His "Holey-ness"

WARNING -- This post contains photos of the holes in Master's belly where wound infections occured. They are NOT pretty. If you are prone to be squeamish, this might be a post that you simply want to skip...

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There are two open wounds on His belly. The central one is along the main surgical incision. It was the first to show up with signs of infection and was opened the first day we took Him back to the hospital. The smaller opening, off to the side, is a second infection site in one of the trocar incisions. Both exhibit "tunneling," which means that the actual wounds continue under the surface for some distance.

Right now, we are packing and dressing these openings twice a day. We are hopeful that Master will have a wound vac by Wednesday. From what we understand, the wound vac exerts negative pressure on the wounds and circulates pure oxygen into them. Both of these things help to promote much faster healing. From what the home-health nurse told us yesterday morning, it could be that, with a wound vac, these could be healed in 2-6 weeks.

Anyway, if you are into some wicked looking post-surgical complication pictures, here's the post you've been waiting for.

swan

Home?

I am almost afraid to say this here, or anywhere -- afraid to jinx it.

So, whispering in a very tiny little voice --

They say that tomorrow, Master might get to go home!

There'll be four different antibiotics to be administered intravenously, and 3x a day dressing changes until the wounds in His belly heal -- perhaps a couple of months or more. That is all a little daunting, and logistically complicated, but we will manage.

T came down to visit this evening, and I packed up most of our accumulated "stuff" and sent it home in her car. Most of it will just sit there in the back of the car until I can get home with Himself tomorrow afternoon, but it is out of the room, and won't have to be dragged out when we finally get the discharge...

I am excited, but also subdued; realizing the size of the mountain we still have to climb to get Him well and strong again. Keep your fingers crossed, friends. Tomorrow we go home again.

swan

Infection

T is home and doing well on this 7th day after surgery. It worries me to death that she is there by herself, but I simply cannot figure out how to be two places at once.

Master is still hospitalized, and really struggling. The doctors have FINALLY decided that He has a major wound infection. They re-opened His incision this morning, and extracted a lot of clear, foul-smelling fluid. It is now packed and covered, and they are running two different IV antibiotics. It does appear (to my untrained but dedicated eyes) that the angry red is receding on His belly this afternoon.

We still have no verdict on what is causing His diarrhea, although it does seem to be slowing down. Perhaps it really is a normal post-surgical bowel pattern. I hope so.

We were visited just a few minutes ago by an infectious disease specialist who has indicated that they will be establishing a PICC line and starting a course of vancomycin in the next 24 hours. This will be some pretty intense treatment, but feels promising as an approach to fixing all of this. I hope!

This afternoon, I've gotten Him cleaned up and into a fresh gown. He is now tucked back in and sleeping fairly comfortably. I am almost daring to hope that maybe things are improving a bit.

swan

Now I am Angry

We had an absolutely awful night last night.

Master had a serious coughing fit that lasted well over an hour starting at about 1:15 AM, and in spite of our repeated requests for something to help manage the ferocity of the cough, or at the very least, some way to reduce the pain He experienced because of it, we were met with indifference, hostility, and a general attitude of condescension. When I finally got stomping angry over it all, the night nurse gave in and called the resident to come look at the situation. He insisted that they wanted Master to keep coughing; that coughing is an important part of getting well; and he was simply unwilling to give Him anything to quiet the spasms. When I got my back up and told the arrogant jerk that this was NOT simply coughing; it was violent and wrenching and was leaving Him gasping unable to catch His breath. The best that the "medical professional" could offer -- IV morphine for the pain. There was just one problem with that BRILLIANT idea... Master's IV port had stopped functioning at around midnight, and no one in this supposedly "excellent" hospital was able to get a new IV started, even though four so-called "experts" tried. Some of those efforts were just brutal. They finally gave up on the whole business, and the coughing calmed on its own. At about 3:30 this morning, He and I finally fell into an exhausted sleep. We were not awakened by the usual parade of residents until 6 AM.

They did finally find someone who could efficiently and effectively re-establish His IV port this morning, and so as of now, He is once again being given IV fluids and antibiotics. He's also been given the go-ahead to restart clear liquids, so He's been given some apple juice and some sugar-free jell-o and a little warm tea. He did regurgitate a bit of that, but so far most of it seems to be staying down.

This morning, He has experienced repeated bouts of diarrhea, and there is some thought that perhaps He has now a C-diff infection. We are waiting to be able to get a stool sample that can be cultured. T is at home, and doing well, but understandably worried and wanting to be able to see Him. I may go home and get her later in the day and bring her down for a visit, but I am reluctant to do that until we know what we have going on here. She is doing so well. We do not need to expose her to some nasty bug and send her into a tail spin.

Mostly I am angry -- beyond angry, I am furious. The very excellent care that both Master and T received in the days immediately following the surgery has devolved to a style of medical practice that is seeming resentful, parsimonious, and just at the verge of neglectful. I am very aware, this morning that, had I decided not to spend the night here last night, He'd have been all alone in the face of the coughing and the horrible IV debacle; and no one would have cared. I find that just outrageous.

I am exhausted, but I am more than determined than ever that, one way or another, we will get the care that is needed here, and He will get better, and I WILL take Him home.

swan

Friday Evening Update

It is Friday evening, and I have been here at the hospital with Master since about 12:30 this afternoon. When I arrived this afternoon, He was miserable. He complained of more or less continuous "regurgitation" of liquid into His throat in quantities that would certainly cause choking if He were not constantly swallowing and/or spitting it into a basin. The coughing and throat clearing and gagging attendant upon all of that was making His already tender belly very sore and achy. On top of that, He hadn't slept (except in brief snatches of a few minutes here and there) in well over 24 hours. Now, some 6 hours later, He is freshly showered and installed in bed, resting comfortably for the first time in about a day and a half.


The working diagnosis, at this point, is that Master has a post-operative ileus -- a temporary paralysis of a part of the intestine, causing food and liquids to back up rather than flowing through as they should. This is apparently a fairly common complication after abdominal surgery. The doctors do not seem to be terribly concerned, and are basically telling us that the treatment of choice is to "rest" the


I've been in regular contact with T, who remains at home, and she continues to do well and feel good. She has reduced her pain medication, and feels really well. We've discussed it, and as it stands right now, I'll likely spend the night here at the hospital with Master. If T needs me, a phone call can take me to her side in about 25 minutes.

One really good piece of news in all of this confusion and worry -- As of this morning, four days out from surgery, Teresa has lost a total of 21 pounds. How kewl is that?

swan

Here we go again

I'm home.
Master is not.
They've admitted Him to the hospital and will be administering IV fluids.
He was feeling some better when I left, but surely not as well as we'd hoped He would be by now.
I'm going to try and get a bit of a nap. I am simply fried from lack of sleep.
His clothes are in the washer, and when they are dried and ready to go, I'll gather up the things He will need and head back.
This was the thing I dreaded -- that Master and T might end up in two places, and I'd not be able to be around for them both. Fortunately, T's mom will be down this afternoon, and so perhaps there'll be a bit of coverage at that point.

Meanwhile, I am trying to stay calm. This is a bump. The doctor is taking a very serious, very conservative approach, but then that is likely why his mortality rates for this surgery are so much lower than most other surgeons. He'll treat whatever this is as aggressively as possible, and soon Master will be home and feeling better each day.

swan

Day 3

What a difference!

We slept last night -- all of us (although the hospital "chair-bed" was a horribly uncomfortable sleeping platform, and has been summarily banished to the hospital corridor).

T is doing wonderfully; taking in clear liquids and off of all her pain medications. She had an exciting early morning as she got her IV tangled in her bed sheets and then pulled it out. She was on the way to the bathroom at the time and so proceeded on in to pee and then trooped down to the nurses station to get it taken care of -- dripping blood the whole way (can you see where I am going to have trouble with her behaving well once we get out of here?). Anyway, she is completely off the IV, and had her first shower this morning. Hooray!

Funny sidebar storyline -- we have a weird, geeky little resident dude that is always the first one into the room in the morning. He is awkward and lacks even a rudimentary personality, and his bedside manner is rough and jerky. He encountered our T in the hallway this morning (at 5AM) trucking to the nurses station with her hospital gown flapping, dripping blood. Solicitous fellow that he is, he said to her, "you might want to tie up your gown -- it is open in the back." To quote T, "I was dripping blood down my arm! The fact that my ass was showing was the least of my worries."

We do have the official word from the doctor this morning that all of Master's x-rays are fine. Today, they'll move Him off the IV pain medication, and start Him on the clear liquid diet. It is possible that T could go home today; Master will likely be discharged tomorrow. So, one of the discussion topics as we go through the day is whether/if we should do that -- splitting the two of them up, or stay together until they can both go home at once.

For today, the big anticipation is for the return of bowel movements. Both are passing gas and urinating normally, so that is really the last important function.

They are about to bring in "breakfast" trays, so we are off and running for day 3.

swan

Yes, I am...

Selkie is the latest in a chorus of exhortations about making sure I'm taking care of myself along with taking care of the family...

"swan, are you taking care of YOU??? are you eating? drinking lots of water? getting some REST??"

The answer is, "yes." I am eating as well as I can in the hospital cafeteria. The food is not spectacular, but it isn't awful, and there are some reasonably healthy choices. So, I was able to get some Cheerios and a banana and some yogurt for breakfast this morning. I had some pizza and a salad for dinner. Not five-star restaurant fare, but serviceable. I'm working hard to stay hydrated -- I have my trusty water bottle. None of us slept well last night, but I am hoping tonight will be better. With luck, we'll maybe be home in our own beds tomorrow night.

I do understand and appreciate the concern from everyone. Thank you, all. I do know how important it is to stay well and strong so that I can do what is needed for the next few weeks. Further, please understand that while He is currently not feeling strong, He is not unaware, and if I did not take care of Master's property, there would be a reckoning.

I am being good. Relax everyone.

swan

Day 2

This has been an "interesting" day.

Both Master and T were taken for a GI scan early this morning. T's came back good, and she's cleared for clear liquids. She is off the IV morphine, and has had no additional pain medication since about noon. No more catheter either, and that surely makes her happy. She's been walking all over the place and really doing very well. She isvery tired this evening, but then, we all are. Hopefully, she'll get a better night's rest tonight.

Master's day has been more problematic. They worked for much longer to try and get His GI tract X-rayed, and just could not get the contrast medium to pass through. They had to come back a couple of hours later in the day and take another shot, and then later, they took Him back and did more X-rays AND a CAT scan. Finally, at about 5PM, they decided that all the connections are fine, and that the flow through the system is as it should be. There seems to be trouble with His bowels; they are in some sort of post-surgical shock which is preventing materials from being passed on through as they should be. At one point, in the early evening, they contemplated entubating Him as an approach to relieving some of the internal pressure, but they opted out of that and are simply allowing things to follow a natural course. He is uncomfortable with lots of intestinal gas and cramping. He's also still dealing with some significant nausea. He too, is off the catheter, so that is some progress.

We are all doing pretty well. Things are moving along. Thank you for all the good thoughts. It really is very encouraging to all of us.

swan

24 Hours

We are just under 24 hours into our new lives.
It was a long day yesterday, and a very long night.

We asked the hospital to bring a "chair-bed" so, I'd have some sort of reasonable sleeping spot. No such luck. So, I bedded down in the recliner in the room. It wasn't bad, and I wasn't in it for very long at any one time...

I think we were awake every half hour to 45 minutes all night long for one thing or another. Pain pumps and leg compression pumps seemed to go into alarm mode all night long. There were repeated visits by the nursing staff as they checked vital signs and blood sugars and urine outputs and... Master has had a fair amount of trouble with nausea, and a significant level of pain, so I was up several times helping Him.

This is a teaching hospital, so the parade of wannabe doctors began just after 5AM. One resident after another came in to peer and poke and stand around awkwardly. We saw the surgeon at just about 6:30, and he seems very positive and upbeat, although there is some thought that Master's ongoing nausea might be due to swelling. Hopefully, if that is the case, it will resolve itself through the day today, and things will improve.

Both are scheduled for a GI series this morning. The X-rays will tell doctors how things are moving through the modified stomach and bowel, and will also show any leakages. If those come back "all clear," we'll begin to see some good progress: clear liquids will be introduced and we'll get them off the catheters. If I can get back on here later, I'll update when that has been completed.

swan