Wednesday, March 17, 2010

The Fistula

My dad has been through a lot lately. He’s 86 years old and lives alone because he’s not ready to give up his independence just yet. But nature sometimes intervenes.

In November, he fell and broke his hip. This is the classic injury for older people that usually marks the inevitable transition from independent living to hospital, blood clot, stroke, and death, often in the space of just a few weeks or months.

The doctors told us that there are different kinds of hip fractures, and his was the least severe of them all. They put in a plate, a rod, some screws, and in no time he was back on his feet, hobbling around with the aid of a cane. My brother-in-law offered to get him one of those canes with the four feet on the end, but my dad scolded him, declaring “Those are for old people!”

And then, about three weeks ago, he collapsed in church and was rushed to the hospital. There, they discovered that he had an infected gall bladder. The gall bladder is a small organ about the size of a pear that dispenses bile (a digestive enzyme) through the bile duct to the stomach. Some people develop gallstones, which are similar to kidney stones. Usually, they’re harmless. But sometimes, a small gallstone will migrate into the bile duct and become lodged there, blocking the delivery of bile.

In the old days, the gall bladder would become infected, rupture, and you would die.

But the gall bladder isn’t necessary to survival. So modern surgical techniques enabled surgeons to remove the gall bladder and treat the infection with antibiotics. People who used to die now lived to a ripe old age. But if you’re already a ripe old age, like my father, surgeons aren’t very keen on performing such surgery, because the mortality rate jumps dramatically after 70.

So they have a new method, involving an endoscope. That’s a long tube with a little camera and a few tiny tools on the end that can be inserted down the throat. The doctors had some things they wanted to try, but first they wanted to get a look at the situation. When they got that camera down into my dad’s innards, they discovered something incredible.

The gall bladder rests against the small intestine. His body, somehow sensing the blockage of the bile duct, had spontaneously formed a passageway (called a “fistula”) between the gall bladder and the small intestine, enabling the collected bile to drain. Apparently, it’s an event so rare and mysterious that the entire medical staff was buzzing about it.

The doctors treated the infection with antibiotics, but my father wasn’t out of the woods. The formation of the fistula was new, raw and exposed to digestive acids. He was in severe pain, requiring large doses of morphine, which barely helped. After a few days, he was released from the hospital, and returned home. He stopped eating, because everything had to pass by the fistula, sending him into spasms of horrible abdominal pain. My sister thought he was fading fast, so I flew to St. Louis, expecting to stand watch at his bedside in his final hours.

By the time I got there, two weeks had passed since his release from the hospital. He looked healthy, cheerful and anxious to get out of the house. His appetite had returned with a vengeance, and when I took him out to lunch, he ate a roast beef sandwich half the size of his head and washed it down with a pint of Guinness. I don't want him to die, but it seems like he's running out of stuff that will kill him.


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