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The drain’s the thing

I was asked about surgical drains: how they’re installed, what they’re for, and why I’m still sitting on one. I will warn you now, not only does this essay describe inserting tubing into torsos, it also describes what was easily the most painful and traumatic part of my surgery and hospital stay. I’ll indicate when I’m about to start that story so you can bail if you’d like.

Basic surgical drains are easy. They are put in during the surgery, and serve to drain leaking fluids out of body cavities while everything heals up. I started out with two of them, both JP drains. It’s a piece of tubing with a squeeze bulb at the end. A single suture holds the tubing in position. Every day it’s emptied through a little plug like the stopper on an inflatable ball. The bulb is squeezed before the stopper is closed again, which provides a bit of suction to help fluids drain. When they drain less than 25mL a day, generally, they are removed. One of mine was taken out while I was in the hospital, and one came home with me.

Because I developed an infection, I needed more drains to get rid of the nasty stuff building up in my body cavity. Those drains were a different type, called IR drains because they’re installed by Interventional Radiology. These drains are gravity-fed (although the internet tells me it’s possible to hook them to suction, that was never done for mine), and comprise a length of tubing with a bag on the end. The bag is emptied daily. The tubing has a stopcock on it so it can be flushed twice a day with sterile saline.

So. The IR drains. It is absolutely wonderful that abdominal surgery is no longer required to put in these abscess-draining tools. That would have been much more invasive than what they do now, which is use CT scans to safely place the drain without puncturing anything.

But still, it was a whole lot of not-fun, and if you are feeling squeamish you might want to stop here.

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Ready?

The first IR drain installed was to drain a spot near my liver, on the right side of my body. IR fits in-patients in around scheduled outpatient work and emergency room patients, so it was rather late by the time they hauled me downstairs to the CT room. This is not so long post-surgery, and at the height of my infection, so I was pretty sick and already in a lot of pain.

For some reason the CT room was extremely warm – the staff were all complaining. The nurses and radiology tech boosted me from my wheelie hospital bed to the CT platform, which hurt. The tech started an IV. I asked for happy juice (fentanyl) and was assured I would get some, along with pain meds.

Then everyone disappeared.

I am now alone in an overheated room with no idea where everyone went or how long I’d be there by myself, in pain, on the table. (The radiology folks were certainly in the shielded room with the window and could see me fine, but I had no idea and wasn’t in good enough shape to really make that connection.)

Eventually they ran me into the CT scanner for preliminary images. You’ll notice I said nothing about actually receiving any drugs. When the techs came back into the room to set up for the actual procedure, I asked again, and was again assured that I’d be getting drugs.

They set up the procedure, which involves sterile drapes, disinfectant, and lidocaine. That’s the only part that didn’t hurt, but I could feel everything below surface level (just not as pain).

My understanding of the way the drain installation works is that they put a wire in first because that can be easily tracked on the CT scans. That part involves several passes through the machine. Having a chest/abdomen CT requires putting your arms over your head. I’d just had my entire abdomen sliced open: this was both difficult and extremely painful. (For the curious, there’s a distinct pop when the wire goes thru the membrane around the liver, but physical rather than auditory.)

My recollection (which could be wrong) was that I didn’t receive either fentanyl or additional pain meds until at least this point in the process, which was far too late. (They’re really only effective if given BEFORE the painful and stressful procedure.) Regardless, by this point I was in the most pain that I’d experienced at any point so far, including right after surgery, and was hyperventilating in the CT machine. I even came away with a bit of CT scan PTSD: my last scan was kind of rough.

Once the wire is in place, they’re done with the CT part except for one final check. The next part is to insert progressively larger tubing over the wire, then pull out the small bits. How do you do that? Jam it in. I could feel every stage. I don’t think any of this hurt; if it hurt at all it was subsumed in the rest of the pain.

Then they cleaned up, hoisted me back on to my wheelie bed, and hauled me upstairs. My recollection is that I spent the rest of the night lying in bed shaking, and that it took pretty much until morning to get the pain under control. Shock? Maybe. I don’t remember that part especially clearly.

Then there’s the second drain. Scans showed another abscess near the colon resection, and it needed to be drained. The best way to do that safely is to go in through the right butt cheek and follow the curve of the pelvis into position. As complicated as it sounds, that appears to be the standard method.

I said I didn’t want to remember it, and the nursing and IR staff agreed that they could arrange that. This time, they gave me a nice dose of something before sending me down to IR. Unfortunately IR turned out to be unexpectedly busy, and I had to wait for a very long time and it all wore off. And the only nurse on duty at that time of night was rather mean about me needing to use the bathroom while I waited, since I couldn’t walk very well and she had to help me. (Ability to take myself to the bathroom: major milestone in my recuperation, but one I hadn’t quite achieved yet.)

Eventually I got into the procedure room, which wasn’t roasting hot, and they managed to give me fentanyl before starting anything else, so while my plan to not remember any of it failed, it wasn’t anything like the first experience, even with the rolling on my side for butt cheek access. (Not at all comfortable; even this far out I can’t lie on my side for very long.)

Stupidest part about the butt drain installation: they put the hard plastic stopcock right next to my butt, so I’d be sitting on it all the time. I got them to change that, but then the only way to flush it would be for someone to disconnect the joint where the stopcock was, and I couldn’t do it myself. I managed to get someone from IR to come put in a new accessible stopcock before I left. He was extremely nice, and amused by the challenge. I have had an equal mix of extremely good and fairly horrible experiences with IR (they did my liver biopsy, which was as awesome as a liver biopsy can get).

The liver drain hurt nearly the whole time it was in: it went through the muscles between my ribs, so flexed around it a lot. It still hurts for the same reason, even though it’s been out for a week. (Compounded by foolishly wearing a bra for a long time without noticing that it was chafing on the dressing until too late.) Nothing but trouble, that one. Except for the whole “contributing to keeping me alive” thing, I suppose.

The butt drain hurts when sat upon, which is most of the time. I can eventually find a comfortable sleeping position with lots of padding, but it takes some wiggling. Somehow trying to remember what works doesn’t result in anything that actually works.

More grossness, and probably TMI, but might be useful to someone someday. I’m trying to be honest and true here, even when icky.

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Ready?

I don’t know when the butt drain going to come out. The nasty lower abscess ate a hole in my vagina wall, and that fistula means that all the drainage stuff is weird and unpleasant. The butt drain may stay until everything heals up. It’s not a very large hole, so we are still hoping it heals on its own, but if it doesn’t I’ll need minor surgery to patch it.

I have another CT scan in two weeks to check on the size of the fluid collections (the remains of the abscesses, which after a month of antibiotics are sterile but still need to go away). They are all shrinking: there are several, but only two were large enough to require external drains; the body can reabsorb quite a bit. If the one with the drain it in shrinks away from the pigtail drain end, I may have to go back to IR and have them move it. You can imagine how I feel about that possibility. I’m hoping it either shrinks enough that it no longer needs a drain and I can get rid of this damned thing, or that it shrinks around the drain end instead of away. My mother wondered if I could get it to slosh in the right direction. I’m certainly willing to try, I’m just not quite sure what direction that is.

I can report that it doesn’t hurt to get them out, no matter what it felt like getting them installed. I could feel the tubing sliding internally, but there was no pain even at the skin surface. I’d been a bit worried because they’d been in so long.

Now I just need to heal enough that the last one can come out. C’mon body, you can do it!

So much sleeping

I think that’s all I’ve been doing, at least that’s what it feels like. It’s helping, though: I have more energy and endurance, though not as much as I’d like, and I’m down to one nap a day instead of two.

My pulse has been fast since about the time I started chemo. One of my many doctors finally did a thyroid test and determined that I’m hyperthyroid, though I don’t have any other symptoms. I had a normal thyroid test a year ago, so this is new. (And really, after a year of chemo and radiation how would I know if I’d lost weight or lost hair for any other reason?) Wednesday I got a call telling me that I could see an endocrinologist in Danville on Friday, or I could wait until January. What do you do? You go where and when they tell you.

I found a friend willing to play hooky from work (thanks again!), so that worked out. I’m not supposed to drive until I’ve been off narcotic painkillers for a week. I’ll be able to drive next week (hooray!), but Friday would have been iffy, even if I were sure I had the endurance for a 160-mile round trip.

Since I was going to Danville anyway, I asked General Surgery if they could squeeze me in, and they found a slot. Good news: I’m down to one surgical drain. Other good news: it doesn’t hurt to get the drains pulled out, even if they’ve been in this long. It does feel rather odd to have something long and thin move through your body, but it’s a brief sensation. I feel so much better just to have them out. It’s easier to get out of the recliner, to move around, everything. And one of them hurt most of the time, and that pain is gone.

But of course the drain in my butt cheek is the one that has to remain. At least now I can sleep on my side so I’m not on it all the time.

The endocrinologist put me on a beta blocker to control the rapid heartbeat, and will start me on an anti-thyroid drug once she checks with my oncologist. She doesn’t think it’s thyroiditis, a short-term problem, and she didn’t feel any nodules or anything or see them on a CT scan which showed my neck (a good thing, though I have a neck ultrasound next week to confirm), which leaves Graves’s disease. The usual test for thyroid function is a radioactive iodine update test, but I can’t do that because I’ve had too many CT scans with iodine contrast agents.

None of the drugs I’ve been on have been specifically linked to thyroid problems, but I still wouldn’t be surprised if it’s messed up because my body is so messed up right now. The plan is to take the drugs for a while, with frequent monitoring. Once I’m otherwise healthy, if my thyroid is still overactive we’ll talk about more permanent solutions.

Because, you know, I needed another health problem to deal with right now. Bah.

At least fewer drains is a definite win.

Along the Sea

I’ve lived all my life along the sea, my parents before me, and theirs before them, as far back as anyone can remember. I’ve seen everything that could ever be seen along our stretch of shore. Storms and sun, dry sand and high water, good years and bad for filling our nets, if never so bad as elsewhere. Shipwrecks, certainly. When fishing was bad we’d lure ships onto the reef. That’s where the silk carpet you’re laying on came from. The sailors never lasted long, but their cargos kept us comfortable.

There have only ever been the four families living here, though sometimes a young man drawn to the sea marries in. Other fisherfolk have moved in, hoping to share our bounty, but they don’t last long. Their boats sink, their women ail, they see great worms along the shore and flee.

But you, you’ve come to build a lighthouse to keep ships safe. And you brought your wife. Young love is so sweet. Excuse me while I go check on her. It’s probably time for more broth. Expectant mothers are prone to dehydration. What’s that? I can’t make any words out through the gag, but I know what you’re asking, what they always ask.

You’re not the father.

The worms herd the fish into our nets. We find them women. Sometimes men, that’s almost as good, but there was only the one egg this time so we didn’t need you.

Oh, don’t fuss so much. We take very good care of them, right up until the eggs hatch.

WFC and me

I’ve had to cancel my World Fantasy attendance. Dammit. 2014 has just been an awful year, and canceling all the fun stuff hasn’t helped any. And here, continuing the trend, I’ve had to bail on my co-panelists for the Ecology in Worldbuilding panel (and Reader, I proposed that panel), and on all the wonderful people I was finally going to meet in person, and on all the wonderful people I see only at cons.

But, you know, recuperating has to come first, much as I hate it.

See you all in 2015, right?

#SFWApro

Zzzzzzzzz

Quick, guess how I’ve spent the days I’ve been home so far.

Sleeping?

You win, well, nothing. But thanks for playing!

The Giant Recliner and I have been spending a lot of quality time together. If I get everything arranged just right nothing hurts, even the butt-cheek drain. Unfortunately I can’t reliably replicate the combination of body and chair position that produces this effect.

I can’t quite remember what I’ve said here. And whatever it was, it probably wasn’t coherent because of the drugs anyway.

So, to recap…

I left behind:
One chunk of colon, consisting of clean tissue on both sides of the Primordial Wurst.
One chunk of the right lobe of my liver, consisting of clean tissue surrounding the Wurst.
Assorted lymph nodes, none of which showed any traces of cancer.

Assorted surgeons told me afterwards how lovely and healthy and wonderful my bowels were. (No really. My surgeon described me as “as beautiful on the inside as out”, the resident who sat in said something similar, and so on. Surgeons are a bit odd.)

I have acquired:
One incision, once possessed of 80 staples, but now plastered in steristrips. Well-healed, doesn’t much hurt but I wouldn’t lift anything heavy (and have of course been ordered not to anyway).

Three drains, of various sorts. One original surgical drain (is it going to hurt to get it out?), and two added by Interventional Radiology to combat the evil infection. These hurt, especially the one in my butt cheek that I have to sit on. I want them out as soon as possible. The others come out of my left side and my right side, so there’s no lying on my side option that’s any good either. I have a GP appointment tomorrow, but I’m not sure if a GP will want to pull drains from some other surgeon. Here’s hoping.

One ostomy, presumed temporary (a few months). (Also described as “beautiful” by various people. My surgeon did a good job, apparently.) This is a bit of an adjustment, but not as bad as I thought it might be. I’m not particularly squeamish, which helps, but it’s really not that bad. I managed to change the whole apparatus this morning, with only a minor mess. There’s a team of ostomy nurses who are utterly determined to make sure that you know how to do everything necessary before you go home, and they’re very good at their jobs. (I did flummox one when I referred to myself as a “fistulated cow” though. She said nobody had ever used that description before.)

Fistfuls of drug bottles: Antibiotic, other antibiotic, various things to help with the care and feeding of ostomies, and of course the all-important pain meds. I’m actually only taking them at night right now (though I seriously considered one mid-afternoon, because these drains are driving me nuts). They provide sleep and lack of pain: very nice. But I can’t drive until I’ve been off them for a week, so I have a great incentive to quit.

I’m not going to count the infection in the “acquired” column, because I’m hoping that I both acquired it and left it behind. Besides the antibiotics, I have no fever or other worrisome signs, so this one can just cancel itself out.

I walked outside today to look at the garden beds. That pretty much used up my endurance. This is going to be a long, slow recovery, and I’m going to hate every minute of it. (Also Boost. I hate Boost. And various other things, but especially the butt drain.) I expect to be cranky a lot, when my vision of what I should be able to do doesn’t match the reality. I’m trying very hard to be a good patient, and eat as much as I can, exercise some but not too much, sleep a lot, yadda yadda yadda.

I sorted through all the mail today, finally. Thank you for the wonderful cards! I appreciate it immensely, and it helps with the cranky.

Home.

Sarah is in the house.

Hospital Math

It looks like my 7-10 day hospital stay will end today. I think that would be 20 days, but I’m a bit fuzzy on some of them what with the fever and all.

I’m free of staples, but covered in steristrips. (Does steristrip glue smell like fir trees or spruce trees?) I’m taking my festoon of drains home with me, even the best beloved butt drain.

I will wear shoes for the first time in three weeks, and a garment that covers my butt. I will not be woken every two hours by a nurse who needs to record a vital sign, or feed me a pill. (As I’ve become healthier, the nurses have backed off, favoring sleep over exact documentation, but it’s still not restful.)

I’ll get to see Nick, and the boxer, and the velociraptors, the latter three under careful supervision. A boxer to the gut would put me right back in the hospital.

I’m taking with me a cocktail of bacteria (the preliminary culture said “a mixture of species of aerobic and anaerobic bacteria,” which covers all the bases at least).

Interlude: Attending strides in, followed by a pair of residents. “Are you ready to go home?” I reply in the affirmative. “Have you been eating?” I reply in the affirmative. “Well then let’s get you out of here.” Exeunt doctors.

I’ll be taking with me the antibiotics to deal with whateveritis I’m infected with. I don’t know yet if those will be IV or oral. (Infectious Diseases says they will be here “later.”)

I’ll be taking pain pills with me too, oh my yes! Three drains, an enormous line of staples, and all the internal healing bits? Drugs are my friend.

So now we’re waiting, on discharge instructions, prescriptions, Infectious Diseases. If they take too exceedingly long, we’ll check out and stay at a motel tonight, as driving home in the rainy night sounds unappealing (no, I’m not driving). But if we can, home tonight!

One thing I’m not taking home with me? The Wursts!

Hospital Math

It looks like my 7-10 day hospital stay will end today. I thing that would be 20 days, but I’m a bit fuzzy on some of them what with the fever and all.

I’m free of staples, but covered in steristrips. (Does steristrip glue smell like fir trees or spruce trees?) I’m taking my festoon of drains home with me, even the best beloved butt drain.

I will wear shoes for the first time in three weeks, and a garment that covers my butt. I will not be woken every two hours by a nurse who needs to record a vital sign, or feed me a pill. (As I’ve become healthier, the nurses have backed off, favoring sleep over exact documentation, but it’s still not restful.)

I’ll get to see Nick, and the boxer, and the velociraptors, the latter three under careful supervision. A boxer to the gut would put me right back in the hospital.

I’m taking with me a cocktail of bacteria (the preliminary culture said “a mixture of species of aerobic and anaerobic bacteria,” which covers all the bases at least).

Interlude: Attending strides in, followed by a pair of residents. “Are you ready to go home?” I reply in the affirmative. “Have you been eating?” I reply in the affirmative. “Well then let’s get you out of here.” Exeunt doctors.

I’ll be taking with me the antibiotics to deal with whateveritis I’m infected with. I don’t know yet if those will be IV or oral. (Infectious Diseases says they will be here “later.”)

I’ll be taking pain pills with me too, oh my yes! Three drains, an enormous line of staples, and all the internal healing bits? Drugs are my friend.

So now we’re waiting, on discharge instructions, prescriptions, Infectious Diseases. If they take too exceedingly long, we’ll check out and stay at a motel tonight, as driving home in the rainy night sounds unappealing (no, I’m not driving). But if we can, home tonight!

One thing I’m not taking home with me? The Wursts!

Rumors!

So, NOTHING DEFINITE, but, from the iPad of the Sarah:

“Rumors of possibilities of hints that perhaps it might not be impossible to go home today, or perhaps tomorrow, unless the tantalizing bits and bobs really refer to something else altogether.”

 

 

Best-Laid Plans

The surgery went great, they got all the cancer out of me, the incision is pretty well healed, and I’ve even gotten half the staples pulled.

And yet, I’m still in the hospital, festooned with drains and on the kind of floor where they check on you every two hours all night.

First there was the vomiting and the N-G tube. Then there was the utterly miserable experience of having a drain installed by people who didn’t do the drugs correctly. Then there was the other drain, put in by a team who didn’t do so badly with the drugs (though nowhere near what I wanted), but absolutely had to put the drain in thru my right butt cheek, thereby eliminating any possible comfortable position. And that’s completely skipping over the potassium wars, the pain med debates, and so many other fun things.

I have some sort of as-yet-identified infection. It’s small: my white blood cell counts are normal, etc, but I’m running a fever. Me and my cancer-free self will be going home as soon as they finish culturing the sample so they can be certain of having the best antibiotic for the job, and when I no longer have a fever.

My role in this is to sleep a lot, walk around regularly (and I finally have permission to go to the bathroom by myself!), and eat a lot, by which I mean nasty grape protein supplements, nasty vanilla general supplements, and meals that vaguely resemble food (I’ve been eating a lot of mashed potatoes).

I’m incredibly tired of being here. Incredibly. But if i leave too early and end up back here, that would just be so much worse.

And hey, no known cancer. I’ll deal with the rest of it.