The Big Surgery

My surgery was scheduled for December 7th. I checked into the hospital the day before for prep, labwork, etc. I eventually spent two weeks in the hospital even the though the estimate had been something like six to ten days.

Once I was sedated just prior to surgery, the next few days were a blur. I was in surgery nearly four hours, so I am told. After that, I was in ICU for a couple of days. While in there, I only recall waking up for seconds at a time and seeing people, like the staff or my family members, appearing and disappearing.

I don't recall any pain at all. I do recall having trouble breathing and hearing people trying to coax me to breathe. I found this coaxing annoying. In my mind I was yelling at them. I was trying to tell them I was trying to breathe but something was crowding my lungs. It's not that I wasn't making the effort, as they seemed to be suggesting, it was that all my effort was hindered.

I do not recall being moved, but on about the third day after surgery I found myself in a regular hospital room instead of ICU. My consciousness came and went which presumably was an effect of the glorious drugs which kept me oblivious to any pain (likely a lot of morphine). When I was conscious long enough to contemplate it, I looked for my stoma and ostomy pouch.

A stoma is when a loop of intestine (small or large) is brought to the surface of the abdomen through a hole and opened so that waste can pass from it into an ostomy pouch, thus bypassing the usual path. In the temporary post-surgical instance, this is to give the surgery time to heal, aka a temporary loop ileostomy. In the permanent instance, this is the method for passing waste outside the body when the usual path is no longer available, aka a permanent colostomy.

When I was shown a video on stomas, I nearly passed out. That bit of bright red internal material pushing through a whole in the outer flesh was just too much for me to take in. I could not fathom that something from inside my body would be sticking out of my body. Furthermore, I could not believe it wouldn't be painful, I didn't care how much they reassured me that it wouldn't. To me, looking at that strawberry thing sticking out of the flesh might as well have been the raw end of a bloody bone jutting out of someone's leg and I knew that would have to be excrutiating. I had to block all of that and trust that these people knew what they were doing and meant what they said. I would just have to wait and see how it really played out.

For more details than that on stomas and ostomy apparatus, please google it.

Now my surgeon, during his briefing about the surgery, had told me that I would have a stoma and an ostomy pouch regardless of what he had to do to remove the tumor and how he had to put me back together. There would at least be a temporary ileostomy so the surgery could heal. I have already stated that a permanent colostomy was something I felt I could never abide, so I just put that whole idea off on some back burner with only a marginal link to get back to it, in case it actually happened to me.

Anyway, my primary fully-conscious first thought was "temporary or permanent?" When I was able to ask, I was happily assured that what I had was temporary and of course I was ecstatic. One of the first post-surgery jokes I made was to a medical tech taking my vitals and I told him how excited I was to know I still had an asshole!! Strange perhaps, but true.

Some days later, during a checkup visit from my surgeon, is when I really found out how complicated my surgery had been. I had already heard I was on the table about an hour longer than expected. My surgeon said that on a scale of 1 to 10 --- 10 being something he explained but I didn't understand --- my surgery was about an 8 1/2 or 9. I had no idea and I got the impression that he hadn't expected it to be quite that complicated either.

Part of the complication was removing all of the sizeable tumor and the regional nodes and getting at least a little bit into the good tissue to make sure he had all the bad. The other complication was in the reconnection. He had to construct a j-pouch from the good end of my colon which was, in my case, a handy redundant sigmoid section. Then, he had to make an opening in the j-pouch and connect it to a very slim margin at the anal sphincter. The available connection at the anus was so short that only an experienced colorectal surgery specialist would have been able to do it. A general surgeon would never have attempted it, so I have been told.

In addition to all of that of course was making sure he did not damage any other organs or structures in the area, and he had to set up the stoma. Fortunately my surgeon had called his older and even more experienced partner to assist with the entire operation and the two of them managed to get me undone, redone and put back together so that I should eventually have a mostly functional large intestine and preserved anal sphincter.

For more information on all of that, google it. I will only add that I later read up on the j-pouch and it is a viable and helpful way to construct a sort of substitute rectum or neo-rectum, serving as a reservoir for fecal matter to be eliminated, rather than a straight-line connection of colon to anus which can be more difficult when it comes to bowel movement control.