Shall we start with the good news? Liver re-section successful. The appropriate slithers of liver have been successfully removed and all seems hunky dory. Mr. L seemed rather pleased with himself, the two tumours that had been lurking deep within the tissue of what was left of my liver were successfully located and removed. No adverse affects to date, liver function has resumed it’s normality, well at least what can be expected of what remains of the largest internal organ in the human body. I saw Mr. L many times in the few days following my operation, although now I come to recollect what was said I’m finding it difficult to remember in any detail. I do remember clearly his plea for me not to return as, in his own words, “there is little left for me to work with”.Thankfully I’ll have the opportunity of discussing more precise details of the operation when I see him in clinic in 4 weeks time, at which point he will have full pathology results from the offending tumours and details of the cancer free margins he was able to attain. I’m sure I discussed all of this with him during my stay in hospital, it’s just that I can’t remember.
I know that he wasn’t particularly pleased that my recovery from surgery was not exactly straight forward. He was anxious that I return to the ward as soon as possible after surgery, it made his post surgery recovery figures look good, and was not best pleased when ICU specialists argued successfully that I should remain on the High Dependency Unit where my recovery could be closely monitored. As it turned out I never did return to the ward as events in the following days would prove the caution exercised by the ICU team to be the right decision. A decision that even Mr. L would concur as events over the following days unfolded. Not for the first time the epidural inserted into my spine prior to surgery failed. OK so it didn’t fail completely, coverage was patchy at best, but most importantly it didn’t allow me to keep my chest clear in the important post operative period. By day 2 post op I was on PCA (patient controlled analgesia) that allowed me to pump morphine into my body as and when required. In truth I think we were both just grateful I had come through the operation without any noticeable complications. My liver was working fine, what else was there to worry about? There were always concerns about my recovery when taking into account what had happened since my last liver surgery. A collapsed and punctured lung, massive chest infection, and the two lung resections I had undergone earlier this year. But I was in the right place, they were aware of my history and at the time further complications were the last thing on my mind. Days 3 and 4 passed without me being aware of any noticeable problems but by Sunday there was increasing concern expressed by doctors and staff on HDU. The oxygen levels in my blood were decreasing even with the added assistance of almost 100% oxygen being administered via face mask, and perhaps more alarmingly, my heart rate was reaching alarming levels with even the slightest exertion. The removal of my oxygen mask to eat or drink resulted in a dramatic and almost instantaneous drop in the level of oxygen in my blood and my heart rate was exceeding 200 beats per minute. The monitors attached to my body were sending out alarms that sent nursing staff rushing to my side. I was suffering from extreme tachycardia, my heart having to beat at extreme levels in an attempt to pump the little oxygen from my lungs to other major organs in my body. The risk of major organ failure was increasing the longer the condition continued. The cause of the tachycardia ? Acute Lung Injury. Not any direct assault on my lungs, but the stress of surgery and a later diagnosed infection on my right lung.
It was now that the benefits of me being kept in HDU would become clear. The stress and deterioration of my condition was being closely monitored. A chest x-ray had identified an area of infection in my lower right lung, an area that was not expanding and encouraging the spread of the infection. Antibiotics were administered almost from the suggestion of any infection, although by now it was becoming increasing hard to get a needle or cannula into any of the conventional veins. I had now reached an all time low in that the only veins accessible on my body were in my foot. A situation I had feared many times before, but never actually believed would become necessary. I was not responding to normal oxygen treatment and so reverted to the dreaded bi-pap face mask that formed a tight seal around my face and forced oxygen into my lungs. I was in the fortunate (or unfortunate) position of having used one of these machines once before. At that time it was not the correct equipment I should have been on, but at least I knew how uncomfortable they were and at least had the knowledge of being able to try and synchronise my breathing with the machine, rather than fight it which is the more natural thing to do. The patient tolerance levels for theses machines is extremely low, perhaps as small as 40%, but I knew it was something I had to try if I was to make any sort of recovery. After almost 24 hours on Bi-Pap the Intensive care consultant carefully explained to both M & I what was happening. There seemed to be little improvement in either my breathing or heart rate. If there was still no improvement the sensible thing to do was to take me into intensive care, put me in an induced coma and let a ventilator take over my breathing allowing my heart to recover and ensure that oxygen was reaching my vital organs. This was now getting very serious and frightening, the infection taking over my lungs was not responding to treatment. He further explained the consequences of intubation. There was no way of knowing just how long ventilation would be required. Two days, two weeks…two months, just as long as it was necessary for my body to recover.
After a further 18 hours on Bi-Pap there was still no sign of improvement and so the decision was made to transfer me to intensive care. It was thought better to do this and put me on a ventilator under controlled conditions rather than wait until my condition was so serious that there was no alternative. Once that decision was made things moved very quickly and I was transferred to the intensive care unit within an hour. I had to stop writing here, it all became a bit emotional, recalling exactly what’s happened. At the time it seems like nothing, but when it’s all over and you reflect on everything it made me realise just how seriously ill I had become. North Manchester General is a hospital with 800 beds, and an intensive care unit with 8 beds. I was considered ill enough to be transferred to one of those 8 beds, that does bring it home and it’s scary. The ICU was not new to me, I had been there last December after my last liver operation. At that time I was heavily sedated and everything was surreal and appeared not to be really happening. This time I was much more conscious and it was very real indeed. As I was wheeled in, the thought went through my mind that I had no idea when I would be leaving, within hours I could be unconscious and machines would be taking over the vital functions of my body. When you’re lying there you can only see other patients, you can’t see the mass of equipment that you are connected to behind you. I was still connected to bi-pap, the mask for which greatly restricted the view I had anyway. My entire focus was on trying to breathe, unaware of the mass of tubes and leads connected to my body. M arrived shortly after my transfer to ICU. It was difficult for her to hide the shock and deep concern on her face. Neither of us could speak much, me because of the face mask, and M because she was desperately, and unsuccessfully trying to hold back tears. As we held hands through the bars on the side of the bed, her tears were cascading down her face falling on to my hands. We didn’t need to speak.
I don’t remember how long M stayed, although I thought I was aware of what was going on, the cocktail of drugs must have been affecting my view of things. This was one to one nursing now. I already knew Jo who was looking after me that first night, the staff from HDU and ICU alternate between the two, and Jo had been looking after me on HDU a few nights earlier. I remember her getting slightly cross at about half two in the morning as she was called to answer a phone call just as she was in the middle of checking or changing some monitor on my chest. It was M, just checking that I was OK. I remember feeling reassured that she had called, and slightly annoyed that she was still awake that time of the morning. It also gave me renewed energy to fight and avoid being controlled by machines. I didn’t want that, and the only way I could prevent it was to get better.
Something happened over the next 24 hours that changed the course of my treatment. My nursing care was now in the hands of Kamil, a huge bearded man who was the gentlest and kindest person I have ever met. The Bi-Pap mask was removed whilst he washed my face. He asked whether I wanted a rest ‘for ten minutes’. Of course I agreed, I can’t tell you how uncomfortable they are and how distressing it can be to have your breathing controlled by a machine. I still had to have an oxygen mask on, but compared to Bi-Pap it was pure relief. An hour later I was still without the Bi-Pap, and my SATS were remaining good even through I was still on 100% oxygen. My heart rate continued to soar every time I removed the mask to drink, and SATS dropped to low 80’s, but it was an improvement. The micro-biologists had identified the type of infection in my lungs, but not the specific bacteria. It was unlikely that they would ever be able to do so now, as the antibiotics that were being pumped intravenously into my veins were at last working and the infection seemed to be under control. Five major operations, chemotherapy and the amount of antibiotics my body had been subjected to over the last 18 months had taken their toll, my body had lost it’s immunity, and a simple throat infection had travelled down into my lungs. Just a normal, simple bacteria that we all carry in our throats had almost killed me. I still wasn’t out of danger, but at least we seemed to have turned a corner, and importantly, it looked that I had avoided intubation and the need to be put in an induced coma, by the narrowest of margins.
I hadn’t told M of the news before she arrived to see me on ICU, but the relief on her face when she arrived, seeing me off Bi-Pap was enormous. I spent a third day on ICU whilst they continued to monitor my progress, and ensure that the antibiotics continued to hold off the infection, but late on the third day I was transferred back to HDU, much to the relief of everyone, myself included. The remarks of the staff on HDU as to how much better I was looking was reassuring, but again brought home to me just how ill I had been. My progress continued slowly over the next week, although I remained on oxygen throughout. My heart rate continued to soar every time I exerted myself in the slightest, but it was felt that this would improve slowly over time whilst my body recovered from the trauma it had been put under. By the end of the following week I was ready to be transferred to an ordinary ward, except that there were no beds available for me. I was aware that the transfer was a necessary step towards my eventual discharge, but I was happy to remain on HDU for the time being. After a further three days waiting for a bed to be available I had had enough, and pestered doctors to allow me to be discharged straight from HDU. Gradually the level of oxygen had been reduced, and apart from a brief spike,my white blood cells levels indicating infection had been falling back to more acceptable levels. Eventually I won. After not being out of bed for almost two weeks I convinced the physiotherapy team that I could walk, albeit with the aid of two walking sticks. The doctors were now sick of my pleading to be released and eventually agreed to the unusual step of discharging me home direct from HDU.
Obviously I am home now. It has taken me six days to be well enough to sit down and finish this. I am still exhausted from doing the simplest of things, but I am getting there, I am improving. I always said that it wouldn’t be the cancer that killed me, but some stupid infection and my body’s inability to fight it. That nearly proved to be the case, and I’m determined not to be in that position again. M is here looking after me until I am back on my feet again. I can never thank her enough for what she has done for me, and for just being there. Thanks also to my brothers and sisters who again made the long journeys to visit me, and the many of you have sent messages or enquired after me whilst I have been away. Soon the whole cycle will begin again. In January I will have scans that will be the base for judging progress over the following months. This time I hope that the cancer free period can be a little longer, like forever. In the meantime I’m going to have a long rest. My body is battered and bruised, both internally and externally. This has been by far the hardest operation of them all, probably due to the accumulative effect from all the previous ones. I’ve been out of bed for five hours now, by far the longest period in a long time. I’m sure this will be a long recovery, but it starts right here, right now.