My, my, my, what a week, and where do I start. My last unloading happened almost one week
ago, Sunday. Sunday turned into a
difficult day, a very difficult day indeed.
For Nicole’s recovery from her Cricotracheal resection was anything but
orthodox. Anything but predictable. And, honestly, even surprised her surgeon,
Dr. Rutter, who is a leading part of the world’s foremost team in open airway
work performing 5 times the airway reconstructions as any other
institution. Which is to say, they have
seen it all. But this place excels in
the land of the unexpected. That’s one
big reason we were here again.
A combination of pain and swelling in her airway became
miserably debilitating by Sunday and did
not start to really improve until Wednesday. However, though the pain, the
anxiety, and the nausea were managed with some success through medication which
kept Nicole sedated almost straight through for most of Sunday and again most
of Monday, nothing seemed to have a positive impact on her breathing. The strider continued and though she was
eventually able to walk across the room to pee by late Wednesday, doing so
significantly compromised her oxygen supply.
She weekly lumbered back into bed and emergently reached for the oxygen
mask in hopes of recuperating before she might be set off in a painful and
halting coughing fit. Coughing did cause
problems. Not only did it slightly tear
the sown tissue in her airway causing a pocket of air to form in the wall of
her trachea, but the high velocity air agitated the swelling wound even further
thus contributing to more swelling. Even
more desperate for her, the coughing was typically an attempt on part of her
body to evacuate mucus, blood, or fluid from her lungs, but with her airway so
compromised, the slighted progress in that regard often became further blockage
which at times caused her to panic.
There was in effect a bit of a nasty cycle taking place.
Come Thursday, things had settled down quite a bit with the
coughing an pain, but her ability to breath was still terribly restricted. This did not add up. Swelling peaks day two and day three and it
should have improved by Tuesday, further on Wednesday, and even further still
on Thursday. Something was amiss. Then Thursday evening Dr. Rutter, his apprentice,
and the adult team from University Hospital paid us a visit in the room. At this time, Dr. Rutter told us that only
10% of CTR patients suffer from swelling and he knew that Nicole would be one
of these 10% as he was sowing her up because the adverse reaction started
almost immediately. But the goal is to nudge
the patient through the peak without obtrusive intervention in order to
aid faster and more thorough healing. This
aid requires all sorts of tricks, but none of these tricks were having a positive
impact on Nicole. We seemed to sit in
mystery, though Dr. Rutter suggested that her swelling might be exceptionally
aggressive. A nasal scope was scheduled
by the team for the morning to assess whether the time slot booked for the OR
at 1PM could be put off or must move forward.
Mike Bowen, the program coordinator was all but certain the scope would
reveal improving conditions and we would be on our way home late Friday. He prepped us for the best. But Nicole was not ready to go home. She knew something was wrong and it terrified
her and she wanted help out of this terrifying hole. She kept quiet with a smile as he spoke,
hoping beyond hope he would prove right, but knowing somehow in her gut, he
could not be.
I was eager to say the least. I popped up at 5 AM and shot over to the ICU
to await the team by 5:30. They finally
came together around 8:30 and the scope was connected to a large screen monitor
which allowed all of us in the room to watch the snake as it wound its way
through her nose down toward her lungs.
Once we made it to the vocal cords, it was painfully obvious that
something had gone wrong. It appeared
that her airway had swollen almost entirely shut. All we could see from this
scope was a tiny hole, just larger than a coffee straw where air might pass
through. I knew before Dr. Rutter spoke
we were headed to the OR. His words
confirmed what she felt and I saw, this required immediate intervention. At the time the team thought the complication
was attributable to swelling and Dr. Rutter pronounced Nicole exceptionally
gifted at swelling and noted that it had been a long time since he had to
surgically intervene in a CTR patient after the initial procedure. But the game was on.
Now, this is the bit I did not discuss with Nicole, but it’s
okay now that it has past. Soon after
they left, I had to run back to the hotel to alter our reservation. I felt cut, almost shattered. I don’t think it was fear, but maybe fatigue
and colossal disappointment. I am sure
underneath it all was a heavy dose of subliminal fear, but fear rarely presents
itself to me as the obvious emotion. It
plays a more crafty game in distorting my perspective. Whatever it was, I felt crushed, and though I
did not weep my eyes out, I did display outward signs of grief in the safe
comfort of my own car. I did not want
her to know I had anything but confidence.
But I was rocked and shocked and trying to find some stable emotional
plane to occupy. She had smiled when
they told her that she was OR bound again.
Smiled because she claimed to know it was coming and was just comforted
they were addressing the issue before we were sent home. Whatever the issue might be. And, I am sure she felt relief, because one
thing I cannot grasp it what emotions and panic come over a person when they
cannot get air into their lungs. She
described it to the nurses as the feeling of drowning. The body with a desperate desire to claim air
and O2 for the body but simply unable to get it in. The times I held my breath under water, I
always knew I could pop up. She lacked
that confidence so many times.
But the moment came when I understood I was not alone in
feeling pain, loss, or fear as she headed back again. As the transport team retrieved her rolling
bed to escort her down to surgery, she held my hand tight and the tears
came. It was a look of helpless
fear. That’s what I saw but I cannot put
feeling in her heart. I embraced her and
held her hand and in time, she steeled her heart for what was to come. Then our beloved pastor Render called just
before she was taken to the OR. I put
the phone in her ear so he could pray with us and the tears came again. Any circumstance which afforded the occasion
for emotion to come out, it just came running out. This prayer and that familiar journey from
the room to the OR were two such occasions.
It all happened so fast.
Dr. Rutter and his team of ENT doctors and surgeons found me walking
toward them in the hall. With pictures,
the clearly explained what had happened.
Scar tissue had connected across, even around her airway, and formed a
thin blockade of tissue. This was not
swelling that would retreat; this was a mortal obstruction to her ability to
live. And, this was incredibly
rare. Having to surgically intervene post
CTR (resection) was odd enough, but encountering such a physical determination
to dismantle the patient was exceptional.
Dr. Rutter used a balloon to dilate the airway and break apart this dam,
then he used tiny surgical snips to carve some of the excess flesh from the
affected area. What was left was
spectacularly open, but it had unusual tissue just the same.
The results were immediate.
When she came to, she was more alert, in less pain, and feeling like she
had a new lease on life. It was, really,
spectacular as I also felt like I had been given my wife back. We have great cause for optimism now, but
there is no guarantee. The scar tissue
which remains needs to effectively retreat and be absorbed into the tracheal
wall. If this does not occur, another dilation
may need to take place or, worse, another subglottic tracheal stenosis could
form requiring another resection. This
is highly, highly unlikely, but the chances are greater with how things
unfolded.
I suppose we must feel what a soldier might feel who has
fought for years in a war with his life on the line at the moment a peace is
declared. I have never been that brave
man, but I can see a connection. There
is a somber celebration. You have seen
things, felt things, and known things you never wanted to know … in fact, we
were not designed to know, but the danger had passed and the future held
promise. It’s a promise which more
wisely understands that the world is no one’s oyster as they say. That we hang by a thread in the hands of a
loving, sovereign God. That our designs
are like sand which might blow across the beach. But it’s a future where the sand can
blow. Our Italian vacation plans have
taken us to Holland these many years instead of the planned for and expected
Italian coast, but, in a way, on this side of it, even though we did not plan
on the flat plains of Holland, we have come to see this peace as a
vacation. Not the one we wanted or paid
for, but the one we were rightfully given.