very much that I get to visit the 5th floor every now and then and see some familiar faces. For now, a bouquet of flowers and a Christmas card would have to do.
So, that was my fourth experience with abdominal surgery. My lovely nurse, Yvonne, put it best when she said I had the GI tract of a 70 year old. Great, thanks Yvonne, I really wanted to hear that. But it’s okay, I accept it. I am here, I am here for my kids, I am here for my wife and all the people who love me for another length of time, however long God deems that to be. And I am eternally grateful. It’s been slow-going at home. Just walking around the house tires me out and I take a lot of naps. Fortunately, this is the time when I started writing this blog too. The personal reflections of the past few weeks were the impetus to share my story…my stories. I hope these posts touch some people who can benefit from them.
Until next time…