By John Gilstrap
Author’s note: My original title for this essay about my gallbladder surgery was “Way Too Much Information” when I posted it on The Killzone Blog, and I caution that it is aptly named. At the suggestion of a Killzone reader, I later posted a version of the essay on a medical bulletin board, where it prompted at least one very heartwarming response. Fact is, when you’re sick and you’re looking for information, you find that the Internet is filled with scary stories of procedures gone wrong and medical incompetence. People seem to be intent on making a bad situation worse by scaring the bejesus out of people. Between you and me, I think most of the scary stories are bullshit.
I write about this very personal (and vaguely embarrassing) episode in my life to offer a bullshit antidote. If you landed on this page because you’re desperately searching for information on what to expect from gallbladder surgery, my advice to you is to relax. At least a little. Major surgery is never fun, and at one level it is always scary. But more times than not (by a huge margin), things turn out perfectly fine.
In May of 2010, I had an emergency cholecystectomy. That’s what normal people would call the separation of one’s gallbladder from one’s viscera. Mine had decided to die on me, and it turned out it had intentions to take the rest of me with it. Murderous bastard. In the end, good triumphed over evil, with Mr. GB incinerated in a medical waste bag, and its betrayed sponsor going home to his family.
I had suspected for a few weeks that my gallbladder was plotting against me. Even as two sonograms confirmed that no calculi (gallstones) were present, and that there was no telltale thickening of the organ’s walls—the two diagnostic indicators of cholecystitis—my symptoms persisted, including vomiting and the feeling that a woodland animal was trying to eat its way out of my abdomen. I’m no doctor, but I know when stuff’s not right, and that stuff was not right.
But it also was not perpetual (thank God). My worst attack lasted about 12 hours; most would run their course in four or five hours. When they were done, and I’d had a chance to rehydrate, I would feel more or less normal. Not so the past six weeks, however, during which I had multiple attacks. We’re talking Technicolor attacks here, shot in biological 3-D VistaVision, complete with Dolby sound. As tests came back negative, I was actually disappointed.
The Alamo of gallbladder tests is the HIDA scan (hepatobiliary iminodiacetic acid). They inject a nuclear tracer into a vein, and then you lie under a camera for an hour. I actually fell asleep. That is, until the results uncovered my gallbladder’s murder plot. (No tracer ever made it to the gallbladder.) From there, it was directly to the ER, and from there to the OR.
During those few weeks when no one could prove what everyone suspected, I did research on my own. The Internet teems with information on cholecystitis and cholecystectomies. You can actually watch videos of full operations. I learned a lot about laparoscopic procedures and about the function of the gallbladder. Since this was my first medical procedure of any import, and because my personality borders on obsessive-compulsive, my thirst for knowledge was insatiable.
And for all that, I never did find the common-sense answers to the practical questions that concerned me the most. So, with the guarantee of providing way too much information, here, for the benefit of others, are the answers I wish I had found (not that the answers would have changed anything):
1. Yes, they shave you for laparoscopic surgery. Crown of my head notwithstanding, I am a fairly furry fellow, and at the risk of sounding vain, this is the summer season, and, well, you know. I was concerned. For good cause, it turned out. They mowed everything to the right of mid-left abdomen, from nipple line to pubic line. They do it after you’re sedated. Now that it’s done, the cosmetics worry me less than the prospect of a lot of itching over the next few weeks. (Months? I have no idea how long it takes to grow back.)
2. Urinary catheterization is not a routine part of laparoscopic surgery. Unless you’re me. Turns out that the opiates they use to anaesthetize you and control your pain have the side effect of paralyzing the urinary sphincter at the same time while your kidneys are processing the flood of liquids they’re receiving from your IV. In all fairness, they gave me ample opportunity to urinate through normal means, but there comes a point of no return. As soon as they tapped me, I filled the bag with slightly more than a liter of liquid. (Hey, I warned you about TMI!) At the time, I confess that the relief of pressure trumped the discomfort of the catheter. I later learned, however, that I’d been tapped by an I/O catheter (in & out, I think), the baby brother of the catheter family.
3. The Foley catheter is a whole different animal than the I/O catheter. My case differed from most cholecystectomies because during the removal procedure, the surgeon discovered impacted calculi in my common bile duct, prompting a second emergency procedure (an ERCP—endoscopic retrograde cholangeopancreatography) the following day. When I returned to my room from the ERCP, my urinary bladder had officially taken the day off. My kidneys, meanwhile, were churning like a Kentucky still. The nurses broke the news: I needed “resident” catheterization.
3a. Note to nurses everywhere: When you’re talking about shoving a 15-inch tube into a man’s winkie, you have to choose your words carefully. I heard “resident” and panicked. Turns out they were thinking along the lines of 18 hours. Sorry, ma’am, but unless you’re a fruit fly, 18 hours is “a short visit.”
3b. Second note to nurses everywhere: I was wrong. Eighteen hours is freaking eternity when you’re tied to your bed by your winkie. They tell you you can get up and walk with that snake installed, but it’s a trick that requires staff. With one hand on the IV pole and the other trying to preserve some dignity despite the open-backed gown, I never figured out what I was supposed to do with the eight-pound bag of effluent. One of my nurse-technicians was kind enough to show me how I could actually hook the collection bag to the IV stand, but during his demonstration, the bag rose higher than winkie-level for a moment, and let me assure you that it’s a very special sensation to have urine run back into your body.
4. Panic aside, none of your catheter/winkie nightmares come true. Once it’s removed, everything functions just fine.
5. A two-day hospital stay for laparoscopic surgery makes you fat—but only for a while. Between the gas they pumped into my belly for the surgery and the fluids they flowed into me to keep me alive, I came home with over three inches more girth than when I’d checked in. Good news: physical activity (i.e. walking) triggers the mechanisms to relieve the discomfort. Bad news: you don’t want to be in genteel company when those mechanisms kick in. I literally peed away six pounds in my first 24 hours at home. As for the residual gas, well, you get rid of that exactly how you would imagine.
5a. Suggestion for all scheduled surgery patients: If you have the luxury to plan your trip to the OR, first go to your local Salvation Army Thrift Store and buy a pair of pants that are way wider than your current waist size, and plan to wear them on your trip home. You’ll thank me for this one.
I’m eight days post-op as I write this, and I’m pleased to report that I feel great. The incisions—tiny things that they are—are healing nicely. I’ve even been able to sleep on them for the past three nights. The only thing that has not yet returned to normal is my appetite. Everything sits well and tastes fine; I just feel full quickly. If nothing else, this cholecystectomy thing is a terrific (if a bit draconian) diet plan.
I know this essay is running long, but since you’ve read this far, allow me one last indulgence. My career focuses on writing books about people who save the lives of perfect strangers; but this is the first time that I’ve ever played the role of the stranger. People I’d never met literally worked overtime to return me to my family with a shining prognosis. I make light here, but understand that the humor is a cover. How do I return that kind of favor? The phrase, “thank you,” seems sort of hollow under the circumstances, but it’s all I’ve got.
So, listen up, Dr. Trad, Dr. Azziz, Dr. Shah and the enitre nursing staff at Reston Hospital Center: On behalf of my entire family, thank you.
UPDATE 1:
I’m 17 days post-op now. I’ve had no digestive problems at all. The diarrhea that I worried would occur never did, and neither did the constipation that the doctor had warned me about. For the first two weeks after surgery, the upper midline incision continued to weep on occasion, but now it seems to have closed completely. The only incision that even looks like an incision anymore is the umbilical one, and it’s shrinking every day, though there continues to be some pretty stiff swelling—feels like a lump, really—around my navel. But that area, too, is shrinking quickly. The two side incisions are barely even noticeable.
I still don’t have much of an appetite, and when I do eat, I fill quickly, especially during breakfast and lunch. While sitting in a straight-back chair, I’ll occasionally feel discomfort in the upper right quadrant—not pain, but just an odd stitch that will startle me and make me straighten my posture. To me, it feels like stuff is moving around in there to fill the void left by the excised gallbladder, but I don’t know if that’s what’s actually happening.
As for foods I’ve tried without consequence, I’ve had lean beef, bread and butter, chicken, pork, eggs, sushi, and even Mexican food with no problem at all. Cocktails and wine, too, although as I alluded above, all in much smaller quantities that I would consume before the surgery. The result is a loss of about 8 more pounds in the last two weeks. Frankly, that trend could continue for another twenty pounds before it would be a concern for me.
So, for those of you who are on the fence about whether or not to go ahead with your cholecystectomy, my experience beyond the initial indignity and discomfort of the surgery itself, has been all good—or, if not good, then certainly non-traumatic. Even the worst discomfort in the couple of days after surgery didn’t come close to the discomfort of a gallbladder attack.
UPDATE 2:
I’m six weeks post-op now, and this will probably be my last update. According to my doctor, everything is progressing just as it’s supposed to. My incisions are all but healed, and I’m back to doing ab crunches in the morning. Since I’m not turning inside out when I grunt, I guess I’m mended.
I haven’t had any bowel problems to speak of. Sometimes BMs haven’t been as well-formed as others, but it’s not a chronic thing, and it certainly would not classify as diarrhea. There’s no unusual urgency to poop, either.
I think my appetite has returned, but it’s nothing like it used to be. Truthfully, I think that has as much to do with the psychological pleasure I feel from watching my waistline shrink seven inches (!), and my desire to turn the low-fat diet that started as a necessity into a long-term lifestyle change. This thing has been good for thirty pounds and counting now. That’s all good.
More good to come out of my cholecystectomy adventure is learning that I am not, in fact, allergic to shellfish. I had assumed for decades that I was because I would become violently ill after eating lobster, and sometimes after eating shrimp. Connecting the dots, though, given that my gallbladder had not been functioning properly for perhaps many years, I realized that it might not have been the lobster that was making me sick, but rather all the butter and other gallbladder-unfriendly rich food that went with it. Sure enough, that was the case. An allergy test proved negative. I’ll still be a little careful reintroducing shellfish into my diet, but this is great news. My doc said it’s not unusual for patients to realize just how sick their GB was making them until after it is removed.
For the guys who are reading this, tummy hair takes longer than six weeks to grow back. I’m past the bristly, whiskery stage (which really wasn’t itchy at all), but a definite line of demarcation remains. The good news is I’ve got a cool scar in the deforested area, so no one will think that I bailed on a Brazilian waxing or something.
Finally, I know that if you’re reading this, chances are good that you or someone dear to you is facing laparoscopic surgery, and you’re frightened. The overarching message I want to pass along is that in my case—and in the case of all the other people I know who have undergone cholecystectomies—the fears far outstripped the realities. Fact is, you sleep through the tough part, and the worst discomfort in the 48 hours immediately after surgery does not come to 10% of the pain of an attack.