Me and my pump

So this, I believe, is a picture of a pump much like the one that’s now inside me. It’s a clever device: one compartment holds the chemotherapy, while the other holds freon, and my body heat causes the freon to expand and push the chemo in the other compartment out via a catheter to the vein serving my liver.

It’s also, as the picture suggests, surprisingly big! I think the true size is about 4 inches in diameter, probably a couple in depth. You might ask – I certainly wondered – how can this thing fit? I mean, wasn’t all the space inside my abdomen already in use? The answer, however, is that it fits in with no trouble at all. The surgeon makes a horizontal incision, to the left of and just a little higher than my navel, and pops the pump in. All right, he probably doesn’t do anything that should be called “popping.” But he (my surgeon was a man) inserts the pump, and evidently everything else in the area shifts around a bit and the pump is in! Then he closes up the incision and glues it shut (yes, literally, glues it shut; the glue on mine is slowly wearing away now, which is fine since my own healing process has taken over), and if all goes well it remains there for the rest of my life.

Just to be clear, inserting the pump isn’t the whole surgery. It’s also necessary to connect the catheter from the pump to the vein serving the liver; this catheter is probably 8 – 12 inches long because that vein is actually some ways away from the pump’s resting place in my lower left abdomen. And to make sure that the chemo that will flow through the pump actually reaches the whole liver, the surgeon had to redesign my liver circulatory system somewhat – cutting off, as I understand it, a vein that used to serve part of the liver but which branched off the main liver vein too early to receive the chemo from the catheter a bit downstream. They also took out a couple of lymph nodes, as part of this redesign. And they took out my gall bladder: that’s a cholecystectomy, in case you were wondering, and is necessary because the chemo to the liver is likely to cause the gall bladder to die. The gall bladder is almost as useless as the appendix, but like the appendix you don’t want it dying inside you.

Doing all this other stuff required a second incision, straight down the middle of my abdomen from a little below the breastbone down to the navel. The incision actually bends around the navel; I thanked the surgeon for keeping my navel intact and he told me it’s “bad form” to cut through it. This is the incision that I had staples in – but they’re now long gone, and the incision itself is a straight and narrow line down my abdomen. I wouldn’t say I’m going to look great on the beach, but the fault won’t be with this incision. The only remaining problem is that one small part of the incision opened up – leaving me with a hole maybe a centimeter and a half long, and part of a centimeter wide and deep. I found this completely creepy, but the surgeon and his nurse were unfazed, and instructed Teresa on how to dress this small wound with gauze twice a day. She’s been doing that as if she’d been dressing wounds all her life, and just as the doctor said, the wound is filling itself in – from the inside out!

Meanwhile, a wonderful thing is happening. The most lasting effect of the surgery on my overall condition was that it robbed me of energy. Walks that I’d have thought as a month ago as very short now left me clammy with sweat. But all of a sudden – I’ve felt it over the past three or four days – my energy has begun to return. I’m not at 100 per cent by any means, but I feel much more like myself. And that’s even though I’m now 10 days into the first round of chemotherapy delivered via the pump; precisely because this chemo goes directly to the liver, and evidently is almost entirely absorbed there, the side effects on my body as a whole are likely to be modest. They watch the liver carefully, though, to make sure it’s not being overwhelmed by the medicine it’s receiving. So: so far, so good.