Detours

Arts

 

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My appendix ruptured three hundred fifty miles from home. That was not the plan. The plan was to spend two nights with my dear friend Shelly. Catch up. Reminisce. Write her obituary. On the cusp of her fifty-ninth birthday, Shell was receiving in-home hospice care for a pancreatic neuroendocrine tumor.

We reconnected after her friend messaged me with the news. He sent Shell’s phone number and said she wanted to get in touch. When I called her, we talked for nearly an hour. We’d met when Shelly was fifteen and I was sixteen. Our friendship blossomed beyond our volunteer work with developmentally disabled youth and adults and, though we hadn’t seen each other in years, bonds ran deep. I said I wanted to see her. She asked if I would help write her obituary. We made a plan two weeks out. I hoped it would be soon enough.
It was. We spent nine glorious hours looking at photo albums, talking, laughing, and crying. We listened to oldies, singing with abandon to songs that reminded her of me: “Diamond Girl”—a throwback to her sixteenth birthday, which we celebrated with her family at a lakeside cabin; and “Sweet Home Alabama”­, which unlocked memories of visiting me in my freshman dorm room.
Midnight before we said goodnight, my pain started soon after. I searched “appendicitis” and “acupressure abdominal pain” on my phone, grateful my pain was low and midline, not the right lower quadrant pain and rebound tenderness I remembered from my nursing school days and February of my boys’ eighth grade years—when appendicitis struck twice.
I worked acupressure points on my shins and belly to no avail. The vomiting started at two-thirty. Shell and I both had restless nights, she with insomnia and I with pain, vomiting, and dry heaves. Her daughter Michelle drove me to an urgent care center that morning. “Food poisoning,” the provider diagnosed. He said my pain wasn’t in the triangular area suspect for appendicitis, but if my symptoms got worse I could return for blood work and a scan. “How does that sound?” he asked.
“Sounds good,” I said.
My cousin Theresa picked me up. I waited in the car while she filled my prescription and bought ginger ale and sports drinks, then I took a dissolvable anti-nausea tablet en route to Shell’s to get my things. I was told I might be contagious, so a hurried goodbye followed, with a promise to return.
Seven hours later I was in the emergency room—at a different facility than that morning. Hours after Theresa delivered me to her home, her twenty-one-year-old son broke his pelvis in a motocross accident. He was in ER with his dad, awaiting admission. Theresa came home to pack an overnight bag and shuttle me to an ER. Made sense to go where she would be spending the night: between ICU, my room, and a waiting room as it turned out.
“Ruptured appendix” was the diagnosis twenty-two hours after my pain began. I asked the surgeon if she thought it ruptured when I vomited in the ER waiting room and my pain shot from 7 to 10. To 15, had that been an option on the pain scale. She said appendixes often rupture at the onset in adults. She also said that adults’ pain can start midline and then migrate right. Mine was low, not around the navel like I’d read online. She said she’d try to remove my appendix laparoscopically but might have to open me up. I said I hoped she wouldn’t have to.
She didn’t.
My husband bused over and drove me home thirty-seven hours after surgery. A local surgeon removed my drain two days later. I left her office with a work-release letter, grateful I’d be returning in time to say goodbye to graduating seniors. I had segued from OB nurse to high school library assistant—trading the magic of birth for the magic of books—and I looked forward to applauding the graduates and their accomplishments.
That night, though, I was again an ER admit, this time with vomiting, chills, and fever. Four times in five days I had to present my insurance card, grateful at each point for the Affordable Care Act and our insurance plan through Montana’s health insurance exchange.
“Bowel obstruction and two pelvic abscesses” were my diagnoses: a ticket to a nasogastric tube and possible surgery. The ER doctor said my obstruction might resolve with the NG tube and an interventional radiologist might be able to drain my abscesses. I clung to her words, changing might to would. I did not want another surgery.
When I got to my room, my nurse said I was scheduled for surgery at noon. I swallowed my objection when the on-call surgeon came in two hours later. He explained the surgery—a laparotomy. He said an infectious disease consult had been ordered, and that I’d probably be in the hospital for four or five days. He didn’t mention options and I didn’t ask, but when the nurse brought in the informed consent and asked if I felt comfortable signing, I said no.
I knew I should have discussed my concerns with the surgeon. I hadn’t, but seeing the written words summoned my courage to dissent. My nurse called and asked him to come back. He called my room instead. I told him I wanted to try noninvasive options; he told me surgery was in my best interest. I asked when the infectious disease doctor would be in. He said he didn’t know. My skepticism remained after we hung up.
I asked my nurse to clamp my NG tube so that I could walk. I wasn’t in pain, and I hoped ambulation would kick-start my bowels. As I lapped the hall, I overheard a snippet of a telephone conversation from behind the nurses’ station. “Okay, I’ll talk to her,” a man said. Assuming he was the infectious disease doctor talking to the surgeon, I was prepared to argue when he walked into my room shortly thereafter.
He pulled my scans up on a computer screen and showed me my distended bowel and pair of abscesses. Both were surgical indications, he said, repeating the surgeon’s words that waiting wasn’t a viable option. Seeing the images prompted my consent.
I was hospitalized for a week, on IV antibiotics pending culture results, then switched to oral antibiotics the day before discharge to ensure I’d tolerate them before sending me home.
Would my outcome have been different had the urgent care provider ordered blood work and a scan? Maybe. Had the first surgeon opened me up? Perhaps. “Probably,” says my nurse friend Marj. In hindsight, both might have been better options but at the time, I was relieved by each assessment: the nonsurgical diagnosis, and then the perceived efficacy of laparoscopic surgery.
Throughout my hospitalizations and recuperations, thoughts of Shelly’s journey put mine into perspective. She had gone to the ER eight months earlier, worried her upper back and chest pain and severe sweating signaled a heart attack. They didn’t. Instead, after two and a half hours of being monitored, poked, prodded, x-rayed, and scanned, she learned she had a tumor on her pancreas. An award-winning special education teacher, Shell went from calling for a one-day sub to calling for a long-term sub to calling to say that she probably wouldn’t be back.
She wasn’t.
An oncologist presented options in subsequent weeks: major surgery with uncertain results (Whipple procedure), a monthly injection to hopefully shrink her tumor (Octreotide), or observation. She chose medication, then stopped it four months later after a consult with a Colorado neuroendocrine tumor specialist.
On her way there, the airport scanner alarmed as Shell passed through, a result of the radioactive Octreotide lighting up her back. When the specialist told her that the $6,000 per-month drug was not guaranteed to shrink her tumor, she decided to quit the medication. She transitioned to hospice care, resolving to meet each day with courage, faith, and grace, determined to enjoy her time with loved ones.
Matt’s accident shed light on my trajectory, too. The day he was supposed to begin a new summer job, he underwent risky trauma surgery for a fractured pelvis. His surgery went well, but he spent his summer in a wheelchair, rehabbing instead of working. I was sad I didn’t get to bid farewell to graduating seniors. He suffered the abrupt ending to his motocross career and the loss of a dream.
Our journeys served as reminders that life is unpredictable. And every day’s a gift. So I changed my oil, filled my gas tank, and took another road trip. Shell and I still had some writing to do.

 

 


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Karen Buley, BSN, RN is the author of the novel, Nanny on the Run. Her collection of nurses’ stories, Nurses on the Run: Why They Come, Why They Stay, was chosen a Best Books 2010 Awards finalist by USA Book News. Her essays have appeared in Family Circle, American Nurse Today, and A Cup of Comfort for Nurses: Stories of Caring and Compassion. In 2013, Karen traded the magic of birth for the magic of books and now works as a high school library assistant in Missoula, Montana.

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