Summary: Esophagectomy performed July 27, 2015 at Georgetown University Hospital by Dr. M. Blair Marshall. Surgery took approximately 8 hours. Other than an incident with a leaking chest tube my recovery went very smoothly. I stayed in the hospital for 10 days. I could have gotten out earlier but we were all interested in seeing if I could leave without the need for a feeding tube. This morning I went for a 1.7 mile walk around my neighborhood. The most difficult aspect of my recovery is being hungry. Food looks good and smells good but I’m just not hungry. For those who know me that’s inconceivable. But I’ve got plenty of weight to lose so I’m not concerned yet.
I had to be at Georgetown University Hospital at 5:30 AM on Monday July 27, 2015. The plan was for me to begin undergoing surgery at 7:30 AM to remove the remaining cancer in my esophagus.
Walking up to the surgical center my wife and I quickly spotted our pastor, Curt Young, waiting for us. While I checked in Robin went to talk to Curt. The week before I had already done a pre-operative screening so the only thing I had to do this morning was confirm who I was, what I was having done and get my first of a few bracelets. Back in the waiting room we barely had 5 minutes to talk before a nurse came to get me.
I was lead to the last bed in the staging area and told to change out of everything and put on the ubiquitous hospital gown. I looked at a clock on the wall and saw it was 6:10 AM. They sure weren’t wasting any time. My wife was brought back and shortly there after we met the anesthesiology team. I was started on an IV and given something to relax. Things were progressing quickly and I hadn’t had time to pray with Curt so I asked one of the nurses if they could bring him back too.
With all the uncertainties of my health over the past two years the one thing I was certain of was God. He was my sure strong fortress in the midst of the storm and the prayers of hundreds of family, friends and friends of friends had helped sustain my faith. Now I needed His words of assurance once more before being taken into the operating room and Curt was just the man to deliver them.
I vaguely remember being brought into the operating room and being transferred to the table. Obviously the stuff they’d given to relax me was doing it’s job. Someone placed a mask over my mouth and told me to take long deep breaths…
Someone was telling me to wake up but I really didn’t want to. I was in a warm land of cotton candy goodness, why would I want to wake up? But the voice wouldn’t let me go back to my dream land. I woke up in PACU (post-anesthesia care unit) with Robin sitting next to me. I was elated that I wasn’t in any pain. I was also elated because I was still under the effects of the general anesthesia. Every inflation of the pneumatic leg cuffs sent a tingle of euphoric delight through my body. I remember raving how good they felt until Robin asked if we should buy some – darn right we should and get me some more of that happy gas while you’re at it.
I kept telling Robin she should go home since she had to be dead by now. She wouldn’t leave until they had me assigned to a room which they were still working on. Worst case I would stay in PACU for the night. As it was they had a room for me very shortly after I woke up.
The CCC Building at Georgetown stands for Critical Care Center. Being wheeled down the hall I recognized ward C41 as soon as we passed through the double doors. I had been here almost two years ago when Dr. Pishvaian wanted me monitored during a chemo treatment. There was concern at the time that I was experiencing cardiac distress from the 5FU. Back then I had a nice private room for my stay, this time they rolled me into a small shared room. Oh well, I figure I’m too wiped out to care – NOT. I wound up with the room mate from hell who decided to leave his TV on all night with the volume up. I asked the nurse to ask him to turn it down and you’d think we were asking for blood. I couldn’t believe the verbal and emotional abuses I heard this man lay on both the nurses and doctors. No one could do anything the right way at the right time as far as Mr. Crankypants was concerned.
After a restless night (thanks roomie) I woke up and started to assess my condition. I had a chest tube coming out my left rear ribs and 3 more coming out the right rear. I had a j-tube (feeding tube) coming out of my stomach just below my ribs on the left side. I was also on oxygen and of course had an IV. At the time they were just providing liquids through the IV. It was also how the Fentanyl pain medication was delivered. The fentanyl was connected to a manual button that would reset every 10 minutes, allowing for self medication. There were times I wouldn’t use it for hours and times (like when I was coughing) when I couldn’t get it to reset quickly enough.
The pain was nothing like I’d imagined. I thought for sure the first couple of days after surgery I’d be in some drug induced, semi comatose state, curled up in a fetal position. Truth is after coming out of the general anesthesia I was completely lucid and while I felt like I’d been kicked by a mule the pain wasn’t any worst that what I’ve felt before. We all know that feeling of our ribs hurting excruciatingly because of a cough we’ve endured for a couple of weeks – well that’s how I felt. As long as I was taking shallow breaths and not moving I had zero pain. But if I coughed – wowzers – I’d jump to a 7 or 8 on the doctors 1 to 10 pain scale. For the first few days I hovered around 2-3 which for me mean it’s annoyingly uncomfortable but manageable. The worst for me was my tail bone since I could only lay on my back elevated – I was always sitting.
So day two rolled around and I got my spirometer to start playing with. The spirometer a the little gadget you inhale into and try to get and indicator to go as high as you can. I started out at 750 – 1000 which seemed pretty low since the gauge goes to 4000. Around 9:00 I started to feel me breath getting more shallow. I couldn’t take in as much air as I had been and when I tried nothing happened. I started to panic as I realized I couldn’t breathe. I pressed the call button for the nurses station. I dreaded knowing I was going to be asked what I needed and wondering if I’d have enough breath left to gasp out, “I can’t breathe.” Thankfully I did and shortly I had two nurses and and a nurse tech hovering over me. Messi, my nurse started evaluating me trying to get me to roll over on my left side so she could see the chest tubes on my right side. It was at this point she exclaimed, “O crap!” My normal smart-ass self wanted to point out statements like that around a patient under duress were not appropriate but I didn’t think my humor would be appreciated. Besides I don’t think I could have said that much if I’d wanted since my breathing was becoming more and more shallow. One of the nurses was paging for a resident while Mesi was fussing with one of my chest tubes. They cranked my oxygen up and 2 resident surgeons showed up. I’d seen these guys on the morning rounds just a couple of hours earlier. As they were asking the nurses questions it became apparent to everyone that one of my chest tubes had become disconnected and had been leaking. I didn’t know what exactly that meant but I knew I felt like I was only getting a mouthful of air at a time. The one doctor kept asking to explain how I felt. One part of me is wondering how I’m supposed to answer Herr Doktor – WHEN I CAN’T BREATHE!! While the other dutifully replies, “Like I’ve got a refrigerator on my chest.”
I tried to keep myself calm but as the seconds ticked by and the pain in my chest increased I could feel panic knocking on the door. I wondered if this the point in the movie where they jabbed the monstrous needle through my chest or how much longer it would take before I’d black out. With the idea of blacking out came the thoughts of this being an unforeseen situation that I don’t recover from. And so I found myself praying like one who is about to meet his maker any minute. In the midst of this I watched one of the young doctors leaning against the door jam just taking it all in. Slowly I could feel the tightness in my chest loosen up. Minute by minute I could take slightly deeper breaths. I kept watching the passive look on the young doctors face and found myself thinking, “well if he’s not going to get all excited about this maybe I shouldn’t be either.” I told Alex days later his calmness really helped keep me from losing it. Alex told me my chest tube had indeed become disconnected and wasn’t keeping a vacuum which allowed my lung to collapse. It took the rest of the day for me to get back to where I’d originally been that morning on the spirometer but I kept working at it. At the end of day two, with great joy, I was moved to a private room on the other side of the nurses station.
I’ll try to remember the days but the whole chest tube incident was the highlight of my recovery in the hospital. Wednesday they helped me move over to a reclining chair where I spent the better part of the day. Because I had so many things hooked up to me moving was an orchestrated but chaotic mess those first few days. Lying in bed I had the IV stand and one chest tube drain container on my left and 2 more drain containers on my right. The drain containers had suction tubes running from the wall to each of them plus I had the telemetry and pulse ox wires. It usually took 10 – 15 minutes to detangle all the wires get me moved and then reconnect everything. The rest of the days all ran into one another.
I believe Thursday they removed the small chest tube from my left side. It was nice getting that out as it also took away one of the drainage containers – one less set of tubes to get tangled. Getting a good nights sleep was never going to happen while in the hospital. I have sleep apnea and sleeping on my back just exasperated the whole situation. I had my CPAP machine with me but my surgeon was concerned the air could go down into my stomach and put pressure on the sutures so using it was off the table. When I would finally fall asleep I’d stop breathing and the oxygen level on the pulse ox monitor would drop. It wouldn’t be but minutes before I’d have a nurse waking me up and telling me to breathe deeply. I had one nurse who I was able to convince I wasn’t going to die and to just let me sleep. Thanks to her I at least had a couple of nights where I could get 2-3 hours of sleep.
Sleep would never be an all night affair. Not when the vampires came nightly at 2:00 AM for blood draws. Other than being woken up at that hour this would normally not have been a big deal. I have big veins and don’t have a problem given blood – normally. Well nothing was normal – I had been having so much liquids poured into me through the IV that my hands and arms were puffed up like the Michelin Man. Every night turned into a hunt for a vein. A couple of times we just went for it. I could feel they were pushing on one it was just a matter of digging for it. I’ve still got some good bruises but they had to get a blood draw and there was no easy way about it so it was one of those things I just dealt with. The nurses tried as hard as they could and if nothing else we had some good laughs over it. Oh and the reason for 2:00 AM was it gave the labs time to have the lab results ready for the doctors morning rounds.
A quick note on the morning rounds. Georgetown is a teaching hospital so I had nursing students, medical students and residents. Every morning at 5:30 AM a bubbly young medical student named Anne would come in and play 20 questions with me. As the residents would move from one patients room to the next it was her job to give them all the pertinent information about me before they entered the room. “They” – usually comprised half a dozen surgical residents. Besides the morning rounds Dr. Marshall made a point of stopping by my room every day – EVERY DAY. She certainly made an impression on me just for her dedication. I’d try to get her to laugh or lighten up a bit but the woman was all business all the time.
All this time I was not able to drink anything and it was driving me nuts. All I wanted was to suck down a gallon of ice water. Friday I had a swallow test to see if anything leaked. I had to stand in front of some kind of CT scanner while I drank the foulest tasting contrast I’ve ever had. 4 times I had to do this and then they switched over to unflavored barium and had me do it 2 more times. At that point I told them one more time and they’d be cleaning up the floor – thankfully they were done and I had passed. My reward was being able to sip on a cup of ice chips. Nothing had ever felt so good. That evening I was also given some broth to drink and a little Jello.
Sunday I had another of the chest tubes removed which eliminated one more of the drain containers. On Sunday they also removed the Fentanyl pump. If I needed any pain killers I could ask for Percocet or Tylenol. That evening I experienced a coughing fit that just wouldn’t quit so I asked for the Percocet. My nurse ground up 2 pills and then injected it into my feeding tube. Well let me tell you it wasn’t 20 minutes and I was flying higher than a kite. For the next hour I sat there in bed feeling no pain and then I started sweating. I was pouring buckets like I’d run a marathon and was completely soaked. That was the first and last time we did the Percocet. I had one more time that I asked for Tylenol and other than that stopped using any pain medication.
Monday it was determined I was receiving enough liquids on my own and didn’t need an IV any longer.
The last two chest tubes worked in conjunction and I had those removed on Tuesday. With those tubes removed I had nothing else connected to me. I told the nurse I felt like Pinocchio – “I’ve got no strings to hold me down.”
Wed. morning Dr. Alex came back in after rounds and removed my stomach tube. By 11:00 AM my wife and I were walking (yes they let me motor out on my own) out of the hospital.
So how am I doing now? Robin was actually in Key West last week on a business trip and I was able to manage on my own. It was a bit tiring but doable. This morning I was took an exceptionally long walk in the neighborhood. My biggest issue is with eating. Food looks good and smells good but I’m just not hungry. I actually wind up forcing myself to eat which for those of you who know me is simply nuts. Of course a plus side to that is I’m finally losing some weight and since I have plenty to lose I’m not worrying about the eating issue just yet. When I get below 200 lbs. I’ll start to get concerned but hopefully this is something that will work itself out as my stomach continues to recover from surgery.