Post Op.

“Only a handful of people in the world have ever had a surgery this big,” remarked Dr. Cameron, during our post-op debrief.

Wow. You know this is a huge procedure, but that adds some perspective. This conversation took place shortly after Sandy was wheeled out of the OR and down the hall to the Surgical ICU, or SICU. During the rest of the conversation, Dr. Cameron told us about how the procedure went, and that he is happy with both the quality of the liver and how well it grafted. He confirmed that they found no evidence of cancer in any of the surrounding areas, including the lymph nodes. All of the things that had been removed—the old organ, billiary tree and the head of the pancreas—would be studied carefully by pathologists in the coming week. He also cautioned us that it is not uncommon for transplant patients to have to go back in the OR for any number of reasons. The liver is highly vascular and bleeding is not uncommon. Sometimes, particularly in the early days following transplantation, that requires additional surgery.

The next thing we are looking for is for the implanted liver to start functioning. This can take a few days. It started making bile shortly after being implanted, which is a good sign. We need it to do more than that, of course.

To our relief, his general tone was that the procedure was successful, that Sandy seemed to tolerate it well, and that both he and Dr. Malley expect Sandy’s recovery to go well.

The process in the SICU is to clean up the patient and get her settled before letting any family in the room. That took about two hours, at which point Beth and I were able to go in.

We had seen her very briefly as they wheeled her from the OR to SICU. She was barely visible under all the covers, but her head was obvious, with a breathing tube in her mouth and various other appliances and infrastructure around her. The crack up was that her tongue was actually sticking slightly out of her mouth, much like Riley used to do as a puppy. The thing that struck me immediately was that her color was already improved. If you saw her in the couple of weeks before surgery, you were keenly aware of the jaundice—she was about the color of a sweet potato, but maybe a little more yellow than orange. Now, she still had some jaundice, but was otherwise colorless. Maybe a little opaque!

There is an attendant in the SICU waiting room that was kind enough to call the nurses periodically to check on how Sandy was getting settled. Only about an hour after surgery, she reported that Sandy was awake. That’s preposterous, we all thought. We were told to expect that she would be unconscious for the entire day, possibly two. Then, about two hours after surgery, we were told that she was situated in her SICU room and we could go in (read: the nurses could now handle us).

Sandy’s parents, Gerry and Bob, had just decided to leave for home. Actually, it’s our neighbor’s home. The thought was that Sandy would not be awake, and only two family members were allowed in at a time. Graciously, they volunteered for Beth and me to be the two. I should confess that earlier, when the nurse explained that only two people could see her, I turned to them and said, “I guess that would be me plus one of you three.” Always the smart-ass.

To our surprise, she really was awake. She was awake and actually somewhat alert, if only for short periods. She was barely recognizable—but understood what was going on around her.

“Do you know that you got the transplant?” I asked her. She nodded. Remember, that was her biggest fear.

“Do you know that there was no cancer in the lymph nodes?” She nodded almost vigorously, and her eyes burst wide open when she did it. She could not communicate other than to affirm her understanding. Her eyes told me that she was grateful.

The machinery around her was spectacular. A ventilator on one side, and racks upon racks of those electronics that administer medicine. There were bags of fluids, antibiotics and other drugs, including her first doses in what will be a lifetime of anti-rejection drugs. What a spectacular sight, but I was glad that we were there.

This gets you to about lunchtime on Friday... Her progress since then has been terrific- I'll try to get some updates posted quickly, so please keep checking back.