SURGERY #2: Pre- and Post-Op

An operating theatre with surgeons performing surgery on a patient. Several medical monitoring machines can also be seen in the room.

A lot has happened in the last two months, and it won’t all fit into a single post. For that reason, I’m splitting the story into a few posts. The first focuses on what happened in the run-up to my emergency surgery at the start of November, the second concentrates on my physical and mental recovery in the weeks afterwards, and the third focuses on my plan for the future. So without further ado, here we go…

THE STORY SO FAR…

For a few months now, we’ve been preparing for my eventual surgery. I’ve been plagued by strictures for years, with partial obstructions cropping up every so often since 2016. Since transferring to my current hospital, they’ve been much more concerned about these, and in August we started talking surgery to deal with them. They’re mostly fibrotic strictures, and the only cure for these is surgery. So I met with a surgeon and we started talking. 

We planned for a strictureplasty: an operation to widen a narrowed segment of bowel. Specifically, a Michelassi strictureplasty (also known as a side-to-side isoperistaltic strictureplasty), which is most advantageous with a long area of narrowing, or several strictures at once. I had both! I was told I’d have a diverting ostomy afterwards, to let the site heal without stool irritating the anastomoses or increasing the risk of internal leakage. I wasn’t bothered about that, it wasn’t the problem. The problem was that I just wasn’t fit enough for surgery. I was so underweight that my risk of complications – both during and after the surgery – was too high. My surgeon didn’t want to take the risk. So in August I was started on TPN, and was discharged at the end of August to continue TPN at home.

SINCE THEN

Fast-forward to mid-October and I’ve gained six kilograms, and we’re discussing transitioning to enteral feeding to lessen the psychological burden. I have an NJ tube placed, start feeds, and look set for discharge. While you’re here, they say, let’s do an MRI. So I do, and wait for a couple of days while they read and discuss the results.

Then one evening my surgeon turns up after dinner.

The MRI showed that there are two main areas of concern in my bowel: not the stricturing itself, but the dilatation (widening) that preceded it. As the bowel widens, the wall of the intestine gets thinner – putting it at increased risk of perforation. And mine was wide enough that they were freaking out. Leaving it to widen any longer would be a risk my team weren’t prepared to take. So although I still had at least 4 kg to go before I’d be at a ‘healthy’ weight, my surgeon came to see me. “I want to do it tomorrow,” he said. He must have been concerned, because ‘tomorrow’ was a Saturday.

I blinked. “Okay,” I said. There was a pause. “I mean, I’m not going to say no,” I added.

And the rest was just logistics. Consent forms, nil by mouth, et cetera. They come for me the next morning, and I joke with the junior anaesthetist, but my eyes follow the consultant as he locates vials and draws up syringes. He slots a syringe of milky liquid into a syringe driver (That looks like propofol, I think in an odd disconnected manner) and, after reviewing my consent form with me, turns to me. “Okay, Emma, I, just going to give you something to help you relax,” he says.

“Sounds good,” I reply.

And then my memory goes black.

AFTER

I wake up in a room that resembles a ward, but oddly industrial – a combination of ward and warehouse. No walls, only curtains to give each patient the illusion of privacy. Every spare space is filled with a trolley, or a computer, or a high-tech piece of monitoring equipment. This is Overnight Intensive Recovery, where patients requiring critical care in the short-term after surgery are monitored until they are moved to a ward. The details of the ward are fuzzy, not because I wasn’t wearing glasses (someone thoughtfully put them back on for me before I woke up) but because I couldn’t find the energy to care at the time. 

I remember only details: being so relieved that I was alive, and my parents were there, that I couldn’t stop talking. The lingering sedation stripped away my filter, and I said exactly what I was thinking. My dad couldn’t stop grinning at my candour. 

At night in OIR, nursing care is one-to-one. I found it comforting. My family thought it odd, but I felt safe that way. My nurse that night is named Eleni, and knowing that she is watching to make sure I didn’t spontaneously stop breathing was reassuring. Even though it wasn’t really necessary. I am hooked up to all sorts – oxygen, an arterial line in my right wrist to measure blood pressure (although that soon stopped working and needed to be removed), a drain in my abdomen, a urinary catheter, fluids and my patient-controlled analgesia through cannulae. I feel like a science experiment, an alien creature kept alive artificially. I have a third cannula in me, too, a massive grey thing in the back of my hand. I wondered what it was for, but only got my answer the next morning. 

“You lost some blood during the procedure,” my surgeon informs me, “so you got a transfusion while we were working.”

“How much did I lose?” I ask, curiosity killing the cat, as always.

“About a litre, a litre and a half,” he says nonchalantly.

Later I would wonder at his glibness. A few days afterwards, I’d do the maths and calculate my estimated blood volume. It is 2.8 litres. So that grey cannula was definitely necessary. 

The following evening the oxygen is removed and I am moved up to the surgical ward. This feels jarring, especially since I had gotten used to the gastroenterology ward downstairs. The nurses all knew me, they felt like friends. Up here I knew nobody, there were two more patients per bay, it was loud, boiling hot, and I was the youngest patient in the room by at least twenty years. I felt miserable and incredibly anxious… but I was alive. The worst was apparently over, but for me the worst was yet to come.

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