The History

Based on what I (Mark) remember, this is what has gone on with Heather:

Heather went in for a hysterectomy on Tuesday (09/30). The surgery went well, and there were no complications initially. The day after surgery went relatively well, and she was sleeping and feeling okay.

However, following surgeries such as this, people often take a day or two to get their bowels working again. When the bowel is moved around during surgery, it can get irritated. This can make it spasm irregularly and disrupt the usual coordination of muscle contractions that are required for peristalsis to take place. As a result, gas cannot move through the digestive system, and it builds up and often causes significant pain. This was the case for Heather.

Her belly became huge and bloated with gas. Everything was so swollen that her lungs were compressed and she had trouble breathing, particularly when lying down. She was quite miserable for several days. When her bowel did not recover as it should, the doctors became increasing worried. They ended up inserting a NG tube that went in through her nose, down her throat, and into her stomach so that they could relieve some of the intense pressure she was experiencing. They immediately drained 1.5 liters of bile from her esophagus and stomach (there was significant risk that if she did not get that drained off, it would begin to go into her lungs), and she continued to have significant amounts of bile sucked out over time.

With this bile drained off, she felt immediate relief and was able to get the first sleep she had had in days. However, this relief was short-lived and the pressure began to build up again. She felt tremendous pain on the right side of her chest, over her right shoulder, and down her right shoulder blade to her ribs. This turned out to be referred pain, probably from the gas and other pressures in her abdomen and under her diaphragm. This pain made it extremely difficult for her to breath.

Sleep was impossible and, not having eaten or slept for multiple days, she began to be very weak and delirious. The doctors were baffled by what was going on and performed multitudinous tests to try to figure it out. After an extremely miserable night, on Sunday morning (10/05) her heart rate was extremely high (135-155), she was having a terrible time breathing, and there were several worrisome test results and vital signs. So, the doctors decided that she needed to go to ICU and should get another CT scan to find out what was happening in her bowels.

They wheeled her down to the ICU and immediately decided that she need to be on a ventilator because her breathing was so compromised. She has been under anesthesia ever since. They wanted to continue with the CT scan, but needed to inject the bowel with tracer dyes which would take a couple of hours to get in place.

My dad had come up to support me on Sunday morning, because after spending several sleepless nights with Heather in the hospital, I was a little fragile myself. (We gave her a blessing early that morning.). While we waited for the CT scan, my dad and I went to get something to eat. As we were returning, the doctors called saying they needed me to sign consent forms for them to go into surgery immediately. When we arrived back at the ICU, the surgeons informed us that, though they could not be completely sure without operating, it appeared that Heather had some kind of flesh-eating bacteria that was quickly destroying her body, and that they needed to operate immediately to try to stop its progress. They informed us that she would likely lose her bowels, large sections of her legs (if not her legs completely), her buttocks, and other organs in the abdominal cavity if she survived at all (which was not likely). They said that her chances of surviving this were very small. They did explain that it may be a perforated bowel, but that it seemed more likely to be the flesh-eating bacteria based on the signs they were seeing in the skin on her legs and belly (deep red marks that seemed to be growing very quickly). This of course was a tremendous and devastating shock.

We spent the next three or four hours waiting to find out that it did not appear to be the flesh-eating type bacteria that they had feared, but that she had suffered a perforated bowel and resulting sepsis. This was tremendously relieving news, but the doctors pointed out that she was still extremely and critically sick and that there was a long way to go for her to be "out of the woods." When the bowel is perforated, the contents of the bowel leak into the gut, resulting in systemic infection that enters the blood and sends the entire body into a reactive shock state. The body tries to protect itself by shutting down cells, etc. The surgeons informed us that they were able to clean out the infection or treat it with antibiotics (about four of them), but that the body continues to have the reaction even after the threat of the infection is gone. This is extremely dangerous because the body is then fighting and damaging itself even though there is no real reason to do so anymore.

The doctors are unsure what caused the perforation in her bowel. They said it was star-shaped rather than a slit, suggesting that it burst rather than being cut. There are many possibilities of why this may have occurred, including that there may have been some scar tissue on the bowel from a previous surgery that weakened it or that the pressure in her abdomen burst the bowel at a weak spot. During the surgery they cut out the perforated portion and three other sections that were dark or gray, for a total of about 24 inches of the 27ish feet of intestine. They left the intestine in three separate sections, which will remain disconnected until she is more stabilized. They won't put them together until she is more stable because otherwise the connections would not heal and would result in a greater risk of infection.

The surgeons also informed us that they will be keeping her abdomen open (They put towels in the cavity and cover it with a shrink-wrap type bandage that they call a vac-pac.). This allows them to take her in repeatedly for additional surgeries or to clean out additional infection that may arise without having to cut her back open every time.

Heather also has ugly red blotches that are bleeding and blistering on her legs. They cover nearly all the skin from just below her waist to her knees. The skin is dead or seriously injured in these areas from toxins secreted from the bacteria or from tiny clots in her capillaries. It is probably the most visually disturbing result of this whole process, but the doctors see it as a low priority for her recovery.

One of the effects of the sepsis is that the cells and connections between them become porous, causing them to leak everywhere. To compensate for this the doctors have pumped massive amounts of fluids into her body (multiple liters each hour). As a result she has become incredibly bloated. It appears as though she has gained over 200 pounds and is pregnant as well. Her face is not recognizable.

So, since Sunday the doctors have been working feverishly to maintain her body and organs, until this reactive process turns itself around. This includes significant medications and observation of all her major organs to make sure they are not failing or functioning improperly. Her situation has been extremely serious (eg., On Tuesday, one of the ICU doctors said, "To be honest, yesterday I wasn't sure that we were going to be able to stay ahead of it.").

Slowly, slowly Heather has been improving ever since. The doctors seem much more optimistic today (10/08). She still has a long, long way to go, but she seems to be either holding steady or improving in every way.