Up until April 5th, 2004, I had never been admitted as a patient to a hospital. There were several instances where I have had to use the emergency room, but never a following admission. That changed with this latest flareup of my Crohn’s condition. I was in severe pain, unable to eat and unable to keep myself hydrated. I dropped about ten pounds of weight over the weekend prior to entering the hospital.
Once admitted, I received aggressive medical treatment to attempt to bring the runaway inflammation of my colon under control. It appeared to be working, such that by Sunday, April 11, the doctors were talking about possibly discharging me on Tuesday the 13th. In order to get there, I had to be increasing the amount of my diet taken orally, and that apparently stressed the system too much. As best I can reconstruct events, I must have perforated my intestine late Sunday evening, which coincides with a sharp onset of pain I noticed in my shoulder. Monday morning, my gastroenterologist got this report and ordered an x-ray. Around 11 PM Monday, I received word from my nurse that the x-ray showed free gas in my gut cavity. By 3 AM Tuesday the 13th, I had an abdominal CT scan to attempt to determine the extent and location of the damage. Around 6 AM Tuesday, I had a surgeon briefing me on the necessity of having surgery to find and correct the damage. I learned that having the surgery likely meant that I would be losing the whole colon.
This news was quite a bit different from my expectations for the day. I asked about how critical the timing was on getting the surgery, and was told it would need to happen that day. I decided that I would defer consent until Diane could arrive and take part in the discussion. She was at the hospital by 8:30 AM, and we started going over the various bits of information in earnest. We also requested a second opinion.
Around 10 AM, another surgeon arrived to brief me and obtain consent. He would be performing the surgery. He was very straightforward and blunt about my situation. The odds I risked as he saw it were that I stood a 20% risk of dying even with emergency surgery. Attempting to simply take a medical solution (lots more antibiotics) would give me less than a 50% chance of survival. Given that the location of the perforation hadn’t yet been determined, I asked that if some other part of the gut had perforated that they not remove the colon simply because it was there and having some trouble. The surgeon said that they would do what seemed necessary, and I agreed that the best outcome and outlook for keeping me alive was the goal. So we concluded going through the consent process by 10:30 AM.
Diane and I had some time together before I was transported to surgery, and we both tried to comfort the other. We have both a marriage and a friendship, which helps tremendously. The possibility of separation weighed heavily upon us. By noon, though, I was off to the operating room.
The lead-up to the operation was not a pleasant time. Upon awakening, I had pretty much the same view of hospital ceiling as I had before, and similar levels of pain, which caused me to ask whether I was still pre-op or post-op. I at least got the “post-op” response, which meant that the pain I was feeling was a residual one rather than the presage of more to come. I was cramping up in the abdomen, which of course had already been worked over well in surgery. Even with pain medicine, I vocalized well on the severe cramps. Diane stayed with me through much of this post-operative stage on Tuesday evening. I have thankfully forgotten much of it already, but I think Diane will be remembering it for a long time.
My recovery has progressed from Wednesday, April 14th, when I had severe pain on any motion involving the abdomen, to now, as I have relatively little pain on motion. Cramping can still cause high pain levels, but is now infrequent.
Since the morning of Friday, April 16th, several things have changed or been learned.
My NG tube was removed that morning, which I was glad of. Around midnight last night, I was also relieved of my Foley catheter.
My guts seem to be moving toward recovery after anesthesia, so I also was allowed ice chips to suck on and swallow. One of the doctors indicated that I would start on clear liquid diet by mouth today in addition to the IV nutrition that I have been receiving.
Even my surgeon, who has consistently painted the severest risks concerning my infection status, agreed that my lab signs are improving. Conditional on things continuing in the positive direction as they have been, he said that I may be able to go home “after the weekend”. I’m interpreting that as Tuesday, give or take a day. The only thing that was out of place was my calcium level, so I received an IV supplement of that yesterday.
I do continue with aggressive IV antibiotics. My steroids are being tapered down such that I will be sent home on a daily dosage of 20mg oral prednisone.
On pain management, the background level of morphine drip has been discontinued, and I have the option to take 2ml doses up to four times an hour via a timer-based self-dose unit. As my guts continue to wake up, I expect that I will appreciate the occasional bit of quick pain relief.
Mark Todd, a colleague of mine from San Diego, has been visiting since Thursday night. Alan Gishlick and Nick Matzke from the National Center for Science Education came by yesterday afternoon. They brought a greeting card with notes from the rest of the office and extended NCSE family. Mark had brought a selection of DVD movies and TV shows, so wehad a screening of some comedy on the laptop for our little group. Diane had a busy day at the University of California at Berkeley campus as she continues to try to find a paying job in the academic field. She arrived here very tired last evening, but seemed to recover somewhat sitting here with me. Mark will be around from time to time today, and leaves for San Diego again Sunday morning.
Nanci Blackwood and Bob Barton had sent an arrangement of flowers on Thursday, and Mark Todd also brought one. They grace the cabinet across the room, adding some much-needed color here.
I had two longish strolls in the hallway yesterday. I have to push around my loaded IV pole with its battery-backed dosage pump. It acts as a sort of rolling walker on these outings.
I’ll close for now and see what the rest of the day brings.