Day 14/Day 1

The past couple of days have been a little crazy. I actually wrote an update on Monday but I have no idea where it is. Not surprising considering my foggy state of mind. Monday was a pretty good day. We were able to relax and we went for a short ride in the car just to get out. Monday night Nate started feeling a little 'blah' so we put him to bed. We had his post op appointment on Tuesday morning, and as we were getting ready to leave, Nate's incision started to ooze some fluid. When we arrived at the appointment, we told our doctor about it, she took one look, and we knew it was bad.

She removed a couple of staples and used a Q-tip to break it open. Fluid gushed out of the incision. She got it cleaned up as much as she could and attached a bag to let it drain while we figured out what to do. She was pretty sure that Nate had formed a fistula, or a hole in his intestine. She called for the ambulance and secured a bed back on the Oncology Unit. The ambulance arrived within 20 minutes and we were off for our .7 mile journey to the hospital.

Nate's 2nd Ambulance Ride...still no lights.

Nate was admitted to his room where he started drinking contrast for his upcoming CT scan. They started a new IV line and accessed his port. He received bolus IV fluids and 3 antibiotics were started. They drew 3 separate blood cultures, and drew labs. We waited for 3 hours and finally went for the scan. After Dr. Lambert looked at the scan she was amazed that Nate wasn't more symptomatic, and just plain sick. He had a large amount of intestinal fluid that had leaked out of his bowel into his abdominal cavity. He was starting to fever and get the shakes.

Nate had a fistula, or a hole that developed somewhere in his intestine. It looked like it had formed a few days earlier, probably during the time Nate had the ileus. It was most likely that the leak was coming from the anastomosis, or the spot where the bowel was reattached during his surgery two weeks ago. She was frustrated because she felt like the anastomosis was an ideal reconnection. She was worried about our timeline and getting us home, but didn't want to make decisions based on that. After she spent a minute assessing Nate, she made the decision that he needed to have emergency surgery. He was getting warmer, and had started throwing up.

Needless to say, we were so discouraged. It was really scary to think about what had been leaking into Nate's belly. The infection risk alone was so concerning. The decision was made a little after 9:00 p.m., and they came to get him at 9:20. We only had enough time to talk to each of our children and our parents. The plan was to get in there, find the hole, clean up the abdomen, and make an illeostomy, which would allow the bowel to rest and heal for the next few months. She thought it would take 2 or 3 hours.

At 10:00 I said goodbye and went to the waiting room. I'll admit that we were both more scared and discouraged than we've been to this point. After a very long 3 hours, Dr. Lambert came out with the news. They had to re-open his entire incision.There was a lot more fluid than she anticipated so it took longer to clean him up. She found the hole, and it was in the anastamosis as she expected. When Nate had the ileus and his bowel filled up with air, his bowel twisted upward trying to find space to expand. When it did this, it put tension on the bottom of the anastamosis and popped the stitch out. Because it had been leaking fecal matter for so long, the bowel was really irritated and inflamed. As a result, she wasn't able to stretch the bowel far enough to create the illeostomy. Instead of closing him up and risking the integrity of the skin and tissue around Nate's incision, they packed the wound, attached a vacuum, and left the wound wide open.This is considered to fall into the 'major' complication category of complications associated with the HIPEC procedure. He's officially in the top 1/3! I'm starting to think that Nate is really good at beating the odds!

Nate was admitted to the ICU at 1:30 a.m., and I got to see him at 2:00. He was so stable throughout the surgery that they were able to extubate him in recovery. Dr. Lambert said that his body, his symptoms, and how stable he was defied all medical logic. She said he was as strong as a horse. Seriously, it's so crazy. This afternoon, Dr. Carroll, the Chief Resident who's been following Nate under Dr. Lambert, stopped by the ICU to check on Nate. He said something like, "In an earlier time you would have been a king, my friend. You would have been able to defeat all your adversaries." He said that he's never seen someone with a fistula do as well as Nate. He said they were usually really, really sick. This is another gift Nate's been given to help him deal with this nasty cancer. I'm grateful. I just hope he can get a break really soon. We feel like we're back to square one.

The plan is for Nate to rest as much as possible until Friday when Dr. Lambert will take him back to surgery. She will unpack his wound, clean it out again, and try to make the illeostomy. If everything is still too swollen, they will re-pack the wound, put him back on the suction, and leave him in the ICU until Monday when they'll try again. If they can't do the illeostomy on Friday, the surgery will be about an hour. If they can do the illeostomy it will take about 2 hours. We are, of course, praying for the least invasive route possible, but trust Dr. Lambert's judgement completely.

We actually had flights booked for tomorrow to come home, so that was a major portion of our discouragement. We miss our kids so much. This setback could cause us to stay for up to a month longer. We know we're in good hands, and are willing to do whatever it takes to get Nate healthy, but we want to come home so badly. It'll be 3 weeks tomorrow that we left home, so it really would've been amazing to get home that quickly, but we were so close!

There is a silver lining to all of this. Dr. Lambert was able to get a look at the effect the HIPEC had on the cancer. She said that she couldn't see any of the mucin that covered Nate's small intestine, and that the small amount of mucin that was left on his colon was completely compromised and it looked like it was breaking down. She said from a cancer stand point, it looked better than it did two weeks ago when she closed him up.

I know Heavenly Father is directing this whole thing, and I know he's mindful and aware of us. I'm thankful to friends and family who remind me of this during these hard times. We truly feel love from our doctors and most of our nurses :), from friends and family back home, and from all of you who let us know you're on our team.

That brings us to tonight, and the Fourth of July. We are in a little cave of a room with no windows where we wouldn't know if it was day or night, and the temperature stays at a cool 62 degrees.  We're sitting here watching the Charles River (Boston) Fireworks on our little ceiling mounted TV. I don't mention this to complain, but to tell you that despite the unfavorable circumstance we find ourselves in, Nate remains Nate. (I did get his permission to share this picture. Granted, he is on a good amount of narcotics. Hey, I need some entertainment too!)

Nate "raising the roof" to Cool n The Gang, 'Celebrate', as it's synched with the Fireworks

 

I do love this man!

Happy Fourth of July!