The last disappointment of 1998.
I got to the hospital around a quarter to six on Thursday morning. Joanie was already awake, and nurses were making last minute arrangements before we would head down to the pre op area. They were checking her blood pressure, temperature and pulse, something that would be done again in a short while in the pre op. I guess they wanted to see if anything changed on the trip down from her room on 7C.
The hospital chaplain stopped by to give some words of encouragement, and asked Joanie if she wanted to pray, something she wanted to do.
As I sat there looking at her I wondered what she was thinking. She wasn’t giving me any clues, except to tell me she didn’t want to be there, and wanted to go home. She said that with sort of a sad smile on her face, but did add that she was ready to get this done with.
Around six-thirty, they called for transport. That’s really an in house taxi. A guy comes with a wheel chair and will take you anywhere in the hospital you want to go, and the best part is you don’t have to tip him.
The pre op was familiar. It was brightly lit, cold, noisy and full of nurses, interns and doctors preparing patients for surgery. They found Joanie a bed, brought her some warm blankets and began to get her hooked up to the IV line. Then another nurse would come by with her file, and would take her temperature, check her pulse and blood pressure. I don’t think it changed on the trip down. She would then ask Joanie about any drug allergies, (she had none), and sign the necessary release forms so the surgery could go ahead.
The routine was the same as the last few times we had been here, first the anesthesiologist would come in, introduce himself and tell her he would be the one in charge of putting her under, and would be monitoring her vital signs throughout the operation and keeping her safe.
Dr. Carson then stopped by Joanie’s bed, and talked with her, telling her what was going to happen. She told us that first they were going to do a physical exam under anesthesia, and after that they would do an exploratory laparotomy, which is really just opening her up and having a look around to find out what they are dealing with, and if they would be able to go ahead with the ileostomy takedown and the hook up of the bowel, the outcome we were hoping for. She did remind us of the potential problem she had told us about the other day, and if they weren’t able to do the reconstructive surgery, the result would be creation of a colostomy. She told Joanie she would discuss the findings with me before they went ahead.
Joanie’s face spoke volumes to me. She acknowledged what Carson had said, but I thought she looked like all of the air had been sucked out of her, and she seemed smaller and more vulnerable than I could remember ever seeing her. It was like she already knew how this was going to turn out. It was hard to watch.
Carson squeezed her hand, and said she’d see her in the OR. Then the nurse anesthetist showed up. She would be helping the anesthesiologist, and she was the one who called for the nurse with the Versed. They gave Joanie a shot of that drug through her IV line, and in moments, her face relaxed, and they began to wheel her bed off to the OR. They were going to turn right to the OR, and I was going to turn left to head for the surgery waiting room so I kissed her and told her “everythings gonna be all right,” but I don’t think she remembered it, her eyes were already beginning to glaze over.
I signed in at the surgery waiting room, told the volunteer I’d be back shortly and went out for a smoke.
There was nothing for me to do now but wait for Carson to tell me what the findings from the physical exam and exploratory laparotomy were. While this surgery wouldn’t take near as long as the exenteration she endured back in February, it still would be a lengthy procedure.
While I was out, I picked up a copy of the Pioneer Press and the Star Tribune as well as a copy of The Onion and stopped by the coffee cart in the lobby for a mocha. I figured reading the papers and doing the crosswords would get me through some of the time in the waiting room.
Around ten or so, my son Ryan joined me there, so there was also someone to talk to. I also had a good deck of cards, if we wanted to play a little gin, and we wouldn’t have to improvise like we did that time in February.
Dr. Carson made an appearance, and we went off to an ante room off the main waiting area, and she gave me the news. It couldn’t be done. In reviewing the notes from the day, here’s what her notes said about what they had found:
“…it was determined that a minimal amount of colonic tissue would be available in order to repair this large rectovaginal defect. It was discussed in great detail among the surgeons that with this patient’s previous history of radiation for her cervical cancer and, most recently, iridium tubes placed for close approximated sidewall disease on the left side and the very large defect, that reconstruction of this rectovaginal fistula would be difficult and that good surgical outcome would be difficult to achieve, given the fact that her tissues have been radiated x 2, and a minimal amount of tissue was present for reconstruction.”
Those notes reflect the clinical aspect of what was going on. What I heard was the fistula was too big, there wasn’t enough colon left from the big surgery to work with, there was damage from radiation, and that reconstructive surgery “would not be advisable or to be able to be completed.”
It was the news we had feared, even as we had anticipated it. The hope we had clung to was now dashed. The upside of it was that they would take down the ileostomy, which was harder to take care of due to the fact there was so much liquid associated with it, and create a colostomy that would be easier to care for.
Carson returned to the OR to continue the procedure, and I was left trying to process all that I heard, and what it meant for Joanie, how she would handle it, and what affect the change was going to have on her life. It was going to be permanent, and that word alone sounded louder when I thought of it than it ever had.
I got Ryan and went outside for a smoke. Somehow everything seemed different now. I thought about that night in February when he and Kim and I were walking to the hotel, feeling good about the news Carson had given us that they would be able to hook her bowel back up after things healed up, and how long ago that seemed now, and how much had happened since. It didn’t seem fair, and it wasn’t.
When Joanie was brought up to her room on 7C, she was distraught. They had put in a Foley to drain her Miami Pouch, and the NG hose, i.e., “nose hose” to drain her stomach was in place, and she had a morphine pump in her hand. She took one look at me and started to cry, not much, but there were tears rolling down her cheeks which were flushed. I couldn’t do anything but grab her hand and squeeze it. We didn’t talk about what had happened, and she didn’t want to.
Joanie was still groggy from the drugs, the effects of the anesthesia and the pain from the surgery, and told me she wanted to sleep. She hit the morphine pump, and closed her eyes.
I had to make some calls to let her brother Richard, sister Ann and sister Ginny know what had taken place. I would let other folks know tomorrow when I had the energy to do so. There would be time for that, we were going to be there for a while yet. Ryan and Kim and I went somewhere, I don’t remember where, it isn’t important now. We had a beer and something to eat, and I went back to the hospital.
She was still sleeping when I got back, and the nurse who was hers for the night said she hadn’t stirred since I left.
As I sat there in the half light of her room on the incredibly uncomfortable chairs they have for visitors, I wondered how this was going to go.
It occurred to me as I sat there, it’s not the hand your dealt that’s important, it’s how you play the hand your dealt that matters. I began to feel better about how she was going to get through this.
She came to for just a few minutes, said hi to me and told me it was okay for me to go. I leaned over, gave her a kiss, told her I loved her and I’d see her in the morning. She closed her eyes and was out.