Reflections on Surgery and Recovery

I am sitting now in my parents' backyard in Lexington where I grew up. It is hot, but the red oaks on the southern edge of the lawn are giving me ample shade on this late August afternoon. The breeze is cool and light, rustling the leaves and stirring the half-dried-out grass. I have been here nearly two weeks now following an emergency open bowel surgery that took a chunk of my colon along with my appendix and part of my small intestine and kept me in a Connecticut hospital for ten days. August has been an intense month.

I had been down in Connecticut with Toni for a family reunion. After dinner on Saturday, I started feeling mild stomach cramps, but I chalked it up to gas and went to sleep. I awoke later that night around 1:30am feeling quite bloated and in intense cramping pain. Getting up to use the bathroom I found that I couldn't stand up straight, and I wasn't able to pass any gas, so I woke Toni. This was more intense than any normal gas pain, and I guessed that what was that I was experiencing was perhaps appendicitis, but I wasn't sure. After weighing what to do, I asked Toni to drive me to the ER.

In the time it took to get to the hospital, the pain only worsened, but thankfully I was processed fairly quickly once I arrived. I was admitted and put in a room before being wheeled off for a CT scan. Toni and I spent the night worrying and waiting and hearing other patients suffer in the rooms around us.

In the early morning, I was informed by a surgical P.A. that I did not have appendicitis. I was suffering from a condition called cecal volvulus, which happens when the cecum -- the beginning of the large intestine (AKA colon) -- twists "like a balloon animal" and causes a major intestinal blockage. This condition is fairly rare, especially for someone of my age, and for me it was the result of a congenital lack of certain connective tissues on that part of my colon, causing it to flop around inside my abdomen. Apparently, it is quite difficult to predict or prevent cecal volvulus before it happens. I had not had any previous digestive issues or any other sense that I was at risk. It was a total surprise and, as far as I understand it, just plain old bad luck. Still, due to the severity of the issue, I was going to need surgery quickly to remove that part of my colon. What was originally meant to be a weekend trip turned into an ordeal.

Soon after learning about the impending surgery, I was able to get in touch with my parents, who immediately packed their bags and drove down to meet me. The surgery was scheduled for noon, and they arrived in time to wish me well. I was rolled into the operating room, which was bright and sterile. The anesthesiology team lay me down on the table and put an oxygen mask over my mouth and nose. My left arm was stretched out, and I told them my name and birth date...

...When I woke up I was in a new room and sore. My wound was covered in an adhesive bandage. I don't remember if my parents and Toni were there then, but they must have arrived soon after. In all honesty, I don't remember much about the rest of Sunday. I was on narcotic pain medication stronger than morphine and delirious, but the extreme cramping pain had been relieved and my intestines had been successfully resectioned.

It took until yesterday, three weeks after the surgery, for me to work up the courage to read through the description of the operation that they provided with my discharge papers. 

SOMEWHAT GRAPHIC DESCRIPTION AHEAD (skip to next caps)

In layman's terms, the procedure went something like this: My abdomen was cut open from three inches above my belly button to around 6 inches below it through my skin and the flesh and membranes beneath. Inside, my intestine looked much like the surgical team had expected -- floppy, twisted, and swollen full of partially digested food. Fortunately, the twisting hadn't caused any circulation loss and so my intestine didn't suffer any tissue damage. The surgeon untwisted my colon and made the final decision to remove the troublesome section to prevent this ever happening again. My cecum was removed along with the parts of my digestive tract on either side -- from the end of my small intestine to halfway up my ascending colon. Since the appendix is attached to the cecum, that came out as well. The two ends of my bowels were now different sizes, so they attached them side-by-side like a pair of pants with the waist sewn up using permanent titanium staples. Then they closed me back up with dissolving stitches on the inside and more staples on my skin.

END OF GRAPHIC DESCRIPTION

Thinking back on it now, I have such deep respect and gratitude for both what is possible with modern medicine and for what the body is capable of. It is amazing that this procedure will allow me to heal fully and go back to my normal life within a few months. It is incredible that my body is able to adjust to losing part of my intestinal tract with such resilience, and more amazing still how quickly the wound sealed up and how relatively little pain I felt within a few days of the surgery. 

Slowly, in the days that followed, I weened off of the narcotic, and I was given fluids and nutrients through IV. The first three days after the operation were my most delirious. I was experiencing persistent nausea and, due to the trauma of the surgery, my digestive tract stopped functioning temporarily. As such, I wasn't able to eat or drink anything and wasn't having any bowel movements at all. Walking was a challenge. I couldn't look at screens without getting nauseous. However, over time things began to slowly improve. My bowels started moving again, and the nausea and bloating got better. Every morning when I would take my first walk of the day I could get a little further down the hall.

It's difficult to describe how those first few days felt. It was like my animal survival brain took over for a while and all I could think were simple thoughts. Keep your head still to not feel nauseous. Sit up slow; unplug the IV pumps; walk slow to the bathroom. Externalize the pain. Breathe, breathe, breathe. It was one of the most challenging things I have ever been through. The first night that relief finally came and the pain and nausea eased I cried and cried and cried.

There is so much more I could say about my experience -- the euphoria of tasting a popsicle after not ingesting anything for a week; how it feels to have IVs in both arms and to have to unplug the pumps and organize the cords and tubes just to use the bathroom, which at times happened twice an hour; the fluctuation between extreme frustration and extreme gratefulness toward one's own body -- it's an experience that has shaped me in profound ways. That said, I will close with this thought:

I think conceptually a lot of us associate medical care primarily with doctors. When we go for a checkup we say we're "going to the doctor," all of the shows about medicine are primarily from the perspective of doctors. However, my experience having two relatively long hospital stays in the past two years has really reinforced for me just how many people it takes to care for a patient. I am incredibly grateful to my surgeon for, with no exaggeration, saving my life, but I am also deeply grateful for all of the registered nurses, certified nursing assistants, physician's assistants, radiology technicians, patient transporters, hospitality workers, and cafeteria workers who cared for me and made me feel comfortable day by day, hour by hour, and minute by minute. I grateful to my parents, who dropped everything to come and care for me while I was in the hospital, and to Toni for being the partner that I needed in a moment of crisis. I am grateful to everyone who has sent messages, letters, flowers, and food while I recover. You are appreciated.

With love,

IJ