Chapter 3 | Part 6: Leaving the ICU with a Plan for the Future

Christopher Graham

by Christopher Graham

That sense of not being able to tell reality from imagination lasted a couple days. During the days it was okay, but at night it would be really bad. I had many conversations with people who weren’t there. I could hear them talking, talking about stuff that I was really interested in, even! And so I wanted to contribute to the conversation. So after listening to what the “people” had to say, I would pipe up with my $0.02. I’d “hear” them in my head, but it felt so real that I’d “reply” in real life and talk to them. Even in the moments when I thought it was a dream or a hallucination, when I knew it was fake, when I tried to respond “in the dream,” I’d talk out loud, on accident. I’m pretty sure that one time I told no one in particular that they needed to watch Breaking Bad, for instance.

Some time passed like this. I was in and out of it, mostly depending on whether it was day or night. But after a few days of dialysis, I started doing better. My lab numbers were stable or improving, with the dialysis at least, and all of the hallucinating and talking to people who weren’t there got a lot better over the next few days. I was lucid pretty much all the time from thereon out. While all the rest of this stuff was happening, even though my mind was on vacation in la la land, I was improving physically. I was able to get up out of bed into a chair on the 2nd or 3rd day post-op. I walked to the bathroom on the 4th day or so. I figured out ways to do things that minimized the motion of my sewn-closed-but-unhealed belly. I wore an abdominal binder from day one which helped immensely, too. I ended up wearing that thing for months. With the dialysis, my sodium started normalizing and they eased up on the fluid restrictions. They wouldn’t let me eat anything, though, until my bowels started moving again (they slow down significantly in people who have had surgery and anesthesia, and I had half of my colon removed to boot).

And that finally happened. I’m not sure which post-op day it was, but my insides started moving again. One of the main jobs of the colon is to remove water from stool, and half my colon was now gone. Well, when you do that, the other half of the colon doesn’t particularly care to be surgerized 1 upon, either. The part they left in decided it was time to take 5, as they say, and it stopped absorbing the water, or doing much of anything else, leaving the water with exactly one way to get out. I had watery diarrhea for weeks after the operation, and it was particularly bad at first. I was going to the bathroom five or six times a day, maybe even more frequently than that.

Food was really hard to eat at first. We started with clear liquids and advanced my diet as I could tolerate it. Nothing tasted very good, though some of that is because of the disgusting hospital food I had to eat. With the kidney problems they put me on a super strict renal diet, and so bad food was made even worse. Another fun experience I had when trying to start eating again was the “gastro-colic reflex.” Ever notice how dogs, for example, need to be let outside to drop a deuce after they eat? That’s the gastro-colic (or, stomach-to-colon) reflex. Well, it was very strong in the immediate post-operative period. A couple of bites into pretty much every meal, I’d have to waddle into the bathroom with my IV pole and two JP drains and two accessed port devices sticking out. And the tunneled line hanging out of my chest. And the 2-foot incision on my abdomen. When I think about how I must have looked, I think it would have been hilarious if it wasn’t so tragic, honestly.

I’d like to take a small pause in the story here to tell you all how amazing my residency program and the radiology department were during my illness. I was missing a bunch of work in February of 2016 as I was going through the work-up process with all of this. My program director, Dr. Mark King, finally asked me what was going on, and by then we did have the final diagnosis. He was as shocked as anyone, but he immediately set to work with Samantha Schnitzer, our program coordinator, in the education office. And they went to bat for me with the hospital and human resources. They made sure I was able to get all of the FMLA time I was entitled to, and helped me through the arduous bureaucratic maze involved with doing that paperwork. In addition to using all of the sick time and vacation time I had, they found out a way that the hospital would let people donate vacation days to me so I’d keep getting a paycheck after all my paid time off ran out. They asked around, and apparently some of the emergency radiology attendings had “too much” vacation. I never thought that could be a thing. But they graciously and selflessly donated their days off, so I could keep getting paid. The education office contacted the American Board of Radiology on my behalf and found a way to delay my board exam until the point when my treatment is over and I’m actually able to take the exam.

But the single biggest thing they did for me, something for which I can never repay them adequately, is that they helped arrange an interventional radiology fellowship for me, to start whenever I’m ready. The IR fellowship is a matching process, similar to residency. That means, if you want to do IR, you apply to a bunch of programs. Then, you get interviews from some of those programs. You go on all of those interviews, and then at the end of the process, you rank them in order of your preference. They do the same thing with their applicants. Then, the computer goes through a matching algorithm to find the most ideal match – the one where the most people and the most programs, get the programs and people they want, respectively. I was in the middle of this process, and had been on a few interviews, when the final diagnosis was made. I had to cancel most of my interviews, and drop out of the match. I was very disheartened, and I thought I’d have to sit out a whole year, too.

But one day, Drs. King and Yu, two of the bigwigs in the department, came to see my family and me in the ICU. They told us that they went to the department chairman, Dr. White, and that together all of them had approached the hospital leadership and arranged a third IR fellowship spot at our institution. They have a third slot they can use in cases of “significant need,” and it was one of the few types of slots that could be filled outside of the matching process, so everything is still on the up and up. I was – I am – going to be one of the IR fellows at my home institution when I’m done with residency. I’m incredibly thankful to everyone involved in arranging that for me. And they did this of their own volition. I didn’t even have to ask. They were under an obligation to do precisely nothing to help me out, too. I intend to thank them in the only way that I really can: passing the boards and working my face off for the rest of residency and fellowship, once treatment is finally over and I’m back at work. So to everyone who had a hand with that: please know that you have my eternal thanks for a kindness I can never repay.

That announcement was made as I was nearing the end of my ICU stay. I had certainly been through the ringer at that point, too. But even with the whole host of problems I was still dealing with, it was still an improvement compared to where I’d been just a few days before. I was lucid again, and oriented 2 to person, place, and time. I was on dialysis, but the numbers were all improving and it was going smoothly. I wasn’t eating much yet, but I was able to eat food and keep most of it down. I was still sick, but not intensive care unit sick. And finally, one morning, one of the residents on the team taking care of me came in to tell us that my ICU stay had come to an end, and I was getting stepped down to the floor.

Read the previous installment by Christopher Graham here: Chapter 3 | Part 5: The Dangerous Reality of Opiate Medications

Christopher Graham is a radiologist who was diagnosed with peritoneal mesothelioma in early 2016 at the age of 32, two months after he was engaged to his now-wife. He has since undergone two major surgeries, intra-abdominal chemotherapy, and has had many significant complications as a consequence of his treatment. He currently lives in Columbus, Ohio with his wife Nicole and their two dogs. Christopher plans to finish residency and fellowship after treatment, and he and his wife are trying to get their lives back to something resembling normalcy after dealing with such a devastating diagnosis. 

Notes:

  1. This isn’t a technical term, it’s just my favorite made-up medical term.
  2. It’s not always clear how “with it” or “out of it” people really are. I mean, some people are just weird people. So we ask people a series of questions to find out how “with it” they are. They can sound pretty stupid to someone who’s with it: what’s your name? Where are you? What year is it? What’s happening right now? Who’s the president of the United States? Sometimes, even people who seem normal will tell you it’s 1988 and Reagan is in charge. So then you know they’re not oriented.

1 Comment on "Chapter 3 | Part 6: Leaving the ICU with a Plan for the Future"

  1. barbara cutts | April 25, 2017 at 8:29 pm | Reply

    brings back memoRies EPP is so hard but it gave us 8 years more keep fiGHTing

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