I was taken up to the surgical ward and no sooner was I in my bed than orderlies arrived to take me to the operating suite.
The operating room was cold. I was laid out on the table, one arm placed straight out like I was being crucified. The anesthesiologist placed a heavy stethoscope on my neck and then started an IV in my out-stretched arm. A well practiced routine swirled around me, as people silently proceeded with their jobs. Too tired to be scared, I was not so sick that I didn’t notice the anesthesiologist’s atrocious breath. An injection into my IV put me out. When the medication reached my brain, I smacked the sleep wall at what felt like 50 miles-per-hour.
Even a solitary human does not live alone; our bodies our host to billions of microorganisms. Some of these, like those living on our skin seem to just be along for the ride. But others, such as those in our gastrointestinal track are essential partners in our life. The collection of these microorganisms are referred to as our microbiota. Within the intestines the microbiota consists primarily of bacteria, with about 1000 different species being present in an adult. Surprisingly there are at least 10 times as many bacteria cells in our intestines as there are “native” cells in our entire bodies. Bacterial cells are much smaller than human cells, nonetheless the mass of bacterial cells in our intestine is approximately one and a half kilograms.
The absence of or imbalance in these bacterial guests results in human disease and poor digestion. An important function of the gastrointestinal tract is to host these bacteria without letting the bacteria enter the body proper. This is achieved through a thin mucus lining that is continually being generated and shed in the intestines. When this barrier is breached, for example by a perforation of the intestinal wall, these once helpful and necessary bacteria become menacing sources of life-threatening infections.^[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC193582/]
The peritoneum is a silk like membrane that lines the abdominal cavity as well as most of the organs within the cavity. The peritoneum consists of an outer layer (parietal peritoneum) that connects to the abdominal and pelvic walls, and an inner layer (visceral peritoneum) that wraps around the abdominal organs in whole (e.g. the stomach) or in part (e.g. the kidneys). Of the two, the visceral peritoneum is by far the largest. In autopsy studies conducted by Albanese et al.^[Surg Radiol Anat. 2009 Jun;31(5):369-77.], the visceral peritoneum was measured to be approximately 81% of the total peritoneum surface area. The peritoneum provides both structural and functional support for the internal organs, with blood and lymph vessels as well as nerves travelling through the peritoneum on their way to the organs.
When the peritoneum gets infected (peritonitis), for example from bacteria entering the peritoneum from a perforation in the gastrointestinal tract, the subject experiences extreme pain which is aggravated by motion. If left untreated peritonitis can progress to sepsis and septic shock where a massive drop in blood pressure is experienced followed by organ failure and death. Not a few famous people have died from peritonitis, including John C. Fremont, Edward Gibbon, Harry Houdini, Henry Wadsworth Longfellow, Rudolph Valentino, and Brigham Young
I went down with a bang, but I woke up from surgery slowly. Despite my mental fog, I could tell I was in a different, smaller room than what I had originally checked into. Not yet aware I was awake, my parents stood at the foot of my bed, dressed in long, yellow gowns covering them from their wrists to their ankles, talking to a tall, slender man with large glasses who was also wearing a yellow gown. Fragments of the conversation drifted to my ears: “…very sick…”, “if…hours…”, “later…,” “might…lost him.”
Despite my incoherence and the reticence of the people around me, a picture of my physical state slowly materialized as I emerged from the anesthesia. I was sick.
Some things I was told: “Your appendix had ruptured.” Other things I discovered during the course of my care. I winced when my surgical dressing was first changed, the adhesive yanking on my pubic hairs. And then I stared.
Just below my appendectomy incision a safety pin had been sewn to my skin. The pin was anchoring a rubber tube that was emerging from a my abdomen. The tube emerging from the open wound was draining the “foul smelling bloody thick puss” (as the surgical report put it) filling my abdomen. Every morning, a nurse unpinned the tube and advanced it a little, the tube tickling me as it slithered through my gut.
Intravenous (IV) and nasogastric (NG) tubes pierced me, bypassing my normal digestion functions, and doing their best to keep me miserable. Not satisfied to visually torment me with the green, foamy fluids it paraded before my eyes on their way from my stomach to the collecting bottle at the side of my bed, the NG tube dug into my throat, painfully reminding me of its alien presence every time I swallowed.
The IV provided both a continual stream of fluid nutrients and a high volume of antibiotics needed to fight the infection eating my internal parts. Unfortunately, my veins kept collapsing, and the nurses would have to start the IV in a new vein with yet another painful prick. Both arms, both hands, even my legs were pierced as the nurses sought for ways to keep the vital fluids flowing into me.
Ironically, I became more miserable as I recovered, at least initially. Slowly weaned from the pain medication, I became more aware of the throbbing cut in my lower abdomen, the black, sticky, black stool uncontrollably escaping my body, and the gnawing hunger twisting my stomach. Food—if ice chips and apple juice or chicken broth can be called food—were introduced very slowly—a thimbleful an hour. When the drops of apple juice failed to quench my thirst, nurses would swab my mouth with a wet sponge the size of a DumDum sucker, a teardrop of water trickling down to my throat. As I recuperated, the clear liquid volumes were increased, then supplemented with full liquids—pudding, Cream of Wheat—and finally, just before I was discharged on June 13th, topped off with solid food, two weeks since I had eaten breakfast on Memorial Day, my last meal.
Visits from my family and especially my friends helped keep me sane during this prolonged hospitalization. Jeff, in particular, was a great help, using my personal plastic stethoscope (a precaution for my open wound) to diagnose a variety of deadly ailments I suffered from. The nursing staff were friendly. During the night shifts I would watch amazed as my one-armed nurse changed my IV bags and bottles, tucking the bottles and bags under the stub of her arm while with her other she inserted the tubing.
When I came home on the 13th, I was 20 pounds lighter than I had been on Memorial Day. I was tired and I was hurt. Above all, I was worried. My appendix had not ruptured on its own. A yellow, two cm tumor had been found in my appendix. We had to wait for a following up visit meet with the surgeon, Dr. Wilkinson, to learn the details of what the pathologist found during the examination of the tissue, but it could not be good.