Discharge Day

Sometimes, I think of this space as just somewhere I go to put down my own thoughts.  I forget that others actually read this blog.  And yesterday, I got a phone call from a good friend, who was checking up on me because there was no update here.

I frequently use Facebook to disseminate info quickly to friends.  My wife and I have done that this time, plus used FB Messenger, text, e-mail, phone calls, etc., in the last week.  But, the blog sat here untouched, so here's an update for my 5 blog readers.  You guys actually get the details that others won't get.

In our pre-op meetings with the surgeon, the surgeon was very comfortable with the problem at hand.  The CT scan last Tuesday showed that the last two rounds of chemo had continued to help.  He also felt that the lesion "in" my liver wasn't really in the liver.  It was "on" it and that meant the liver did not need major resection.  

As for the bowel area, he thought there was a primary likelihood, and then two other possible findings - one better than expected and one way worse.  The expectation was that they would do some resectioning of the bowel.  I wrote about the options in my last post. 

I was warned that the cutting into the psoas muscle would cause some permanent (although allegedly harmless) loss of skin sensation on my right leg.

Pre-op went smoothly.  The doctor was there, ready to go.  Prep didn't take long at all, and I was allowed to walk into the OR - a first for me.  I hopped up onto the table, they put a mask over my face, told me to breathe deeply and I remember nothing for hours.  The first thing I remember after surgery is being in a lot of pain in the post anesthesia care unit (PACU).  I don't remember how all of the conversations went, but Fentanyl was not controlling my pain well.  Someone, possibly me, suggest Dilaudid as an alternative.  This switch provided near instant relief and we switched from the higher strength medication to the lower strength option.  I had a button that I could push as often as I wanted, but it only worked once every 10 minutes.  We then found out that the hospital was overbooked and they had no room for me.  By 10:00 or so, my wife left.  We still had half a dozen patients in PACU with a handful of nurses.

Oh yeah, before my wife left, she relayed news from the surgeon.  All of the tumors had come out in the best possible fashion.  He was able to get the tumor off the outside of the liver.  The two bowel tumors peeled right off and required no resection.  He was able to get good margins with the psoas tumor, although the numbness has been way more significant than I expected.  But, I lost very little healthy tissue and no organ tissue.

I was supposed to go to the 15th floor, but sometime after 11:00, a room opened up on the 16th floor.  They decided that was close enough and I went to my room.  I slept fitfully, but I had the pain button and got through the night OK.  In the morning, my breathing was a bit labored, but that wasn't fully unexpected.  But, my nurse told me that I had a pneumothorax and needed to have a chest tube installed.  This just hit me in the gut.  Chest tubes can be really painful.  I was alone in my room, waiting for my wife, waiting for the doctor, and contemplating trying to get up and walk out of the hospital to avoid the tube.  When the doctor showed up with the official news (the nurse had leaked it to me in advance), I explained my reticence, but also acknowledged the breathing problem.  The doctor explained that the tube I would be getting is a newer style of chest tube - much thinner and more comfortable than what I'd had before.

So, we headed downstairs to interventional radiology for procedure.  After getting the standard "twilight sedation" cocktail of Fentanyl and Versed, I was still talking a lot.  The anesthesiologist decided to "up her game" and added some propofol.  Ten minutes later, which felt like one second, I woke up and the chest tube was in.  It was never a problem, to be honest, and my breathing improved instantly.

My wife finally found me in the recovery room after the procedure.  She was in a panic.  She had gone to the 15th floor first.  They'd never heard of me, but finally tracked me down on the 16th floor.  There, they couldn't find me either, and finally told her I'd been taken downstairs for a "procedure".  But, they didn't tell her what the procedure was or why it was happening, and she was imagining I was back in major surgery.

From there, things started to improve.  I walked a bit that afternoon (Friday).  I got moved to the 15th floor and shared a room with a very nice gentleman from South Carolina and his wife.  Friday night, my wife stayed in the room as well.  Saturday morning, my wife flew home to take care of things there and I continued my recovery.  I found out that it was 14 laps to the mile walking in circles on the ward.  I did 3 sets of 10 laps on Saturday.

I was walking more and more each day and my night nurse asked me how many laps I'd done one night - maybe Monday night.  I told him I'd walked 64 laps that day, having built up from 30 a few days earlier.  He told me the "record" was 75 laps.  So, I walked 101 laps the next day, with my IV pole.  That's over 7 miles, and it took me about 3.5 hours total.  I knew then that things were over the hump.

I had chest x-ray's every day and the pneumothorax had fully resolved very early.  The tube stayed in for a while, but only because the IR team insisted.  My surgical team wanted it removed earlier, because they knew more details.  They had caused it by nicking my diaphragm with a scalpel during surgery, allowing some air into the pleural space.  They had also repaired the nick, so they weren't concerned about it returning.  The tube was finally pulled yesterday.

The original guess was that I'd be discharged Thursday (today), but I needed to pass some gas, have a bowel movement, and then eat some solid food before I could go.  I was bloated by gas for a few days as my bowels slowly came back to life.  I'd pass gas or have a bowel movement, and then lock up again.  Finally, on Wednesday morning, things really got going, and I moved a lot of gas out of my system.  I finally ate some food.  And then, we knew it was time to get me out of here.

That's a short version.  It appears that the surgery was a success, although I don't have the final pathology report yet.  But, liposarcoma is relentless, and there's no guarantee that I'll be disease free when I have my next CT scan in July.  For now, I want to heal, get back to my life, help my daughter decide on college for next year, and I'm looking forward to a family vacation to Lake Tahoe in June.  And maybe start training for the Ghost Train ultras in NH in October, although I am planning to hike rather than run most of my miles there.  Oh yeah, it's soon trout season.

I finished reading Atul Gawande's "Being Mortal" in the hospital this past week.  Reading that book while spending a week in one of the top cancer centers in the country, where some of the toughest cancer cases aggregate, has been eye opening.  You can be sure I'll be writing more about the book and the related experience in the near future.