A complication

This past Saturday morning, September 17, Teresa put a new bandage on my central incision. She'd been carefully packing a small wound that had opened up here, and we were both pleased that the wound had in fact sealed itself - just as the doctors had told us it would.

But then she noticed a new development in the other incision - the one on the left side of my abdomen, through which the pump was inserted. Now the area around that incision was red, seemed warm, and maybe was swollen too. That was enough to make us decide we had to "call it in" to the surgeon's office. We did, and they told us to come in to urgent care at the Memorial Sloan Kettering hospital in NYC.

The upshot: They hospitalized me, and this afternoon (Tuesday, September 20) the surgeon told me I might need to remain here for another week! I'm on the same floor where I stayed after the surgery 5 weeks ago, and it looks like I will wind up being here longer this time than for the surgery itself.

Why? They've concluded I have cellulitis, an infection of the cells in the area of the incision. What concerns them is that I have, as someone said, "hardware" - the pump - just underneath this skin. Bacteria evidently like hardware - like piers for barnacles, I guess - but I definitely don't want to give them an internal haven. So I'm in the hospital to receive intravenous antibiotics, which they expect will successfully knock out this infection.

Exactly why this has happened is hard to say. Infections like this evidently occur in 5 % of these surgeries - but mine is especially unusual because it didn't start till 5 weeks after the surgery. Last Wednesday, three days before we noticed this problem, I'd been at MSK for chemotherapy. I received an infusion of a drug called gemcitabine intravenously; could it have weakened my resistance to infection? Wednesday also concluded my first two weeks of chemotherapy through the pump, and that meant that nurses drained the remaining chemo from the pump and then loaded it with saline solution and heparin (an anti-coagulant). But this didn't go perfectly; the rather long needle went in to my skin and into the pump beneath, but initially it didn't bring anything out, and two nurses worked to get the needle to exactly the right place. Did something in this process cause my infection? We don't know.

Meanwhile of course I had a bunch of tests, including a CT scan. The CT scan showed I didn't have accumulation of fluid - and that's good. In fact, I don’t really have any signs of infection, except for the skin redness that Teresa first noticed, and I feel just about the same as I’d been feeling during the week before she noticed it – in other words, not bad. The CT scan also showed some contraction of the tumors, presumably the effect of the first dose of the pump chemotherapy - and that's good too. Meanwhile the healthy parts of my liver seem to be handling the impact of the chemotherapy reasonably well - also good. If I weren’t in the hospital, I’d say everything was going all right!

What's oddest about being back is that in day to day terms I may be the healthiest patient on the floor. Many or most of my companions are recovering from surgery - but I already did that. So when Teresa and I go for walks (12 laps is a mile, or so we were told by one nurse 5 weeks ago), we zoom by all the other patients, because they’re still recovering from one invasive procedure or another. I on the other hand am fine (except not quite).

One other thing is very odd: while Teresa and I waited on Saturday evening in urgent care, another quite different situation was playing out on the streets of New York a few miles away - a bomb blast on a popular street on a Saturday night. For a lot of people, that was their emergency, and a very frightening one; ours was in the hospital uptown, and our first responders were the nurses and doctors who are now taking care of me.