2.5: The Pancreas

Of all my injuries, the hardest to deal with has been the pancreas. Apparently, this is well known in medical circles. One of my trauma doctors said it was the first lesson she was taught in general surgery:

Welcome to surgery. Eat when you can. Sleep when you can. Get to the washroom when you can. Don’t f$#% with the pancreas.

Your pancreas is that phallus-shaped organ that sits below your stomach, with its base wrapped around your duodenum (the start of the intestine) and its shaft, about 6 inches long, poking into your spleen.

At first it wasn’t obvious that my pancreas was injured. When they first opened me up, I had been bleeding a lot internally and everything was a mess. They focused on what they knew was wrong: a ruptured spleen. It was only in later imaging that they discovered my pancreas was torn through the middle, almost into two pieces. There was no way to sew the organ back together, so they removed the tail in a second surgery.

The pancreas is very soft. It’s made up mostly of secretory cells that ooze digestive enzymes into the space between them. The enzymes pool into ducts, that eventually flow into your intestine. Unfortunately, if you cut the pancreas, there’s nothing to keep the ooze from flowing into your abdominal cavity, instead of down your digestive tract. Now those enzymes, instead of digesting your food, are digesting you.

The enzymes inhibit healing, so as the rest of my abdomen repaired itself, I was left with a channel connecting my pancreas to the surgical incision, which leaked constantly. In the ICU, it leaked about 500 mL a day, about a pint glass.

I first saw my abdomen in this state when I awoke in DC. I had been sedated for days leading up to the flight, and taken immediately to surgery upon arrival. At the end of that surgery, they had packed my open abdomen with foam, sealed it with clear plastic tape, and attached a vacuum tube to suck up extra fluid. A wound vac.

I woke up in the middle of the night, around 2 am. I was in a new ICU room, in a new hospital, in a new country. It had been days since I was last conscious. I woke up because I felt wet. My gown and the bed beneath me were soaked with fruit-punch-colored fluid. I pulled up my wet gown, and was surprised to see the new reality of my abdomen. In the dim light, it was a red-black, shiny mass, sticky and wet. There was nobody in the room with me. I was confused, and quickly getting scared.

I searched for a call button, but perhaps because I had been unconscious, nobody had placed one where I could reach it. The only thing I found was a glowing green button that would administer fentanyl. The metaphor felt painfully clear.

I was intubated, so I couldn’t call out. I banged on the rails of the bed, softly at first, then harder. I felt no pain, but I hit the green button anyways, hoping to get someone’s attention. It felt like a long time before a nurse came. The tape seal of the vac had ruptured, so the vacuum had failed. She changed my gown, then left again. I waited.

Eventually, a resident came to my bed. She repacked my abdomen, and placed new tape. It felt weird to have my abdomen opened up like that in my ICU bed, but I was getting IV antibiotics, and nobody else seemed concerned. Cutting and packing the foam is very ‘arts and crafts’, and I would get to watch it many times.

In the hospital courtyard, a few days before I was released. Meghan is holding the pump for the wound vac. By the time they sent me home, the leak had slowed, and they replaced the vac with a smaller unit.

The abdominal wound, its healing slowed by my leaking pancreas, has been an enduring problem. After returning home, it was almost 2 more months before the leak fully stopped, and the wound could start healing in earnest. The wound vac came off, replaced by a series of gauze and foam dressings, which Meghan has artfully taken care of day after day. Today marks 6 months since my accident, and the wound is still not quite closed. It’s strange to me that a deliberate surgical incision would be so slow to heal, but I’m grateful that it’s almost done. I’m looking forward to swimming.

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