Apology

Yes, I know, if I’m going to post at all, I oughtta post something important, something relating to the somewhat impressive difficulties my small family endured this summer. Unfortunately, return from Omaha was an escape of sorts, and so I didn’t blog; school has since intervened, as have the election (loved the end of McCain’s speech, though were my policy differences with him great enough, it would not have persuaded me to vote for him), and the looking-like-it-might-be-abysmal Notre Dame football season.

Suffice it to say, for now, that Kay is doing well, mostly. A few small issues from the operation remain – a healing thrombosis, scars, a not-quite-normal-feeling abdomen (muscularly and otherwise vaguely, though seemingly improving); and then there is the sadness of it all, and her continual frustration with my position, which never boils over and only occasionally seems to surface.

I will be back. I will provide the answers to the five questions. I will, when I know, answer the question of, will we try again? I will discuss some of the adoption advice I’ve heard (four routes, one bad, one probably best, that one sort of like what happens in Juno, so they say). And you’ll hear a small yippee from me when we (they, I suppose) beat Michigan next week, most probably by something like a point.

Results

Kay’s follow-up surgery is over, and went reasonably well, though not as well as it might have, in a best case scenario. Kay knew that, if she woke up in the recovery room after the surgery without me already attendant upon her, she would be staying in the hospital. Although it was not the predicted outcome, it did happen. She immediately searched for confirmation of her worst non-death fear – a colostomy – and found that she had not received one. Indeed, no indication had been given that such a measure was even a possibility, much less a likelihood, but it is one of her least dispellable fears. She did find, however, that she had been fitted with another JP drain, and if she looked at the clock, if there was even one available, she found that she had been in the operating room for two hours total, one more than had been planned.

The reason for the extended surgery time was simply the difficulty of the surgery. The abscess wreaked considerable havoc in Kay’s gut, essentially undoing all that had previously been done to un-stick the organs from each other. All was tender, inflamed adhesion, as far as the scope could see, which was not far, as of the reproductive organs only the end of one fallopian tube – whether left or right could not be discerned – was visible. (This tube, for what it’s worth, did have intact fimbria.) Drs. Hilgers and Fitzgibbons also found some remnant of the abscess, though only a teaspoon-sized portion, which they removed, and they “irrigated” – medical-speak for “rinsed” – the area with an antibiotic wash. The JP drain was fitted to allow anything remaining of the abscess to be pulled out, along with blood, irrigating fluids, and whatever other incidental liquids had collected as a result of the surgery.

The primary object of the operation was, I may remind you, the extraction of three pieces of GoreTex bandage. Those bandages had been placed over Kay’s ovaries and uterus to reduce the normal adhesions due to any surgery as much as possible, but had been overwhelmed by the toxicity and ubiquity of the abscess, which left scarring everywhere else. In their efforts to remove these pieces, they had to remove some of the new abscesses, but were hindered in their efforts by the effective blockade created by the jumbled and cohered organs. They hesitated to do much in the way of what they had done last time – separating the organs by removing the scarring – because the inflammation has not yet settled down, and the organs are thus weaker than they would be normally. Of particular concern was the possibility of penetrating the wall of the bowel. Both because this surgery was planned to be less severe, and thus a full bowel prep was not ordered, and because of the weakened nature of the bowel due to the inflammation, which could result in a torn bowel, the surgeons in the end chose to curtail their chase for the third and final piece of GoreTex membrane, leaving it behind.

Kay stayed in the maternity ward, where all of Dr. Hilgers’s patients stay when hospital time is required afterwards (this is either ironic or appropriate, depending on the eventual outcomes of their cases – though the Pope Paul VI Institute and the nurses there were good enough to inquire of us whether we thought the maternity ward was a bad choice for their patients; we told them we were happy to see the babies, if for no other reason than that they were a welcome diversion from the task of healing). The maternity nurses, though a bit shocked to see us – they had hoped Kay would have to endure no more hospital time – were as kind and attentive as ever, apparently giving Dr. Hilgers the news that they felt Kay deserved a gold medal for her behavior, news he promptly passed on to us. Kay was a bit befuddled by this compliment, asking me, “What have I done to deserve a medal? How terrible must the other women be who come through here that I deserve a medal?” I told her it was due to her almost utter lack of complaining, to her patience and mildness when she called the nurses in for help, to her continual sense of humor, to her persistent efforts to comply with their healing instructions (particularly the need to take multiple walks a day). I doubt the other women, mostly delivered mothers recuperating for a day or two, were great termagants, but the nurses’ sense of pity for her rarely precedented stay in their ward, and her perfect behavior throughout, likely elicited the compliment.

On Monday, at one o’clock in the afternoon, Kay and I had our regularly scheduled post-op with Dr. Hilgers, though he had been quite attentive that week already – as is customary he came in to see us every day, skipping only Sunday this time as Kay was clearly in no danger (though he did send his resident in to see her). He had little to say that he had not already said, and his usual joviality was rather suppressed by his discouragement over the results of the June procedure. We had plenty of questions for him, of course, mostly about the future. As the blog format and its readers, however, are polonian in their prejudices, I will attain brevity by saving those – including the questions addressing the mystery of the missing third bit of GoreTex and what happens next – for the next posting.

A Strange Season

This has been an odd summer. As Kay and I walked in the cool of the summer night around ten o’clock, the breeze just ruffling the leaves so that their silver undersides glimmered dimly in the street lights, we marveled at just how little heat there has been this summer. We’ve been blessed, though, for the heat would have added to the discomfort she has felt recovering from her surgery. In the cool, she is progressing apace, and looks to be healing fully. The hole from the JP drain is closed and is almost healed, and her scar looks great. There are still a few issues that seem to be left over, however, from the stress her body has been through. She’s still complaining of an odd taste in the mouth, but I think that will go away once the effect of the antibiotics wears off and her system is allowed to return to normal. Because of her temperature being lower than normal for the past few days, we are not really worried about a resurgent infection, but the doctors have suggested that she may have a bit of anemia, so they have scheduled a blood test for tomorrow. And she has had some problems with digestion. We have introduced new foods to her system gradually, a few fruits here, a couple of seeds or nuts there, but after a particularly rich delayed anniversary dinner (we hit five years in early July), including escargots, Alaskan king crab, and rice pudding accompanied by the ever-perilous raspberry, she awoke at 2:00 AM with stomach pains. Sitting up helped to ease them and allowed her to sleep eventually, and nothing more occurred. Tonight she is a bit uncomfortable, too. I hope that some Tums antacid will help her to sleep.

Meanwhile, I have become beleaguered as well. Yesterday, lying on the bed in the hotel room we ended up scoring for free on the night of our anniversary celebration, I felt the room begin to spin. Only once or twice did it go round, and then it was over, but it was alarming. Rising, I realized that I didn’t feel quite right in the head, and I haven’t since. My head spins seem to be related to the motion of getting up or lying down, and it’s more common when I am lying down. Luckily, my mother is office manager for a neurologist. When I called him after hours yesterday, having mentioned these odd symptoms to my mother late in the day and getting her imprimatur to call her boss, he dashed away my apologies, saying something like, “No, you are not allowed to apologize – you are a member of an honorable family that are good friends of mine. You are welcome to call.” When I explained my symptoms and answered his diagnostic questions, he said I was likely suffering from something in my inner ear, not my brain, but that I should get an MRI anyway, just to be safe. So off I go tomorrow, to relieve my wife’s (and my own) lingering fears that I might have a brain tumor or a stroke, that she will not be left alone at the end of this strange cool summer that we have spent fearing for her, not for me.

The String Has Been Cut

For some reason, I have found myself unable to finish off a review of Neil Gaimon’s American Gods and so have done nothing else in the way of publishing in my concentration on, or wholesale ignoring of, that so far abortive project. I’ve not talked about Lovecraft, whom I’ve also been reading (he’s kind of silly, overall), and I’ve not updated Kay’s condition, despite knowing that there may be some who are interested in the latest. Those who are interested, by the by, are welcome to prod for more information, either through the comments (all three of which I checked before allowing two of them to be published, the first being abusive), or through personal e-mails to jrrhawking@gmail.com.

Kay’s condition is pretty good. A few days ago her spirits received an uplift when we were called by Dr. Hilgers’ office to let us know that the second bacteria in her abscess had been identified, and that the Flagyl she was already taking orally would kill it. Up to this point, knowing only that the E. Coli was being taken care of, we were uncertain that the second, as-yet-unidentified, bacteria was going to be destroyed. They had told us that the Flagyl was likely to do it, but not knowing the identity of the bacteria, they couldn’t be sure until they received a positive identification. As the days stretched on, we were both worried and mollified, worried, because we weren’t sure whether the delay was caused by the slow growth of the bacteria (which we assumed could only be good) or their inability to find something that would kill it (which we assumed could only be bad); mollified, because the output of the drain both lessened and became less yellowish-brown, more clear, with a pink substance we were told was new tissue, white blood cells, and other signs of a return to normality. Clearly we are not really sure how bacteria cultures are accomplished. But however it’s done, it’s been done, and the infection is at bay, if not positively defeated.

So effective has Drs. Hilgers and Fitzgibbons’ effort been, in fact, that the drain’s outflow has dropped beneath the magical number of ten cc’s per day (cc’s are apparently equivalent to milliliters). Once beneath that number, said Dr. Fitzgibbons, the drain could come out. It attained that level on Thursday, at which point Kay called him, and he contacted a local surgeon to remove it. That local surgeon was leaving for vacation, but asked a colleague to do it. This colleague, whose odd name I will not repeat, because I am about to make fun of it, but the oddity of which can be hyperbolically approximated by the pseudonym “Dr. String Barracuda,” was available today, Monday, and, after having been needlessly warned by Kay, as she had been told to warn the person taking it out, to “cut the string,” thus releasing the coil that held it in place, removed the thing out without incident. The extra time with it in did cost Kay another few days of mild discomfort, and some lost sleep as she does not sleep naturally on her back, but it also afforded us the added satisfaction of knowing that the level of drainage did not go up. It has, in fact, not gone above around seven per diem since then, implying that the infection is properly finished. She will, however, watch the leftover wound – small enough to be only bandaged – closely, to make sure there is no excessive drainage, and plans to continue taking her temperature well after this entire project is over, as fever seems to be a good indication that the body is up to something that is causing it exertion, whether or not it is obvious on the outside.

Dr. Barracuda and Kay chatted about how she had gotten to this point, and he did worry her some by his surprise that Dr. Hilgers was using GoreTex to reduce scarring. Just now, in fact, I went into our bedroom, where I found her sitting in front of the TV with worry stitched into her face. I reminded her, as I reminded her earlier, that Barracuda is not a fertility doctor and has no previous experience doing or exact knowledge of what Hilgers has been doing, with some success, for many years. Presumably, had GoreTex not, in the past, precluded adhesions from forming post-surgically, Hilgers would not be wasting his time with the stuff. I also reminded her that Dr. Fitzgibbons, the chief of surgery at Creighton, is aware of and accepting of what Hilgers does, and has said that he uses internal GoreTex bandages all the time. Back when we were in Omaha, Dr. Fitzgibbons said, specifically, that he would have no trouble removing the bandages when we came back. These reassurances had their good effect, but more will undoubtedly be needed, for worry with Kay is like a persistent army that lays siege to her piece of mind, fortified howsoever it may be, and will not be dislodged without a determined assault on his supply train, or an end, altogether, to the war.

We are due to arrive again in Omaha on the 30th of July, with the 31st reserved, we assume, for a pre-op visit, and the surgery scheduled for the 1st of August. Assuming all goes well, and assuming the surgery is able to be conducted laparoscopically (there is some potential that it will become a laparotomy, mini- or otherwise), we will head for home on the 3rd or so, with just under two weeks to prepare for the beginning of the school year. Whether Kay will start on time or not, or as a full-time teacher or not (we are lucky in that, childless and with some help from our families, we can afford to do either), depends on the outcome of the surgery (which will be reported here), as well as on a conversation she will have with her school principal, a woman sympathetic to her because of similar fertility ordeals she underwent herself, some years ago. One way or another, we hope for things to continue looking up, so please place or keep us in your prayers.

We're Home

Kay and I are at home now, having gotten back to our apartment around 7:00 last night. Her parents came over last night with dinner, and my mother will be bringing dinner over tonight. My dear sisters brought over flowers and basic groceries for us, leaving them with a sign that said, “Welcome Home!” By the time we got home, the cold I'd been nursing along the last few days was in full force, so I've been feeling poorly to the point that I could barely rouse myself at 10:00 this morning. I only got out of bed because the nurse was coming over to administer Kay's IV. Having the family care has therefore been a great boon.

The nurse, who came from Coram Specialty Infusion Services, was very friendly and professional. She was entirely unfazed by the abscess – beyond feeling bad for Kay that it had happened – saying that these things happen and are easy to solve. When we said we didn’t know what the second bacteria causing the abscess was (the first is e. coli – very common and nothing to worry about once identified, she said), she speculated that it might be a type of staph infection from the skin. No matter how much they do to clean the surface of the cutting area, she told us, sometimes things survive. Kay lamented that she forgot to wash with Dial antibacterial soap before the surgery, but I figure that if the iodine and things they use in the OR didn’t do it, store-bought bar soap is unlikely to. Still, would have been better to be safe than sorry, I suppose.

We are likely to return to Omaha in about three weeks, when Dr. Hilgers and Dr. Fitzgibbons (the chief of surgery at Creighton) will remove the Gore-Tex bandages. By that point, the course of anti-biotics will be over (the one being given via IV will end on Tuesday), and, we hope, the drain will have been removed. Kay is doing pretty well overall, though she is suffering some minor discomfort from the drain – when the nurses ask her to list her pain on a scale from one to ten, she usually says one or two. Her taste buds are also a bit discombobulated, we think as a result of the antibiotics. All told, we will be glad when the bandages are out and this part of the process is over. We can only hope that the inflammation from the abscess has not undone the progress of the surgery, but we won’t know until we go back in August.

Some Minor Relief

Something I forgot to mention in the last post. Before she went to bed (a good couple hours before I posted “The Waiting Game”), Kay asked me a question: “What if they can’t kill it?” Not quite understanding, I asked for clarification. She then gave me to realize that her conception of the bacteria-identification process was this: the doctors take the culture and then try to kill it with various antibiotics. When they succeed, they know what bacteria they are fighting, and they know how to kill it. Kay’s culture was taken on Sunday evening, and still has not been identified. The longer the wait, the more worried she was getting: they still haven’t been able to kill it!

I responded to this novel concept by reassuring her: no, they identify the bacteria by letting it grow until it identifies itself. But there was a small stab of horror within me as I said this, because I frankly didn’t really know how they do it. I know there’s a disk of sheep’s blood and that the stuff grows on the blood, and that’s about all I knew. I wondered, could Kay be right that this is how they do it? After all, shouldn’t a microscope do the trick? – what needs all these days of growing? Finally, when the nurses came in to hook Kay’s PICC line up to the antibiotic bag, I decided we had to ask. Turns out, I was right. The stress melted out of Kay when we heard this, and I pray that she will sleep better tonight as a result.

The Waiting Game

We know now what we knew the last time I reported anything: Kay has a pelvic abscess. It seems to be under control. She has a little plastic drain coming out of her right abdomen, just a tube and a bubble pump that, when squeezed, wants to expand to its natural rotundity and so suctions out what is inside – a translucent brown liquid that is, if I’ve been listening closely enough, a combination of mucus, germs, and a foreign saline pumped in to liquefy the others. The hand grenade, which is what we call the pump for its resemblance to that weapon, hangs pinned to her clothing, transparent to allow for an easy measuring of the poisons extracted. The plan is that the amount will decrease regularly, implying a decrease in the amount available to be pumped, and that the lab will then figure out what the bugs in the brown fluid are and what antibiotics will destroy them.

Our doctors have been very good to us. Dr. Hilgers comes by every day to keep us up to date, even though there has not been much to tell in the past few days. He is always upbeat and always willing to answer the questions he can. There is none of the condescension in him that one sees so often with doctors, though he is always confident, in an understated way. Kay likes him quite a bit, as do I, and all the nurses speak quite highly of him. (This abscess, incidentally, is apparently the third time he’s seen one in twenty-five years of doing this surgery.) The GI surgeon with whom he has been consulting, and who has been very reassuring that they will fix what ails Kay, comes by every two to three days, and a Hungarian doctor from the radiology department (they put in the pump) has come by on a number of occasions to make sure the hand grenade is working well.

The wait comes from Dr. Hilgers and the GI surgeon needing more information to decide whether they want to take the internal bandages out sooner or later. On their own, Gore-Tex bandages are not a problem – they are used because they are non-allergenic, and their use is fairly common, from what we’ve heard. But as an artificial mesh, they are attractive to germs, and once the germs are in the same region, there is a chance they can colonize the Gore-Tex. Once they do that, they will be protected from antibiotics, which can only reach the abscess through the blood stream. The removal of the Gore-Tex is thus desirable, but the surgery to take them out could stir up the infection dangerously. Therefore we play the waiting game: suction and then reduce or destroy the infection with antibiotics, then go in safely to remove the Gore-Tex at a later date. What that later date will be depends, probably, on what the culture turns up and how long the appropriate antibiotics take to destroy it. It will not be more than three to four weeks, we’ve been told.

The problem now is to wait without getting too down. Kay is has been down for the better part of two days, and doesn’t know whether she wants to leave more or be well more – well, she knows she wants to be well. But she doesn’t want to be here for another week or two while it happens. We are able to go outside, but Kay is confined by doctor’s orders to the hospital grounds. There is some talk of her going home with the grenade – either to the hotel or really back home – then coming back for the Gore-Tex-removal surgery, but until they know what kind of bug or bugs she is fighting, they don’t want to let her go. Ultimately, we just want her to get better, and we’ll do whatever they want us to do to make sure that happens.

Faith and Its Fluctuations

From the beginning of this whole process, Kay and I have been ready to rejoice, only to find our hopes disappointed. The first month we tried to get pregnant, Kay was late with her period. She was never late, she’s rarely been late since, but she was not pregnant. For well over a year we tried, but nothing happened. Finally, they went in to take out her ovarian cysts, not having anything else to try (various fertility drugs, such as Clomid, had failed) only to find that she had endometriosis. At first, that seemed like a good thing: we knew what was wrong and had heard it could be cured with hormone treatment (I think I’m remembering this correctly), not to mention the scraping they had done already. It turned out that it would not be so easy – endometriosis is infinitely more complicated, and as we found out later, the scraping did possibly more bad than good, as it left behind adhesions as effective as endometrial tissue at physically isolating and damaging, through inflammation, the reproductive organs.

We finally began the process with Dr. Hilgers and the Pope Paul VI Institute, well over a year ago (perhaps a year-and-a-half ago), and things seemed to go well in the operation, though we knew it would be a difficult one, and by no means guaranteed success. But these last two weeks have been full of nothing but setbacks, it has seemed: a good first day followed by the somnolence of atalectesis; her revival and subsequent eating followed by vomiting and diarrhea; a bowel revived from ileus followed by fever and renewed coughing; plaintive hopes for pneumonia followed by revelation of the pelvic abscess. Now the less harsh procedure of the catheter and a dose of antibiotics is our hope, against which is juxtaposed the six-month colostomy. (This is not to mention the damage this kind of inflammation can do to ovaries, tubes, and uterus, which, along with the coughing, is for now a secondary worry.) I hope our beleaguered troops hold the line here.

The military metaphor arises because I have been reading the first volume of Shelby Foote’s The Civil War. I am not alone in having Lincoln as my favorite president because of his thoughts, expressed in his profound and serious words. I was too poor a philosophy student to say whether Lincoln’s thoughts were particularly original, but the humility and cadence of their expression is moving in the extreme. There are two writings that Foote quotes, in each of which Lincoln addresses situations of much greater extremity than that in which Kay and I are embroiled. In speaking to a Quaker woman who called on Lincoln to show her support for his having issued the Emancipation Proclamation, he said,

We are indeed going through a great trial – a fiery trial. In
the very responsible position in which I happen to be
placed, being a humble instrument in the hands of our
Heavenly Father, as I am, and as we all are, to work out
his great purposes, I have desired that all my works and
acts may be according to his will; and that it might be so,
I have sought his aid. But if, after endeavoring to do my
best in the light which he affords me, I find my efforts
fail, I must believe that for some purpose unknown to
me, he wills it otherwise. If I had had my way, this war
would never have been commenced. If I had been
allowed my way, this war would have been ended before
this. But we find it still continues, and we must believe
that he permits it for some wise purpose of his own,
mysterious and unknown to us; and though with our
limited understandings we may not be able to
comprehend it, yet we cannot but believe that he who
made the world still governs it.

Kay and I are not so much instruments here, not so much operating as being operated upon (quite literally, in her case), but still her subjection to treatment and my support for her can be said to be our “efforts,” and certainly our “war” would have ended before this had we been allowed our way. And our little case is as worrying to us in its threat to the world for which we are responsible – our parents, our marriage, each other – as the horrendous losses of Antietam were in their threat to the vast arena for which Lincoln was so tragically and movingly responsible.

Lincoln also wrote a private piece, left on his desk but apparently not intended for publication. It was rescued by his secretary John Hay, being published later. In it, Lincoln attempts in effect to reconcile the existence of men such as Bishop-General Pope, and his prayers, with the equally fervent Northern clergymen, and their many prayers:

The will of God prevails. In great contests each party
claims to act in accordance with the will of God. Both may
be, and one must be, wrong. God cannot be for and
against the same thing at the same time. In the present
civil war it is quite possible that God’s purpose is
something different from the purpose of either party;
and yet the human instrumentalities, working just as
they do, are of the best adaptation to effect his purpose.
I am almost ready to say this is probably true; that God
wills this contest, and wills that it shall not end yet. By
his mere quiet power on the minds of the now
contestants, he could have either saved or destroyed
the Union without a human contest. Yet the contest
began. And having begun he could give the final victory
to either side any day. Yet the contest proceeds.

This passage is perhaps less applicable to Kay’s and my situation: there is no one, after all, praying against us. But the enemy that (or who) has entered the field has not been prevented from bringing his soldiers against us. The contest proceeds. We can merely fight by our best lights and pray that, supposing it is His will on earth and in heaven, we receive our daily bread, and that our trespasses will be forgiven us. Father, if Thou wilt, remove this chalice from us: but yet not our will, but Thine be done.
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Thanks, by the way, to The Abraham Lincoln Association, as well as to that perfidious academic institution holding the electronic version of their The Collected Works of Abraham Lincoln. As their version contained some confusing punctuation – perhaps in the manuscript sources? – I have made some changes to match Foote’s version, on pp. 709-10 of Volume I of his work.

Worst Day 1.2

Well, now we know. The fever and the white blood cell count are due to a pelvic abscess. Who knows whence the cough, though that is not our worry now. What is an abscess? It’s not like an ulcer, apparently. I always figured it was a spot in the surface of the organ (skin or internal) where the germs were multiplying and eating away at the flesh. Instead, an abscess, or at least a pelvic abscess, seems to be a collection of germs surrounded by a membrane created by the body in an attempt to ward it off from the rest of the body – it sounds as if its appearance is not dissimilar to a bubble, though this one apparently multiplies and spreads itself wherever it can, without concern for a globular appearance. Worst case scenario, and fairly likely it sounds like, is a temporary colostomy, which would apparently give the body and doctors a chance to fight off the infection in Kay’s interior. The less-bad case, and the one they will try first, is a temporary catheter inserted through her side. This will drain and collapse the abscess, allowing antibiotics to more easily reach the whole of the infected area, which is cut off currently from blood supply. If this is successful, it may preclude the need for a colostomy, which would save Kay six months of that indignity and inconvenience. But better six months of indignity and inconvenience than various worse alternatives.