It Might Get Messy

So the docs came up with a slow-and-steady response plan to the failure of Tuesday’s surgery to stem the flow of body fluids from the lymph vessels to my chest at large. Concept was to stop using my gastrointestinal tract completely to let the physiology heal itself, in the meantime reestablishing my devastated nutrition via intravenous (vs. gut-tube) feeding. After a few days, the theory was, the exploded lymph system, decoupled from the forward pressure of the gut, might start to knit itself together enough to slow the tidal flushing.


For mostly logistics reasons, this plan went immediately awry. The scrip for the IV nutrition, apparently dangerous if not meticulously prepared, precipitated a kick around between the pharmacy and the docs. The potential for several days invested in mostly waiting with a fairly high potential for little therapeutic return seemed to be on everyone’s mind. The docs didn’t seem all that confident, but were reluctant to move immediately to more drastic and intrusive fixes.


That all went down over Wednesday and Thursday. Friday was now the day to begin to implement the attrition strategy. So it was something of a shock when Doctor H walked into my room at 9 o’clock Friday morning to say “Listen, I got an idea. How would you feel about going in for another round of cutting. Like, say, now. We can get an operating room on an emergency basis at 10:00. I think this will work and we should do it.”


This is one of those moments that patient advocates, patient advisors, and patients with any rational concept of risk management decision making would have a million detailed questions, starting with the basic “what do you want to do while you’re back inside there?” I’m sure we had time for at least a few inquiries and answers, a few moments for reasoned consideration and risk/benefit balancing.


I didn’t bother with any of that. I told Dr. H that if he thought there was something he could do by hacking his way back inside my chest within the hour, I was on board and ready to rock. He said he’d go scrub, I could sign the releases while they wheeled me downstairs, and he’d see me in the operating room in half an hour.


Next thing I knew, I hurt like hell again, Cathy and Molly had dropped everything and hotfooted it to the hospital, and nurses were injecting me with pain killers in the recovery room.


On his way home for the weekend Friday afternoon, Dr. H stopped by my room. He’d come to apologize, he said, for the way I got slapped into another round of surgery with zero notice and minimal technical justification. But he said he’d been waking up in the middle of the night all week worrying about the inability to stop my fluid losses and growing increasingly ticked off about a passive response strategy. He said he finally snapped, figured he knew which way I would prefer to go, and essentially over night lined up his department head, graybeard faculty guy who had more thoracic surgery experience than god, to participate in the operation. He said they dug into my chest until they found three cryptic lymph vessels leaking way in the back corners and tied them off. Then he glued me back together. 


I not only told him not to apologize, I thanked him for having the courage to take a hard-core aggressive path and to cover details like getting his department chair on board.


Status? I hurt like hell, especially my mouth, which has big-ass inflammation from, I think, the breathing tubes, and parts of my neck. But it looks like they cut the flux of lymph. Hell, if my mouth heals and this weird IV feeding bag stuff works, I could be a functional human being in no time.


You gotta love a surgeon not only willing to trust his own instincts but enterprising enough to make it work when he had to line up an emergency operating room and staff and engage a busy senior colleague and courageous enough to suggest to me that I trust his instincts as well. A professional masterpiece on Dr. H’s part that I can only admire and humbly learn from!