laparotomy Archives -

Alive & Screaming (Again)

The wrap-up: Part 4 of ‘To Hell And Back’, Paul Riekert’s account of having emergency surgery. (If you haven’t yet, first read the other parts here.)

It has been a year and a half since my medical adventure. An eternity. It feels like the traces of a nightmare or a disturbing film. I am very far removed from where I was when I walked out of that hospital. Yet, if I consider the vivid quality of the flashbacks, it could have been yesterday.

The last seventeen months have been gruelling, exciting and completely insane. There was no leeway – I had to (and desperately wanted to) get going, salvage and re-build. The odds were not favourable, due, in part, to my horrid financial state, the stranglehold of a lockdown, and an industry that had become dormant (or very stingy).

Thanks to the generosity of others, I could pull most of it off, with a fair success rate. Among other things, I’ve physically recovered from the surgery completely, scaled down my life, did lots of hard and rewarding audio work, and moved to a new place. There’s still a long to-do list waiting in the wings. Some stuff will take longer to normalise (if such a thing as “normal” exists), but at least I was in the fortunate position to be able to give it a good shot. This would have been impossible without the support of many people, people close to me, and also complete strangers that I’d never met. To you: my humble, sincere, eternal gratitude.

Humble? Oh yes. Apart from all the other details, it’s been a humbling experience. Not that I think I was particularly arrogant before, but at times the universe brutally strips you of your delusions. Life sometimes rubs your nose in it. For example, the little bit of pride I had felt for being independent has gone the way of the dodo. A brush with death brings new perspectives. For one thing, you realise how frail you and your plans are; how everything can completely go to shit in the next few seconds. It’s an aggressive reminder: be careful how you spend your time.

On that happy note then, an incomplete account:

To be able to go back to my own place, which I had lived in for long, was a wonderful anchor in the madness. I didn’t exactly tidy the place up before being rushed to hospital. Everything was exactly as I had left it. I instinctively tracked my last movements according to the objects lying around.

It was a great relief to be back home. Damaged and broke and half deranged, but back home. First stop: proper coffee. Fresh grind, double espresso. It was so good I could pass out.

(Acquiring something close-ish to coffee in hospital involved bribing one of the staff to go and get me a sachet of freeze-dried instant coffee from one of the vending machines. Before I figured that out, I had gone for the tea instead, as the hospital coffee was – well, not coffee. The tea, on the other hand, was so-so, but at least it was real, actual tea leaves.)

Doing domestic things and moving around the place seemed easier than expected. I felt strong, in control. It was only in the evening that, when I finally decided to go and pass out, I was reminded to take it easier. As per usual, I switched off all the lights and went upstairs in the dark. Halfway up, I felt unsteady. It resembled a bed-spin, but I was still on my feet. Barely. If I didn’t compensate quickly enough, I would have tumbled backwards down the stairs. My internal gyroscope needed re-calibration. For the first time in my life, I had first-hand experience with the term “infirm”. I shuffled up the rest of the stairs very carefully, a bit shaken. Just a bit – I was still on a fistful of painkillers per day, which didn’t allow for much stressing out.

To my dismay, I had two imperative post-operation appointments with my “favourite” surgeon. After being discharged from hospital, I thought that I might have judged him too harshly. Going to these appointments made me realise that I had not. I still couldn’t stand the little brute, his personnel, and even the decorations in the tiny foyer of his “suite”. The operation saved my life, that is true, but he did it for a rather handsome fee, for no other reason. I don’t think there’s anything wrong with that. It was a transaction like any other. You don’t have to like the tow truck driver or the chef either. That said, it still feels odd to think that this guy was scratching around inside my abdomen with his rubberised little fingers, brandishing sharp tools. The whole thing becomes rather personal.

Within a few months, the wounds healed completely. The scars went through a few colour changes – dark red to bright pink, to white, and then closer to the hue of the skin around them. At one of the post-op appointments, I met a guy who had gone through the same thing I did – three times. (Not the emergency part, but the same operation, involving a full laparotomy.) Three times! He told me that his wounds were not healing so well anymore – “like the frayed end of a piece of rope”, he said.

I focused completely on my physical state – getting my body to function properly again. I ate well and gradually exercised more. My body loved it and responded really well. I was feeling stronger, trusting my body a little more.

My head, however, was a mess. Odd details kept rising to the surface – mostly details I’d rather forget. It felt like my brain was reading random things from its hard drive and I was powerless to make it stop. A month or so after being discharged from hospital, this started to take the form of PTSD -like flashbacks. For a brief moment, I’m back in the ICU, with images, sounds and smells. And that horrible feeling of being completely helpless. Moments later, the flashback passes, but the emotional impact lingers.

There was other weird stuff happening. For example – suddenly all my emotional “buffers” were gone. I would get angry, sad, indifferent, ecstatic, nostalgic, bitter (the list goes on), all in the space of a few hours, and with full intensity. No brakes. It was very disruptive. I had to manage it like a production. Getting through every day became a balancing act.

Yet, despite all this crap, I was determined to squeeze joy out of life. An act of defiance, in a sense. It was easy. After the torturous ICU, everything in my “normal” life seemed absolutely spectacular. Even simple things, like taking a walk in the sunshine, were euphoric. Everything felt like an indulgence. The Stoics had a soft spot for gratitude – the importance of counting your blessings. I think they were on to something.

While in hospital, I craved to be near my instruments and equipment. I wanted to translate some of what I was experiencing into sound, looking forward to making lots of new music. However, when I finally sat down in the quiet studio, it stayed quiet. I didn’t feel the urge to create. It felt great to be back, of course, but I just didn’t feel like making something. I didn’t force it; let it run its course. I also attempted to write some more, but my words dried up completely. I could barely finish the other To Hell And Back -parts before it all became quiet. Writing a simple piece of text became excruciating. I had to force the words out. Inside, a tornado was raging, and it was impossible to express what was happening.

Then, more than a year after my stay in hell, my head started filling up with creative ideas. Once again, I was compulsively writing down or recording things. It was like welcoming an old friend.

The timing was a bit off, as I was in the middle of another project: moving to a new place after fifteen years. I had to focus on it completely. I hate moving, and It was one of the most difficult, most tiring things I’ve ever had to attempt. I gave away, and threw away, about half of what I owned. I traded the huge space I inhabited for something petite with a big view and a more forgiving price tag. The re-designed studio is now up and running and I’ve been working on new material. Finally.

Life goes on.

To Hell and Back (Part 3)

In June 2020, Paul Riekert had emergency surgery. He lived to tell the tale.

(I strongly suggest you read Part 1 and Part 2 if you haven’t yet.)

The wounds have healed. When I run my fingers over the laparotomy scar, I can feel two rows of tiny staple scars next to the big one in the middle. Like metal plates that had been joined by welding and riveting. Do you ever touch your scars? Try to imagine what they must feel like to other people?

There’s still a bit of pain sometimes; it’s random but short-lived. I’m getting used to suddenly seeing the scar in the mirror. It’s my scar, after all, and I like scars. But it still feels a bit alien.

I remember my surprise when they removed the long, heavy plaster for the first time. I certainly did not expect a row of staples from the tip of my sternum past my navel. The first time I saw it, from that angle, it resembled the big front zipper of a bikers’ jacket. When I woke up in the ICU, no-one had an information session with me, explaining things. No. They grudgingly told me the basics, but, for the rest, it was one big surprise package.

On my fourth or fifth day in hell, I think, the dieticians sent to me: clear liquids like fruit juice and chicken broth. The horrible pipe, which was meant to vacuum-suck my stomach empty, and protruded from my nose, was taken out. The nil-per-mouth-rule was revoked! It sounds like a really humble upgrade – clear liquids – but it was of major importance. Despite being fed and hydrated intravenously up to that point, I was hungry and thirsty most of the time. It was incredible to feel water in my mouth again.

Within about five days I was allowed solid food. Sad and bland solid food, but at least stuff you can chew, that vaguely tasted like something.

After many days in the ICU, could have been six or so, I stopped wishing to leave the ICU immediately. I resigned myself to receiving intensive care indefinitely. Bring it on. It was the only way to cope with what was going on: accept that artificial milieu as normal and move on. Don’t fight, feel it. It worked, mostly, although at times a debilitating air of despondency would sneak in. Stuck. Stuck.

The physiotherapists gently forced me to get up and go for a walk every day. I could see the outside world, get stronger, and have shards of normal conversation. It would make me feel better; bring an air of solidity to those dismal 24-hour stretches without darkness or daylight.

On my tenth day in hell, incredible things happened.

The external drip port, which was inserted into five different blood vessels, was taken out. No more intravenous stuff! Then the cardiovascular monitoring cables were disconnected. I could move a bit! And shortly thereafter, senior personnel announced that I was being moved out of the ICU. My personal belongings in the bedside metal cupboard were stuffed into a big clear plastic bag and put on the bed near my feet. My oxygen tube was disconnected from the wall unit and connected to a portable cylinder. All these sure signs…and yet it was difficult to believe that I was finally getting out of there, that wherever I was going would be better. But when a cheerful porter arrived, I realised that it was actually going to happen. I was being wheeled out of the ICU. Just like that.

The porter pushed the bed at what seemed like breakneck speed. We travelled along the standard tall and wide corridors for most of the journey. At some point, after using a huge lift, the corridors became smaller, framed “art” started appearing on walls, and sections were clad in marble.

“This is the suburbs -part of the hospital”, the porter said, before pushing my bed into a small empty ward and disappearing.

I couldn’t believe it.

He was only half-joking. It was a small room, a few stories up, with huge windows and a 170-degree view. Sunlight was streaming in. I could see an old suburb with wide tree-lined streets below. A biggish television was mounted on the wall in front of me. To the left was an open door that led to a bathroom. All of it completely private. With no drips and sensors and cables and tubes attached to me. Yes! It seemed extremely luxurious compared to the hellish ICU; like I had hit the jackpot. Despite the pain, I got up out of bed and stood by the window. I could feel the sunlight on my face and arms. I was alive.

I experienced an enormous sense of relief. It was so intense that the effects lasted for more than an hour. Pure, unadulterated joy.

It was such a novelty to be able to move about freely, without all the attachments. I couldn’t exactly do star jumps yet – I still had pain-inducing drainage systems with bags hanging from holes below my rib cage and a long, tight row of staples embedded in me – but to have a choice how and when to move was amazing. I started wondering why I was put in a private ward. Was it for my benefit, or for the benefit of others? Who was being protected against whom? Both options seemed hilarious.

For the first time in ten days, I could take a shower. (As opposed to being bullied into an involuntary “bed bath”.) I received specific instructions NOT to get the wounds wet; luckily the bathroom was geared for that sort of thing, with adjustable horizontal showerheads.

Being confronted with a mirror was a bit of a shock. I had lost weight. And I didn’t have any to spare. I looked really thin, almost emaciated. Apart from the serious plasters and drainage bags, I had an array of small wounds and scabs on my arms and chest from intravenous gear. Like shrapnel wounds. I had a full, mostly grey beard, with an almost entirely black moustache, and my hair was the longest it had been in 24 years. I could do with a tonsor.

Instead, I got a dietician, who was kind enough to arrange some cheese and biscuits for me. Plain salty biscuits and humble cheddar cheese. To taste something that was engineered to taste good, after all the bland liquids and food, was euphoric. It had a healing effect.

This is a concept that only certain medical personnel seem to grasp: if you feel better, you heal better. Most of the medical personnel I encountered fit this category. Kindness came into it at some point. Others skip this chapter completely. They see you as a meatbag, a soft machine at most, that has to have the right readings – on the machines and according to, say, the blood tests or radiology results. Whether the meatbag is uncomfortable, cold, in pain or experiencing mental anguish, doesn’t really concern them. At the extreme end of this scale are the sadists, who love to torture the helpless patients, postponing their painkillers, or denying them water, or do whatever would cause them short-term discomfort.

In this vein, the two doctors, whose exact details shall remain vague, had very different approaches. The one was a delight: rational, reasonable and friendly. The other one was the exact opposite. The bastard had the bedside manner of a carnivorous insect. I wanted to choke the crap out of him from the word go. The two of them had complete control over my stay in the medical facility: where I should be, what food and drugs I should consume, when I am officially getting better, and so on. They visited daily. Some days both of them would pitch at the same time. It never lasted longer than two minutes, yet they both billed me thousands for each “visit”. I loathe such obvious and shameless milking. But I shouldn’t be complaining, I guess. They did perform the most important parts of their duties in an expert manner, otherwise I wouldn’t be sitting here, very much alive, complaining about stuff.

The few humble improvements in my daily existence made me feel human again, and less like a meatbag. For the next few days, I made the most of the setting, enjoying the view, the sunshine, the starry night sky, the privacy, the improved menu. The semblance of normality also triggered an increased longing to go home. To re-enter the existence I’d been violently plucked from.

The medical personnel became very interested in the drainage bags. After absent-mindedly emptying them before, they suddenly started measuring their contents in millilitres. There was less liquid in them every day. It seemed that, when those bags stayed empty, I could go home.

About three days later my “favourite” doctor signed the discharge form. Unceremoniously. And barked orders at an incredibly tall nurse who spoke with a Caribbean accent. She took out half the staples, every second one. Unbelievably, she was cracking jokes while she worked. Good ones, too. Then she proceeded to detach both drainage systems embedded in my abdomen, removing the bags too. It was really painful – a return of the fiery pain I felt right after the operation. I wanted to protest (or rather, scream in anguish and demand anaesthetic), but then I thought: just get this over with, keep quiet, just grin and bear it. Don’t give them any reason to keep you in this place for a second longer. I was ice cold and sweating from handling the pain by the time she was finished.

She gave me instructions, handed me a pack of “dressings” for all the wounds, and excused herself.

I got dressed, in “real” clothes, gathered my few belongings, then took a moment and sat on the chair next to the bed. It felt strange. A bit overwhelming. I was looking forward to that moment for many days, and there it was. Action.

I was slowly winding my way through the labyrinth, finally turning into the widest, tallest, longest hallway that would take me straight to the outside world. On my right, about halfway down, was the entrance to the ICU. It made me walk faster. At the end of the hallway, down a staircase, I entered the glass-and-aluminium foyer of the hospital. Many people were cueing at the entrance, being screened for Covid-19, but the exit was clear. The automatic glass doors opened in front of me and I stepped into glorious sunlight. I made it!

I was among the living again! I had been to hell and I made it back.

To Hell and Back (Part 2)

In June 2020, Paul Riekert had to go for emergency surgery. He lived to tell the tale.

(You can read Part 1 here.)

I didn’t know whether I was going to wake up. And if I did, where I would wake up. So, the entire thing – passing out, major surgery, waking up, figuring out that I was in the ICU, the incredible pain and the damage – was a complete surprise. That first day in the ICU was like being hit with a big hammer repeatedly. I was confronted with a load of horrible things in a very short space of time. It required a lot of processing.

It was difficult to accept my broken state, to accept that I needed all those gadgets and personnel to stay alive. That said, getting better wasn’t an option then. It seemed impossibly far away; complete fantasy. Dealing with immediate stuff, like staying alive and not having a meltdown, seemed more important. I also had an inkling that staying alive was going to be very expensive and involve monumental levels of discomfort. Looking back, I grasped the general idea but the details turned out to be beyond anything I could conjure up.

One of the comforts that the ICU offered was oxygen on tap, 24/7. It was everywhere. I didn’t find it reassuring – the other times I was near it was when close friends or family were seriously ill or dying. The oxygen feeder looks like a bridle made from translucent tubing, with two protrusions feeding oxygen into your nostrils, hissing softly. And there was no choice – ICU personnel insisted that every patient partakes in oxygen huffing permanently.

Most of the patients in that section of the ICU had invasive, major surgery done to the abdomen. It means that about half your body’s breathing gear is severely damaged. So, for most of us, it was too painful to cough properly. You would try – everyone did – but once was normally enough to learn all about it. You had to postpone that possible cough until the last second. You coughed. And then you collapsed, moaning with pain.

So then, on my second day in hell, the consulting clinicians sent to me: a physiotherapist. She was one of several masked people in medical garb who showed up next to the bed that day. At first, I wasn’t impressed. Physiotherapy? What for? They could just as well have sent a pastry chef or a pyrotechnician.

I did co-operate, though, when she asked me if I could sit up and bend slightly forward. She proceeded to slap my back repeatedly. Quick, multiple, hard slaps, from scapula to scapula. It felt a bit too violent, given my fragile state, but I was still heavily opiated and to protest seemed like too much effort. After doing this for about 30 seconds, she said:
“Cough.”
I hesitated, of course. Coughing meant blinding pain. She repeated:
“Cough.”
I coughed, successfully clearing my trachea without collapsing in a heap. The pain was there, but it was tolerable. I could cough more efficiently, with little movement. What a relief! I experienced an immediate attitude adjustment.

The physiotherapists gradually pushed me from almost-dead-lying-down to slow walking and climbing stairs over about a week. It went from sitting in a chair next to the bed to standing up, to walking around the ICU, and then to taking short walks outside in the passages of the hospital. Every time, before each activity, all the attached pipes and tubes and cables had to be re-organised. The intravenous cluster was hooked to a drip trolley, which is a pole on wheels. It also had space for a small gas cylinder to enable the perpetual oxygen feed. The other attachments, and their attachments, had to be carried manually.

One of the fourteen things attached to, or sprouting from me, was – horror of horrors – a catheter. On the other end, the pipe was connected to a container that looked like a small translucent briefcase (with a handle), hanging on the side-rail of the bed. It had measurement -markings on the side. A nurse would empty it periodically.

In a few days, I would go on one of my first painful little walks outside the ICU. It was super uncomfortable. Every step sent spikes of pain through my abdomen. I kept walking. The physiotherapist was pushing the drip trolley. It was cold. I was still wearing a hospital gown, which was flapping about and not very private. And in my right hand, I was carrying a small translucent briefcase full of piss. It was like a crude bit of absurdist theatre. Too much.

(It was worth it, considering that it took me out of the ICU for a few minutes. I couldn’t help feeling relieved that the outside world still existed.)

On my third day in hell, malice was oozing from the walls, the floors, the ceilings, from everywhere. It turned from horrible (but neutral) into pure evil. Everyone, including the other patients I could see, became an enemy. I was watching pharmacologists prepare my intravenous drug concoctions, convinced that they were tampering with the formulae and trying to harm me. I wanted to yank out all the cables and pipes and censors attached to me and get out of that miserable situation. Walk away.

I started pulling at some of the cables and drips, and the ICU personnel around me went berserk. The five of them were frantically trying to restrain me. I was so drugged and weak that I couldn’t put up a good fight. So I used a painful but very effective second weapon: I shouted, as loudly as I could – for help! This freaked them out completely. It drew (unwanted) attention from outside the ICU too, with some senior personnel wanting to know what the hell was going on. I felt like a spectator, watching the scene play out. Everything made perfect sense.

Another clear bag was added to the intravenous collection. I could feel myself relax soon afterwards. I still felt malice coming from everywhere, but I didn’t care any more.

A few hours later, could have been at midnight or 9:00 AM, a psychologist came past for a little chat. When I asked her whose side she was on, she politely said that it sounded like paranoia. Apparently, it could be brought on by sudden, large, continuous doses of morphine. It is uncommon, but some people react that way. I half-accepted this, for practicality’s sake, but I am still not convinced. Was all that evil just make-believe? Did I hallucinate entire scenes with intricate dialogue?

The attitude of some of the ICU personnel did improve dramatically. Or was it just the tranquiliser cocktail talking? More than a tinge of doubt still crosses my mind.

I was improvising to a large degree, having never been confronted with anything like this before. I had to get better, or else. Or else what? Or else I would dwell in the tepid twilight of the ICU forever.