Down but not Out

Yesterday marked four months since my most recent surgery, at the Mayo Clinic in Rochester Minnesota. No, not going to say “four-month anniversary,” a major pet peeve, because the “anni” in “anniversary” is Latin for “year.” I regard the misuse of this term as one of the many symptoms of our ongoing decline, if not an actual cause.

So far I’ve had four surgeries and four hospitalizations in less than two years. The first surgery was to remove a stage 1 tumor from my lower GI tract. It was, or least should have been, a routine surgery followed by a routine recovery. But as they say, “mistakes were made,” and so what should have been a brief hiatus turned into a genuine saga. But with any luck the Mayo Clinic chapter will be the final one of my Health Care Adventure.

The Mayo tells you “three months to full recovery,” but with an asterisk. You’ll be moving about, going about life normally, or at least simulating your normal routine. But you will have lingering issues for probably another year, if not longer. There continues to be pain, manageable but persistent, I have yet to fully recover my energy and stamina, and certain rather important parts do not as yet work correctly.

The good news is that I’m alive and mostly functional, and that almost didn’t happen. The failure of the original excision surgery caused a bad case of abdominal sepsis. Not that there are any “good” cases. And twenty five years ago that would have been the end of it. “Sepsis” would have been my official cause of death, because until quite recently, literally everyone with this condition experienced that outcome.

But timing is everything, and recent advancements in the treatment of infection have trimmed that death rate. Now only about 40 percent of those with abdominal sepsis die.

I was lucky. Most of those who survive my particular condition are in hospital for months. I was out in 13 days. And between the good genes and much-improved infection control, I came out of it reasonably intact, albeit with a very lengthy recovery. Which was interrupted 6 weeks in by yet another emergency surgery and week-long hospitalization, this time to drain a painful, potentially deadly, fist-sized abscess on the abdominal wall next to the sacrum. But even with that interruption, full recovery was still on the table. And once that was complete, after a year or so, I would be able to go forward with the restoration surgery. That was the plan, anyhow.

But they didn’t entirely kill off the original infection, which simmered. They also left an avenue for additional infections, which happened one after the other. A time bomb was ticking in my gut, poised to cause a cascade of dreadful conditions that would culminate eventually in death. Not all at once, mind you, but gradually, with increasing debility, and pain like you couldn’t even imagine. The exact timetable was fuzzy, but the outcome wasn’t.

I found all this out the hard way. The Mayo Clinic was supposed to restore me to normal function, to make me whole again. But the scans and examinations carried out in service of this goal found chronic infection and much damage, far too much for there to be a positive outcome. So no joy.

We had to go in a different direction. Dead and damaged tissue had to be removed, avenues of infection closed, and grafts performed to fill the void left by the infection. The surgery would require three teams of specialists, and could run to eight or nine hours, a long time to be under full anesthesia.

They weren’t sure about the true extent of the damage, so there was a Plan A and a Plan B, either of which could be put into effect depending on what they found when they cut me open. The damage turned out to be severe but not catastrophic, so surgeons were able to go forward with Plan A. I was on the table for a little over six hours. The surgery was to be followed immediately by antibiotic therapy to purge all traces of infection.

The first round of infection control, following the sepsis incident, had involved weeks of intravenous antibiotics. At the time this made only limited sense to me because, as I understood it, the infection was mostly in the lining and the nooks and crannies of my gut. Intravenous drugs would only get the infection inside the tissue, I reasoned, but potentially leave unmolested any pathogens floating about in the gut cavity. Why not also attack this infection directly, by washing the cavity with antibiotic solution? I posed this question to my care team of the time. Well we just don’t do it that way, was the response, accompanied by a look of annoyance, as though I had said something really dumb.

But that is exactly what Mayo did. They hooked me up to a gallon bag of antibiotic solution, which flowed by gravity through a tube into the abdominal cavity. Another tube, connected to a vacuum pump, served as a drain. After 24 hours, the lines were switched, and what had been a drain became a source, and vice versa. After 48 hours, a doctor said “enough.” And that was that. They didn’t even run blood tests. A visual inspection of the drainage was sufficient to make the ruling. Color is about right, no sign of cloudiness hence infection. Good to go. Low-tech, simple, effective.

The initial recovery was somewhat complicated by a respiratory virus that was making the rounds in Rochester. Carolyn got it first, and then gave it to me. The principal symptoms were a hacking, persistent cough and a mother lode of phlegm. Nearly four weeks it took to get rid of that little malady. A time or twenty I feared I might burst my stitches, so intense were the coughing fits, which came along roughly every five minutes. That didn’t happen, but the spasms did cause the inner bladder wall, inflamed from surgery, to bleed profusely. You haven’t lived until you’ve passed urine the color of port wine.

Anyway, life goes on. I’m alive and in relatively good shape, considering. It could have been much, much worse.

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