Tag Archives: surgery

Constipation

I have pondered for more than a week whether or not to tell this tale, and to be honest I don’t know at the moment that I am scratching out a first draft with pen and paper if I will actually complete it. If I end up doing so I will then have to decide if I will publish it. This may not be a story for all readers. My good friends, wonderful people all of them, may feel uncomfortable reading about this experience which I am about to share. If that is the case, please don’t read this. My sole intent is to share information in the hope that anyone who reads this will take precautions to prevent a severely painful situation which I experienced from happening to them, but I value my friends above most things in life and would never want them to feel uncomfortable reading anything that I write.

I never want to publish a story simply to shock, and the story that I have now set out to tell consists of details unsavory enough to shock and gross out many people. I suppose the trick will be to see if my writing skills are adequate to deal with the topic in a way that gives objective information of a deeply personal story in a way that the unpleasantness of the topic doesn’t detract from the point. I will assess upon completion of my first draft whether or not I have achieved my goal. Only then will I push the ‘Publish’ button and send this out to a world which may not even be interested in it at all. We shall see. (author’s note: I obviously assessed this story and decided that it should be sent. As I wrote a moment ago, we shall see).

The title of this tale is simply “Constipation” and, not surprisingly, that is also the topic. And it is a topic that many people do not consider to be serious; the butt (forgive the pun) of an inferior comedian’s potty humor or something that old people in the retirement home speak about often. But when constipation, and I mean real constipation, hits you all of the jokes and laughter fall away and you find yourself praying for some kind, any kind, of relief. Most people can avoid constipation by eating a balanced diet, remaining active, and staying hydrated. Surgery changes all of that however, and it is in the context of a recent major surgery which I underwent that this story is being written.

I recently suffered a heart attack and had to submit to bypass surgery to enable my heart to receive an adequate supply of blood. I was under general anesthesia for over three hours and then given regular doses of a narcotic pain medication for the next five or six days on a regular basis. I tapered off of the narcotics over the next two weeks but still needed them sometimes in order to quell the ache in my chest so that I could sleep. A side effect of the anesthesia and narcotics is that they interfere greatly with normal bowel function, and part of my daily post-surgical physical examination was to listen for the sounds that normal, healthy intestines make. Mine were obviously making normal sounds, so other than a stool softening pill given to me once a day I received no other attention to this potential problem. That would come back to haunt me.

In addition to the effects of the drugs that I was now taking, the other three components of healthy elimination were removed. I was very restricted in my walking around or doing any other exercise by the fact that my split chest was now held together with wires and stitches, and the heart medications given to me made me very light-headed and therefore unable to walk very far or very safely. My appetite vanished after the surgery and even if it had not done so the diet was virtually devoid of fiber, and they wanted me to lose some of my body fluids for reasons I don’t understand so I was put on a diuretic. The result of this perfect intestinal storm was that by the time I was released to go home I had had one small bowel movement and that was all. I was told to be conscious to avoid constipation but not given a plan to do so which fit my new situation.

Returning home was a wonderful thing. I now had the foods which I like to eat and my appetite slowly returned. I ate a lot of salads and other greens, and drank a great deal of water too. I hoped that this would do the trick, but nothing came of it. By day three I began to suspect that I was in trouble, but my preoccupation with safely rehabilitating with my light headedness and healing chest wound, plus the effects of all of the drugs that I was taking, diverted my attention from what should have been a priority. On day four the degree to which it should have been a priority burst upon me with a pain that one could hardly imagine unless one experiences it firsthand, and experience it i did.

I could tell when I arose that morning that things were moving to a conclusion. I tried a couple of times to eliminate but the bolus of stool reached the last centimeter of my digestive tract and then refused to budge any further. I gave up after a while and arose to return to my place on the sofa, but the stool was far enough down to be painful. I hobbled gingerly back to the sofa and sat/lay in a position that caused the least discomfort and waited for something good to happen. Nothing good happened. This was at about ten in the morning.

After a couple of tries I had moved things along another millimeter or two, which only sufficed to lodge a bigger chunk of clay-like stool right at the porthole of freedom, where it was as painful as it could possibly be. It was like having the gnarled, knobby end of an Irish walking stick or the spiked ball of a medieval mace stuck in my rear end. After a few more tries I sent my wife to the store to purchase a laxative, which is precisely what I should have done four days earlier and would have it I had been properly (in my opinion) counseled upon discharge. The bad news, I later learned, was that the laxative was great for future bowel movements but would be of no use for the problem at hand.

Time after time I returned to the toilet, and each time the pain increased but no relief was obtained. I was beginning to get desperate. The pain was intense and offered no prospect of diminishing anytime soon. My wive later told me that she was approaching the point of taking me back to the Emergency Room, such was my physical discomfort and her emotional anguish from watching as I suffered. I finally found myself praying to God for relief, even though I suspected that God is not in the business of giving colonics. I knew that God, when He was with us on Earth, suffered greatly too and that He understood my pain, and that gave me some comfort although I confess that it wasn’t much.

By four thirty in the afternoon I clutched at my final straw. I asked my wife to go to the store and purchase an enema. When I was a kid we had one of those in the house, although I cannot remember ever seeing or hearing of it being used. I didn’t even know if they made the things anymore but as luck would have it, they do. My wife returned with my last best hope, and after about twenty minutes of assembly and test runs, we put this final plan into action.

At this point I will cease with close descriptions of this drama. They are gross and embarrassing. The procedure itself was painful in the extreme and not immediately successful. Repeated attempts, each one introducing a little more of the warm water which I hoped would loosen things up, resulted in having to clear and clean the nozzle while I waited in almost breathtaking pain so that I could try again. Finally, after the third attempt, while the nozzle was once again being cleaned and prepared for use, all hell broke loose.

I could hardly believe that my ordeal was over. I simply said to my wife “it’s out”, but she could scarcely believe it either. She continued to clean the nozzle and I repeated “it’s over. I got it out.” Finally she allowed herself to believe it, and we just looked at each other; her standing by the sink and me sitting there doing my own interpretation of “Game of Thrones”. The relief washed over both of us and we went about the business of cleaning me and the bathroom up.

I returned to my sofa, but this time in considerably less pain. It would still be the next day before the fire down below was finally extinguished. At this point I began to take the laxative, drink glasses of prune juice, and a glass of water containing a tablespoon of psyllium seed husks every day, plus up the fiber in my diet even higher. It was and continues to be my intention to never go through that again.

If anyone is still reading this tale of my scatological nightmare I would like to reiterate why I wrote it. I did not expect to need bypass surgery. We never know when such things will overtake us. Anyone reading this may find themselves tomorrow faced with a difficult and painful surgery in their immediate future and if, heaven forbid, that is the case you might find yourself in the same position that I was. If I have properly utilized this opportunity to tell one person this messy and embarrassing tale, and if it in turn results in that person avoiding the dreadful situation that I endured, then I will understand why I had to endure it at all and will celebrate that I was able to help that one person avoid the pain.

There is my story. I urge you, reader, to take it to heart and make of it what you will.

Serious As A Heart Attack, Part V

Day number three after open heart surgery dawned in a fog, much as day number two had ended. My nurse had configured my bed in such a way that I was semi-upright all night, and for some reason that helped to control the pain which had run riot in my body the day before. As always I slept most soundly in the later morning period, so I slumbered pretty much right up until breakfast arrived. I was transferred to my chair and waited for my breakfast tray to be brought over to me.

I don’t remember what it was that was brought to me for breakfast but I do remember my response; I grabbed the nearest plastic bucket – they kept one within my reach at all times – and threw up explosively into it. I had hardly anything in my stomach so the volume was low, and I felt a good deal better when that was done. I had no interest in breakfast however and asked them to remove it from me. It would be several days before I would have any desire to eat again.

Nobody had arrived to visit with me yet and so I remained in my chair for a while with my eyes aimed in the direction of the television screen but with no real recognition of what channel it was on or what they were saying. Time passed in this manner as people slipped into and out of my room, some to draw blood from the central line in my neck, others to poke my fingers to monitor sugar, and still others to give me some kind of injection into the fat around my belly. Most merciful was the nurse who came in to push another syringe full of Dilaudid into my central line. More than that is only a blur and I would not be able to accurately describe it.

As the morning wore on the various doctors taking care of me stopped in to check on me. First was the Family Medicine general practitioners, usually consisting a trio of Dr. Manning and two residents who are not yet licensed to practice on their own. Dr. Manning and I have known each other for years and he is a lover of history as I am, so we usually ended his visits by giving each other a history challenge question. “What was the Beatles’ album which changed the course of rock music?” (Answer: Sergeant Pepper’s Lonely Hearts Club Band), or “Which WW II battle took place in May of 1942 and changed the course of the war?” (Answer: Battle of Midway), and so on. On this day I was in no kind of shape for such banter and Dr. Manning could sense that. A brief examination by the residents ensued and I was returned to my bed because my exhaustion was now becoming more of an issue than the pain.

My wife appeared at this point and took up her position by the bed, stroking my forehead or brushing my shoulder, completely unable to reduce the pain but communicating clearly that she would do anything in the world if she could to take it away, and there was comfort in that. We passed an hour or so I think in that way until the next group of doctors made their appearance.

Dr. Willis is with the surgical group of which Dr. Grossing, my surgeon, is a partner. He was checking on me that day along with Rachel Lenz, the physician’s assistant who was involved with my actual surgery. They examined the incision site on my chest and declared it to be infection free so far and healing nicely, and then they knelt down by the bubbling canister at the foot of my bed. “Take a breath and bear down on it Mr. Durden” said Ms. Lenz. I drew a breath and bore down on it as much as my stoned stomach muscles and screaming chest would allow. “That looks good Mr. Durden. How would you like to have your chest tubes out?”

I had been told that the tubes draining grunk from my chest could be a major source of the pain I had been experiencing for the last day and half so I jumped at the opportunity. In a flash the tubes were gone and after a little puttering around on my chest, which probably represented suturing the holes where the tubes had been, I was finally free of the tubes and the urinary catheter which they removed at the same time.

The improvement in my pain situation was almost instantaneous. There was still pain aplenty but the Dilaudid was more than adequate to keep that down to an acceptable level. I could finally lie in my bed and enjoy my wife and son, who appeared a short time after one in the afternoon, and carry on a conversation with them between naps which tended to remain on point more or less. I would describe that afternoon as pleasant, at least as pleasant as one could expect it to be under the circumstances.

A big change occurred at about five o’clock however. A gurney appeared and it was time for me to leave the CVICU and transfer to the sixth floor where less critical patients continued their recovery. I knew right away that I would miss the staff in CVICU. They had been very kind and attentive and I felt very well taken care of. I want to visit them very much when the time comes that I can walk and move about with more ease than is currently the case.

The sixth floor was an entirely different place with an entirely different mission. Once deposited (lovingly) like a sack of potatoes in my bed in room 6102 I was in the care of people who’s mission was to get me ready to function at home again. Because I arrived in the afternoon, rather close to shift change, I had a grace period where I could lie quietly in bed with my thoughts and narcotic dreams. My new nurse and her team of two assistants introduced themselves and then that was all that I saw of them that night unless somebody had to take vitals, take blood, give me pain meds or empty my urinal. The evening was passed in broken sleep, but the morning came soon enough and my new recovery plan took off in a big way.

Serious As A Heart Attack Part IV

The second day of recovery began when I emerged lazily and with some difficulty out of a fog of anesthesia, narcotic pain killers and sleep. My wife was beside me, as she almost always was, and as the fog cleared she was asking if I wanted to sip some chicken broth. The doctors had explained that it was important that I resume eating and drinking in order to speed up my recovery. There was nothing I wanted more than a speedy recovery, so I was eager to comply.

The broth was listed as low fat, low sodium. I guess that this is standard for hypertensive cardiac patients, but I thought that low taste, low interest would have been a good deal more accurate. Still, an order is an order, so down the hatch it went. I drank a cup of cranberry juice as a chaser and relaxed back into my bed to continue my nascent healing process.

I knew that my urine was draining out from my bladder through a catheter and found the convenience of that arrangement comforting. All of the peeing in a urinal that I had been doing before my surgery had now been taken out of the picture, and I didn’t miss it. I was actually mildly disappointed when the catheter was removed the next day, which will illustrate as clearly as possible what a lazy man I truly am. I also had one or two surgical tubes protruding from my chest and coursing into a bubbling container. Why the container bubbled is a mystery to me. Those tubes were draining blood or air or anything else which might be in my chest post-surgically but didn’t belong there. I was practically unaware of those tubes at first, but that would change.

My nurse, who was one more wonderful person in a parade of wonderful people, was constantly flitting in and out of my room taking vital signs, checking IV fluids, and generally making me feel as comfortable as possible, and the latter duty involved administering periodic doses of a pain killer called Dilaudid. The dose was prescribed to be given every three hours as needed through a catheter threaded into a vein in my right neck.

My son made his first post-surgical appearance that day and I greatly enjoyed chatting with him, although the pain killer had the exceedingly weird effect of loosening my grip on reality. I have an active if somewhat shallow mind and it is not at all difficult for me to slip in and out of a daydream at any time. Under the deluge of Dilauded which was pouring down my central line I was no longer slipping into daydreams; I was now jack booting down the door and commandeering the residence.

A conversation might go something like this. WILL: “I’m going to go to the house tomorrow and water your garden. Are there any special instructions that you have for me?” ME: “Yes. Use the sprinkler on the onions and just lay the hose at the base of the tomatoes. Don’t worry about the dog (author’s note: I don’t have a dog), he stays in the shade and will fix the bicycle tire himself if you have a…. Wait a minute, that didn’t make sense, did it?” WILL: “Some of it, Dad. You told me to sprinkle the onions and just put the hose in the tomato beds.” ME: “Yes, that will work. Do the same with the cucumbers and squash and don’t worry about the asparagus because they take care of themselves since they moved out of the house and haven’t had much trouble except that one time that the police….” It was like that all day.

As morning moved into noon the pain in my belly began to grow and by lunch had come to dominate my consciousness. Hospitals like to use a pain scale of zero to ten, with zero being no pain and ten being agony. Those scales are highly subjective of course, and for me skinning my right foot and plunging the raw flesh into salt would be about a three. By noon I was at five or six. I sat up in my chair and tried to eat, and the pain seemed to subside a bit, but I was not able to eat much and soon returned to my bed.

The pain began again to cresendo and soon I was begging for more of the pain medications with the result that I became even more stoned but not one bit less in pain. I had maxed out my Dilauded dose and still I was crawling up to an eight-and-a-half. My nurse was truly sorry for my pain and tried anything she could think of to bring it down, including exchanging morphine for Dilaudid a couple of times, but nothing worked.

The nurse’s instructions were to get me up in a chair as much as possible so that the changed position would keep fluids moving and allow me to inhale as deeply as I could on a device designed to help me gain greater expansion of my lungs. I groused about having to move in my pain but complied. It slowly began to register with me that I really did feel somewhat pain-diminished when I was sitting up. Not pain free by any stretch of the imagination, but pain-tolerable. My nurse noticed this as well, and I stayed in my chair until it was time for visitors to go home and for me to try to get some sleep.

“There’s no way that I will be able to sleep if I lay down” I told my nurse. “I know” she replied. “That’s why I’m going to turn your bed into more of a chair.” With that she began to fiddle with buttons and my bed began to move like a Transformer. The head began to raise up almost like the back of a chair and the foot of the bed dropped down towards the floor, leaving me a shelf to be seated on with feet dependent and head upright, then she tilted the whole thing back so that I was reasonably in a kick-back mode. In that bed I passed through the night. The pain level stayed down at a four or so and sleep, with the help of the Dilauded and a benedryl capsule, stole over me and I enjoyed something which approached acceptable comfort the rest of the night.

That second day was one of the worst of my life. I have suffered physical and emotional pain before and this day stands out from all of the others by a long shot. The pain in my belly felt like the larval stage of “The Alien” was eating his way up from my intestines through my liver and diaphragn and into my chest. It was hard to breathe and I performed very poorly on the device through which I inhaled in order to expand my lungs. The pain was almost like a physical entity; a beaked, taloned and tentacled monster from one of the ‘B’ sci fi movies of the 19650’s that I loved so much as a kid

Only there was no love here on this day. The tentacles embraced me with a power which refused my lungs the ability to inflate. The talons dug into my flesh and denied me the opportunity to shake my monster off in any way. The beak ripped and tore through bone and cartilage and muscle to feast on the crying organs at my core. This monster came to stay, and none of the tricks and devices which became available at the end of the ‘B’ movies to enable the humans threatened with destruction to escape the final victory of the monster was becoming available to me. I was the captive of PAIN. I would remain that way. Tough luck, Kiddo.

The pain meds, which no doubt prevented me from shrieking at the top of my under inflated lungs even if they seemed to not be working at all, also kept my mind in the fog that I mentioned earlier. It was a humorous side note to the day when I would prattle on to my family and then stop, both of us knowing that I was not speaking of anything real at all. But there were those times when I was not speaking, when I stared vacantly at the television or at the ceiling or simply into the pain which gnawed at my belly, and they were not humorous. They were dead, or at least deadening. They robbed me of what is peculiarly me and replaced my me-ness with a stoned, mentally wandering imitation of me.

I am not a narcissist by any measure, but I have grown over the years to like myself. I am glad to know that I have some good points and I can clearly see the bad ones and work towards their correction without self-loathing. I have managed with the help of God to be a blessing – a mixed one to be sure – to a wife of thirty seven years, two children whom I adore and three grandchildren. I short, as the saying goes, I’m ‘comfortable being in my skin’. The drugs blurred my self awareness and I became ever so slightly not me. The sensation lasted most of a day and a half and never came to wholly dominate the real me. It tried however and it was not pleasant, and I was eager to cut down on the narcotics as quickly as the pain would let me, which I am told was a great deal more quickly than most people who have undergone my surgery have done. That process would become easier by the events of the next day, which will have to wait for my next post.