Wednesday, September 12, 2012

Now Breathe

 photo Ober Kline

Bill had his gallbladder out on August 16th. Plain old laparoscopic cholecystectomy. Only, when his surgeon (whom I know professionally pretty well from work) came into the surgical waiting room to tell me everything went fine, he was not wearing his "everything went fine" expression.
He face said, "God I hate having to tell people stuff like this."

My heart screamed.

There was something wrong in the intra-operative  cholangiogram. (After they take out the gall bladder they put dye in the common bile duct to make sure a gallstone isn't lodged in the duct.) Only this didn't look like a stone. Or sludge. Or a benign stricture. It could be one of those things. But.

It looked like the infamous 'something else'.

Bill would need to have an ERCP. (Endoscopic Retrograde Cholangiopancreatography). They don’t do that at any hospital in Paducah. It’s a long, risky procedure which makes malpractice rates go up and our gastroenterologists have plenty of business without doing ERCPs. Bill needed to have an ERCP so they could biopsy the common bile duct and the pancreas. To rule out pancreatic cancer. To rule out a malignant bile duct stricture.

This couldn’t be happening.

That was Thursday. On Sunday, Luciano was put to sleep. He hadn’t kept anything down for nine days, despite IV fluids, anti-emetics, and pain meds, and now the ultrasound showed that he had a mass on his pancreas. How was that possible? I had taken him in to Ol’ Poke ‘n Stick in the early spring, saying I thought something was wrong. Nothing specific.  I was afraid; Looch wasn’t quite himself.  All his blood work was fine, and we decided that I was being neurotic. I was happy. Now, he was lying in my arms, giving me a sweet kiss, and then he was quietly gone.
  photo Laurie Erickson

I was all tangled up in Looch and Bill and I was a wreck and my vets are so very, very compassionate. What a blessing they are in my life. Pure and simple.

The one doctor in a hospital forty-five minutes south of here who does ERCPs was out of the country.  We saw her nurse practitioner and finally got the ERCP scheduled on 9/11. We liked the office staff very much, and we liked the folks at registration at the hospital. Everyone had a ready smile and a sense of humor, and there was no waiting. The first day back from the doctor’s vacation (her European family had never met their grandson) was Monday the 10th, so we were grateful that they scheduled Bill on the 11th. (Though we worried – just a tinch – about jet lag.)

On Tuesday, August 21st I ran into our primary care doctor at work and I asked him about a CT scan. “Yes,” he said. “Yes we should do one. I’ll order it.” I saw Bill’s surgeon at work later that day and I told him I had asked about a CT scan. The surgeon’s eyes got huge and he patted/rubbed/grabbed my arm. (The surgeon is NOT a touchy/feely kind of guy. At all.) “A CT scan is fine, Patience, but he still  has to get the biopsy.”
“Yes, yes, we understand. It’s just … the waiting is awful, and at least the CT scan would be doing something. And if it’s normal, we can be happy about that.”
“Okay, of course.” (Still patting/rubbing my arm. Earnestly. ) “But he has to get the ERCP and get those brushings, even if the CT scan is normal. He can have a CT scan, sure. But make sure they do pancreatic cuts. They have to do pancreatic cuts.”

I ducked into the locker room and crumpled. My kind Nurse Director came in after me to see if I was okay. “It is inconceivable,” I bawled.

I am surrounded by the most wonderful people. My friends! Oh! How they put up with me! And  I am surrounded with kindness, compassion, and prayer at work. My Best Ever Charge Nurse quickly rearranged my schedule so that I would be off when I needed to be. My fellow nurses hugged me and switched around their schedules and prayed and stepped up.  I vacillated between feeling overwhelmed, and touched, and silly, and terrified.

Bill and I planned a Sludge Party. If we found out that all this fuss was because of some leftover gallbladder sludge in Bill’s Common Bile Duct, we decided to have a potluck, bring your own Sludge, party. We’d give prizes for the food that most resembled sludge, and for the best tasting sludge. We joked about pesto, guacamole, chocolate mousse.  Maybe hummus?

Bill was scared. I’d never seen Bill scared. In thirty years I’d seen him concerned, angry, sad, and dismissive, but I’d never seen him frightened;  he has such faith. He didn’t want to leave me and the kids. He didn’t want to have pancreatic cancer, or a malignant bile duct stricture.

The treatment of malignant bile duct strictures (biliary strictures) requires consideration of a number of factors, the most important being the extremely low survival and cure rates associated with the disease. Most patients die from malignant bile duct strictures within 6-12 months.

The ERCP was yesterday. A diverticulum arising from his duodenum was mimicking a mass and pushing on his Common Bile Duct. My New Very Favorite Thing in the World, a diverticulum. Oh how I love that sneaky little out-pouching of intestine! I may have to name my next whippet Diverticulum. I could call him Pouch! Warburton Duodenal Diverticulum: catchy, yes?

Bill is home. He spent a morphine-drunken night in the hospital, unable to relieve the pain from the ERCP, but the pain is abating now. All of those years prescribing morphine, and he’d never had it himself. He has a huge fat lip (apparently he is a difficult intubation) and he is feeling pretty puny. Isn’t that just the most wonderful thing? We have to wait for the official biopsies, but the specialist was confident and y’all better start planning your dish for the Sludge Party. Now I can miss Luciano, the way I should. He had a good life and was a sweet dog.

It feels so good to breathe again.

hug your hounds and everyone whom you hold dear