From Chapter One
It’s been a worrying day, but Cliff is elated when he hears the good news at one o’clock in the morning. Judy has come through her emergency surgery successfully. His broad smile beams his relief to Fran, who has been keeping him company, that someone has finally rid Judy of her terrible pain. She will return to him. Things will go back to normal. He and Fran chatter about what has happened and reassure themselves that Judy won’t miss such a small piece of bowel, after all the bowel is extremely long. The only thing that now concerns Cliff is what to tell the children in the morning before they leave for school. Fran suggests saying that the surgeon removed her appendix. That should be light enough not to frighten them. He agrees. And he knows Judy would agree too.
The days slip by as Judy seems to heal, a Penrose drain attached to a noisy pump speeding up the process by suctioning fluid and infection from her abdomen. But she starts to feel the old pain again, on top of the post-surgical pain. Worse, large amounts of cells and pus start flowing out of her drain. The surgeons discuss this worrying turn. Perhaps the sutures tying the two ends of her bowel together have come apart, causing the bowel contents to leak out into her abdominal cavity and on out through the drain.
A new surgeon examines Judy on September 28th, one who knows more about operating on the intestines than the first guy. She is moaning and semi-conscious from the pain, and Dr. Michael O’Dwyer decides to X-ray her the next day and re-operate. He has the staff inform Cliff.
The X-ray reveals a scary story: her intestines are paralysed. They are not working. They wheel Judy back into the operating room on September 30th. O’Dwyer slices her skin, revealing a nice pink peritoneum. So far things look normal. He slices through the covering over the intestines, and shock halts his hand. Fecal-stained and bloody fluid has flooded her insides from her diaphragm to her pelvis. He touches the small bowel gingerly, now grey-white in colour, not its usual red. It falls apart. Frowning, he looks at the gall bladder. Its wall is necrotic, and bile has stained it and has spilled onto the stomach, the duodenum, and the liver. He notices a number of yellow-grey patches on the liver surface and later as the surgery continues that they are increasing. Wondering how and where the blood flow has stopped, he feels the pulse of first the superior mesenteric artery, the main source of blood supply for the bowels. Nothing. Then he feels the celiac artery. Nothing. The hepatic artery. Nothing. The splenic artery. Again, no pulse. Hesitantly he checks the aorta. It is pulsing away. Relief. Next he examines the colon, the large part of the bowel, and tries to mobilize it. But here too gangrene has set in. He absorbs this information. From the fourth portion of her duodenum all the way down to the cecum, her bowels are dead and her omentum, the fat that sits underneath the stomach, is grey green, lifeless. The contents spilling out of her bowels and the dead tissue have created a rampant infection inside her abdomen. She’s finished.
Still, something moves him to believe that life is possible and not to stitch her back up with autopsy stitches and send her back to her room to die.
With his scalpel, he swiftly excises 32 feet of dead bowel from the third portion of the duodenum to just above the rectum, as well as the gall bladder. He ties off the cystic artery just in case blood flow returns and it starts to bleed. He hunts for the clot that has created this mess and finds it in the superior mesenteric vein — with blood unable to flow out of the digestive system, it had backed up into the arteries. Eventually, circulation had stopped altogether. That’s how the gangrene set in. He puts in a one-inch Penrose drain, attempts to stitch together the two far-apart stumps of bowel, stitches her wound up, and sends her to Recovery. Now for the hard part.
“We found a previously healthy bowel grey and friable,” he explains to Cliff later in Judy’s room so that both can hear the news in person, not over the impersonal phone. Judy seems comatose. “We had to excise her intestines from the duodenum down to her descending colon. Unfortunately, Mr. Taylor your wife cannot live without bowels. We will of course keep her comfortable.” Cliff reels. Judy cannot die. This crisis is all supposed to be over.