The last couple of days have been pretty rough on Derek. It’s one thing to go into a major abdominal surgery/organ transplant when you’re healthy, it’s an entirely different story when you have your second transplant and 3rd surgery after being in the hospital for 4 weeks. It takes a toll. Derek felt pretty good coming out of surgery, likely do in large part to the steroids and the intravenous morphine. Once he got back to the 6th floor the pain and misery of stomach staples, drain ports, and overall soreness started to add up. One thing to remember is that in order to get to the liver, the surgeons have to sever the abdominal muscles. They sew them back up, but they’re pretty much useless for a while. Even if you wanted to use them, you wouldn’t be able to. The body instantly compensates and transfers the work to other areas.
In Derek’s case the work has been transferred to the lower back. For a guy who has a past history of lower back spasms, this is torture. Nothing is comfortable. Not lying in bed, not sitting in a chair, not reclining, not standing. Nothing. Two days ago Derek got a cholangiogram to see if his new liver was doing its job. This involved him being propped up at a 20 degree angle for about ten minutes. As he was half standing/half leaning, he started to feel his back seize up. For the past couple of days Derek and his doctors have been trying to figure out a plan to get his back to feel better because the oxycodone didn’t touch it. He also needs to get up and walk around but the back pain makes that a challenge. I don’t want to speak for him, but I think he would agree that he’s pretty frustrated.
Yesterday I brought him a memory foam mattress pad in the hopes it might make the hospital bed feel less like a pile of rocks. When I arrived he was pretty miserable and jaundiced. An hour or so later they came to pick him up for an ultrasound. He wasn’t sure why he was going, they hadn’t mentioned the test during morning rounds. The nurse double checked and said they ordered it because his bilirubin had spiked to 13. After they wheeled him away I started to do a little research on why his bilirubin might have spiked. Sometimes it’s indicative of rejection, so I thought I would go and hunt down one of his doctors to see if that was the case. I found the PA in his cube and asked him why they ordered the test.
He quickly explained that the cholangiogram has been known to cause a jump in bilirubin numbers. The test involves injecting dye into the biliary tree while the patient is undergoing an abdominal x-ray. The good news is that his cholangiogram looked perfect, the surgeons were super pleased with the results. The bad news is that the dye can stress the bile ducts causing bilirubin to rise. The rest of his liver function tests (LFT) looked normal so signs weren’t pointing to rejection. His white blood cell count was slightly elevated and they also wanted to make sure he wasn’t fighting an infection. He told me to sit tight, they would come tell us the results as soon as they got them. A few hours later, the result came back and showed that everything looked good. By the time I left last night Derek’s jaundice looked a bit better and he had successfully taken a 2 hour nap and later a 1 hour nap. We even took a couple of walks around the 6th floor. His mood was vastly improved and he was pretty confident that the night would be better.
One of the hardest aspects of all of this is the chain reaction. This medication causes X to happen so they have to give him Y to counteract it. He doesn’t have functioning abdominal muscles so all of the work of moving and standing up transfers to his lower back which suffers from over work, which causes pain and necessitates a cocktail of pain medications. He needs a cholangiogram to make sure his liver is functioning, but that causes the liver to feel yucky and suddenly he needs an ultrasound because his bilirubin has spiked. One thing leads to another.