On Wednesday the 25th of November Neu finally went under the surgeons knife. We were warned by the surgeon that he was unsure as to what they would find when they opened Neu up. He was optimistic that it would be a simple surgery, yet prepared for any eventuality, which as it turned out was just as well.
At 1pm they took Neu through to surgery, I was told I should come back around 4pm when they would be able to give me some news.
I wasn’t wholly surprised when there was no news at 4, nor when there was no news at 5 but when the reception nurse went home at 6 and the only news was that they were still in surgery, I began to get a bit worried.
Neu was very lucky to get into surgery when he did, as there was a strike planned by doctors and nursing staff, to protest over the diabolical situation in the hospital. Neu’s doctor did a little dance and almost kissed the ground when the porter came to take him to the surgical unit.
I fully support the strike as the constant lack of even the most basic supplies is not something new, nor is the 2 month late payment of salaries (we witnessed these problems back in June and they are just getting worse) but as I say, we were lucky that Neu’s surgery went ahead. I think he was one of the last to be operated on and the strike began at 6 pm that night, hence when the reception nurse left, there was no one to replace her and consequently no one to give me news.
The only other person in the reception area was a woman called Andrea whose mother had gone from surgery to the recovery room. Andrea chose to stay with me until we had some news of Neu for which I was very grateful and relieved not to be on my own.
Around 7.30 through the small window in the surgery unit doors, I saw the aneithatist walking past. Andrea and I leapt up and banged on the door to get her attention. She said the surgery had just finished, it had been extremely complicated, full of surprises which gave the surgeons quite a headache but Neu was fine and I should go back to the ward and try to rest, he would not be out of the recovery room for a good few hours but all was tranquil, he was fine.
I was so relieved I cried a few tears on Andrea’s shoulder. Then with perfect timing, Andrea’s mother was brought out of the recovery room to go back to her ward, so then it was Andrea’s turn to cry. After a quick supportive hug and expressions of gratitude we went our separate ways.
Neu came back to the ward around 10pm, quite off his head on morphine and with a huge bandage from his sternum to his pubic bone. He looked a bit shell shocked but managed a watery smile. All in our ward joined in my sigh of relief, including the man whose surgery had been cancelled earlier in the day for not being urgent enough.
Bright and early the following morning the surgeon came to see Neu. He said that on opening Neu up they had the biggest shock, it was as though someone had tipped a bucket of glue into Neu’s intestines, they were virtually all glued together with so many fibrous adheisions and complicated knots. He had never seen anything like it in his life and said the pain Neu must have been in didn’t bear thinking of. Frankly he didn’t know how Neu had survived.
However the surprises didn’t stop there. They found what they thought was his bladder but in the wrong place. The surgeon explained that in some forms of pancreatic disease the bladder can become displaced and that might be an undiagnosed condition with Neu. Fearing they might have nicked it while opening him up, they inserted a catheter and filled his bladder to check for leaks, only the thing they were looking at didn’t fill up.
From the multiple ultrasound and CT scans Neu’s had, the surgeons knew that he had 2 abcesses but this thing turned out to be (in the surgeons words) "a beautifully organised" 3rd abscess lying across his lower belly. No one could understand how the thing had remained hidden, it was huge yet doesn’t appear on any of the scans.
Oddly enough a few days back when Neu had an episode of colic, we had seen this large sort of sausage shaped form rise up from his belly (watching the rise and fall of his belly was like watching for Alien) but by the time the doctor came, it had gone back down again. When we told the surgeon about it, he said yes that would have been the abscess.
The two larger abscess were cut out and the smaller one drained. One of the larger ones was over the area of Neu’s appendix but it is still whole and not implicated in any of this, much to my surprise.
Then began the painstaking work of separating the intestines, which was what took so long. Several surgeons came in to lend a hand having finished their own surgery and hearing of this unfolding problem in surgery room 7. The surgeon made several attempts at putting Neu’s intestines back in a way that wouldn’t let them roll up on themselves but they were not playing ball and he had to do it repeatedly before they finally settled down, which conjures up some images in my head.
Unfortunately the adheisions are likely to come back but knowing what they do about Neu now, we should be able to get him seen and treated in the future before the problem becomes so serious.
As to what caused all this; the surgeon thinks it probably started with the surgical procedures to insert the peritoneal dialysis catheters. Neu had to have the first one removed due to a post operative infection he picked up during the initial surgery, then a 2nd one was inserted. He then had a bout of peritonitis at a later date and the surgeon believes that these events led Neu’s body to over produce fibrin, with the problem being aggravated by the dialysis fluid itself.
Any abdominal trauma, including surgery, severe bruising and infection, can lead to the formation of adhesions. Many people have little trouble from them, however for some, like Neu, they cause serious and life threatening intestinal obstruction. They do not show up on CT or ultrasound scans and the only treatment in severe cases is to surgically remove them, which increases the risk of them forming.
Neu has a long way to go until we can go home, he needs to build up to eating solid food for a start. The surgeon had asked for him to be fed intravenously but owing to the strike there was no one to insert the catheter that is needed for that and so another doctor ordered Neu onto a limited liquid diet, which meant herb tea and watery fruit juice. After I had a bit of a hissy fit that my husband was far too skeletal for my liking, which sadly is not an exaggeration, they found some vitamin mix to add to his lunch time juice and the surgeon told me this evening that Neu will go onto thicker liquids tomorrow.
Neu is also due physiotherapy to help get his intestines working normally again, they know the faster that happens the fewer new adheisions will form but as with everything else, that will have to wait until after the strike.
Meanwhile I’m doing my best to get him up and walking, we totter up and down the corridor and maybe tomorrow will go on a longer voyage, it’s exhausting for Neu and he aches all over but as the surgeon said, Neu’s certainly tough and the worst is thankfully over.