Major Surgery Reveals the Importance of Enjoying Relationships with Family and Friends

In August 2014, I had major surgery. These events really helped me to understand what is important in life — enjoying and nurturing relationships with family and friends.

Below is a Facebook post made at that time.

Friends — I’ve asked my wife Deborah Lotterman to post her account of the last 10 days on my behalf.

Gordon is doing beautifully. He continues to progress physically and he’s in very good spirits. He left the ICU yesterday afternoon, is on the main surgical floor and is, with help, up and doing short walks down the hall. As you can imagine, he’s pretty popular with staff.

For those of you who want the power point version:

Gordon has had emergency surgery
• Effectively non-elective bypass with additional organs
• Expected to make full recovery
• Will be able to eat: small, frequent meals
• Is completely intact mentally
• Will be in the hospital at least 1 more week

For those who like a lot of narrative:

Gordon has dealt with upper GI distress for years. I’ll try to keep the ick-factor to a minimum. But it was low grade and then he’d have vomiting episodes, oh, maybe every three months. I, with all my infinite medical wisdom, suggested he had gastroparesis, which is when the stomach doesn’t move and is slow to empty. The two general practitioners who he’d seen over the last several years minimized his discomfort. Two weeks ago, his doctor of nearly 30 years told him to lose weight and stop overeating.

He began feeling poorly early last week. He was dealing with his issue. We were set to go on vacation, to meet my best friend, Deb Baker and her kids in Ocean City, Maryland. The trip already was convoluted as her husband, Ron, had to leave for the Philippines the week before as his mother was dying. And Deb had a procedure on her eye (for a long-running, painful condition) earlier in the week. So she couldn’t drive. The plan was for us to drive to Timonium. Then I would drive Deb’s car and we’d caravan to OC.

We were supposed to wake at 5 on Saturday morning, but Gordon woke at 2 with a migraine. I trundled everyone into the car at 5:30. We stopped by my office to grab papers and Charlotte grabbed a Coke. I snapped a pic of her and Gordon in the back seat. Some of you may have seen it on Facebook. Our good friend, Martha Kennedy, also a nurse practitioner at Hopkins texted Deb, “What’s wrong with Gordon?”

Gordon basically puked his way down the upper eastern seaboard. Around Delaware he began to complain of pain – but it was on the wrong side for appendicitis. He suggested diverticulitis, which he had a bout of in 2007. I thought about taking him to hospital there, but we were an hour away from Deb, I thought he’d get over it. He’s always such a hypochondriac. I was crabby about having to do all the driving.

He crawled into bed. I took the girls to the pool. We waited to see how he did.

Deb didn’t like the pain. She didn’t like the way he looked. She called the hospital hoping that her favorite trauma surgeon, David Efron, was on. He was and he agreed to direct Gordon’s care. By the time we got to the hospital, he’d virtually admitted Gordon and we went straight up to the floor, skipping the ER. By now, he was in a lot of pain.

They ran a CAT scan – and there were actually a number of findings (this is why we don’t scan people on a regular basis – you always pick stuff up). Yes, there was evidence of diverticulosis, there was a hiatal hernia, there was a dissection of an artery in his groin, there was a very large kidney stone high up in his kidney.

For a while, the running theory was that it was the kidney stone that was causing the pain. The urology team wanted to insert a percutaneous tube to drain the kidney and potentially, later, blast the stone with a laser.

The pain got worse. He was grey and basically unable to focus on anything else. Didn’t ask what the kids were doing. Didn’t have any conception that the other seven of us were watching our vacation (and rental) dwindle away. We kept saying things like, “well, maybe it’s diverticulitis and they’ll give him some antibiotics and discharge him. He can recover in a beach house as easy as Timonium.”

On Sunday, we came home from the hospital and wavered over whether to buy a bag of charcoal for the beach house. We opted for. Iona called it a “vote for the future”

On Monday morning they pumped his stomach. He said he felt 10 times better. Pain was all gone. Called and said he was lonely, wanted to see the kids. His surgeon didn’t like the disappearance of pain. He ordered another CAT scan and asked his favorite gastroenterologist, David Cromwell, if he would do a scope on Gordon that afternoon.

We went down to see him. While we were there I got a call from his GP – I’d called to get all the doses on his meds, and I wanted Alan to know what was going on with Gordon. Alan told me he’d relooked at the CT scan from 2007 and both the kidney stone and the hiatal hernia were there. Neither Gordon nor I have any memory of being told these findings.

Again for the record, this is why we don’t regularly scan. People can live for years with a hiatal hernia or kidney stones. It’s when they present themselves, when they become symptomatic, that you address them.

But the thing is, Gordon had been symptomatic for years. And he’d taken his concerns to his doctors.

We brought the kids down to the hospital. We visited for maybe 15 minutes and they took him down for the scan and then he’d go for the endoscope. He waved goodbye. Charlotte set an alarm on his phone to say “I love you” for 5:00.

We took the kids to see the owl aviary our godson, Peter, (Debbie’s son) had built for his Eagle Scout badge. It’s quite beautiful.

We made plans to see a movie. We got in the car and were driving towards the movie when David called Deb. She put him on speaker. He said, “It looks very bad down there. His stomach is ischemic. It’s very scarred. It’s been bad for a long time. We need to do surgery. He’s already intubated from the scope, we’d like to go directly to the OR. There’s a chance we’ll need to remove his whole stomach.”

Somewhere in the middle of that I pulled over.

I gave my consent. I told the girls “we aren’t going to the beach” as even minutes before we’d been strategizing if we could get there in maybe two days . . .

The surgery took over seven hours. Though David had a team of fellows and residents, he called in another attending surgeon to help manage what was, he later told us, the hardest case he’s had this year.

They removed his stomach, his gall bladder and his spleen.

Gordon was on a respirator for two full days. His hands were restrained so he wouldn’t inadvertently pull the respirator tube or the naso-gastric tube (down the nose, into his new gut – esophagus attached to small intestine with a number of other anastaomoses [sutures connecting/sealing all the other –ectomies]) The first day, he was quite groggy and only able to nod, shake, squeeze hands, thumbs up.

The second day he was able to write and his first question was “what surgery?”

Up to then, we’d kept information very simple, “you’re in the ICU, you’ve had a big surgery, you’re going to recover, you need to rest”

That’s what they tell you to do. But imagine you’re Gordon, and as you’ve slowly come back to consciousness, you can’t move, you can’t speak and no one is offering any information.

It was just he and I, when he asked the question. I explained, as best I could what had happened.

I didn’t give him, at that time, the full explanation of causation, which is that the hiatal hernia – which is when the top of the stomach pushes up into a weakening and eventually, a hole in the diaphragm. In many cases, the stomach just moves in and out easily. But in some cases, in Gordon’s, the stomach gets stuck – which causes great discomfort. Because it had been going on so long, that was probably what the heavy scarring was. But when it became really acute last week, it was likely stuck for a long time, which cut off blood supply, which lead to ischemia (lack of blood flow) and ultimately, necrosis (tissue death).

Because the rest of his system had been working overtime to compensate, his gallbladder was 4x normal. And the spleen, apparently, is just a pain in the ass

His next questions were:
Can I talk?
Can I travel?
Can I drive?
Can I do dishes? (good man!)

I had explained that he will be able to eat. That’s what they tell us. It will be a slow, retraining process. He’ll take nutrition through a feeding tube for a while. But ultimately, many small meals a day (the way we’re all supposed to eat). He’ll learn what his body can tolerate, what it can’t.

He got the breathing tube out on Thursday and within hours was speaking normally, though raspy, and astoundingly positive. He started asking the question Debbie and Martha had been posing: if he’d been this sick, this burdened for years – something he’d just grown to accept and accommodated – what would it feel like to be free of that?

As you all know, we’ve shed many things this year. Now, hopefully, Gordon has shed one more set of conditions that was weighing him down.

He left the ICU yesterday. He is able to walk short distances. He continues to say he’s in very little pain. I haven’t had a chance to count the staples yet. It’s a really big incision.

We continue to be amazed at our good fortune. That we were here. At Hopkins. With Deb. That he went into surgery strong as they’d already spent two days rehydrating him, getting his blood pressure under control. That David Efron, pretty much our new favorite person in the whole world, was working that night. Get a sense of him (all 7’1” of him) and his own amazing personal, clinical story here:

http://webcast.jhu.edu/Mediasite/Play/ea766b7045ec49ff96ada16781e2b29d1d

(just wait through the first slide, where some dude intros him)

The girls and I are doing fine. We are exhausted, We look forward to leaning into the hugs you are all so ready to dispense. We get back in the car this morning to head to Boston. Gordon will stay in the hospital with Deb and Martha checking in on him. Best case scenario, he’s home in a week or so.

He doesn’t really want visitors. He’s looked better. He’s focusing on healing.

Oh there’s tons more, but I know how you all have been worrying, and this is a ridiculously long note.

Thank you all for your energy, your thoughts, your words. We will call on the help you offer. We will need it.

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