Waking up From a Bowel Perforation Surgery

The whole genre of my healthcare had changed when I first woke up, swathed in warm blankets after my emergency surgery for a bowel perforation.  I had just been raced over from the children’s psychiatric unit ten hours earlier before my eight-hour surgery after one of the nurses realized that there was something seriously wrong with me. 

The Lead-Up to the Surgery for a Bowel Perforation

When she took my vital signs my blood pressure was in the basement and my heart rate was dangerously high. I’d also had a fever of 105.5. Suddenly I’d felt myself being loaded into a wheelchair and raced off the psych unit and into the CT scan suite.

“They need to get a picture of the inside of your belly,” Liz had explained to me when we got to the room where they do the CT scans.

“I’m sorry no one listened to you when you were throwing up and telling people it hurt. That was wrong. I think you have a really bad tummy problem that is what was stopping you from eating. I don’t think you’ll be coming back to our unit, i think you’re going to need to have surgery and go to the medical floor and then go home.” she had explained to me.

“Is my mom coming?” I asked.

“Your parents are on their way but they might not get here before your surgery starts, but these really nice nurses and doctors will take super good care of you and your parents will be here when you wake up from the surgery.”

Under normal circumstances, I would have been ecstatic that someone had finally realized that I had an actual medical issue and didn’t belong on a psychiatric unit, but I was in agonizing pain, freezing cold from the fever, and felt like I had been run over by a truck.

The Cause of My Bowel Perforation

The results of the CT scan showed that the feeding tube formula they had been pumping me up with had congealed inside me forming a hardened mass called a bezoar. The bezoar had gotten in the way of my intestines and caused a bowel obstruction. I spent four days complaining of feeling sick but being ignored while I was supposedly being treated for an “eating disorder”, while locked in an inpatient psychiatric unit for children. Then the obstruction had finally just ruptured causing a bowel perforation. They had to remove 2.5 inches of dead bowel.

Sepsis and a PICC Line

A human’s bowels are so full of bacteria so my bowels rupturing had caused a body wide bloodstream infection called sepsis, giving me that high fever.

After I woke up from my surgery i noticed that I had a different kind of looking IV line in my right arm. It had two different tubes coming out of it instead of one.

“Why does my IV looks so different?” I asked the nurse in the recovery room.

“That’s called a PICC line,” the nurse explained to me. “It’s a very special type of IV line. This type of IV line is called a central line. Central lines end in the big vessels that dumps into your heart,” she explained.

PICC Lines and Long-Term IV Antibiotics For a Bowel Perforation

“But it’s in my arm,” I told her, looking at her like she was crazy.

“I know,” the nurse smiled, “The PICC in PICC line stands for ‘peripherally inserted central line’. Peripheral means far away from the heart. The PICC line gets placed with a wire for guidance, and even though it goes in through your upper arm, it goes all the way up your shoulder, across your chest, and down into the area where your heart is.”

“Why is it there? Why don’t I have the same kind of IV I had before I went to the psych unit?” I asked her.

“We are giving you really strong antibiotics through it that would really burn your veins, and you are going to need to be on these antibiotics for at least six weeks to fight the bacteria that spilled into your bloodstream and made you septic when you had a bowel perforation. You will probably go home on these IV antibiotics. The type of IV you had before was called a peripheral IV and is only meant to stay in for a few days at a time. This PICC line can stay in for up to six months. she explained.

The End of the Food and Bathroom Nazis

After my surgery for a bowel perforation, the hospital stopped bringing me trays of food. They stopped making me sit in front of all that food while my stomach flipped and flopped and made me feel like I was going to puke. There were no more people sternly telling me I had to eat or I would have to drink an entire Ensure Plus in twenty minutes or less, while my stomach was busy developing a bowel perforation from my tube feeding.

Now no one was forcing me to avoid the bathroom for an hour after my pathetic attempts at eating. This meant I wouldn’t pee all over the plastic chair in the dayroom. I would no longer be that ten-year-old girl sitting in a puddle of her own pee in public. Having an accident in the Dayroom was made even more humiliating by the nurses and counselors. They would chastise me and send me to my room for “acting out and displaying inappropriate behavior”.

A Bowel Perforation Turned Me Into a Legitimate Patient

Now I was no longer a psychiatric patient in need of tough love. My mom had gone back to sleeping overnight with me. She would sleep in the pull-out chair next to my bed. It was provided for parents of patients in the children’s hospital. Suddenly a bowel perforation had turned me back into a legitimate patient. Although they didn’t know what was wrong with me despite the fact that I’d had a bowel perforation, they knew something was physically wrong with me. They knew my GI tract was messed up and that I had a real medical issue not a psychiatric issue like an eating disorder.

The NG Drainage Tube

However to my horror, they’d replaced my NG feeding tube with an even bigger NG tube. They weren’t feeding me through this NG tube though, this NG tube was hooked up to this big suction canister mounted on the wall behind my bed. It drained out all my stomach contents. This tube was so big that it made my eyes water and my nose run constantly. It made it hard to swallow too. I felt like I was trying to swallow a giant plastic pill that kept gagging me. My throat felt all raw and scraped up and sore.

Finally, after 6 days they pulled out the NG tube.

Throughout the rest of my childhood and adolescence, this would happen to me frequently. Although I never had a bowel perforation again. Now I have a GJ tube, so when I get a bowel obstruction we can just hook my G port up to wall suction for a few days. I don’t need any NG tubes anymore, thank God!

Waiting For The Medical Testing to Prove Me a Psych Patient Again

The whole time I was on the pediatric medical/surgical floor they ran a bunch of tests on me.  It made me really nervous. What if the doctors didn’t treat my constant agonizing pain and crippling nausea? I had already been branded with the label of a psych patient. Psych patients can’t get sick. Their craziness immunized them against physical illness. The medical community seems to think you can either have medical issues or mental health issues, but you can’t have both

The nurses and doctors on the pediatric medical/surgical floor talked and joked with me. They got me warm blankets when I was cold, and brought me down to the activity room to play video games, watch movies on a huge TV screen, play board games, and do art projects.  I kept waiting for the shoe to drop. I was waiting for all the tests to be done. In the back of my mind, I was sure that at that point they would ship me back to that psychiatric unit. The unit where they gave me medications that made me feel crazy and then locked me in an empty room with no toys.

The Testing to Search For Why I Had a Bowel Perforation

The doctors at the hospital here did some of the tests the other hospital did. They did an X-ray and a CAT scan. Then they had me swallow this awful white goop and took X-rays. Days later I still couldn’t poop out the white goop they called barium. I started to get scared another bowel obstruction was developing and that I was going to have a bowel perforation again.

Instead, they mortified me in a different way.

“I have to give you an enema,” announced a nurse, walking into the room with a small bottle and a long tip covered by an orange cap.

Enemas seemed like they were the stuff of nightmares or historical fiction. I didn’t even know they were real things still used in medical practice.  When you’re ten years old and shy, an enema is mortifying.

An Enema After a Bowel Perforation

The nurse at least was female.

“I just need you to slide down your pants and roll over to your left side,” she told me.

I pulled down the cartoon tiger hospital pants and rolled over.  She then proceeded to squeeze an entire bottle of liquid up my rear end. I had always thought that was an “exit only hole”. I could have died of embarrassment and discomfort.

Then she told me to hold it in as long as possible, to try for fifteen minutes.  That would be ideal, she told me. Well, there I was, lying there in the hospital bed; clogged up with pasty, thick, white, and chalky barium that really had no business being in my body in the first place as far as I was concerned. My pants were around my ankles and the nurse was just standing there.

“Hold it in for about fifteen minutes,” she was trying to tell me, as the enema threatened to make a projectile-style exit off the next exit.

Fifteen minutes?

Hmm, how about 15 seconds

I managed to hold it for about four minutes. Then the enema, some poop, and a good amount of barium made an emergency departure from my body rapid-fire into the bedside commode.  Any shred of humility I had been holding on to, got flushed down the toilet with the contents of the commode bucket.

We still had to find the reason my stomach was failing me.

Did Gastroparesis Indirectly Cause a Bowel Obstruction?

A bowel obstruction is what caused my bowel perforation and a bezoar is what caused my bowel obstruction. One of the main causes of bezoars is gastroparesis. Because of this, the hospital GI doctor ordered a gastric emptying scan to check for gastroparesis.

Normally with a gastric emptying study in the USA, a person fasts for about 4 hours and then eats a small meal of eggs or oatmeal with a radioactive tracer, toast, and water. After that, you lie under a camera for four hours. Some doctors order 2-hour gastric emptying studies or even 1-hour ones. Those are helpful indicators but the gold standard test for checking for gastroparesis is the 4-hour gastric emptying scan.

A Liquid Gastric Emptying Study With Pediasure

Because we knew I couldn’t tolerate solid food without getting a bowel perforation (I couldn’t really tolerate liquids either, but the doctors figured that just 5 ounces should be okay), I was going to do the study with Pediasure.  If I threw up, the Pediasure then I would have to redo the whole test. During the test, I had to swallow back actual vomit a couple of times. It rose up into my mouth. I tasted the milky, vanilla, yet rubbery flavor of the Pediasure. It was mixing with the sour bitter bile that comes with liquid that has already entered the stomach at least once.

My dad tried to distract me by reading the third Harry Potter book to me, but it’s not easy to lie still under a camera when you’re ten years old. Plus, it was making it harder because my stomach couldn’t really handle the Pediasure. The entire time I was under the camera my body was begging me to allow myself to puke it up. Little mouthfuls of vomited-up undigested Pediasure kept coming up in my mouth. I would have to swallow them down again to make sure that the test would be accurate and work.

“Most people’s stomachs empty after about one hour with liquid, but you will have to stay the full four hours if her stomach still isn’t empty,” the GI doctor explained to us. “If after four hours she still has Pediasure with the tracer in her stomach, that will pretty much guarantee that she has gastroparesis anyway.”

A Bowel Perforation Caused By Severe Gastroparesis

After about two and a half hours I started asking if I was empty yet. Deep down I knew that I wasn’t because I could still feel something sloshing around inside me, that I was fighting not to vomit back up..  Sure enough, the lab tech’s answer was a consistent ‘no’. My liquid gastric emptying scan lasted the full four hours and I had 70% left in my stomach.

“This gastric emptying study shows that she does have gastroparesis, she has quite severe gastroparesis, but I still want to do an endoscopy to make sure that we are not missing anything from the whole picture,” the GI doctor explained to my mom when he came into my hospital room the day after the gastric emptying study.

On the endoscopy, they found some of the Pediasure from two days prior still swishing around in my stomach.  They also found some more evidence of gastroparesis. My stomach, instead of contracting rapidly to churn and push food through the digestion process, was sluggish and barely moving.

A Bowel Perforation Was the First Step In my Journey Through Chronic Illness

This clinched it.  I had a definitive diagnosis of gastroparesis.

They had taken me off the terrible Klonopin and kept me on the antidepressant, but who wouldn’t be a little depressed going through what I had just gone through?  However, now I figured things would get better since we had a diagnosis. I just hadn’t realized that although gastroparesis was a major issue, my journey through the land of chronic illness was just beginning.