Twisted: The Trauma of Bowel Adhesions

bowel adhesions
The strong, active man who walked his boisterous golden retriever three times each day in all weathers was now lying on his back, softly groaning, with his legs partly flexed like a dying beetle.
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“Your dad’s not so good”, said my 84-year-old mother when I arrived on my weekly visit, her face taut and the dark smudges under her eyes suggesting she was sleep deprived. Her greeting turned out to be an understatement of epic proportion, one so characteristic of elderly people when describing their health.

Over the previous month, my father, 83, had suffered intermittent pains in his abdomen – in fact he actively avoided describing it as ‘pain’, opting instead to refer to the sensation as “discomfort”, despite his visible grimacing and wincing. A fortnight earlier, I had escorted him to the local emergency department to be assessed, my own concerns heightened by the knowledge that, at the age of 79, he had undergone bowel surgery to remove a cancerous growth. On the occasion two weeks ago, the young doctor who examined him diagnosed ‘chronic constipation’, prescribed a laxative and sent him home.

As I entered my parents’ bedroom, the frail figure lying on top of the duvet did not resemble my dad and I required a second glance to confirm he was no imposter. The strong, active man who walked his boisterous golden retriever three times each day in all weathers was now lying on his back, softly groaning, with his legs partly flexed like a dying beetle.

“Why didn’t you call me earlier?” I asked. “Or, even better, ring for an ambulance?”

“We didn’t want… to make …a fuss,” he whispered, his words punctuated by breathlessness. “It’s not… an emergency.”  

Deciding it would be quicker for me to drive rather than waiting for an ambulance, I put his arm around my neck, shuffled him into my car, and sped to the Urgent Care department of our nearest hospital. During the journey, after a period of silence, my father spoke with greater clarity.

“My last will and testament is in a green folder, bottom drawer of the dining room cabinet”

I did not respond, keeping my eyes fixed on the road ahead.

“And if anything happens to me, keep an eye on your mum” he said.

“Don’t be so bloody morbid”, I said, while pondering whether the old fella had some sort of sixth sense about his imminent demise.  

Upon arrival at the local hospital, I linked my dad’s arm and guided him to a chair in the waiting area. I noticed his eyes were glazed and he appeared perplexed by the array of other patients sitting around him, many displaying cuts and bruises. He whispered to me that he felt nauseous.

I hurried to the reception desk and gave my father’s details and asked for a vomit bowl. ‘He really needs to be seen as soon as possible; he’s in a bad way’ I said.

‘Just take a seat in the waiting room and the triage nurse will be with you shortly’ replied the receptionist, while handing me a grey-cardboard basin.

I returned to my father and sat in the plastic chair next to him. He leaned against me, his head resting on my shoulder. I could hear him panting, his rate of breathing seeming to mirror his abdominal pain, rapid at its peak while slowing during the remission. Two minutes later, he lost consciousness and slumped across my thighs. I shouted for help but there was no need; nurses were already descending upon us from all directions, one armed with a trolley. They hoisted my father’s limp body onto the carrier and wheeled him directly to the resuscitation area; a dramatic collapse is a sure-fire way of achieving pole position in a hospital waiting room.    

By the time we reached the appropriate cubicle, my father had re-gained consciousness. Throughout the afternoon his mental state fluctuated between periods of lucidity (during which he could share a joke about how his theatrical flop in the waiting room had been an excellent queue-jumping ploy) to disorientation (when he would talk gibberish and display no awareness of being in hospital).

A procession of doctors and nurses examined him. One of the junior medical staff repeatedly referred to my father as a ‘frail old man’; my efforts to explain how, until a month ago, my dad routinely walked three miles each day while in charge of a frenzied dog failing to shift the doctor’s underestimation of his typical level of fitness. Despite repeating myself several times, the physician seemed reticent to accept that my father had suffered a recent sharp decline in his physical health, preferring to hold on to the stereotype of a doddery 83-year-old who had experienced a gradual deterioration in his already compromised condition.

When the doctors and nurses retreated, I saw that a complex array of wires and tubes connected my father to an assortment of hi-tech monitors that bleeped, apparently at random, as they spewed out readings of his blood pressure, pulse, breathing rate and the level of oxygen in his blood. Each time the tone or frequency of the bleeps changed, I feared a further decline in his physical condition, and looked around the ward expecting concerned staff to rush to his aid. But my worries were unfounded, the nurses seemingly unperturbed by the capricious noises of the technology.

In addition to the serial medical examinations and constant monitoring of his vital signs, three samples of blood were extracted – after much probing with the needles, due to his shrunken veins - and sent to the laboratory for analysis. A nasal-gastric tube was, at the third attempt, pushed up his nose and down into his stomach. A catheter bag was fitted as a means of monitoring his fluid output. During these procedures he was asked several times by the attending professional, “Am I causing you pain?” Each time my old fella replied, “No, not pain; just a bit of discomfort”.

But it was a bog-standard X-ray of his abdomen that confirmed the diagnosis.

“We can see air bubbles on the photograph,” said the consultant physician, case-notes in hand as he joined me at my father’s bedside. “This indicates that there is a bowel obstruction, a blockage in the gut.”

“So what will have caused that?” I asked, fearing a reoccurrence of the cancer.

“Your father suffered carcinoma and underwent bowel surgery about 5 years ago?”

“Yes” I replied, my apprehension mounting.

“Given that history, the most likely cause of blockage is bowel adhesions where, over time, scar tissue from the surgery causes the bowel to twist like a balloon, ultimately resulting in a complete blockage where neither food nor stool can pass through.”

The consultant studied the handwritten notes. “I notice you brought your father to Urgent Care two weeks ago when he was complaining of abdominal discomfort?”

“Yes, that’s right” I said. “The doctor who examined him said it was chronic constipation and prescribed a laxative.”

“I can’t seem to find the X-ray from that visit.”

“No X-ray was carried out” I said.

The consultant pursed his lips. I formed the impression that a junior doctor would be hearing from him some time soon.

“We will need to operate to untangle his bowel and get things moving again,” said the consultant, “but I think we’ll wait until your father regains some strength so that he can withstand, what is, major surgery.”

But the wait didn’t materialize. In the early evening of the same day, when I’d returned to my parents’ house to pick up a dressing gown, pyjamas and toiletries, I received a phone call from the ward sister.

“Your father’s condition is deteriorating,” she said, “so we’ve decided to operate straight away. The consultant surgeon would like to speak to you beforehand; can you return here as soon as possible.”

I drove back to the hospital, with my mother in the passenger seat. Neither of us spoke, each absorbed in our private thoughts. When I glanced to my side I noticed my mum’s lips moving, ever so slightly, and suspected that she was asking her God to spare the man who had been her partner for the last 62 years.

When we arrived at my father’s bedside around 8.30 pm, the female consultant surgeon – “the best” according to the sister - had been called in from home to do the operation. She was already gowned, with a mask hanging from her neck, when she took us to her office to provide an update.

“Your father is very ill,” she said, “and as his observations indicate that he is gradually getting weaker, I have decided operate straight away.”

The surgeon went on to describe the need for urgency and how she didn’t yet know how much damage the twisting had inflicted on his bowel. Her parting comment, one that endeared her to me and my mother, was, “I’ll do my very best for him, as if he was my own father; you can be assured of that.”  

The nurse then led us to the Faith Room to await the outcome of what was anticipated to be a three-hour operation. Mother and I sat in silence, gazing out the window at the lights of the nearby town, reflecting on what we’d just heard: operating while his general health was so compromised, calling in the consultant surgeon from her home, and suggesting we remain in the Faith Room, all forewarned against a successful outcome.   

I realized I had not yet contacted my brother to inform him of our father’s decline. As no signal was available inside the hospital, I wandered into the car park to ring him on my mobile.

“I sense we might lose him, Tony”, I said after updating him on the events of the day, my eyes moistening at hearing me speak aloud what I’d been pondering since the ward sister’s phone call.   

When I returned to my mother’s side I noticed an enhanced level of closeness between us, an intimacy that soothed and calmed. We reminisced, and laughed together as we shared stories that illustrated my dad’s quirks: his habit of wrenching stinging nettles out of the garden with his bare hands; how he hated being the center of attention yet, on a family holiday, managed to wedge himself in the swing doors of a hotel in Margate after insisting on carrying two huge suitcases; how he spent far too much time on the 19th (drinking) hole of the local golf course; and his unintended heavy-handedness when play-fighting with his grandchildren on the living room floor. As mum and I shared these experiences, ones that bound us together in a way only close family ties can, I wondered why we hadn’t shared these exquisite moments more often.

Almost five hours later, at around 1.00 am, the consultant surgeon entered the Faith Room smiling, with her thumb in the air. The operation had been a resounding success: my father’s bowel was now untwisted, there were no signs of cancer at all, and the intestine – much to her surprise - appeared undamaged by its contortions. My mother hugged her with relief, clinging on so tightly that the surgeon’s mask was almost wrestled from her neck.

My father remained in hospital for four weeks, two of them in intensive care. At the time of discharge, the scales confirmed a weight loss of 30 pounds and he moved like the doddery old man that the junior doctor had assumed. Twelve months on, dad has regained his usual physique and has resumed normal service, involving regular gardening and hiking three-time daily around the local countryside with his golden retriever.

Intriguingly, since that traumatic day, and without any conscious decision to do so, my visits to mum and dad have increased to twice per week.

 

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