The last full day.
Friday, the 6th of March dawned with the sun out for the first time in weeks. I took it as a good sign.
That morning I loaded up the car with my bags and Joanie’s bag and left Tom’s place in St. Paul, where I had stayed since a couple of days after her surgery, and headed for the hospital. I would check into the Radisson sometime in the afternoon. We were getting close to going home.
When I go to the hospital that morning, I found that Joanie had thrown up around six, but they weren’t concerned, and there was nothing to indicate a delay in her discharge.
We went for a walk around the halls of 7C, and she was doing quite well, I thought. She didn’t look that good, but her determination was evident. She was going to go home, and nothing was going to get in her way.
They took her down for another X-ray of her abdomen, for a last look to be sure there weren’t any problems. As of late that afternoon, we hadn’t heard anything, so we assumed there were not.
The second reality check.
Then it came time for the session on the ileostomy. We were going to learn how it works, how to change it and how to avoid any problems with it. This was the one change Joanie had dreaded, but now that it was here, she accepted the fact we had to deal with it. She always looked at it as temporary, and I think that helped her.
The ileostomy is formed by making an incision and making a hole about the size of a quarter, and bringing the small intestine up to the surface of the skin and then suturing it in place. This means basically that waste goes directly from the small intestine into the “appliance,” as they call it. I never could figure out why they called it an appliance. When I thought of an appliance, I thought of a toaster, stove, washer or dryer. They were appliances, but I thought of this as being more like a medium size sandwich bag with an opening that covered the stoma. Stoma is a word for the opening through which the waste passed.
The ET nurse who gave us the lesson first started out with the basics. There were the bags, or pouches, which had a hole in the back side, the side that was attached to the skin. There was a tube of stoma adhesive, which you would use to squeeze out a bead around the stoma before applying the bag. There was adhesive removal, to be used when the bag was changed, and it would remove any residue from the previous change and help to insure a good seal.
The back side of the bag, the side with a hole in also had a larger, adhesive based flange, that when pressed over the stoma and it came in contact with the adhesive and skin would make the seal. A good seal was important, due mainly to the fact that Joanie would have no control whatsoever on what came out of her body into the pouch. We were also told it would help the seal if Joanie would hold her hands over the pouch and press for a few minutes after it was applied, and the heat from her hands would help the bonding.
We were also shown how to prepare the pouch. The ones they were using didn’t have a hole in the back, just a small opening that would have to be enlarged using a sharp sizzors to cut out the hole and make it the right size to fit over the stoma and not interfere.
Later, after we were back in Bismarck, we were able to get custom made pouches with the right size hole already cut. The bottom of the pouch was more narrow than the top, and it was folded over and held in place by a clip that would be removed to facilitate emptying it.
I began to see the problem we were going to have right away. First off, since the stoma was located on her right side, Joanie couldn’t look directly at it to either clean it, put on the adhesive or place the “appliance” over the stoma and insure there was a good seal.
One suggestion the nurse made was to lay the bead of adhesive around the hole in the flange of the bag before applying it over the stoma. I saw where that could work, but I knew the business of changing, at least at first, was where I was to come in, and I got quite good at changing it over time. Besides that, I too, was planning on this being temporary, and when she was sufficiently healed in a few months, they could take down the ileostomy and restore the normal function of her bowel. At least that what we were hoping for.
After we were done, I knew that I would also have more items to be included in the bag along with the Miami Pouch materials. That meant several pouches, at least one tube of stoma adhesive, adhesive removal pads, and additional clips to hold the pouch shut. With that I figured we could handle just about any contingency no matter where we went.
The lesson, and the reality had tired Joanie out. I was a little worn out myself. She slept and I went over to Sally’s for a beer and to consider all that had gone down the last two days, and how things were going to go when we got home. I had a good idea of how to handle everything by now, but it was the unknown that I was sure would pop up, as it always does, that left me uneasy.
Back at Joanie’s room, we went for a walk, and talked about tomorrow. Before I left for the night, she asked me to get her a popsicle. I did, and I think I enjoyed it as much as she did. When we were done, I kissed her good night and headed for the elevator.
The lobby was quiet, as it was every night around ten o’clock, and my friend, the night security guy, asked me how things were. I told him this was the last night I’d be walking through his lobby, they are going to let me take her home tomorrow. He smiled at me, shook my hand and wished us good luck.
As I left to walk back to the Radisson, I remember thinking I liked how that sounded.