Communicating during a personal medical crisis

This Thanksgiving I am thankful for being home again after spending 21 days in the hospital here in Boise. On October 24, 2018 I had routine abdominal hernia repair surgery at Saint Alphonsus Regional Medical Center. I came in at 5:30 AM and was sent home in mid-afternoon.

But by late the next morning I had not urinated. I called the surgeon’s office, and was told to come to the emergency room (ER). I thought that overnight my bladder had overfilled, and simply inserting a catheter would drain it. In the ER they ultrasonically scanned my bladder and found it was empty. They told me my kidneys had shut down (renal failure), and admitted me. My digestive tract also had stopped moving, which is called an ileus.

I was put in Telemetry, with EKG chest leads, needles for intravenous (IV) fluids in both arms, a nasogastic tube (with suction to keep my stomach empty), oxygen via nasal cannula, and a Foley catheter for urine. My kidneys started up again, and eventually my digestive tract began moving. Finally I was moved to rehab, and stayed for eight more days. The day before I went home (last Thursday, November 15th) they finally removed the catheter.

During my regular stay two staff internal medicine physicians (hospitalists) -  Dr. Lisa Nelson and Dr. Carolyn McFarlane managed my care. Both did a wonderful job of communicating ‘we’ve got this.’ They told me about my current condition and treatments, what they knew, what they didn’t, and what tests were next to find out more. It was very reassuring to know where things were, and how I was improving.

     

I texted my sister Ellen (who has a Ph.D. in Biology from Princeton and once was a Research Fellow at Merck for six years) about those conditions, and she replied:

“Acute renal failure (ARF) occurs in a small % of people undergoing abdominal surgery. Some people suffer ARF following any surgery involving general anesthesia, A few suffer irreversible RF; and a few go into coma following general anesthesia. Shutdown of GI tract (aka ileus) is a more common complication following abdominal surgery, especially in older patients.

Lots of garbage on the internet: need to look at reputable sources (e.g. Merck Manual; Mayo Clinic, various NIH sites).”

The Merck Manual of Diagnosis and Therapy is a standard medical reference book. At home I still have the 13th edition from 1977, which has 2165 pages of nine-point type, is 5-1/2” wide by 8” tall by 2” thick. The entry for ileus in the web version says:

“Ileus is a temporary arrest of intestinal peristalsis. It occurs most commonly after abdominal surgery, particularly when the intestines have been manipulated. Symptoms are nausea, vomiting, and vague abdominal discomfort. Diagnosis is based on x-ray findings and clinical impression. Treatment is supportive, with nasogastric suction and IV fluids.”

Both the Mayo Clinic and Medline Plus have pages about kidney failure that have less jargon. 


One positive outcome from my stay in the hospital was losing weight. In August I had weighed 205 pounds, but when I got home I was down to 190.  

An image of a man in a hospital was adapted from Openclipart.