The emergency surgery

This was right after dad's emergency surgery. He was still in ICU.

The Emergency Surgery

On November the 20Th I received a phone call from mom around 6:00 a.m. She had to call 911 at around 4:00 a.m for dad. Dad had gotten up to go to the bathroom and that is around the time his small intestines had ruptured. Mom relayed to me later that dad literally had to crawl back to the bedroom because he was in so much pain. I didn't get to the hospital til around 10 that morning. I recorded the conversation with dad's doctor that performed his surgery that day. Only because I have a hard time retaining information and when you're under stress you don't always hear everything at the time. I transcribed it and edited it for easier reading. I'll let the good doctor explain things... This conversation was immediately after dad's surgery on November 20Th. So this is the first we were told of what was going on with dad.
------------------------------------------------------------------------

November 20th 2009

The morning of dad's bowel perforation surgery

Doctor's conversation with family after surgery

Dr.: Your husband was pretty sick, and he got extremely sick last night. Something happened last night that changed his condition. What happened was his bowels perforated. That is that the intestines basically sprung a leak. Now what is normally inside the intestines went all over inside of his abdomen. First of all, that is horribly painful and usually when it happens to people they can tell you the second that it happens because it’s like "my belly is hurting" and then bang! "My belly is excruciating!" This makes you terribly, terribly sick. When I got to him this morning, when you had just left, he was in shock. Shock means that his blood pressure wasn’t high enough to work his kidneys and what we had to do was, we had to reverse that. We had to get medications into him, mostly that means antibiotics and a lot of IV fluid and he wasn’t even in condition to go to the operating room at that time. We had to get him good enough to get him to surgery. That took us a couple of hours. Now we’re finished with the surgery and frankly he’s a lot better now than he was two hours ago, but, that’s a far cry from saying he’s well. He still needs medicine to keep his blood pressure up, which means he’s still in shock, but his shock is much better. We know we can tell that because he’s now making urine and the acid amount in his body is much lower. The problem was that his small intestines for a distance of that far (he was showing us two feet distance with his hands) had died, and the valve (I’m assuming he’s using the term Valve to refer to the small intestines) was kinked up and knotted up in a ball and when the valve dies it blows open and I had to remove all of that. He can live without that and he didn’t lose enough valve that it will be a significant problem but when there is that much dead valve and that much contamination it is not safe to put the pipes back together again so what we do is we do what is called an Ileostomy. The valve comes out of his belly on a bag and if we get him through this, when we get him through this, a month, two months, three months from now, we’ll put it back together again, but it is not safe to do it now while he is so sick, ok. We’re not out of the woods; we need him to recover now. First of all we need his heart and lungs to tolerate the horrible insult that he has had, ok. We need him not to develop anymore infections. We need the wound to heal without an infection. We need him not to get pneumonia and we need his kidneys to continue to work. I would think that by tomorrow, I would hope to get him on the pressure medicine, the medicine that we’re using to keep up his blood pressure. I would think that just by washing him out and taking out the dead valve that we would have a big gain on him making his own blood, holding up his own blood pressure. This is all very complicated and I’m trying to keep it as baseline level as possible. So what we’re sure of is he’s terribly sick and he’s better than he was and I expect he will continue to get better, but, I need some luck here. I need some things to bounce in his favor. Now the question that is behind everybody’s mind is “why did this happen”? The short answer is, I don’t know. At the center of this area of bowel, where it was all drawn together, there was a very hard knot. It was harder than infection, it was harder than appendicitis or diverticulitis and I’m very concerned that there is going to be a cancer at the base of this. I don’t know for sure, I didn’t see it clearly enough if you follow what I am saying, ok. My way is to tell exactly what I know when I know it. There is something very hard in there; it caused the problem because the valve didn’t die on its own. It doesn’t quite work that way. Something else caused it to get bound up like that. We will know the answer to that by Tuesday or Wednesday; it will take that long to get it all taken out. That’s not going to change what I’ve got to do over the weekend. Right now, our first problem is getting him through the acute problem of having the bowel perforation. I can’t stress how big a problem that was because this had been that way over night. At least this didn’t just happen today. I’m thinking this happened yesterday.

Hopefully tomorrow we will be able to get him off of the breathing machine if he wakes up enough. The good news is he is not a smoker, doesn’t have heart disease, doesn’t have lung disease, and doesn’t have intrinsic kidney disease. All of those things are in his favor and he’s not a diabetic and he doesn’t have any other immune diseases that would keep him from recovering. So for all the good things, for all his strengths, I expect that he has a better than average chance for someone his age to bounce back from this, ok.

Mom: Are you checking that spot to see if it is cancer?

Dr.: Absolutely, absolutely

Mom: because they have been running tests on him

Dr.: I know that, I know that

Mom: it has just been terrible.

Teresa: why didn’t this show up in his colonoscopy?

Dr.: This isn’t in his colon; it wasn’t in his intestines either. It’s outside of the intestine and that’s why I’ve waited to see what it is. It was in the tissue next to the intestine pulling the intestine down to a point you wouldn’t find it on any colonoscopy or upper GI endoscopy. I promise, just a bluntly as I am, I’ll tell you when we know what that is. For the time being, my first control is we have a house on fire and my concern is not finding out who set the fire. My first concern is putting out the fire. We have gone a long way, now I need to make sure there are no ashes, if that all makes sense for an analogy. So you can visit with him, ok, but don’t expect him to know you are there till tomorrow. Right now I would just assume let him rest, but at the same time he is going to tell you that he feels better than when he came into the hospital. Washing that stuff out, getting the dead valve out, dead valve is very, very painful, he should feel better. So I believe in prayer, go ahead light your candles and say your prayers and I will be in everyday to see him. If you have any questions you tell the nurses to get in touch with me, otherwise I’m through with the procedure, ok?

Apparently I asked the doctor about the mass and this was his response:

It wasn’t a very big mass at all. It was like an acorn, but I don’t know what it is yet, and I don’t know where it came from. I don’t believe it started there that’s the other thing. So when I know more I will tell you, and in the meantime I have every reason to expect we will get him better, but we need nothing to go wrong, ok? The lower intestines, the part you examine with the colonoscopy, was all fine. It was the small valve, and we have about 20 to 25 feet of small valve, so he won’t miss that. He’ll probably feel better now than he has for months. Alright now, he’s not out of the woods yet, no celebrating yet.