A Pancreatic Pseudocyst

I was settling into the ward quite nicely… things we’re becoming less strange. A dietician came to see me and told me that if I didn’t start eating soon they’d put a tube back in my nose. i’d got vague memories of really not enjoying the tube going up my nose in intensive care so I tried to eat. The dietician told me to eat “two spoons of his and two spoons of that”

It seemed a huge amount, I struggled. Physically I just didn’t have the strength and I didn’t feel hungry at all! But I managed it and the tube stayed away!

It’s hard to describe how I felt… “not right” is as good as a description I can give. I still couldn’t go to the toilet despite huge amounts of laxatives, which i’m sure were making me hallucinate, though that could have been the pain medication. The most obvious symptom was the vomiting. It was odd, I didn’t feel nauseous or even sick. At times it seemed to come out of nowhere. Eventually I realised it seemed to come when I changed position or moved. I had a scan, then a very good Heptalogy Doctor called Mr Gomez told me I had a Pseudocyst. “What’s that, a cyst that’s not a cyst?”

“We’ve looked again at your scans and we feel the procedure is too risky for you”

“It’s basically a sack full of Pancreatic enzymes, blood and necrotic tissue that’s formed on your Pancreas” He replied. “So I don’t have Pancreatitis?”

“Yes you do, but now you also have a Pseudocyst, the size of it is what’s casuing you to vomit as it pushes against our stomach. Pseudocysts are complications of Pancreatitis. Don’t worry” he said and gave my leg a pat on his way out. The plan was to drain the cyst via an Endoscopy the next day. I had another scan late that night and anxiously waited.

Next morning I waited for the allotted hour but instead of a hospital porter to take me to surgery a junior doctor (A registrar) came to tell me it was cancelled. I was disappointed, of course I didn’t want any kind of “procedure” but I also didn’t want this “thing” inside me and now i’d seemingly been dropped for a more important patient. Just while I was feeling sorry for myself a  senior consultant, a professor, came to see me. “We’ve looked again at your scans and we feel the procedure is too risky for you, the danger is that the cyst could rupture leaking an infection into your body we’d like to wait”

I was shocked, I think i’d forgotten how bad things had gotten. Later that day I started to finally read about Pancreatitis online. I saw scans, the same type of scans I’d had. I read that as the complications increased so did the mortality rate. Especially if a patient was so bad that they couldn’t wait for the “nice” keyhole surgery through the back that the doctors had in mind for me some long and distant time away.

The vomiting continued. That night a registrar told me that if the vomiting wasn’t under control soon i’d have to have a Nasogastric tube to handle the bile… “In your weak state if you vomit in your sleep you could end up accidentally swallowing and getting vomit in your lungs”

Tired, weak and exhausted I was getting very scared. I didn’t want a tube and so my wife told the doctors i’d sleep in a raised position to prevent swallowing. Sleeping was still uncomfortable. I wasn’t moving very much and was on a special mattress. I’d lost a few stone in weight by now.

Another day and another scan. And then.

“Martin have you eaten today?” My consultant asked “We need to drain the cyst. It’s grown to the size of a football and there is a risk it could rupture”

“Oh yes it is, but you see i’m the best in this hospital, probably the whole country and I wouldn’t do this if I thought failure was possible”

All mention of the dangers of the procedure, were now pushed to one side as they explained the size of the cyst was the real threat. I looked down at my stomach… there was a lump… but it didn’t seem that big. I was expecting to be whisked away at any minute. Yet hours later I was still in my bed. “We’ve shown your scans to the doctors that perform the endoscopies and there’s no one on duty prepared to carry out the drain. There is however a senior consultant, a professor coming on duty tonight, they’ve phoned him and he’s willing to look at the scan and make a decision tonight”

Doctors are very good at putting you at ease, they are also really good at scaring you witless!

As I signed the consent forms with a nurse the Professor came in. He was a kind elderly Indian doctor with wild wispy hair. He was confident to the point of arrogance yet his kindly nature meant I believed him when I asked “Is this dangerous” and he replied “Oh yes it is, but you see i’m the best in this hospital, probably the whole country and I wouldn’t do this if I thought failure was possible”

“he is the best, he’s brilliant” The nurse said as she took me through.

I lay down on my side with the nurse holding my hand and smiling. As the sedative worked I felt calm, the small LED lights on the huge banks of machines twinkled. I woke up with a very sore throat. The same nurse was there and gave me a huge smile “It’s alright, it was a success. You’re going to be ok!” I don’t think I’ve ever felt such relief.

The kindly indian professor came into the room and told me he’d drained a litre from the pseudocyst before they had to stop. “but don’t worry, I’ve inserted a stent, a tube from the pseudocyst into your stomach, the juices will flow into your stomach and be destroyed by stomach acid”

This all sounds rather genius I thought! And it was… the next day I felt great. Weak and unable to walk any distance but great. I was even able to eat a little more. Two days later the Ward Sister gave me permission to attend my brothers wedding. I felt a little guilty that i’d take some attention from them but more than anything I was so very happy not to have missed his big day.

A few days after that and I was back home with our three month old baby and my wife…

… I thought it was finally over.

 

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