Three and a half small incisions, one stitch, and 6 bandaids.
Thirty-six hours later, and that is what I came away from the hospital with.
Pretty good, I say!
I also came home with gratitude in my heart for our amazing public health care system. Yes, I know it is not perfect, but it is pretty damn amazing.
I walked into emergency at 7am on Friday with really bad cramps, a terrible backache, and a distended belly. I would have expected all those things if I were 9 months pregnant, but I am, afterall, a post-menopausal 59 year old woman. I know that in Property Law we teach about the Rule Against Perpetuities using the hypothical example of "the pregnant octegenarian", but... not the case. So, I had Steve drop me off at emerg. I was quickly into triage, where my blood pressure was registering at 182/115, so i got a lovely little red bracelet, and then was off for an ECG, some blood work, Dr assessment, and CT scan. While waiting for the CT results, the fabulous nursing staff hooked me up with an IV, a pole with a bag of fluids, and shot me up with a mililitre of some delicious hydromorphone to take the edge off the pain.
I will confess that it was a tough day hanging out there, since my mind kept flashing back to 2 years ago, and taking my mom Arta over to emergency because she had a sore back, a stomache ache and a distended belly. So, yes, pancreatic cancer was on my mind while sitting in the very very crowded ambulatory area, remembering all the different chairs I had occupied there with Arta during the last 3 months she lived with us (including a very strong memory of sitting in ambulatory, and her asking me for a pen, and then her using it to take notes on one of those disposal paper vomit bowls they hand out.) [indeed, below is a video I made of her taking those very notes back in 2021] https://youtu.be/GikRpCFrSyI
And so, when the Dr. came back out, sat beside me, put her hand on my shoulder, came in close to my face and started talking, I was prepared for the worst. When she said that the blood work came back totally boring, but that CT scan showed a bowel obstruction, I nearly started cheering! Yea! Only a bowel obstruction!
Yah, yah. I understand that it is technically a 'medical emergency', but it is NOT pancreatic cancer. She told me that they would need to address it right away, so that she was off to make some calls, and to see about getting me admitted for surgery. She also told me before she left that the first thing they would likely do was a nasogastric tube up my nose, to release pressure in my belly. She said that it was a bit of an uncomfortable procedure, but that she would be looking around to find a room to do it in (they were past capacity in ER, so were having difficulty finding open spaces). And off she went, leaving me there hooked up to my IV pole, with my drip. Uh,......nasogastric tube, eh? Heavy sigh. I signalled the nurse over to fix me up with another mililitre of the good stuff.
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| This kid looks way too happy |
So, I was a little bit less happy. An uncomfortable procedure?! Well, THAT is an understatement. I sat beside Arta in a room down the hall back back in 2021 while she got a nasogastric tube shoved up her nose. I would put it a bit higher than uncomfortable (Arta later said it was worse that either the cancer OR childbirth...even worse than "bees!"). I nearly passed out watching it (they had to bring a chair and have me drop my head below my knee level). I also suspected that they were having a challenge finding a room, because the procedure would definately be followed by the announcement saying "Housekeeping, clean up in Ambulatory". I found a picture of one of these nastograstic tubes out on the web for those who don't know what one looks like. I PROMISE you that Arta did not look as happy as the kid in this artistic rendering would suggest.
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| (random internet photo: excuse the expletive in the message) |
I think there is a bit more 'truth in advertising' in a different image that I found out on a web search for 'nasogastric tube'. I think this guy's sign says it all. I was not really looking forward to this option. But what are you going to do?
At this point, my name got called again, and I was directed to another side room, where I 'thought' i would be getting the "nose-prong" but it was instead a visit from the four person surgical team. They said they would get me up into surgery that evening, and talked me through the 'consent-ish' kind of stuff, telling me that there was a blockage, and they would do laproscopic surgery to get in there: three small incisions, and one other little hole. They would fill my belly up with air, get in there with a camera and laser and cut out any icky stuff.
Dr Malik said they wouldn't know the cause of the blockage until they got in there. They could tell there were some 'adhesions' (i didn't look that up til getting home.... just consider yourself lucky that i am not attaching pictures to this blogpost). He said they would expect to see those if I had prior surgeries but...I have not yet had that experience. He did not know yet why they were there, and wouldn't know until they got a look inside. In typical surgeon style, he listed off a bunch of possibilities, like some unexpected growth, or ruptured bits of colon or something like that, and if there was, then they would cut that out and set me put back together while they were in there. At least, in my contented hydromorphinated state, that is what I recall. Off they went, and I was again invited to return to ambulatory to wait (lots of apologies from the nurses, who reiterated that they were at full capacity). I was just happy that the room situation was apparently still too tight for them to set up the nose tube thing.
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| Hanging out with Arta and sibs in 2021 |
Catherine gave me a call from Montreal at this point, and talked me through possibilities. It is handy having a sister who is doctor. She said that I should take advantage of how busy it was, and suggest to the doctors that they wait to do the nose tube until I was already under anaethetic. And so... that is exactly what I did. :-). By 4pm, they had me found me a room over in the beautiful Patient Care Tower, one floor down and three rooms over from the Palliative Care ward where Richard, Mary and I spent a month taking shifts sleeping on the couch bed beside Arta.
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| back in the tower in 2023 |
I couldn't resist taking one quick selfie after changing into the lovely hospital gown.
No, I am not 'making a face' here. I am using the Cree method of pointing with my lips. I am pointing at that red lidded cup behind me, since it is the cup I would be attached to if they hooked up the nasogastric tube!
And below, there is a comparator photo with Arta (AFTER the tube was finally out, but you can see the red cup in the background).
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| Arta, happy now that the tube is OUT. |
When the nurses came back, with the nasogastric tube packages in hand, I told them that I really was feeling quite good, and I hadn't vomitted since the night before, and had no nausea at all! Following Cath's suggestions, I asked if they could just have the doctor put that in when I was already knocked out for the anaethetic. They talked a bit back and forth, and agreed that it had been more than 12 hours since i last threw up, so said they would just write that up on the chart.
I got to rest for another hour while waiting (signing all the expected consent forms on both the surgery, and consent to blood products if needed). They asked me what I like to be called, so they wrote that down, but did add "Rebeca" (sp?) for precision. I guess "she-who-must-be-obeyed" takes too long to say? I dozed for a bit, and then was wisked off to pre-op for another conversation with the Anaesthetic dr person.
It turned out (as is often the case) that the Anaesthesiologist Dr. (Alexander?) had a sister who also graduated from UVic Law (Caroline Alexander?) It made me laugh (does every family need to have one doctor and one lawyer at the ready?). Anyways, we talked briefly about my decision to avoid the nose tube, and he agreed they could skip it and go straight to a tube down the throat. He told me they would put me under faster than usual (to avoid the aspirating vomit thing). All good. Just more initials on the the consent forms, and it was off to lala land.
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| Another photo from my hospital room window |
And before I knew it, I was surfacing in post-op, which seemed quite the party place. :-). I loved hearing all the sounds of happy conversation with the surgical team and nurses while cycling in and out of consciousness (coming from a big family, I feel happiest when there is lots of background noise). Dr. Malik stopped by to tell me that they surgery was successful, that they had cut out the adhesions, but didn't have to do anything else, since there was nothing else in there of interest. He was able to leave my intestines alone. He shrugged said something like "I get one like you every year."
Not quite sure what that meant, but I understood it was a good outcome. My blood pressure was also back at a perfectly respectable 120/80 (which they kept checking what felt like every 10 minutes or so). I hung out there for several hours, drifing in and out. I recall hearing scattered bits of conversation from the post-op nurses indicating that the nurses back at the tower were swamped, so they were helping out by just keeping me in post-op a bit longer? Sometime just before 10pm, they woke me up for the move, telling me that Steve had been waiting downstairs since 6pm, and had finally headed back home once visiting hours had ended in any event. Poor him! (I think i said something like "why was he so stupid!?", but I really meant, "Ah... that sucks! I wish he had been comfortably just waiting at home"). Well... I am sure Arta was on his mind too. A bit of a stressful day for us both, altogether, but it ended well.
Finally, back to my lovely little private room by 10pm, the lights of the city twinkling in the darkness, for a night of sleepy delicious painfree rest. I never knew a bed to be so comfortable (or was that the anaesthesia talking?). I had been hoping for some more yummy hydromorphone when I woke up at 1am, but.... some things don't last. The nurse told me the doctor had already taken me off that and moved me down a level to tramacet. Bummer. But OK. I could live with that. I was, to be honest, so surprised by how much less my belly hurt.
Indeed, the main thing that was surfacing was a brutal headache. By 4am, it was really top of my mind (excuse the pun). I raised it with Jordan (my nurse for the night). I told her I was beginning to wonder if I had a brain tumour. And then the penny dropped, and I realized that I had been a couple of days without coffee. She told me there would be coffee with breakfast at 8am. I told her I could not wait that long. She said they only had instant. I told her I would be happy to just eat the powder with a spoon. She thought it would be better if she mixed it with water, but warned me that she could not guarantee it would be tasty. We both agreed that we could consider this as a request for meds (rather than me asking a highly trained nursing professional to bring me a cup of coffee). She came back with the wateriest cup of coffee ever. I couldn't have cared less. It was medicine to address my withdrawal symptoms, and it did in fact do the trick! |
| yummy cream of wheat with brown sugar! |
Breakfast was "fluid forward" or something like that. The goal was to see if I could tolerate eating without hurling. Now, for some people, Cream of Wheat for breakfast may be the trigger for nausea. But not me! That is my very favourite porridge in the world! I considered asking for seconds, but I was actually a bit full and a bit tired. So... more resting.
And truly, the room itself was so restorative. It was just offering me beautiful views out the window. I did not have my groovy camera with me, but did have my phone, and I could get a number of pictures without having to turn or roll. And so I enjoyed watching the amazing clouds moving across the sky, and over the mountains across the sea. Here are some photos from my "bowel obstruction hospital window series."
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| I liked how the blue grey pallete of sky echos my pillow in the photo above |
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| The construction on the right is on the building beside my family doctor! fun seeing that out the window. |
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| wondering if i can get more wyona lessons on doing cloudy skies in watercolour... |
Taking pictures out the window, I was very aware that it is cold and snowy right now in other parts of Canada. The app on my phone said it was something like 8 degrees here today. Snow drops are up, and some of the trees have blossoms. With this view out the window (and the tremacet still flowing in my veins) I was feeling content with life.
Dr. Malik stopped by soon after, to see what I could recall of our conversation last night, and to see if I wanted the non-drugged version. I did. I asked him why he told me he gets one like me every year (since i was not sure what that meant). He told me that he does lots of these bowel obstructions surgeries. Probably 20 a year over the last 10 years. He says he can usually identify the source of the obstruction. But he says that each year he gets maybe one person where he just can't say why. He said that he had probably had two cases like mine, where he really had no idea. He told me that there were adhesions, and that most of them tore loose when they pumped my belly full of air, and then he just went in and cut out the rest. But he is not sure why they were there in the first place. He didn't see anything else in my belly that was the least bit interesting to him. In fact, everything seemed to be fine. I told him I was delighted to hear that he found my intestines to be particularly boring! He wondered if maybe I had had a bout of appendicitis at some point without it rupturing, which perhaps produced the adhesions. I don't recall such a thing, so... who knows?! But the long and short of it is that this was caught early, while it was still a partial obstruction, and not a full one, and they blasted those sticky bits out of my guts and I already feel better. I am supposed to take it easy for a couple of weeks, and that is it. No need for me to stay in the hospital, so he told me I could stay for lunch, and then gave me the green light to rest up at home in my own comfy bed.
Steve arrived shortly after, so we debriefed while I ate lunch (and kept telling him to move his head to side so I could capture another beautiful view out the window).
And so, three and a half small incisions, one stitch, and 6 bandaids: one bandaid at my elbow from the blood work, two bandaids for the different IV's that got poked into each of my arms, and three big bandaids covering the incisions from the laproscopy. Three incisions (held together with surgical tape), and one little stitch (also hiding under one of the big bandaids on my belly).
Into the hospital on Friday, and home again on Saturday. and no 'bill' to follow. Here's to public health care. Here's to our tax dollars at work. Neither Steve nor I have any complaints!
