ICU: Bed 23, Day 45.
Feb. 20th, 2021 10:20 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterIf anyone has experienced the worst of the worst complications from a normal vaginal birth (NVB) it is bed 23. NVB is not without it's risks (as is anything in life: like crossing the road) and despite the statistics, there are risk factors but no real certainty regarding how things will go.
.
This basically means that when she was giving birth, her vagina was ripped down, through the perineum, and into the muscle that surrounds the anus. This, if not repaired would cause her to be fecally incontinent.
Despite surgical repair if her anus : she continued to have both fecal and urinary incontinence.
Further complications ensued from the surgery. She healed poorly and had complications whereby despite the procedure/s she was not successfully continent.
She had hernias - multiple, painful ones - likely either due to or made worse from (it's not clear from her notes) her pregnancies.
?decades later-
She's now 75. And somewhere along the way ; someone decided that a colostomy would solve her fecal incontinence (and it does). But how long was she fecally incontinent before they decided that was the only way to fix the problem, I wonder.
They also tried to do a mesh repair for the hernias, and to support her pelvic floor which clearly, was not functioning.
She had more complications: infections in the mesh; long hospital stays.
All complicated by obesity; diabetes; obstructive sleep apnoea (OSA).
Despite this; she managed to keep up a job until quite recently -- despite being able to retire at 65 - and she lived independently in a flat.
Then she got a small bowel obstruction (SBO) and an enterocutaneous fistula. Vomiting and fearing the stoma wasn't working due to severe pain and lack of output (aka. no stools passing through for 24 hours) she called an ambulance and this is how she ended up in hospital for months on end.
They found a small loop bowel obstruction.
They recommend surgery.
She tried to put it off.
They put her on TPN (total parenteral nutrition: it's like; all your energy needs in fats and proteins and etc, intravenously- it must be run via a central line into your superior vena cava or other major vein) and NBM and she the surgeons and Bed 23 hoped it would resolve.
Her diabetes went extra uncontrollable with the TPN and NBM diet.
They had to phone the endocrine team to titrate her insulin regimen; and every time they changed her diet.
She'd get upgraded to clear fluids (jelly and juice).
Get stomach pain, stoma wouldn't work - and she'd end up back on the TPN.
They'd recommend her surgery.
She'd sorta half refuse. Fearing a similar admission to what happened when her mesh became infected and the surgeons then had recommended no further surgery as it would not serve to improve her stomas.
They'd put her back onto TPN.
She'd get better.
They would give it a week;
Then try again on a free fluid diet again -
Then pain and the hernia's would get painful again -
They called family meetings to talk to her daughters about the surgery.
Somewhere along the way she asked if they could do gastric banding for her at the same time as resolve the SBO.
When they got a review for her regarding that she refused the idea of surgery again, feeling better.
The nurses started having to call for reviews for her pain. Pain was getting worse. They started subcut morphine.
She was afraid of surgery - but had agreed - and so her team set up to plan for the complex procedure that was to come.
It seems (to me) they must have repaired her SBO through the old stoma because there is no abdominal wound.
Since that surgery: it's now been 45 days in ICU.
In which she became a long term ventilatory wean requiring tracheostomy.
Her kidneys were failing with sepsis postoperatively - so she ended up on CRRT (continuous renal replacement therapy).
Her stoma site looked broken down and horrible around the site, it clearly extended around.
She became delirious, would grab at the tracheostomy; state she couldn't breathe, that the necktie was choking her.
She had chronic pain, all over. Abdomen mostly. Addicted to the pain relief medications possibly. She'd shake in the bed and gesture and mumble to herself.
She lost a lot of weight, being on NG feeds now, stoma working well.
Finally, she turned the corner.
They started doing tracheostomy weaning.
She hasn't stood up for 45 days.
She hasn't eaten anything orally for 45 days.
She's been stuck in a single room ; with no windows ; due to VRE/ESBL.
Due to Covid-19 we've all been wearing masks; so she hasn't seen half our faces for the entire time she's been sick.
Her daughter comes (almost) daily. Thats a burden. Every day; having to block time to ensure she came to visit.
Imagine being the daughter whose birth cause their mother to be incontinent of feces for the rest of her life such that she had to undergo the formation of a stoma-- and the mesh -- and all the sequelae from complications because somehow: she just caught them all.
She's on her way to getting better. I hope she never has another SBO or enterocutaneous fistula, or needs surgery again.
I hope she can go home and be independent again.
.
This basically means that when she was giving birth, her vagina was ripped down, through the perineum, and into the muscle that surrounds the anus. This, if not repaired would cause her to be fecally incontinent.
Despite surgical repair if her anus : she continued to have both fecal and urinary incontinence.
Further complications ensued from the surgery. She healed poorly and had complications whereby despite the procedure/s she was not successfully continent.
She had hernias - multiple, painful ones - likely either due to or made worse from (it's not clear from her notes) her pregnancies.
?decades later-
She's now 75. And somewhere along the way ; someone decided that a colostomy would solve her fecal incontinence (and it does). But how long was she fecally incontinent before they decided that was the only way to fix the problem, I wonder.
They also tried to do a mesh repair for the hernias, and to support her pelvic floor which clearly, was not functioning.
She had more complications: infections in the mesh; long hospital stays.
All complicated by obesity; diabetes; obstructive sleep apnoea (OSA).
Despite this; she managed to keep up a job until quite recently -- despite being able to retire at 65 - and she lived independently in a flat.
Then she got a small bowel obstruction (SBO) and an enterocutaneous fistula. Vomiting and fearing the stoma wasn't working due to severe pain and lack of output (aka. no stools passing through for 24 hours) she called an ambulance and this is how she ended up in hospital for months on end.
They found a small loop bowel obstruction.
They recommend surgery.
She tried to put it off.
They put her on TPN (total parenteral nutrition: it's like; all your energy needs in fats and proteins and etc, intravenously- it must be run via a central line into your superior vena cava or other major vein) and NBM and she the surgeons and Bed 23 hoped it would resolve.
Her diabetes went extra uncontrollable with the TPN and NBM diet.
They had to phone the endocrine team to titrate her insulin regimen; and every time they changed her diet.
She'd get upgraded to clear fluids (jelly and juice).
Get stomach pain, stoma wouldn't work - and she'd end up back on the TPN.
They'd recommend her surgery.
She'd sorta half refuse. Fearing a similar admission to what happened when her mesh became infected and the surgeons then had recommended no further surgery as it would not serve to improve her stomas.
They'd put her back onto TPN.
She'd get better.
They would give it a week;
Then try again on a free fluid diet again -
Then pain and the hernia's would get painful again -
They called family meetings to talk to her daughters about the surgery.
Somewhere along the way she asked if they could do gastric banding for her at the same time as resolve the SBO.
When they got a review for her regarding that she refused the idea of surgery again, feeling better.
The nurses started having to call for reviews for her pain. Pain was getting worse. They started subcut morphine.
She was afraid of surgery - but had agreed - and so her team set up to plan for the complex procedure that was to come.
It seems (to me) they must have repaired her SBO through the old stoma because there is no abdominal wound.
Since that surgery: it's now been 45 days in ICU.
In which she became a long term ventilatory wean requiring tracheostomy.
Her kidneys were failing with sepsis postoperatively - so she ended up on CRRT (continuous renal replacement therapy).
Her stoma site looked broken down and horrible around the site, it clearly extended around.
She became delirious, would grab at the tracheostomy; state she couldn't breathe, that the necktie was choking her.
She had chronic pain, all over. Abdomen mostly. Addicted to the pain relief medications possibly. She'd shake in the bed and gesture and mumble to herself.
She lost a lot of weight, being on NG feeds now, stoma working well.
Finally, she turned the corner.
They started doing tracheostomy weaning.
She hasn't stood up for 45 days.
She hasn't eaten anything orally for 45 days.
She's been stuck in a single room ; with no windows ; due to VRE/ESBL.
Due to Covid-19 we've all been wearing masks; so she hasn't seen half our faces for the entire time she's been sick.
Her daughter comes (almost) daily. Thats a burden. Every day; having to block time to ensure she came to visit.
Imagine being the daughter whose birth cause their mother to be incontinent of feces for the rest of her life such that she had to undergo the formation of a stoma-- and the mesh -- and all the sequelae from complications because somehow: she just caught them all.
She's on her way to getting better. I hope she never has another SBO or enterocutaneous fistula, or needs surgery again.
I hope she can go home and be independent again.
no subject
Date: 2021-02-20 03:51 pm (UTC)