In the past when we asked about the wound being open we were told it would be allowed to heal via secondary intention. This means it's allowed to heal closed on it's own. This typically allows the wound to drain without trapping any infection inside, but tends to cause more scarring. They had begun to show us how to clean and bandage the wound for this kind of closure. The surgeon came around to check on Karen and we asked about something we were seeing through the wound. It had a strange vertical texture and no one else we had asked was able to tell us what it was with any certainty. It turns out, what we were seeing was the mesh they had placed. When the surgeon saw it he made a face where he pushes his lips up over the top row of teeth. The only time I have seen this expression before was in October 2014, right before he told me the cancer was something Karen wouldn't be able to beat. So I think it was a bad thing, but I don't know how bad. He said it should normally be covered with tissue, and he might put a few stitches in before we leave. He also said Karen's ready to move on to solid food again, and advanced her diet.
The palliative team lowered the dosage of Karen's fentanyl patch because she was doing so well with her pain level. They told us it's one of the least likely medications of it's class to cause constipation, but with her pain level being so low it's worth trying a lower dose. However, later in the day the surgeon surprised us by coming back with another doctor. Together they stitched the wound closed - which was more than a few stitches - and put a catheter in through the old JP drain site. They say the catheter will function like a JP drain, but it has a tertiary valve and they also intend to use it to flush antibiotics through the wound three times a day. As such, they also put glue over the stitches to make sure the wound was air tight. She will also be on IV antibiotics until it heals - which, luckily, we can do at home thanks to her power port. They numbed most of the area with lidocaine, but some spots just didn't seem to take to the local anesthesia, and parts of it the suturing were very painful for Karen. She said she felt like screaming. Her pain level has ranged from 4 to 6 out of 10 since then. It's particularly painful twisting to get out of bed. We've tried some additional oral meds, but if things haven't settled down by morning I'm sure they'll return the patch to its previous strength.
My biggest concern is the sudden change of plans with the wound and the urgency with which it happened. Before the surgery we were told the biggest risk is that of the mesh getting infected. And today we heard one doctor say that they hope to "salvage the mesh." The pharmacy had a hard time getting the order worked out for the antibiotic flush, and none of the nurses have seen this sort of thing before. Even the connector for the catheter had to be pieced together with supplies taken from the operating room, and part of that starting leaking a few hours ago. A nurse replaced the leaking part with some kind of lock connector we use with the power port. The whole thing feels very much thrown together. Still, they insist none of this will delay our release, so they must be at least somewhat confident that this is the right thing to do, even if it is somewhat uncommon.
With all the fluids yesterday Karen had been getting up to pee a lot during the night. I think poor sleep in a hospital is just par for the course. We had a couple good nights in there, but it's probably easier to just say when she is able to get a good night's rest, rather than when she isn't. We're curious about how much weight she's lost with all of this not‑eating she's been doing, but haven't been weighed in a while. All of her vitals have been fine though. Her heart rate is slightly elevated compared to what would be considered normal, but it's around what it was when we came in. I think this has been a thing since her earlier surgeries. I don't know if it's cancer related or what. Oh, and she's finally completely disconnected from all IVs, montors, etc. Her port is still accessed, but she isn't even attached to an IV pole. When she needs something via IV they just give it to through her port and then disconnect when done. We expect to go home tomorrow, Tuesday, or the day after at the latest.
