This is the fifth in a series of articles about my recent trip to the emergency room, my intestinal surgery, and my recovery afterwards. Here is an index to all of the articles in this series.
They always say you can live a couple of weeks without food, a couple of days without water, but only a couple of minutes without air. So the verdict was in and I was going to need surgery and the hard part of it all was going to be keeping the air moving in and out of me and once the surgery was over being able to continue to breathe on my own unassisted.
As I had previously heard the resident doctor in the ER get a page from radiology and from my primary care doctor Dr. Swinney, I soon heard him get paged from Dr. Vohra my pulmonary doctor. On many previous occasions I have discussed with him the consequences of having general anesthesia. In the battle to treat my chronic urinary problems, my urologist had suggested a couple of surgical procedures that might have provided some help. I really didn’t want surgery and to convince the urologist it was a bad idea, I consulted with Dr. Vohra who gave me a really good argument why I shouldn’t have surgery. It was his fear that once I had been put on the ventilator during surgery they might have difficulty weaning me off of it. He said there was a real possibility I could end up on a ventilator the rest of my life.
About 12 years ago I had a nasty case of pneumonia that landed me in the hospital for 12 days. Ironically just before that hospital visit I had seen a documentary about Nobel prize-winning physicist Stephen Hawking. It told about his groundbreaking research into black holes, the Big Bang, and the nature of the universe as well as about his personal battle with ALS (sometimes known here in the US as Lou Gehrig’s disease). ALS is a motor neuron disease somewhat similar to SMA. Professor Hawking has been in a wheelchair since the 70s and on a ventilator full-time since he contracted pneumonia in 1985. As a result of the severity of his disability he can’t just sit down with a pad of paper and pencil or stand at a chalkboard and derive complex mathematical equations. He has to visualize the entire thing in his mind and do all of the calculations in his head first before he describes them to an assistant or colleague. These visualizations are in the form of three-dimensional shapes that represent the equations. His colleagues say that because he has to do this graphic three-dimensional visualization, it has given him insights into the equations that would not be apparent if you had manipulated the raw formulas in a more traditional written form. In other words if he wasn’t as severely disabled as he is, he wouldn’t be able to have the insights into the nature of the universe that he has. Hearing this from his colleagues, it reaffirmed my own beliefs that my disability was as much a gift from God as it was a handicap or drawback. Specifically however when I was lying in the hospital all those years ago with pneumonia, I could look at someone like Professor Hawking and realize that being on a ventilator need not prevent me from doing valuable and productive work. A few years later actor Christopher Reeve provided a similar example that being even more disabled than I was didn’t necessarily prevent you from doing great things with your life.
As I now again face the possibility of a tracheotomy and respirator, it was a comfort to think about Stephen Hawking and all that he has done and continues to do. I read an article that recently he was in San Francisco scheduled to give a lecture at some conference. As they were getting him dressed that morning he went into full cardiac arrest. They were able to resuscitate him and he wanted to go ahead and give the lecture. They ended up setting up a video phone link to his hotel room where he gave his presentation using his usual computer synthesized voice. Granted I’m not a Nobel prize-winning physicist with his resources nor am I arguably the smartest SOB in the world as is he but if he can do good work in his condition I know I can as well.
I had had general anesthesia on a couple of occasions maybe 12 or 13 years ago. I had a different urologist in those days. To avoid libel we’ll call him Dr. Lousy (not his real name). My urinary problems in those days were caused by stones which collected in my bladder. Dr. Lousy did a procedure where he would insert a scope into my bladder. He would find the stones he would zap them with a laser beam and they would pulverize into fine powder that could be easily passed. Although some urinary cystoscopies can be done while you’re awake, this laser thing is apparently traumatic enough that they want you knocked out for it.
At that time I had never had general anesthesia. In fact I knew so little about anesthesia than I thought the term “local anesthesia” meant it was made by Eli Lilly & Co. (For those of you out of town who don’t get that joke, they are a locally based pharmaceutical company. “Don’t gimme none of that out-of-town stuff. I wanna local anesthetic shipped fresh from the south side of Indy”)
The biggest problem in putting me under is that they can’t get an intubation tube my throat because my mouth doesn’t open very far. They had to use a nasal intubation tube. I had had tubes up my nose into my lungs prior to that one time. When I had the pneumonia they had done a bronchoscopy to suck some gunk out of my lungs. It wasn’t a very pleasant experience but it sure helped me breathe. The first time Dr. Lousy put me to sleep it went relatively well. Sometime later we tried to do it again and it was a minor disaster. It took them over 45 minutes to get the tube up my nose and into my lungs. They scraped the living daylights out of the inside of my nose and back of my throat. I was supposed to be knocked out as they were trying to insert the tube however I kept waking up partially in a panic. It felt like I was in a bad Stephen King horror movie lying there helpless while these jackasses try to stuff a tube up my nose. When they would fail, they would pull it out dripping with blood, and then I would spit blood and tissue into the suction tube while trying to tell them what they were doing wrong. When it was all over the doctor found nothing in my bladder that time. I was furious and somewhat hysterical that I gone through all that hell for nothing. Furthermore he gave his report directly to me in the recovery room while I was still pretty much out of it and had no idea what he was saying. Then he refused to talk my parents and left the building. Needless to say we transferred my business elsewhere. My new neurologist Dr. William Sherrill is a really great guy.
Even though I tolerated the anesthesia pretty well, that was over 10 years ago and I know I’m in worse shape now than I was then. I didn’t have Dr. Vohra the pulmonary specialist at that time but I’ve had him for many years since then and he is consistently recommended no general anesthesia unless it’s absolutely necessary. Of course a perforated intestine can be life-threatening so it was absolutely necessary.
From what they were telling me this surgery was going to happen right away. I had hoped perhaps they would admit me, perhaps do a few more tests, and schedule surgery for tomorrow morning but it didn’t look like that was going to happen. While I had plenty of doctors working on my case there was something else I needed which was equally important… prayers. Right after the ambulance left my house, Mom had made a quick phone call to Margaret Arthur who is in charge of St. Gabriel’s prayer chain. That put into motion about 30 or 40 people praying for me in a matter of minutes. That was just to get me to the emergency room and get diagnosed. For a life-threatening surgery I would need bigger spiritual guns. I really wanted to be anointed before the surgery and that means I needed a priest.
It used to be that if you were sick and they sent for the priest you were a gonner. The sacrament which was commonly known as “The Last Rites” was technically called “extreme unction”. That means it’s an anointing (unction) that was only to be used in extreme circumstances like on your deathbed. In more modern times it has been renamed “Anointing of the Sick” or “The Sacrament of the Sick” and you don’t have to be knocking on death’s door to get it. Anytime you have serious or chronic illness you can be anointed. Most people get it before major surgery which this certainly was. About once a year they have special Mass where anyone who is elderly or chronically ill can just come up after Mass and get anointed. I’ve been anointed many times. St. Vincent’s Hospital is a Catholic hospital and there was a possibility they had a priest on the premises. I had the nurse called the chaplain’s office to send someone down. If I had a better idea exactly when the surgery was going to be, I could’ve called St. Gabriel’s and if Father Larry was around he could have been up there in 20 minutes or so but I hated to have him drop everything and get there two minutes before I was in surgery or something similar to that.
Soon a young man whose name I sadly cannot remember arrived from the chaplain’s office. He explained that he was a Catholic chaplain but was not a priest. He said if I really needed a priest they can try calling a nearby parish. I told him it wasn’t necessary. I just thought if they had one handy I would get anointed. There is a theological principle called “baptism of desire”. It says that if you really want to be baptized but for some reason cannot and you die before you are able to be baptized then it still counts as a real baptism. I speculated with him that perhaps there is also an “anointing of desire” and if you really want to be anointed the cannot it still counts.
I told him about the risks I was facing and the possibility of life on a ventilator. I told him about Stephen Hawking and his life on a ventilator. I also told him about my friend Buz who just lost his adult son to a three-year battle with cancer. I told him I’d tried to be a source of spiritual strength for Buz and tried to encourage him to hold onto his faith during his crisis. “I guess it’s time to practice what I’ve been preaching” I told him. There is that old saying “It’s easy to be a holy man upon the mountain but it’s much tougher to do so down here in the real world.” I thought about all the things I had said to Buz over the past several years and realized I had really meant them. I wasn’t just regurgitating doctrine to him all that time. As I reflected on the confidence I had in encouraging Buz, it renewed my confidence to face this crisis of my own.
The chaplain shared with me the story of his own struggles. About a year ago he had had bariatric surgery and as a result have lost over 170 pounds. He showed me his hospital picture ID from before his surgery and you could tell he had lost a bunch of weight just from the shape in his face. He looked like he was in really good shape now. He talked about how his faith had sustained him through his ordeals. He also talked about his belief that angels watch over us. He didn’t know I’m not a big fan of the theology of angels. However I thought about all the people who were praying for me and so in some respect they are my angels although probably not in the sense he was talking about. Anyway my visit with him seem to give me some needed support.
Pretty soon an anesthesiologist named Dr. Hurd (or perhaps Dr. Herd) came in to discuss my case with me. I explained to him that he would not be able to intubate me through the mouth. I told him I had another anesthesiologist go through my nose with no problem but another one had had a terrible time getting the thing in me. I have since remembered vaguely that the first guy had used a pediatric size tube on me. I only weigh 100 pounds and my last pulmonary function test said that my lung capacity was only 28% normal for someone my size so a pediatric tube was probably sufficient. He asked lots of good questions and listened well to everything I told him. He seemed suitably concerned about what a tough case I would be. I liked that. I don’t want some cocky know-it-all who doesn’t recognize a challenge when he sees one. Later Dr. Hurd came back with another anesthesiologist colleague who was going to assist him. He wanted someone handy to work with him in case he needed an extra pair of hands. I really liked that as well.
Next came the surgeon Dr. Chad Davis whom I’d never met before. We learned however that he was partners with my mother’s surgeon Dr. Arregui who worked on Mom’s pancreas a couple of years ago. He is a very personable man who did a great job of explaining to me what we had to do. In all likelihood he would end up having to remove the section of my colon. He would create a temporary colostomy which means that my intestines would be attached to an opening in my abdomen called a stoma. I would then wear a plastic bag attached to my skin with adhesive. It would collect my feces. The remainder of my colon would be stapled closed. When he used the word “temporary” immediately I’m thinking in terms of two or three days perhaps a week. When I asked what he meant by temporary colostomy he said very calmly “probably two months”. That was a real shock!
As I’ve mentioned, I’m dependent upon a back brace for sitting up in my wheelchair. The brace is like a plastic body cast. It’s a two-part shell that runs from just under my armpits down to my waist. The brace is probably 30 years old and I’m doing everything I can to make it last as long as possible. A couple of years ago we tried having a new brace made for me but it never did it right and I gave up on it. The prospect of needing to cut a large hole in this brace to accommodate an ostomy bag really had me worried. The big question is where to cut the hole and how large to make it. I start out the day with a brace on me rather low. Throughout the day I slip down inside the brace and it rides up under my arms. Even if I had the hole in the right place to begin with, by the end of the day things could be really out of whack. This problem was one of the reasons I had been avoiding bladder surgery.
If I couldn’t get away for my back brace to peacefully coexist with my colostomy, I could end up in bed with the brace off for the entire two months. That amount of inactivity would weaken my lungs and my arms so that when all was said and done I might be in really nasty shape even if I did get off the ventilator without any difficulty.
Dr. Davis was very confident that I could pull through this okay. He had looked at my cat scans and knew that my insides were kind of messed up because of the severe curvature of my spine. I discussed with him the possibility that the air in my abdomen had not come from a perforated intestine. I wear a CPAP device at night which forces air into my lungs. I asked him about the possibility that my lungs could be leaking into my abdomen and the result was that air that the CAT scan had shown. He was skeptical about the possibility but realized the seriousness of this surgery. He offered to begin the surgery using a small incision in my navel where he would insert a laparoscope to look around first. This would confirm whether or not my intestines were really perforated. If they were, then he would have to open me up with a larger incision and do the bowel resection and colostomy as originally planned. I really liked the idea of doing the simpler exploratory first.
Dr. Vohra would be in to see me soon to give me his latest input on my situation however at this point it was just a matter of waiting until they were ready to perform the surgery in about an hour.
At this point I just had to turn everything over to the Holy Spirit and trust that everything would be okay. The Holy Spirit is sometimes referred to as the “Breath of God”. Some translations of Genesis 1:2 say “a mighty wind swept over the waters.” Other translations say “the breath of God swept over the waters” and still other translations simply say “the Holy Spirit”. It was the breath of God that breathed life into Adam.
By whatever name, I simply had to put my own breathing concerns into the hands of the Breath of God… the Holy Spirit.
Click here for the next article in my blog which takes a brief time out from telling my hospital story.
Click here for the next installment of the hospital saga where I deal with loose ends before my surgery.