In the beginning

The news about Dennis.

In The Beginning.

When they arrived Dennis was having some discomfort when he used the loo and went to the local doctor. The doctor referred him to a consultant surgeon for an examination. The surgeon found a tumour in his lower bowel. A biopsy was taken. The surgeon’s immediate view was that the tumour was malignant and the course of treatment was begun on that basis. His case was discussed in the weekly cancer meeting attended by the surgeon and the other doctors, such as the oncologist, were made aware of the case. Dennis was sent for a CT scan at Hinchingbrooke Hospital in Huntingdon. He had to drink two pints of contrast enhancer over the twenty four hour period prior to the scan and some more immediately before. After a lot of setting up the scan itself took a matter of moments. A follow up interview was arranged when the surgeon explained all the details and options to the family. He said that the results of the biopsy were inconclusive, but were sufficiently indicative for there to be no change in opinion about the tumour. The cells showed significant change from normal cells under microscopy. The results of the CT scan were more encouraging. It showed that the tumour is small enough to be operated on and can be removed. It also showed that the cancer has not spread into the lymphatic system which suggests a full recovery is possible. The surgeon told us that they wanted to take random cases to subject to radio therapy as there were indications that this could have therapeutic benefits and Dennis will be receiving radio therapy prior to the operation as part of these trials. Dennis went for preparatory procedures at Addenbrooks Hospital prior to the radio therapy. The oncology clinic is run by Dr Tan. The purpose was to map Dennis’ body and place targeting markers on him with indelible dye which will be used to align the equipment when undergoing the radio therapy treatment. The procedure took about forty five minutes while Dennis lay face down on the targeting platform. Many x-rays were required to ensure the target would be positioned to receive the correct dose.

The Plan.
Dennis was booked in to attend Addenbrooks Hospital each day of the week beginning Monday the 9th of September. He will be admitted to Hinchingbrooke Hospital on Wednesday the 18th of September for preparatory procedures which will flush the bowel clean (stand well back!) with the surgery being performed on Thursday the 19th. The five and a half hour operation will remove about 25 cm of bowel and reconnect the two ends. The method of stapling used to reconnect the bowel might leak which would give him peritonitis. To avoid this complication he'll have an illeostomy bag for between two and six months while the bowel heals and then he'll have another operation to remove the bag and close the illeostomy. The tumour is very close to the anus so there's a chance he won't be able to retain enough bowel to reconnect successfully and will need a permanent colostomy. The surgeon assured us that the Queen Mum had one for forty years and all the jokes about her not using the toilet were, in fact, true. Dennis is due to remain in hospital for twelve days following the operation. He will then remain at Jonathan’s house near Huntingdon for two or three weeks while he recuperates. The original booking for the return crossing on a ferry from Portsmouth to Bilbao was for the 24th of August, but has been changed and Dennis and Rae are due now to return to Spain on the 26th of October. Dennis will then return to the UK in the spring next year for the illeostomy to be removed. He’ll be in Hinchingbrooke for about seven days following the operation before final checks and a full return to normal life. Initially the bowel and the sphincter will not have been used since the first operation up to six months before and there will be a period of retraining before he is gas and water tight !

The Reality.

At the 20th of September.
Dennis attended Addenbrooks Hospital for his radio therapy. The 25 mile journey in each direction was tiring for him and he was glad when the end of the week came. On Wednesday the 18th, we rang the hospital to confirm that a bed would be available and were told to come in later in the day. Dennis was admitted to Hinchingbrooke Hospital Willow ward at 11:30 am, although no bed was available, he spent the day in the Day Room and was given the bowel preparation medication. He was given a bed just before 5pm and declared that he wanted to put on his PJ’s so he could be ‘one of the boys’. He went into theatre at noon on Thursday. The operation was more difficult than expected due to his large size and small pelvis and took seven and a half hours. In fact, the surgeon later said that it had been the most difficult operation of its type that he had ever done. It was successful, about 30cm of bowel was removed, the bowel was reconnected and the surgeon was able to confirm the results of the CT scan that had showed that the cancer had not spread into any other organs. Dennis was fitted with a temporary illeostomy, a bit like a colostomy bag, but connected to a part of the small intestine called the ileum instead of the colon, which he will be able to have removed in the spring. He arrived in intensive care at about 7:30pm. He was sedated, wired up to the monitoring equipment, given a drip and an epidural to block any pain. He was put on a respirator to assist his breathing. All these procedures are standard practice and do not indicate any problems. His first night in the ICU passed without incident and he awoke Friday morning and was able to communicate with the staff.

Update on 21st September
After a difficult night the epidural dosage was increased slightly from ‘8’ to ‘10’ and Dennis was eventually able to get some sleep. A different bed and different chair were both more comfortable than the previous day. Dennis was in good spirits and joked that the bowl provided in case he felt sick made a good hat and he wore it until everyone had had a good chance to appreciate it. Some of the equipment used to monitor blood pressure in an artery in his right arm was not giving the correcting readings and was removed in favour of the more traditional cuff. The 20 wires and tubes going in and out of Dennis were consequently reduced by three. Dennis found it difficult to sleep at night due in part to the night shift staff in the Intensive Care Unit who did not feel it necessary to speak quietly or avoid making loud noises or disturbing the patients with their personal ‘phone conversations. Their behaviour was generally upbeat, but missed the mood and was perhaps inappropriate.

Update on 26th September
Dennis was moved from the Intensive Care Unit to Willow ward at about 11am on Sunday morning and found it an altogether more agreeable place. Coincidentally, all the other patients had been moved out of his bay, although new patients replaced them during the course of the week until an even mix of male and female patients occupied the spare beds. One of the abdominal drains was removed from his right side.
On Monday he was able to swap the face mask which provides oxygen for a more convenient tube system running just under his nose. A recent high point has been a cup of tea, something Dennis had been asking for since being admitted a week ago! One of the abdominal drains was removed from his left side. The IV line was removed from his left arm. After making solid progress for several days, Dennis has had a couple of issues recently. He has picked up a chest infection which has been diagnosed as pneumonia; he has a urinary infection, caused by his catheter; his operation wound has a red patch, indicating an infection; all of which are being treated with antibiotics. It is quite common in these cases for the bowel to develop an abscess at the site of the join, it would need keyhole surgery to drain it if one develops. On Tuesday evening his heart started fibrillating (beating with an erratic rhythm). Although it settled down again with medication over night, it did it again in the morning. The medics suspected the uncharacteristic problems with his pulse were due to the infections, but may alternatively have been caused by an imbalance in his fluid levels. Dennis is normally helped out of bed into a chair for an hour or so during the morning, but on Wednesday this caused him to vomit. At lunchtime he had a slightly erratic heart rate of about 170 beats per minute. He felt dreadful and was tiring quickly. He was again given medication intravenously to slow the rate and it responded slowly and came down to a more reasonable 120 bmp over the course of about an hour. The medication continued with the same infusion, this time being administered over the next 23 hours. He was placed on a more stringent regime of observation and is receiving the close attention of the medics. He drifted in and out of sleep during visiting time. The remaining abdominal drain was removed. Dennis now has three IV lines entering his neck, an IV line in his right hand, a catheter, a heart rate monitor wired to his chest, a blood oxygen saturation detector on his left index finger, the oxygen supply and his illeostomy. The epidural line came out by itself and Dennis is now taking soluble paracetamol to reduce his abdominal discomfort. Early Thursday morning Dennis had a leak from his illeostomy in the early hours. He was able to get back to sleep after this disruption and was generally able to sleep better during the night, both before and after the incident. Although he is still feeling dizzy, nauseous, weak and woozy, he is looking much better after a wash and a shave and is more alert. He was in the arm chair for the duration of visiting time and showed some interest in the news paper, something he had been unable to concentrate on previously. His heart rate has come down again to about 70. His blood pressure remains normal. He retains the supply of oxygen under his nose. He has occasional bouts of nausea. The intravenous line that was being used to monitor the central venous pressure, a measure of the balance of pressure in the heart, was shown to be in the wrong place for accurate readings by an x-ray and was disconnected from the monitor. It was still adequately positioned to be used to administer IV medication and fluids, but at least it meant that Dennis was able to have another couple of tubes removed. A couple of the clips were removed from his operation wound where the infection was found the previous day and a dressing placed in it. A smaller dressing has replaced the first and the infection shows signs of responding to treatment. The doctors are concerned that Dennis has not eaten anything for over a week and are preparing to feed him through a tube this evening.