Map of life expectancy at birth from Global Education Project.

Thursday, September 29, 2005

Ileus . . .

is not a legendary Greek hero.

For those of you who are newcomers to this site, a while back I started to tell the story of my own disemboweling by surgeons who were under the erroneous impression that I had colon cancer. I digressed to tell about the disgraceful and appalling treatment of my Russian roommate, who spoke no English. Now I owe the rest of my story, so here’s the next installment. It's too long for a blog post but that can't be helped.

I’m still hooked up to a urinary catheter, a morphine drip, a nasogastric tube continually pumping out my stomach, and plastic sleeves on my calves that continually inflate and deflate. I haven't had anything to eat or drink for several days.

Normally, waves of contraction travel continuously down the intestines, moving the food along as it is digested, and eventually out the exit. Now think of your distant ancestor whose abdomen is mauled by a saber-toothed tiger. His only hope of surviving is for the system to shut down, so that feces aren't pumped into the abdominal cavity and lacerations have a chance to heal. Actually, it's probably not a bad idea for even the carefully re-sewn juncture created by surgery -- called an anastomosis -- to have a chance to knit free of strain.

Also, my fever was too high. Usually, this is a sign that the patient is failing to clear the lungs, because of shallow breathing and inability to cough. I would just have to cough. Alas, it was impossible.

A woman came with a plastic device that could measure the volume of my inhalations. Every hour, I was to suck on this thing ten times and try to make the little yellow cylinder rise as high as possible. What they didn't tell me was that I would be billed $25 for her 30 second visit and $39 for the plastic doohickey, which was easily worth $4.50. Actually, they billed me for two visits by the respiratory therapist, one of which never happened.

It was a great day, though. The head surgeon came to see me and I asked him to get the damn tube out of my nose. He did it! He told me to take a deep breath then he pulled it right out. Then I asked him to get those damn inflating booties off me. He made a deal with me. He would do it if I would walk. It didn't seem possible, but I was willing to do anything. Nurses came and pulled off the booties. Then they took the catheter out of my penis. They waved a syringe at me the size of a coke bottle, but not to worry. The syringe was to draw out water through a little bypass off the main tube. The principle of the thing turned out to be a water-filled balloon inside my bladder that kept the catheter in place. Once the balloon was deflated, they just pulled the whole apparatus out. The sensation startled, but it was tolerable.

Now the trick was to stand. I still couldn't sit up on my own, but the magic bed could get me into a full sitting position and, with the help of the morphine button, I could get my legs over the side and slide my feet down to the floor. With a nurse pushing the IV pole, I walked down the hall 20 feet and back. I needed someone to lift my legs back into the bed, but you have to admit, all of this was progress. It was painful and strenuous, but was advertised as having multiple benefits. Not only would it prevent blood clots from forming in my legs, then breaking off and killing me, but it was the only known way to encourage the bowels to start operating again. My assigned goal in life now was to pass gas. I should let them know right away if any should depart my posterior.

Then the chief surgeon came again and told me I could have something to drink immediately. He put me on what is called a Full Liquid Diet. He gave me his card. "After you're discharged, I'll want to see you in a couple of weeks. In the meantime, if you have any problems or questions, just call." The card read: "Beth Israel Hospital, a major teaching hospital of Harvard University. Andover G. Knozall, Instructor in Surgery."

Debbie, my regular nurse, was off that day. Nurse Huang gave me a lunch menu. Mirabile dictu! I could order tomato soup, vanilla pudding, cream of wheat. I lustfully circled my choices. Then Ms. Huang told me I could get juice from a refrigerator across the hall.

It turned out the juice came in a little container that looked like a urine sample. I drank some apple juice, trying to be cautious, but it was gone in a minute. I will not try to describe this experience; you can imagine what it meant after nearly a week with nothing getting past my front teeth except a wet sponge on a stick.

I waited a half hour or so and still felt fine, so I went for a urine-sample container of orange juice. I was on my way out of there! I got a little anxious, though, the next time I got up to walk and discovered that my abdomen had blown up into a hard, geometric hemisphere. When my lunch came, I was too bloated to eat. I was sick, getting steadily sicker.

I began to feel surges of pain in my abdomen, always in the same place directly below my navel. As each one subsided, my diaphragm would spasm and acid would burn through my chest and into my throat. My friend Peter, who is a physician, came with his eight-year-old son. JJ had brought me his electronic baseball game, to help me pass the time.

In the end, that people care for you is the meaning of life. But pain, in its time, is the whole universe. The cramps came every minute, and grew stronger every time. They would start in a tight focus just below my navel. Then pain would swirl through my belly and explode into my groin and up through my chest and neck like a cluster bomb, trailing acid fire into my throat. After every attack, I violently gulped the air I would need to make it through the next one. My memory of this whole episode is a blur of agony, but I am sure that my nurse knew that I was in serious distress before Peter and JJ came. She paged the intern on duty right away, but he didn't come for more than three hours. By the end of that time I thought the spasms would break me in half.

Peter did everything he could to help. Even though he is a doctor, it was not his place to intervene. He tried to talk me through a meditation exercise to conquer the pain, but I could not concentrate. I was not simply in pain: I was possessed. My body was no longer my own. I wanted JJ to leave, afraid he would be hurt and disturbed by what he was seeing, but I didn't want to send him away either because I wanted him to know that I liked having him care about me. It was up to Peter, anyway, and Peter let him stay.

Peter urged nurse Huang to page the intern, again and again. She argued with him, defending her own conduct. Finally he threatened to call my attending physician -- Andover Knozall -- at home. Five minutes later, the intern came. His name was Dr. Huang. No relation? I don't know.

"Ileus", he said to Peter, who agreed with him. That's a fancy word for the paralysis of the bowels I'd had all along. Peter had explained to me that the cramps came from the bowels starting to work, but without coordination. One section might start a wave of contraction that met up against another section that was locked up tight. The problem came, ultimately, from the apple juice I had drunk that morning. My stomach was trying to send it on down to intestines that just weren't ready.

Dr. Huang said he was going to pump out my stomach. Peter and JJ left the room. Dr. Huang had a little roll of thin orange tubing. He cut off a piece and dipped one sharp looking end in some vaseline. Then he stuck it up one of my nostrils. It felt exactly as though he had stuck a burning match up there. "Don't do that don't do that don't do that" I yelled. I couldn't yank my head back because it lay against the mattress. I couldn't struggle with him because I was paralyzed by another cramp. The match burned back through my skull and down into me. "Where is it?" Dr. Huang asked.

"My throat my throat my stomach my stomach take it out take it out." Then I gagged and vomited onto Dr. Huang's shirtfront. I vomited again, and a third time. By then, he had a bowl under my chin. The tube came up with the brown glop in my stomach, and I pulled it out of my nose. The cramps eased.

Peter came back in and he helped Dr. Huang change my smock. "Actually," Dr. Huang said, "I'm more concerned about his fever. It should be going down by now. It's still 102." I was lying back exhausted. Peter and Dr. Huang left. I still had cramps, and they still came every minute, but they stayed in that tight little focus under my navel, no longer exploding through my vitals. Every minute, a little surge of pain. But no more cluster bombs, no more back arching and throat clenching.

Nurse Huang came in. "I did everything correctly from the standpoint of nursing. Your friend was wrong to say he was going to call the attending." She leaned over to lecture me. Yes, the nurse actually made a point of coming in to berate me. Now think about it. If this had happened to me on the sidewalk in front of the hospital, somebody would have called 911 and I would have had help within minutes. My mistake was to have a medical emergency in the hospital.


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