28 January 2006

More Parents, pouring rain, and Portland -- Discovery

When I walked into the intensive care unit early Monday morning, I knew I would hate what I saw. My mother is among the least patient patients on the planet – something she shares with many other medical professionals. But lying in the hospital bed, just 12 hours removed from surgery and general anesthesia, she looked passive to me. I didn’t know this Virginia, and I didn’t understand how this came to be. I read the monitors and saw that her vital signs were fine. The burbling of the chest suction, the beeping and whirring of the various infusion pumps and all of the machinery of medicine were distracting both my mom and me. The ICU nurses assured me that she was recovering remarkably quickly from an invasive and serious surgery.

Her surgeon went into great detail about the circumstances of her illness, surgery, and prognosis. I asked him questions. And yes, it was pretty much the shorthand you see here. Talking with surgeons is better if you keep it terse. Surgeons know how to cut. Diagnosis, talking and compassion is better left to other medical professionals.

Me: Diseased gall bladder?
Surgeon: Yes, very.
Me: Cause? Possible malignancy? (He was a surgical oncologist. He would know.)
Surgeon: Very doubtful. I’ve done a lot of these. I didn’t see anything to make me concerned.
Me: Possible mass on her liver?
Surgeon: No, a liter and half of pus.
Me: Pus? (!!)
Surgeon: Yes, your mother’s gall bladder was necrotized. The bladder was probably decaying in her for three to six months before it perforated. (For you, gentle readers, read “gangrenous” for “necrotized” and “exploded” for “perforated.” Think of a dead, exploding “Chestburster” stage of the xenomorph in “Alien” for my internal reaction. Outside, stoic: I’m talking to a surgeon, remember? )
Me: So what did you take out?
Surgeon: Well, because her gall bladder was so diseased, I had to make a large incision along the length of her abdomen, retract her abdominal muscles, remove pus and the diseased gall bladder, and clean and cauterize any other possible sites of infection, and lavage all the remaining pus from her abdominal cavity. I left part of her gall bladder attached to the base of her liver.
Me: Wow. That’s a lot of surgery for an 82 year-old woman.
Surgeon: Yes, it is. She had a very sick gall bladder.
Me: So, what do you think her recovery will be?
Surgeon: She’s a tough old bird. (A unique and accurate description for my mother that seems offensive but isn’t.) She had no co-morbidities and her vitals were strong throughout the operation. If we can avoid sepsis (of course, there has to be more rotting and pus), I’d say she’ll be fully recovered in about six months.
Me: OK. What about the next few weeks? (I’m venturing into dangerous territory here, asking a surgeon for a medical prognosis, and I know it.)
Surgeon: Oh, she’ll need a lot of care, probably in a skilled nursing facility, for up to three months. Assistance with moving from the bed, walking, bathing, care of her drains and chest tube: that kind of thing.
Me: Wow. OK. Thanks.
Surgeon: You’re welcome.

Well. That put everything in perspective. My mom had been ill for a long time. But I knew this: she’d claimed for ten years that old age had forced a change in her diet, and, loving son that I was (and am) accepted this as gospel. Clearly, something else was the cause of the change. The “something else” was that her gall bladder had failed, and had been failing for a very long time. Without providing bile, Mom wasn’t digesting fat effectively. Which lead to a variety of unpleasant side effects that Mom had catalogued in our conversations for, well, about ten years.

So, the first revelation: Listen to your body. Get medical attention. If the first diagnosis doesn’t fit, keep at the process until the diagnosis and treatment actually correct the problem. If the problem is with someone you love, gently but firmly convince them to follow the above process. General medical treatment is a lot more pleasant than surgery and recovery in an ICU.

Now, aside from being able to joke about rotting from the inside with my mother and the hospital staff, I knew two things: One, Mom was going to be OK. I now understood why she looked the way she did in the hospital bed, and I knew that her condition would improve. Two, I could do something. Mom was going to need more attention than I would be able to provide (because G2 and my work, while allowing – and encouraging and supporting -- me to attend to Mom and her needs, weren’t really going to be happy if I were to move to Mt. Angel/Silverton, Oregon for the next three to six months). So I went in and talked with my mother, and the ICU nurses, and left them to make my to-do list. And started to work.

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