Reality comes calling.
Today, Thursday, March 5th, was three weeks since Joanie’s surgery, and I had learned a lot in my time at the hospital. I knew not to get exited when the Baxter beeped. I got to know all of the nurses who cared for Joanie. I learned not to get exited when she threw up, but just go about matter of factly cleaning her up. I knew where the ice cubes were. I knew where the popsicles were, and I had learned that things don’t always go as planned, and not to get excited when that happens. I had also learned to not be afraid to ask questions of either nurses, or doctors. I learned that the nurses on 7C were as knowledgeable about Joanie’s situation as anyone who wasn’t a doctor could be, and there was a comfort that came with that knowledge. I had learned where every joint where I could go for a burger and a beer on the campus was, and there was some comfort there as well.
What we had focused on during the past 21 days was just getting Joanie healed up so she could go home. We really hadn’t dealt with the reality of the change the surgery had brought with it. That was about to change.
Today, the last of the drains came out, another good sign. When I got to the hospital she was doing well, but then I discovered they were treating her for a fungal infection, something I had been unaware of. Seems like even when you think you’ve been paying attention, things get by you. I was told it was something that would not hold up her discharge.
We got a visit from the discharge nurse today, and it was her job to notify home health care in Bismarck that Joanie would be home shortly, and clearing any help we might need when we got home with the insurance company.
Now we got down to the business of what Joanie would be facing for the rest of her life. The first thing was learning about dealing with the Miami Pouch, her new bladder. The change meant that unlike it was before the surgery, when she could feel the pressure telling her that she needed to relieve herself, now there would be no pressure. Her kidneys would just drain into the Miami Pouch, and she would have to empty it at least four times a day, or more depending on her intake.
Today we were getting our first good lesson in the mechanics of emptying the pouch. Up to now, there had been a Foley catheter that drained it into a bag on the side of the bed, doing the work on a full time basis.
One of the nurses, Lori, guided Joanie through the process. The first thing we were told was that she would insert the catheter, called a #14 Red Robinson that had small holes in the end of it through her naval. She would have to put just a small dab of Surgilube, a lubricant, on the end of it, to help get it past the flap that was built in to keep urine from leaking out.
The next step, one that didn’t have to be done every time, was irrigating. Because of the nature of the pouch, which was made from part of her bowel, mucus would have a tendency to build up, and it could plug the Robinson.
We were given what looked like big plastic syringes, and a bottle of saline solution to be used for irrigation. There was a plunger in the tube, and we were told to fill the syringe with the saline, and then slowly push the fluid into the pouch through the Robinson. The catheter had a larger opening at the top to facilitate irrigation and drainage. When all of the solution was in the pouch, reverse the process and slowly pull on the plunger to begin drawing fluid out of the pouch, and let it run a receptacle until it stops. Think of it as priming the pump.
We would find out, over the course of years, irrigating the pouch was not always necessary, but we never went anywhere out of Bismarck without a bottle of the solution, at least two of the syringes, a tube of Surgilube, a supply of #14 Red Robinsons, a receptacle, and a supply of large Ziplock bags. I had made up a special bag that was ready to go anytime.
Joanie handled the lesson well, irrigating the pouch by herself, under the guidance of Lori, but that was probably the last time she did it by herself, usually leaving that job to me. Lori also cautioned her about going too long between emptying, since a build up of urine in the pouch could make it difficult to get the catheter, even with Surgilube into the pouch because of pressure on the flap. This would then present a bit of a problem that could require some medical attention.
When they finished the lesson, they hooked the Foley catheter back up to the pouch so she wouldn’t have to worry about again until tomorrow.
The reality of what this surgery meant in terms of changing her life, was no longer an intellectual idea, but an emotional reality. As I said, up until now we had just been focused on getting her healed up so we could go home.
Tomorrow, would come another lesson, dealing with the handling of the ileostomy, something Joanie wasn’t looking forward to, but the thought of it being temporary made it a little easier for her to adjust to it.
Around five o’clock or so, Dr. Chen comes in and informed us Joanie is “out of here on Saturday.”
That news made both of us happy, if not just a little apprehensive. So the rest of the evening, until I went back to Tom’s place, we walked a couple of times, and talked about the new reality of her life.
She seemed ready to meet it head on, and there was no doubt in my mind, as difficult as this situation was, she would.