Poppy Day 4

Abstract

Acute intestinal ischemia is a gastrointestinal emergency resulting from a sudden decrement in intestinal blood flow. It may occur as a consequence of mesenteric vascular occlusion and/or hypoperfusion and may involve the small intestine or colon. Bowel infarction, sepsis, and death may result, making prompt diagnosis and management imperative. Acute mesenteric ischemia generally stems from interruption of blood flow within the superior mesenteric artery or vein, and leads to small intestinal hypoperfusion and infarction. It carries with it a mortality rate of approximately 70%, but improved survival may be achieved as a result of early diagnostic consideration, undelayed angiography, and surgical intervention, when appropriate. Acute colonic ischemia occurs typically as a result of a transient mismatch between intestinal blood flow and the metabolic demands of the colon. Although infarction may occur, colonic ischemia is often a reversible condition with mortality rates considerably lower than those witnessed in acute mesenteric ischemia. This article reviews the pathophysiology, clinical features, diagnostic, and therapeutic options applicable to patients with acute intestinal ischemia.

Yep, that's what Poppy had. Look at the bold, underlined part. 70% mortality rate. He really shouldn't have survived, but he did and he was out of ICU and walking under his own steam 36 hours after the surgery. What he hasn't been able to accomplish, much to his eternal frustration, is the requisite poop. One of the doctors who came in while I was there assured him that 4 days post-op was not uncommon, especially with as much trauma and handling of the intestines as went on during surgery. "The bowels do not like to be touched, noooo touchy. And the surgeon basically pulled them out, cut out 4 feet of dead bowel, stitched the ends back together and put them back in you. They are not happy. They are pouting. They'll get over it, be patient. Like a woman, no?" (Say all that with a thick German accent). Poppy is bored and restless and wants to be cut loose. All the monitors are gone; the catheter is gone; the direct line was replaced with a peripheral line. It's the only thing tethering him. Physical therapy has him running up and down the halls 3-4 times a day; actually, he has them trotting after him with his IV pole. They are making him use a walker for stability, and he's trying to figure out how to align the wheels. "Pulling a bit to the left, Jim, got any tools with you?"

Yesterday was the first time I saw him on his feet. Watched him tool down the hall from his room and back and was impressed. That's when he blew past me, Jim huffing and puffing behind him, and headed down the other hall towards the elevators. I was sure he was trying to make a break for it, or at least for the Cafeteria. After he got settled back in his bed, I asked him if that was what he was doing. "Why? Do you think I could have made it?" This was about 50 hours post op. I was shocked to find him still in his room this morning.

Today, after combing Amarillo for a handheld electronic Solitaire game that does not exist outside of Amazon, I brought him a deck of large print playing cards. We played 5 games of Gin, he won four. And he cut for high card and won three hard candies (two Werther's and a Jolly Rancher) from one of his doctors. I'm betting there will be legends of high stakes Strip Poker with the night crew by the time he's discharged. But with all of this, still no poop, still nothing  by mouth. It's a really weird request, but please pray for Poppy poop. It's the last hurdle he has to clear.