Life: 5 days in the hospital - bowel obstruction ... again

I was in the hospital from Sunday to Thursday.

Want to say thanks to friends and family who prayed for me and encouraged me during this time of health concern. Some of you are occasional blog visitors and might want to know more of what happened. Since I have a habit of writing out my experiences as part of dealing with them you've come to the right place.

I imagine some readers will find this blog post via google or yahoo or some other search engine because either you or someone you know is going through the same thing and want to read more. I hope this post will be helpful in some ways in pointing medical web pages and descriptions of what the experience was like.

The short version - just the facts ma'am

My diagnosis: a partial small bowel obstruction. For a web page that is a bit more graphic, try this one. Here is another web page where X-ray's of intestinal obstructions are shown.

My treatment: nasal-gastric tube and supportive hydration via IV until obstruction clears on its own which it did!

The longer version - the full play-by-play

Sunday

On Sunday afternoon, I had a mild pain at 1pm after spending my morning at church. I had a bit of lunch at my parent's place figuring a little food might settle down the discomfort and then I took a nap. I woke up at 5pm to increasing abdominal pains and felt muscle aches in arms and legs and an overall exhausted sensation.

The abdominal pain continued to increase and by 8pm, we decided it was time to go to ER at Cedars-Sinai Medical Center.

In October 2004, I had surgery to relieve a bowel obstruction. I was advised by my surgeon and by doctor friends that there is always the possibility of a re-occurance. They said the risk was low but not uncommon and I should act quickly should I suspect it.

During my recovery time from that prior surgical experience, I wrote about it in this blog: Part I, Part II, Part III.

In the ER, I filled out the information form describing my symptoms and waited. It wasn't too long before I was shuttled into the ER exam room. One of the staff told me it wasn't too busy ... for a Sunday. I guess busy is a relative term! I saw that some patients were in the hallways so in my mind that seemed busy!

An IV-line was put into my left arm and blood drawn for testing. The ER doctor came in and she quickly did a medical history and physical exam. She naturally asked about the prior surgery and I told her all I remembered about the details. She said certainly obstruction is on the top of the list but there are some other possibilities. We will send you off for an x-ray and that should tell us more.

X-rays were shot of me lying down and standing up.

Back in the exam room, I waited as did my parents. One person is allowed with the patient in the ER exam room so my mom and dad took turns being with me and being in the ER waiting area.

Monday

The ER doc came back and reported her findings: indeed, it was an small bowel obstruction and that it was a partial one.

I asked if surgery would be needed. She said, maybe, maybe not, I'm getting a consultation on that. A specialist will be here shortly.

Since I was previously operated on at CSMC for this condition, they found that one of my surgeon's assistants was on call that night. She came to the ER and was brought up to speed on my case and she did some examinations as well. She said, it is partial so it may resolve on its own. I'm admitting you for observation and we will wait and see. At this point, the pain was reaching high levels and I finally opted for the morphine shot.

For those who have never taken one, it is a strange sensation. Since the IV was open, they feed it right in the line and within minutes I could feel a warm sensation course through my body and for a minute or two the pain increased but then ... it fades and you feel like you are flying away.

Pain is the way your body tells you something is wrong. When reporting to the doctor what you are feeling note when the pain started, the type of pain (dull, sharp, increasing, decreasing, sporatic, constant, etc.), where the pain is and severity. All of these are clues for your doctor to figure out what might be wrong.

Low levels of pain are those you notice but it doesn't interfere with concentration. Moderate pain does. When you get to the point when all you think about is the pain and you take shortened breaths and moan, it is getty pretty bad.

I was wheeled to 8 South where I was last time. It was about 3AM.

It was deja-vu all over again. I was in room 8803. I think I was in 8801 last time!

But the key difference was that last time I got to 8S after surgery while this time it was a possibility but not determined. I was doubled over like a shrimp, had an IV in my arm and was now waiting for what would happen next. And it did, I tossed my lunch into the pan.

The morning was a blur as I was feeling nausea, in moderate pain and exhausted ... there was the morning exam by the doctor, the gurney ride to the x-ray facility, more blood samples, IV change outs (for those who care about such details I think it said 0.45% sodium chloride, 5% dextrose, 20 milli-equivalents of potassium chloride - this would be food and electroyltes that would help keep me going) that would punctuate waiting around.

In early afternoon, a CT scan with oral and iodine contrast was ordered up.

I slowly sipped the pink liquid. I asked the nurse, I'm going to vomit this up aren't I?

She said, maybe, but I hope that happens after the CT scan.

Oral contrast fluid is x-ray opaque. The material will coat various surfaces in the digestive system and give the radiologists and doctors a better view of my "plumbing."

The CT scan churned away.

I was also injected with iodine. Iodine is also x-ray opaque and since it came in via my blood stream, it will mark off blood flow to my intestines. One of the factors in determining whether surgery is needed or not is whether blood flow is compromised to intestines. Without blood flow, the intestines die and that would be a serious problem!

The CT scan churned away.

I was carted out of the imaging room and promptly threw up four or five times. There I was with my pink bucket with pink liquid. Hey, I'd be proud to tell my nurse I held onto it until AFTER the CT scan!

My nurse received me back at 8803 and awaited for the inevitable order for the nasal-gastric (NG) tube. With the order officially logged she and one of the older nurses threaded the tube through my nose, down the back of my throat and down into my stomach. The whole process took hardly anytime at all. These people are pros and I suppose having been through it once before meant I probably didn't have the usual terrified look which requires more explaination and assurances.

The concept is to empty stomach contents (reduce nausea and vomiting) and relieve pressure behind the obstruction.

Monday afternoon ... Monday evening ... I drifted in and out with the Monday Night Football game on. I noticed Indy was making short work of the Pats. I was surprised.

Tuesday

Tuesday morning ... surgeons and their assistants keep early hours ... I can't remember when she came in to fill me in on what was ahead for the day. She said it is only a partial and said the CT scan was helpful. She told me my blood flow to the intestines were fine and reiterated it was only a partial blockage. She reported that more often that not, these resolve without surgery. She said an x-ray was ahead for the day and more wait and see. She encouraged me to be up and about and as active as possible.

I wonder how common are female surgical residents?

It was in some moments of relative clarity of mind after this that I realized that female doctors were the major players in this latest health episode: the ER doc, the surgical consultant called by the ER doc and now one of the surgeon's top assistants seemed to be managing my case. She usually had one to three other doctors in tow using the opportunity to teach them the process before and after visiting with me.

I suppose in the distant past, when female doctors were so rare, patients might feel uncomfortable. As I saw it, if you know what you are doing and are making an effort to communicate, I'm glad you are on my side!

Minutes drifted into hours and I walked around the floor, channel surfed TV, slept sitting up in the chair, listened to the sound of the NG-tube gurgling away and watched fluid accumulate into the vessel.

One can't sleep for any length of time with an NG-tube in. It is like having a mega sore throat all the time. And when I would toss or turn, it would poke a bit and I'd wake up. I probably didn't sleep for longer than 45 minutes at any one time.

I took to saying ... not too loudly, lest people think I was losing my mind ... hey, intestines, wake up!

Wednesday

Wednesday morning ... IV change outs, x-rays, MDs listening to my bowels, flushings of the tubing of the NG-tube to keep the flow going.

Finally, Wednesday afternoon, light at the end of this tunnel!

The nurse brightly announced, the MD has ordered that the vacuum on the NG tube be stopped for four hours. If the stomach filled back up they would reconnect but if it didn't back fill that would be evidence that the digestive system is moving FORWARD!

After 4 hours, the vacuum was reconnected and they wanted to measure how much material would be aspirated in 30 minutes. The nurse checked back in 30 minutes and noted the volume in the collection vessel. She seemed hopeful. She said I'll tell the doctor the numbers and we shall see but I could sense from her expression that her experience told her it was probably good news.

And indeed, the NG-tube came out!

I had broth for dinner Wednesday night. No problems.

I actually slepted sort of well that night ... in two-hour bites.

Thursday

In the morning I had solid food for breakfast. They wanted to see if I could handle that. I even went to the bathroom afterwards!

After a few hours of no problems with the solid food. They cut me loose Thursday afternoon.

What happened?

Most likely, I have scar tissue or adhesions or both in my intestines from the prior surgery. Metaphorically they are plumbing and pipes (a static metaphor) but since they absorb nutrients out of food they are highly dynamic digesting the material and pushing it along like a peristaltic pump. These things are highly dynamic and there is considerable motion and activity. Generally, they don't kink or flip or pinch. But sometimes they do and get stuck. With a prior surgery, the chances of that happening are higher.

Will it happen again?

The risk is elevated. I've known people who have had blockages and haven't had one since. Nevertheless, I have to be aware of how my body is reacting.

Thoughts on hospital quality

I have to give a huge shout out to Cedars-Sinai. I hear their radio ads, "The Quest for Health" and reports of how they do well in ratings of hospital quality.

One big issue in health care is reducing medical errors. It may seem repetitive to be constantly asked who you are and to show an ID band but it makes sense. Take a typical trip to get an x-ray. Transport aide enters my room and IDs me. He/she wheels me to the Grand Central Station for the imaging unit and logs me into the desk there. On one of the mornings, I noticed 6 other patients moaning and groaning as they awaited imaging work of various types. A radiology tech checks with desk, IDs me and moves me into the imaging suite. The radiology tech takes the pictures and carts me back to the waiting area and logs me into the main desk. A transport aide logs in to the desk and IDs me and takes me back to the room.

Nursing to transport to radiology to transport to nursing... put that on your baseball score card! Fill in the names of the multi-ethnic people who make CSMC go and you've got yourself a tongue twister of a double-play combination!

Another issue is helping the patient know what the heck is going on so they feel they are a partner in the process. I was told what every shot was, what every IV bag was and what every diagnostic test was. I was given a sense of what the next steps were.

Also huge is infection control. It is re-assuring and good health practice to wash hands and it was indeed good to see my medical personal constantly hitting the hand sanitizer dispenser.

I've been fortunate that in my life, I've only been admitted to the hospital twice.

I've visited people in a few hospitals here and there.

I must say, CSMC is one of the cleanest and brightest looking hospitals I've seen. As a patient, I think that helps. Imagine you are sick and wondering what will happen next and when you look around you see ... a dirty and dingy and dark looking hospital?

Disclaimer: I am an employee of Cedars-Sinai though I work in the Research Institute and am not involved in patient care. Suffice to say, if I never had to have first hand experience with the clinical side of the hospital, I would have been quite pleased. 8-) But since it did happen, I'm glad CSMC does such a good job!

Psalm 4

With a name like Cedar-Sinai, you would know that it has its roots in Judaism. I have great appreciation for the influence of Jewish values in American life. As a Christian, I have a passing familiarity with the Hebrew Scriptures.

As I drifted in and out of awareness in the post-midnight hours while in the hospital, I kicked myself for not being better about memorizing Scripture. I had remembered reading a Psalm recently where I could imagine David composing it after having a difficult night.

I looked it up today and want to share an excerpt:

Meditate in your heart upon your bed and be still.
Offer the sacrifices of righteousness
And trust in the LORD.
Many are saying, "Who will show us any good?"
Lift up the light of Thy countenance upon us, O LORD!
Thou hast put gladness in my heart
More than when their grain and new wine abound.
In peace I will both lie down and sleep
For Thou alone, O LORD, dost make me to dwell in safety.




Disclaimer: The material above is a description of my health experience. Though I have attempted to be accurate I am not a medical professional. If you are in need of actual medical advice, please contact your physician.