Recovery and the Power of Prayer

10 days later

It’s hard to believe it’s been only 10 days since my surgery. To anyone reading this post who offered a prayer for me, thank you so much. I firmly believe that your prayers enabled me to experience a blessing of healing in the last week and a half. If you want to skip the over sharing, you can jump down to “Heading Home”.

Ten days ago I was in the PACU, prepping for surgery. Beyond the typical questions and prep, I was also given a smorgasbord of random pills whose collective intent was to coat the lining my small intestine in order to dampen the pain and promote post-op healing. These meds collectively were part of an ERAS (Enhanced Recovery After Surgery) protocol; I’m sure most procedures now have this protocol, but I was amazed at the effectiveness of the seemingly random conglomeration of meds used for GI surgery. Celebrex? Really?

Anyway, because I’m me, and I cannot move my neck, I need to get intubated before they knock me unconscious. The idea being that if they apply the general sedation and then cannot move my head to secure the airway, game over. They need to secure the airway while I’m conscious.  If that sounds bad, the reality is much worse. In preparation for getting intubated, the nurse anesthetist (CRNA) stopped by to start numbing my throat. First, she gave me a shot to dry out my mouth (I can’t even imagine the rationale for developing such a med) and then hooked me up to an inhaler with lidocaine in the bowl. Folks, it’s 2019; you’d think that they could develop a vapor med that tastes less like licking a compost pile but, alas, no.

Fortunately, after answering all-the-questions and getting an IV started, Larisa was permitted to join me. We had over an hour to kibitz, worship, and listen to a recording of breathing techniques intended to help us relax and help me heal better. All too soon, the transport service was there and I said goodbye. If you’ve never been through surgery, this is a really poignant moment. Your brain is grappling with the realization that you may only have 30 minutes of human consciousness left; this may be the last time you ever feel your wife’s hand, or look at her lovely face. Faith is real. To fear the unknown is human. Through my multiple surgeries and procedures, Larisa has learned not to say goodbye. Instead, she says, “See you soon,” because no matter what happens, it’s true. Hopefully in just a few hours, but if not, just a few short years until Heaven.

They wheeled me outside of OR 47 at 8:26AM and parked me beside a bunch of empty boxes. Literally lying beside the trash to be taken out. Cleveland Clinic needs to work on this metaphor a bit. The CRNA came out and added more compost to my inhaler. Thanks. Then my perky nurse came out, introduced herself and asked what surgery I was having. After I explained my redo, she piped up with “and you know you’re getting stents placed, right?”. Stents? What stents? To grossly paraphrase Acts 19:2 - I had not even heard that there was a stent… this is not what you want to hear immediately before surgery. When your mouth tastes like compost.

At 8:33 I was wheeled into the OR and shimmied over to the operating table. It’s bizarre because the table is so tiny they have put arm boards on the side so your arms don’t hang to the ground. There was only about an inch on either side of my hips. I’m not sure what they do when they one of the Cleveland Browns shows up for knee surgery… presumably two arm boards?

Over the next little while, my CRNA alternated between spraying lidocaine down my throat and and keeping me on the inhaler. Good times. Also, my surgeon arrived; this was cool because, during any of my prior surgeries, I don’t ever remember seeing my surgeon before the procedure. While discussing possible outcomes, my surgeon opined that I would almost certainly need a temporary ileostomy. While he was confident in his skills, he didn’t intend to let everything pass through the newly connected site unless all the conditions of the surgery were perfect. This isn’t really what I wanted to hear, or what we had discussed previously, but there isn’t really any turning back when you’re on the operating table and know that both permanent and temporary ileostomies are possible outcomes. I was also able to ask about the stents and got an answer that didn’t help much at the time. Later, I came to understand that the stents were inserted into my ureters to provide rigidity so that when the surgical team was poking around with small bowel they could feel where the other plumbing was located.

It turns out, we were waiting for the Anesthesiologist to show up. The doc was covering two cases and because of the complication of my intubation, she wanted to get the other case started first. I could tell that my surgeon was not amused by this, but he passed his time fiddling with a new machine off to my right. Somewhere in this timeframe, the CRNA administered two doses of Versed. This is a sedative that blocks short term memories from being formed. I remember asking her “So, I’m talking to you fine now, but won’t remember it later, right?” Right. Except I do. I’m guessing the adrenaline of the impending intubation negated the effect of the drug.

The Anesthesiologist finally arrived and the team huddled one last time. I asked if I could pray with them, which they graciously allowed. I hadn’t factored in the super dry mouth (that med worked!) or my now thoroughly numb tongue and throat. I’m not sure the team understood what I prayed; hopefully they got the gist. Regardless of whether they understood a word, God understood it all.

It was time to be intubated. I hate this part. They literally blindfold you and then put a bite guard in your mouth with a hole in the middle. At this point, you just hope it goes quick. It didn’t. I remember squeezing my nurse’s hand hard enough that it probably bruised. I remember three times being told to “take a deep breath” as I could feel the tube in my throat and my body fighting to stop it. This is so hard because your mind is trying to suppress every gag/fight/flight reflex while your body is, understandably, sure that it is being murdered. Finally, they must have secured the airway and, like a light switch being flipped, all memories ceased.

My next memory is in the PACU (aka recovery room). If you’ve never recovered from surgery, the only way to describe it is non-linear and random. There isn’t really a “first thought” or progression; all recollections are kind of held at the same time. My “first memory” is telling Larisa that I didn’t have an ileostomy (Yay!)... but I have memories of talking to my nurse before Larisa was called back, and also of discovering for myself that I didn’t have an ileostomy.  What is first anyway?

Woven into these memories is the slow realization that you are, still, alive on Earth. This is a mixed bag; I’m so thankful to see Larisa again, and to know that she is not dealing with the crushing grief of loss. I’m grateful that my sons do not have to deal with yet another separation. But, truth be told, it is also a little disappointing. There’s a lot of Philippians 1:23-24 happening in this moment. I don't remember this, but Larisa tells me that I asked her to pray with me. She asked if there was anything specific that I wanted her to say, and I responded, "I'm just so thankful." Later, I told Larisa that I was pretty sure that if Paul had been married, his take on Philippians 1 may have been slightly different. Not that the good Apostle would ever have put a wife above Jesus, but waking up to Larisa was an awfully good option if I can't be in Heaven.

One of the amusing, or so I’m told, consequences of all the meds I was given during surgery is that I say a bunch of funny things. Larisa says that I don’t have any filters. This isn’t exactly true: I do have filters. It’s just that all thoughts and words are inspected and given the green light. They seem like really good ideas at the time. I’m pretty sure I chatted up all the medical staff and propositioned my wife multiple times. It seemed like a good idea. Pretty soon a kind man named Paul came to transport me from the PACU up to H51, which is a colorectal floor. I’m fairly certain I mentioned something about the trip being a missionary journey. Again, it seemed like a good idea.

Heading Home

When I was hospitalized in October and December, I was fortunate enough to have a room on the H51 colorectal floor both times; being admitted through the ER is pretty much luck-of-the-draw as to where they can find a bed, and I was thankful to land on the very floor where they were so acquainted with my kind of problems. As a result of these experiences, I got to know several of the nurses really well and in the PACU requested to be transitioned to H51. Thankfully, a bed was open and I was able to return to my home away from home. I adore these nurses! They know what they signed up for, and are gracious and kind through the most disgusting and humiliating moments of life.

In the grand scheme of things, I had very little pain. This is amazing since they couldn’t finish my surgery laparoscopically and had to do an open incision to wrap things up. However, they were able to do a “block” on the pain receptors in my abdomen. Between this block and the ERAS medications they had given me pre-op, I required virtually no narcotics to deal with the pain. It was all NSAIDs and Tylenol… and something for my nerves (sensory nerves, not anxiety nerves).

One of the major concerns with surgery, especially colorectal resections, is that the general anesthetic administered during surgery stops the peristalsis in your intestines (this is the muscle action that pushes things along). Restarting peristalsis is a complete unknown - in 2009 it took me about a week to get things working properly. However, this time around my peristalsis restarted immediately, and I was moving things along within hours of regaining consciousness.

Honestly, the worst part about the recovery was having my catheter removed. My nurse aid was training a new aid. I’m pretty sure the new aid had never removed a catheter before. She was almost, but not quite, able to walk the line between caution and torture..

Prior to surgery, I was told that typical recovery time for this type of surgery would be a minimum of 5 days in the hospital. I was discharged on day three. I was expecting a lot of pain and an ileostomy. I had neither. In fact, my surgeon told me afterward that ileo-rectal redos are extremely rare, because you need almost the entire rectum to accomplish them. In spite of 3 prior surgeries, I still have all of my rectum, which is almost unheard of in this type of situation. I was expecting to burn through a lot of PTO time, but was able to start working on Tuesday, less than six days post-op. On day nine post-op I ceased all pain meds, not even needing the occasional Tylenol.

I attribute this success to two factors: excellent care, and the power of prayer. It is true that the Cleveland Clinic is amazing: from my excellent surgeon to the the ERAS protocol and pain block, and on to the nurses on H51, everything went smoothly and was optimized for a rapid recovery.

However, this is true for all their patients, and few are blessed with the speedy recovery I’ve experienced. As far as I know, there is no way to prescriptively restart peristalsis. There is no way to insure that wounds heal or infection stays at bay. There is no guarantee against a leak at the surgical site, no matter how skilled the surgeon. All these factors are dependent upon the body responding and doing what it was designed to do: the miracle of our fearfully and wonderfully made bodies. I attribute my body’s response to all of you who prayed so diligently on my behalf. Thank you.

Redo

It’s not often in life that you get a redo. Yet, as I sat in the office of my colorectal surgeon in the middle of January, that was the opportunity presented to me. A redo of a surgery that I had performed nearly ten years earlier.

 In winter of 2009 I got spectacularly sick as the result of a Crohn’s disease flare. I lost about 25 pounds over the course of two months and was in a significant amount of pain. After some testing showed that portions of my colon were perilously narrow, my doctors decided to surgically remove the remainder of my colon. (I had previously had half my colon removed in 2005.) As a result of my surgery, I currently have the end of my small intestine (the ileum) connected to the remainder of my rectum in what is called an ileo-rectal anastomosis (IRA… like an Independent Retirement Account… but completely different.) That’s the short story.

The long story has many more details. You’re welcome to skip to “Back to 2019.” My wife tells me that I over share. ;-)

 As I just mentioned, in 2009 I was spectacularly sick; so sick, in fact, that the weekend before my surgery I had to be admitted to the hospital to get blood transfusions and IV fluids, just to be stable enough to operate on. The imaging tests that were run before the surgery showed a colon with advanced disease and extreme narrowing. This was indeed the case and, just for bonus points, the surgical team also had to deal with a softball sized mass in my colon that had been previously unknown and was wrapped around my spleen. The whole procedure ended up being long and “bloody” (their words.) They also said that I was a miracle and should not have survived as long as I had.

 To top things off, I had a very difficult time recovering and was in the hospital over a week. By the time I got home and had hit rock bottom, I had lost a grand total of 50 pounds and was very weak. Worse, I was in a lot of pain. The medication I use to control my Crohn’s disease also alleviates my Ankylosing Spondylitis pain and does a good job of keeping the AS from worsening. However, I was required to be off this medicine for eight weeks before the surgery and for as long as possible after, by which time the pain and fever associated with my AS was running rampant in my body. Following that surgery, the AS was so out of control that my doctors eventually took me off of any medications to control Crohn’s so they could instead put me on a drug that they knew had previously controlled my AS.

 Predictably, about 18 months after my surgery, my Crohn’s was back. This was really scary because, based on estimates from my surgeon, if the Crohn’s kept progressing at this frequency, there was a good chance that I wouldn’t live much into my 40s.

Several things changed at this point. First, I did some testing and found that certain foods really irritated my GI; while I had intuitively known this, it was affirming to have it revealed through testing. Second, I started to see a naturopathic doctor and the holistic treatments really helped. Finally, I switched medications to a very powerful drug that addressed both my Crohn’s disease and AS. Over the next three years, I stabilized and ever so slowly started to turn the corner and improve. 

So, getting back to my IRA, one of the difficulties with this type of plumbing is that over time, it can start to form scar tissue and narrow. Not everyone with an IRA has this problem, but I did almost immediately. In order to keep this condition from closing off my bowel, I need to undergo stricture therapy (the narrow part is called a stricture) every 6-12 months. I kid you not, they literally insert a balloon into the narrow area and inflate it, thus stretching out the tissue. However, as scar tissue isn’t as elastic as healthy tissue, it doesn’t like being stretched and often bleeds, tears, and otherwise rebels; ultimately beginning the process of narrowing once again.

After my annual stricture therapy in spring of 2016, the doctor announced triumphantly that for the first time in years there was no sign of active Crohn’s disease. He then mentioned that he’d used a new procedure to cut out some of the scar tissue rather than do balloon dilation. In summary, this new procedure put me in the hospital in 2016 and 2017 with copious amounts of GI bleeding.

That brings us to 2018. For various reasons, all related to the stricture in my IRA, I ended up in the hospital in March, October, and December of 2018. Five trips to the ER and five hospital admissions (including two stints in the ICU) in three years was enough; stricture therapy had reached the limit of its usefulness, and all my doctors agreed the old IRA needed removed.

Back to 2019. Thus, I found myself in the middle of January, sitting in the office of my colorectal surgeon. I wasn’t sure what he’d recommend. In order to keep all my plumbing on the inside, there would need to be enough healthy rectum to remove the old IRA and still have room to reconnect. Otherwise, I would need a permanent ileostomy.

The news was all good: I currently have the entirety of my rectum still intact and, even after removing the old IRA, there should be plenty to reconnect. Further, the part of my rectum currently involved in the IRA is notorious for having poor blood flow and forming scar tissue. There is good clinical evidence to suggest that a new site lower in the rectum will behave better. Additionally, in the intervening decade since my last surgery, the surgical community is much less concerned about the medication I am taking and now only requires a little over four weeks off the drug. Further, the plan is to restart my treatments (the medicine is given via IV) as soon as it’s clear that I don’t have an infection post op.

 There are several key unknowns with my surgery. First, during my last surgery (2009) I had a temporary ileostomy while the IRA healed. As explained above, the surgery was so big and bloody and traumatic that the new connection needed time to heal. Once the IRA was healed, they stuffed everything back inside and stitched up the site of the ileostomy. This site is further up my ileum than the IRA and has also experienced its own minor episodes of narrowing. There is healthy intestine between the ileostomy repair and the old IRA and the surgeons are optimistic that they can use a procedure called strictureplasty to “fix” this area. However, there is no clear direction on how much intestine to remove. Do you hack out 16 inches of irreplaceable healthy tissue, or risk surgically repairing a small section that has historically narrowed a bit, leaving two surgical sites to heal? 

Second, the redo: once the surgeons have removed the gnarly (that’s the medical term) old tissue and used their Singer sewing machine to restitch my innards, they will put the whole thing under water and force air through it to make sure the wound is sealed. Bubbles, bad. No bubbles, good. If that process sounds familiar it’s because it is exactly the same high tech process used at Winkler Tire to look for leaks in my tires. Should the new IRA not be completely sealed, I’ll need a temporary ileostomy to give the wound time to heal.

 All that said, the prognosis is good and the surgeons expect to be able to redo things, use strictureplasty to save as much small intestine as possible, and not have a temporary ileostomy. They expect the best case scenario: I get a redo on a better location on my rectum. I’ll be on powerful medication almost immediately following surgery, and my Crohn’s will never have a chance to bother the new IRA. I live the rest of my life with my plumbing all on the inside, no complications, and no more trouble beyond the monitoring. (Of course they cannot predict this last sentence... but hey, best case.)

 But, the truth is, what does anyone know of “best case”? Maybe the redo heads down the same path as 2009 with annual stricture therapy and subsequent hospital stays. Maybe the “best thing” for me is a permanent ileostomy. Or maybe a permanent ileostomy is a bad idea for some reason we don’t currently know. We don’t know the future.

 The truth is, I don’t know what is best. But I know who does. And I know He loves me. If you’re reading this post, I ask you to join me in praying for my surgeons; not only for their work, but also their decision making. They will be faced with decisions of what to remove, where to cut, where to stitch and, ultimately, what solution to provide. Pray that the “best case” will be the obvious decision based on what they find.

Waiting

This is the final in a series of four posts. Please see the previous posts for context.

Honestly, there is not much more to tell. I was healed. As the GI consult team cleaned up from their procedure they decided I didn’t need the NG tube any longer; I wasn’t going to argue. What a relief to have it removed! All that was left was to wait and make sure that I stayed healed, to ensure that food would flow through my GI tract properly, and test whether or not I could use the restroom and walk around without passing out.

Saturday night was exhausting. While I can see God’s hand clearly in retrospect, in the midst of the ordeal -- drugged, exhausted, and weak as I was -- all I could do was cling to God’s nearness rather than appreciate the work He’d accomplished. Poor Larisa only had about an hour and a half of sleep, and as Sunday dawned we were facing a very long day.

A funny thing happened during rounds Sunday morning. As the doctors huddled up outside my door, my nurse insinuated herself into their conversation and invited Larisa to join them as well. As the night staff presented my case and history to the newly arrived day shift, there was some question as to the nature of my procedure on Friday. Larisa interjected at this point to tell them that the doctor who performed the procedure said he had “used a knife to cut out” the scar tissue in my stricture. This answer was soundly dismissed by the team: lasered out or burned out, sure, but scar tissue isn’t “cut out with knives” during a sigmoidoscopy. They then consulted the medical report from my procedure and were collectively stumped with the notation “performed NKSt”. What is a NKSt they wondered? Nobody knew, so they consulted…wait for it…Google. For real. The sight of five medical doctors clicking away on Google was actually both amusing and refreshing to me; my line of work is at the very fringe of medicine, and I fully appreciate that there is no way for any doctor to know everything there is to know. The fact that they could freely acknowledge this and look it up was reassuring to me. As it turns out, Google failed them initially, coming up with the Universal Reformed Christian Church in Nigeria, much to their chagrin. Finally, one of the residents piped up with “Needle Knife Stricturotomy!” Sure enough, tiny little knives used to cut out a stricture. Just like the patient’s wife had said.

The only hiccup in the rest of my stay was most likely caused by diet. For those of you unfamiliar with hospital diets, they range from Clear Liquids on through Full Liquids, GI Soft, and up to Unrestricted. Sunday morning I was on Clear Liquids and the fellow in charge of my case zoomed me all the way out to an Unrestricted diet. I should have known better than to tackle the chicken fingers, but I hadn’t eaten a decent meal since lunch on Thursday and dug right in. Just as I was getting ready to transfer out of ICU and down to a regular floor, I had a tiny bit of blood in my stool -- the only blood, in fact, all day Sunday or Monday. I could see the disappointment in my nurse’s eyes as she stared into the commode and told me this would almost certainly keep me in the ICU another night. She was right.

That’s about it. Thank you to our dear friends who drove our car home Sunday night so Larisa wouldn’t have to drive. My wife was such a comfort to me, and I’m grateful for good and Godly friends to watch out for her when I cannot. My nurse on Monday was a true blessing. A “praying man” by his own admission and a real treat to interact with. In fact, the entire nursing staff in the ICU was, by far, the best nursing team I’ve ever experienced. Competent, compassionate, and collaborative. One of them joined our family in prayer, and another compared Bible study notes with me.

On Monday morning, I had a visit from the ICU physical therapist, who walked me around the unit while holding onto a thick black belt that was buckled around my waist, while my wife followed us with a recliner, just in case. This little exercise proved that I was, in fact, able to move about on my own without fainting, and I was given the all clear to get out of my bed without the assistance of the staff.

Early Monday afternoon I was discharged directly from the ICU, a very uncommon occurrence as I understand it. So uncommon in fact, that my nurse had never done a discharge before. He had just received his RN in December and the only other patients who had left his care had been transferred to somewhere else in the hospital.

It’s good to learn from hard experiences, and here are a few of my lessons:

• Don’t have procedures done on Friday. If anything goes wrong, you’re much better off heading back into the hospital on a weekday than a weekend.
• Don’t leave the ER until you’ve stopped bleeding or have at least had a consult with specialists in the parts that are bleeding.
• Doctors would much rather talk about the implications of the color and volume of your stool than actually inspect it for themselves. While understandable, make them look. The penalty for not doing so is to have a small pipe shoved up your nose.
• Don’t skip steps in the diet progression from soft to hard
• Pull the nurse cord in the bathroom!

That concludes my story. Larisa says I can’t post pictures. So sorry to disappoint.

Thank you to everyone who prayed for, cared for, and loved on us during this episode. It is such a blessing to have a family, friends, and church family who can be counted on any time day and night. I’ve been home three days now and am back to work and feeling stronger each day. Other than a cancelled business trip this week and two little boys who are more clingy than usual, life is back to normal. I have so much for which to be grateful.

A Miracle

This post is third in a series of four. Please see the preceding posts for context.

I vaguely remember three members of the ER team lifting me into the bed. Clarity came back quickly as I laid flat. What had just happened? I remember watching our nurse comfort Larisa, who was pretty shaken. I can remember being thankful that this happened; I knew I was sick, and I was glad the ER staff was able to observe both the bleeding and the fainting. As people scurried about the room, the resident realized that my IV fluids had not been hung yet and had a few choice words for the nursing staff.

Shortly after the falling incident, the attending physician came in. He ordered more blood work and assured me that he was working to get me admitted to the hospital. In fact, the GI doctor who had performed my procedure was in charge of one of the wards for February; the exact ward I’d be going to. This was great news to me: even given the trouble I was having, I trust this doctor implicitly. Also, it’s just one less variable having the original doctor also be the attending physician of the ward you’re in.

As we waited, Larisa started to receive texts from people who were praying for us. On the way to the ER, we’d alerted our families and a few close friends to my situation. Also, Thursday night we’d let our Bible study know of my procedure, and as they checked in, we let them know what was going on. The saints were praying.

About twenty minutes later, I needed potty break #5. There was no way the nurse was letting me down the hall, and she asked if I could wait for a bedside commode. While my need was urgent, I could wait a few minutes, and the commode was quickly placed directly beside the bed. I slowly got out of bed, sat on the commode, and commenced…you get the picture. Almost immediately the room started to swim, my ears started to ring, and I gasped out “Oh no” before passing out completely.

I understand from Larisa that she grabbed the nurse, who was leaving the room, as I slumped on the commode. The nurse asked if Larisa could hold me up while she ran to get help. She was only out of the room a short time, but during that time my eyes rolled back in my head, and I started to have seizure-like behavior. The nurse returned with the attending, resident, medical student, and at least two paramedics.

I remember coming to sitting on the commode. It was bizarre: exactly like one of those scenes we’ve probably all seen where the focus is fuzzy, the background is black, and someone is leaning over the camera saying “Can you hear me?” In fact, for a moment, my brain registered that I was watching a medical show…I couldn’t process what was going on. I think I regained vision, but couldn’t really think at all. The staff of six moved me back to my bed and, again, as I lay flat, my mental faculties quickly returned. The room was a beehive of activity as my shaking, terrified wife backed into a corner.

Then my lab results came back and everything went crazy.

The day before in the ER, my hemoglobin had been at 14.7. Roughly 24 hours later, my first draw in the ER had been 11.7: not good, but still well within the normal range. However, only about 90 minutes later my hemoglobin was down around 8, and that was drawn before potty break number #5. The attending asked how much blood was in the commode, and my nurse responded “about a cup and a half." If you chart the hemoglobin over time based on those three points you get a parabolic decay. While not mathematically precise, the picture was clear enough. As I understand it, organs can start shutting down at a level of about 5. Given the time since the blood draw and the content of the commode, it was not unreasonable to think we were getting close. (I’ve put this together after the fact… I wasn’t charting any parabolic decay just moments after fainting… although I did remember my nurse’s name which convinced her I was, in fact, lucid again.)

Apparently the attending physician was creating this chart in his head, because he barked out “Change everything! Order two units of emergency release blood stat, get his blood type immediately and order two more units of cross-matched blood, and send him down to the -- [[insert proper term for the serious end of the ER]]”. Larisa fielded questions about whether there were any reasons why I would refuse transfusions, was told the risks involved, and signed off on everything.

A paramedic appeared to start a second IV on my other arm, and in very short order, I was whisked down to another area of the ER that was literally buzzing with activity. A new doctor appeared to tell me that she had authorized the emergency release blood, that my blood pressure and heart rate looked better, and that I was to “hang in there”. This was actually consoling. Larisa and I had known for a while that things weren’t right, and now apparently, so did the ER docs. This end of the ER hummed with calm efficiency. There was a comforting reassurance in the measured, rapid pace of the staff. I was simultaneously being prepped for two units of blood and for transfer to the ICU.

As it turns out, my stress response is to turn into a chatty-Kathy. I was asking everyone their names, about their families, making lame jokes… generally making their job more fulfilling no doubt. Poor Larisa, though, felt like she was watching her husband die. I can’t even imagine how I’d feel if our roles had been reversed.

We only had about half an hour in the busy ER, but it was actually a very precious time. I asked Larisa to come over and read to me the scripture from Acts 13 that I’d read in the morning and as she did, we wept together. She looked down and asked “Are you afraid?” I knew what she meant: Was I afraid of dying? Was I afraid of death? Did all the precepts that we both hold so dear hold up in the busy ER? As I searched my heart, I found God’s Word: He always fulfilled His promises. He always loved His Children. His servant David brought Him pleasure. Unimaginably, inexpressibly, my heavenly Father had prepared my heart only that morning for the answer to this, the only, question in life. I was not afraid. There was no room in my heart for fear because in this moment of crisis, my heart was completely occupied by the love of the Father: Jesus. I held up my fingers, put them together and said “Not even this much”. We wept together at the sheer presence of a God who sees us, loves us, and meets us in our need.

Immediately after our impromptu worship service, the two units of blood arrived. They told me the blood would be cold and that it would be administered as fast as possible. They were right on both counts. They started with my right arm, and within seconds my forearm got that ache you get when you play in the snow without gloves; almost like brain-freeze of the arm. I could follow the sensation up my arm and it died out somewhere around my shoulder as my body warmed the blood. Then they started the IV on my other arm. I remember asking the nursing student -- who had been a civil engineer before deciding to switch jobs -- how much energy it would take to raise two units of blood from freezer temp to body temp. Seriously, these were the silly things pouring out of my mouth as a response to my stress…

As the blood flowed into me, hospital transport arrived, and we set out for the ICU. The journey was uneventful, and upon admission a medical resident reviewed my case and ordered a consultation with the GI staff on-call.  When the GI fellow arrived, it turned out she remembered me from my call earlier in the day. We agreed that I’d made the proper decision to come into the ER rather than wait this out.

What happened next was truly bizarre, because the first several hours in the ICU were defined, if you can believe it, by the color of my bowel movements. Was it bright red? Maroon? Black? Some medical terms that I don’t think actually equate to color? If I’d know this was going to happen I’d have had the ER folks just save the mess in the hat and send it up with us.

It turns out that because I claimed my stool was black (sorry folks… you can stop reading now) there was some concern that the bleeding was higher in my GI. My prize for sticking to my story was to get an NG tube inserted to check for blood in my stomach. I should have gone with really dark maroon…

If you’re not familiar with an NG tube, the N stand for Nasal and the G stands for Gastro. It’s a tube that runs from your nose to your stomach… but don’t let the “tube” part fool you. Small pipe is more like it. Think of those big, fat straws they give you with a thick milk shake. Now think of them sticking it far enough up your nose to reach your stomach. The best part of the process was they used a lidocaine gel on the tip of the NG tube. This was nominally used to numb the area where the tube went. Whether or not it worked is hard to tell, but when my nose started to bleed some of the lidocaine ran down and numbed a bizarre section of lip. So there is that.

This was actually the most miserable part of the day for me. My parents had arrived and had taken Larisa downstairs to get some supper, because she hadn’t eaten anything all day, and there was no way she was going to watch them shove a pipe up my nose and down my throat. Every breath. Every swallow. Every word elicited a gag reflex that needed to be forced down. Once the tube was in place, my nurse pushed 120 ccs of water down to my stomach and then suctioned it back out. No blood. Woot! This meant that the trouble was all down near the other end, just as we expected. I should have gone with maroon.

With the NG test complete, the GI fellow started to set up a mobile endoscopy station. As best I can tell, an endoscope is something like a very expensive Wii. The physician uses tiny controls to navigate a machine through a maze, attack bad guys, try not to blow up the sensitive parts… all while watching on a big-screen TV. Knives: check. Flame gun: check. Water gun: check. I could be persuaded that these procedures are actually performed by a cub scout troop in Boise, sitting on beanbags and munching Doritos.

Meanwhile, an hour south, my church family was gathered for a Chili supper. Although I didn’t know it at the time, they announced that I was in the ICU and called for prayer. Larisa continued to get texts from friends and family. Keep that in mind as I describe what comes next.

Once the mobile endoscopy unit was ready, the GI consult team arrived. Because my blood pressure was fairly low, they were only able to give me two thirds the medication they had administered for the same procedure the day before. As a result, I was able to, more-or-less, watch the big screen as they set out to find what had caused me to lose nearly half my blood in previous 36 hours.

And here’s the miracle: they found nothing. No gaping wound, no seeping incision. No fresh bleeding. Nothing. Only old, dried up blood. Whatever had been causing me to lose about a cup and a half of blood every hour or so had suddenly, inexplicably, stopped.

Later, my nurse explained that she’s seen this before: the change in blood pressure and the drop in temperature from the new blood caused the wounds to coagulate as they should have after the procedure. Possibly. But given the blood loss in the ER, it seems a stretch to assume that such a wound would completely, immediately stop. What seems more real to me (and more likely by far) was that our God heard the prayers of His children. Besides, as Nicole C. Mullins says: “I know my Redeemer lives. I spoke with Him this morning!”

Decisions: one bad, one good

This post is second in a series of four. Please see the preceding post for context.

Immediately following my procedure, Larisa and I hiked through the hospital (think several city blocks…for real) to visit a friend who was recovering from surgery. My first solid recollection after my procedure is sitting in the room sharing the success stories of our respective experiences. I have no memory of getting to her room. After this visit, Larisa and I headed down for some lunch.

The doctor who performed my procedure said to expect some bleeding the next couple times I used the restroom, but that things should clear up shortly. Having no colon, I am pretty regular, and I had to use the toilet immediately following my procedure and once again, an hour later, right before lunch. This is when the trouble started.

As I exited the restroom and headed to the restaurant (still in the hospital), I started to feel weird; similar to the sensation you get sometimes when you’re sitting or lying down and stand up too quickly. As I grabbed a tray and started doling out soup, things got progressively worse: ladling was more complicated than usual. There was a restaurant employee cleaning up beside the soup tureens, and I had a hard time figuring out if I should stop and move. Then I started to feel weak, and I handed my tray to Larisa so I could go take a seat. Unfortunately, I only made it about three steps until I slumped back against a counter as my head swam. The last thing I remember is my vision narrowing, and Larisa standing in front of me asking what she should do.

I came to sitting in a chair in the restaurant, weak, sweating, and totally muzzy headed. After the fact, Larisa told me that she had been forced to put down our tray, put her arms around me, and help me walk from the food area to the seating area; probably over 60 feet. There we sat, panicked as to what to do next. I tried to call my doctor, but through the fuzzy-headed fog was unable to navigate the phone hurdles set in place. Larisa asked a doctor sitting close by what to do and he said to call 911. She did, and was informed that since we were actually in the hospital, they could not respond. Fortunately, the doctor who Larisa spoke with saw my state and called the Hospital’s emergency and cardiac response teams, who were on the scene in about 3 minutes.

When the response team was able to ascertain that I wasn’t having a cardiac episode, they turned me over to the paramedics who had just arrived. The paramedics got me onto a gurney, wheeled me to an ambulance, started an IV, and drove me several blocks around to the ER.

In the ER, they immediately drew blood work and did an EKG. Not surprisingly, I was very dehydrated as a result of prepping for my procedure and the ER doc order IV fluids. We explained our situation and our concern that my intestine had been perforated as a result of my procedure; pretty quickly, I was sent for X-rays to see if anything was leaking on the inside.

As we waited for the test results, I continued to need to use the bathroom every 30-90 minutes, all with the same bloody result. As the test results rolled in, the news was all good: blood counts were very healthy, nothing on the X-ray, and as a result of the IV fluid all my vitals were back in line. The ER declared victory, writing the episode off as a result of dehydration and sending me home. We discussed several times doing a GI consult, but I don’t think that ever happened.

In retrospect, I should have either demanded a GI consult or refused to leave until the bleeding stopped. Although the ER folks asked if I was still bleeding, they neither checked the results in the bowl or had me go into a container for inspection. I should have forced this issue. Neither Larisa or I was comfortable with the discharge, but home we went.  Going home from the ER was a very bad decision.

Friday night was rough. I maintained my bloody pattern with no relief. Larisa and I kept asking what exactly a “couple” bloody movements meant. While I slept OK, Larisa was gripped by fear and had a very hard time sleeping.

Saturday morning we resolved to call the GI fellow on-call if things hadn’t improved by noon. About 8, things started to improve a little. During the course of the morning we took a long walk and I noticed that I was more winded than I should be for a leisurely stroll up and down the street. It’s not as if I’m a 26.2 guy, but I do walk/jog 3-5 times per week and push myself fairly hard for 20 minutes. Strolling for half an hour should be no problem.

During devotions, I took a long time praying and asking for two things: first, that God would speak to me. Chastisement, direction, comfort  or encouragement…I just needed to hear from my Father. Second, I prayed that He would help me to make a good decision. Paying another $250 ER visit co-pay wasn’t high on my list, but neither was getting critically ill. I opened the Bible to Acts 13 where Paul is addressing the synagogue in Antioch of Pisidia. As Paul recounted God’s faithfulness to His children and his delight in His servant David, an inexpressible peace flowed through me: it was going to be OK. I was going to be OK. (For the record, I realize that I am not David, king of Israel. However, I suspect that most of us with Biblical names take special note when we pray to God for guidance and then see our names in the passage we read).

Shortly after 11, I passed a lot of blood once again and called the GI fellow. The doctor responded immediately, was very sweet, was able to access my records, but after about 10 minutes indicated that my only options were to wait it out or go to the ER (she also indicated that the pictures I took wouldn’t be helpful…yeah, yeah I did). Larisa immediately made me pack an overnight bag, but I thought we should still wait. About noon I noticed some dizziness when standing up or using the bathroom, and that was the final straw. We called my parents to watch the boys and, after praying with my boys and playing one last game with them, Larisa and I headed back to the ER.

It turns out that there are two areas in the ER: the “this guy ain’t so bad and we’re gonna send him home” area and the “uh-oh, this is serious” area. On Friday I had been to the former area and after clearing intake on Saturday I was once again channeled to the “give him some IV fluids and send him home” side of the house. While waiting for the doc to see me, a paramedic came in and started an IV. Gentlemen, let me just say that you never want a male to start an IV or draw blood; they always turn it into some sort of macho-pain competition. Guys: pick the female phlebotomist. Every. Single. Time.

I headed off to potty break #1 in the ER, and my nurse had the wherewithal to put a hat down. This keen little device looks like, well, an upside down hat, and it sits inside the lip of the toilet bowl to collect…stuff. Upon completion of my duty, the hat contained ample evidence that I was, in fact, passing a lot of blood. Back in the room, a resident and med student came to see me. Interesting aside for the folks at work -- the resident was a Podiatrist. Anyway, they studiously avoided the full hat in the corner and ordered some IV fluids.

Next up: nurse shift change and potty break #2. Larisa and I sat. And sat. While nobody was actually coming into the room, Larisa was shamelessly eavesdropping on the conversation at the nurses’ station. Apparently my hemoglobin had dropped from 14.7 the day before to 11.7 when I was admitted to the ER on Saturday; this, finally, caught the attending physician’s eye.

Things started getting really exciting as I headed off to potty break #3&4 (I was only planning on one as I headed out). The frequency of my potty breaks, as well as the amount of blood that I was losing, had picked up markedly since I got to the ER. #3 was a mess and as I rose to wash my hands, I felt a little woozy and contemplated pulling the nurse string in the bathroom. However, before I could finish washing my hands, #4 announced it’s presence with a great deal of urgency, and I sat back down. You’d think that the 90 second interim would lessen the amount I was passing, but not so (note here, this is not exactly uncommon for folks with no colon and strictures… things don’t always play nice).

Standing at the door to the bathroom after washing up, definitely feeling light-headed, I had a decision to make: pull the cord for the nurse or walk the 25 feet past the nursing station and back to my room. I did what all self-respecting males would do and staggered down the hall. I even had another chance to make the right choice at the nursing station immediately across from my room. However, rather than just asking for help I bolted toward my bed.

I only made it as far as the door. As I slumped against the door-frame, I called Larisa’s name in desperation as the blackness swam up to meet me (this is real folks.) Just like in the restaurant the day before, the last thing I could see was my wife, panicked, coming to my side. However, unlike in the restaurant, my legs didn’t hold out. We made it five steps when I went completely out, slammed against the bed, and hit the floor.

In answer to my prayer earlier in the morning, we had made the right choice by going into the ER. Any earlier and we’d probably have been sent home after receiving IV fluids. I shudder to think about what would have happened if we had tried to wait this out. We were in the ER. We even had everyone’s attention. Finally.

Crohn's In Remission

Warning: This is David. If you are looking for cute quotes from the boys and don’t want to hear an update on my medical condition, then you may want to skip the next few posts…

As many of you know, I’ve been battling Crohn’s disease for nearly two decades. This disease manifests itself in the GI tract and varies in severity from causing minor diarrhea to destroying the large and small intestines, leading to death. My particular brand is on the more aggressive side, as it has already destroyed my large intestine which I’ve had to have surgically removed.

As a result of my surgeries, I now have portions of my bowel surgically reconnected, and these areas tend to form scar tissue and become narrower, a condition called a stricture. As part of my ongoing treatment, I need to have these strictures widened periodically, using endoscopic procedures. Last Friday, 2/19/2016, I went in for sigmoidoscopy (lower-end… we’ll leave it there) to dilate my stricture and to see how my Crohn’s was coming along.

During the procedure, I was administered a heavy pain killer and a narcotic and, consequently, I have no recollection of the follow-up consult with the physician -- I only have vague recollections of some nurse aid calling me “Big D” (which is better than dinky diddums… I guess.) However, when I finally “came to,” Larisa shared two things with me: first, there is a new procedure available, and instead of dilating my stricture with a balloon, the doctor had widened it by using “needle knives” to cut out the scar tissue and, second, the beautiful news that there was no sign of active Crohn’s disease. The doctor said we could consider the Crohn’s to be in remission.

Praise God for this good news! I would gladly repeat the last several days if doing so would ensure such a good report.

However, as I will share in future posts, we were not able to savor the moment for long, especially since the narcotics didn’t wear off for about an hour after the procedure. Following is an executive summary of the events following my procedure:

• I experienced heavy bleeding
• I passed out three times
• I went to the ER twice
• I received three units of blood
• I ended up in the ICU two nights
• I experienced a miracle

To be continued....

The Remodel....A Year Later

Last year at this time, the four of us had been crammed into roughly 400 square feet of our basement for over a month, and it was definitely wearing on us....but let me start at the beginning.

David and I bought our 864 square foot ranch home in 1998, right after I graduated from college. It was our "starter" home, and we thought we'd be there for 5 years or so before buying something larger that was more "us." A couple years after we moved in, we finished the basement, adding a second bathroom and another bedroom, along with a crafting space and our computer room. A year after that, we added central air. By this time, we had decided we liked life with just the two of us, and since we weren't planning to have kids, we started to rethink the idea of buying a bigger house. Didn't it make more sense to stick with our small mortgage and stay put? After all, the house was just fine for two people.

Then God called us to adoption, and before we knew it, we had added two more people to our little family. Okay, the house seemed a little smaller with two busy boys, but really? We had seen where they came from in Ethiopia, and it just didn't seem fair to think about buying a much bigger house (and going into a lot more debt) when there were so many without.

At the same time, two rooms in particular were really starting to make me feel claustrophobic. Our tiny galley kitchen felt cramped, and as the boys' main in-and-out-constantly access door swung directly into my refrigerator, I found myself losing my temper a few times too many as they came crashing through the door to the garage right as I tried to move something to or from the fridge. There was very little counter space, a wasted soffit area above the minimal cupboards, and I was really starting to regret the fact that we had no dishwasher. Our pocket-sized bathroom had almost no storage, and all of our towels were stored in the base of our bookshelves in our "library" across the hall. All of it was looking very cluttered and dated as well.

In the summer of 2013, I began to sketch out some possible additions to our upstairs. As we started to talk to a contractor, we ruled a couple of things our right away. Some plans were too elaborate and too expensive. Others just didn't fit the rest of our house. After a lot of praying, discussing options, and talking to the bank, we eventually settled on a plan that added 125 sq. feet or so onto the kitchen and upstairs bathroom.

The builders began work on the project in October by digging additional space for our basement in the backyard. They built a temporary wall across what had been my craft space to protect the rest of our finished basement from the mess, and the processes of framing, roofing and pouring cement began. The new kitchen extended about three feet into our garage as well, over what had been a stoop to the old kitchen.

Our temporary wall across the basement.

 

Smashing out the exterior cement block wall of the basement.

 



The former stoop in the garage was enclosed to become part of the kitchen.

 



 

 The enclosed addition onto the back of the house.

 

By mid November, the old kitchen and bath were ready to be torn out, so we moved our living quarters to the basement. The basement bedroom became our makeshift kitchenette, as well as clothing storage and sleeping space. (Our upstairs bedrooms were closed off and taped shut, to try to keep the dust and dirt to a minimum.) Our computer area became our school room, craft area, eating space, and sleeping space for the boys at night. Our downstairs bathroom was shared with a steady stream of construction guys through the day (and I came to realize how blessed I am to share my home with guys who never put the seat up.) ;-) It was a bit of a fun adventure at first, but then we were in the midst of the holidays, with presents and Christmas cards arriving daily, and no place to cook my offerings of food for family gatherings. Thank goodness for microwaves and crock pots! We used paper products as much as possible, and I drove to my mother-in-law's house to do dishes three times a week. Sintayehu melted down even more than usual, and we spent our evenings looking at appliances and tile samples, and sketching designs for our cabinet maker.

 

The basement dresser/kitchen counter.

 



Kitchenette, consisting of the microwave, toaster oven, coffee pot, and crock-pots.

 



Bed/laundry room 

 

Crafting, eating, schooling, and sleeping area.

 



 

 

 

 The light colored rectangle of subfloor in the middle of this photo is where my kitchen sink used to be.

 

 

 It seemed like forever, but really, it was only about a month and a half until we were completely moved back upstairs to our new space. The addition to the basement meant that the boys had gained a playroom and a closet for toy storage, so moving all toys to the lower level brought a whole lot less clutter upstairs. My new kitchen has cabinets that go to the ceiling for maximum storage, about three times the counter space, and a DISHWASHER!! The extra space also gives us room for entertaining once in awhile. Our bathroom has a small walk-in shower and a lovely amount of storage for linens and bathroom necessities. (It is such a luxury to have plenty of towels in the bathroom, and a whole drawer to store the stuff I use to get ready every day.)

 

 Basement craft and play area

 

 Yay! My basement school room, returned to normal!

 

 

 We have our eye on a gorgeous, copper-topped table, but until that fits into our budget, this one opens to comfortable seat 8 people.

 

 

 

After a year, I still love my "new" house. It is the perfect size for the 4 of us, and I marvel that this was accomplished by adding less than a 5 foot width to the back of the house. Sure, my home will never be the show-place that I once dreamed of, but you know what? I'm really okay with that. This is just right for us, and I am so thankful for what I have.