They Did What, Now?

Durham VA Medical Adventures, Part 2

This is the second part of a three part series on my family’s crazy summer, and my personal misadventures at the Durham VA the last few weeks. You can find part 1 here. Part 3 comes tomorrow, and I will share some final reflections on Thursday.

So. If you read part one you know that by the 24th of June, our family was already dealing with a lot of stuff. Willie had ruptured a testicle, Liz had almost lost her battle with mental illness and my stomach was hurting.

While normally I would do my best to ignore it, all I could think about was the fact that I was supposed to fly to Korea and see Matthew on the 28th. My consultation with Dr. Google told me that the pain I was experiencing was usually appendicitis. The last thing I needed was to have my appendix burst in a plane over the Pacific, hours from a hospital. I didn’t want to die on a plane, so Barb and I drove to the VA on the morning of the 24th so I could get checked out.

I was triaged and back in the ER fairly quickly. Some exams and a scan led to a diagnosis of appendicitis and I was told that the goal was to have my surgery within 24 hours. I was near the bottom of the list. The scan suggested I had routine appendicitis, so I was urgent, but not critical. So I would wait until the afternoon of the 25th for my surgery.

At this point I was hopeful that a routine laparoscopic surgery would have me out of the hospital within a couple of days at most. One of the last thoughts I had as I went under was that, with any luck, I would be on a plane to see Matthew in just a few days.

Then, there were two major complications. The first was that the doctors realized almost as soon as they were inside me that the scans weren’t capturing the full extent of what was happening with my appendix. It was not a simple straightforward fix. My appendix had perforated, and had been leaking gunky bacteria inside my system. It had also formed a “rind” - a thick layer of tissue on the outside of the appendix. They needed to get it all out of my body, and quickly.

Then came the second complication. While I was in surgery, my VA medical records dryly note, I “fell from the operating table, disrupting the procedure.”

Yep. You read that right. They dropped me during surgery.

To do an appendectomy, the table is tilted so that the patient’s abdomen is toward the doctor. In my case, the table was tilted and the doctors began the surgery. I was under anesthesia, intubated, and had the laparoscopic tools inside my belly. That’s when, according to the records, I “began to shift position.”

I slid off the table and landed on the left front of my head and my left shoulder.

The team then picked me up off the floor, secured me to the table (for real this time) and completed the surgery. They removed the perforated appendix, sealed everything back up, and sent me for a whole body CT scan (a pan-scan) to ensure that there were no injuries - other than the big ass bruise forming on my forehead - as a result of my fall. The scan came back clean and I went to the Surgical Intensive Care Unit (SICU) for my initial recovery. When I told them my shoulder hurt, I went back to imaging for an x-ray of my shoulder which showed no structural damage. I also received a visit from neurology for an exam. I did not do well on the initial tests, and had to be retested a day or two later.

Over the next couple of days, my recovery progressed. I felt some nausea, which I assumed was just part of recovery. I had to cancel my flight to Korea. I’ll be honest. I cried. Through it all, I had held out hope that I would be able to see Matthew and have our time together. But it wasn’t to be.

On the morning of the 27th, I got my discharge instructions and headed home. From the moment I walked in the front door, it was obvious something wasn’t right.

While I was at home I was either sleeping or violently ill. I couldn’t keep anything down. I felt waves of nausea. My belly hurt. My head felt like it was splitting. My fever was never below 101. I was extremely irritable and uncomfortable.

Barb called the number on the discharge sheet, and was told a nurse would call us back. When no one did, she decided to escalate the matter.

Because of my fall, the VA was extremely accommodating. We received visits from the VA’s Chief of Staff Dr. Goldberg as well as the Chief of Surgery Dr. Lagoo. We also received a visit from Risk Management, and that is who Barb called to say that there were problems and we couldn’t get a call back from either a resident or nurse. Risk Management called Dr. Lagoo, who called Barb. After a brief conversation, Dr. Lagoo told her to take me to the ER immediately and to call her when we were checked in.

So on Monday the 29th I was back in the ER. They determined that I had formed an abscess (think a sack filled with infection) on my abdominal wall. The abscess hadn’t been caught during the procedure because my intestines had wrapped around the abscess to minimize its impact on my system. That abscess had to be drained.

I was taken to Interventional Radiology (IR) which uses imaging tools to help guide surgical interventions. They placed a drainage tube to help drain the abscess and I was admitted to the general hospital ward on the 7th floor of the VA.

The night of the 29th was hard. Unlike the SICU - where I had a dedicated 1-to-1 nurse - the ward had a ratio more like 6 patients to 1 nurse. I went 6 hours at one point that night without seeing anyone. On the flip side, my drop from the OR table seemed to have some bonuses. I had an individual room and private bathroom.

I wasn’t eating though. Even taking in water was a struggle. The primary doctor in my care - Dr. Chase Bowen - was great. By the afternoon of the 30th, Dr. Bowen and the team, in consultation with Dr. Lagoo, determined that I had something called an ileus. In essence, the stress of the surgery (and its complications) had caused paralysis in my intestines. This temporary paralysis prevented the normal passage of food and waste, causing a functional - if not physical - blockage. So they had to place a nasogastric (NG) tube - a thin, flexible tube inserted through the nose, down the esophagus, and into the stomach. The tube is used for short-term feeding, delivering medications, and removing stomach contents.

And yeah, it is as bad as it sounds. You essentially have to swallow a hose, which then lives at the back of your throat. You can’t eat, you can’t drink (not that I was interested anyway). It constantly feels like there is something in your throat you haven’t quite swallowed. It was the worst part of a very bad two weeks. And that’s saying a lot considering what came later.

When your body has a major trauma, it starts to hoard resources. There are 3 things that have to work no matter what. Your heart has to keep pumping, your lungs have to keep breathing and your brain has to keep functioning. That’s it. Your body sees everything else as optional. I had the tube because all my optional functions were shutting down and they had to have a way to drain my stomach acid.

Early on the evening of the 30th, I was in my hospital bed, IVs and tubes dangling from me, when I felt the urge to go to the bathroom. When I started to pull myself up, I felt something warm behind me and knew I had - quite literally - shit the bed. I rang for the nurse, told her what happened, and she helped me up. I looked behind me to see what I had done and that’s when I saw it.

I hadn’t just shit the bed. I shit blood.

Finishing in the bathroom confirmed it. The dark, almost black, stool with bright red flecks around the edges meant that I was bleeding internally.

I was transferred back to the ICU immediately, and I would end up staying there until July 9. During that time I came as close to dying as I ever have, and I will remind you that I jumped out of planes and served in combat. And I was more scared than I have been at any time in my life.

Also more grateful for all the amazing people in my life.

I was scared beyond words. I am also more blessed than anyone has a right to be.

And that’s where we will pick up the story tomorrow.