Sunday, May 17, 2009

STI: Live to fight another day

May 17, 2009

Live to fight another day

No one promised life would be easy and I intend to treat every setback as a challenge

By Lee Wei Ling 


At about 5am on Jan 25, I woke up because of a vivid dream.


I had dreamt that I had signed up for a commando course. To get to the place where the course was being conducted, I had to climb down an almost vertical cliff with no proper path or steps. I stared down the cliff and wondered how others who had signed up for the course would get down safely. At that point, I woke up and found myself in Singapore General Hospital. My ileostomy bag was almost full.


An ileostomy is an opening in the abdominal wall, from which the contents of the small intestine can trickle or pour out unpredictably. The intestinal content is faecal-like. Hence the need for an ileostomy bag.


Fortunately I had not turned to lie on my left, my preferred sleeping position but also where my ileostomy was. Hence the semi-fluid, smelly contents of the ileostomy bag had not leaked. I changed the bag and pressed the bell to get the nurse to clear away the mess.


The preceding day, I was not so lucky. There was a leakage.�I have highly skilled nurses looking after me in SGH. They took meticulous care in changing the wafer. The wafer is the base to which the ileostomy bag is attached. Changing the wafer is a tedious process that can take up to 30 minutes. Despite the excellent care of the nurses, the wafer often caused severe itching.


The background to my surgical problems in January was that I had a small perforation in my ileum or small intestine, where it joined the colon. Intestinal content contaminated my peritoneal cavity, or the space lined by peritoneum inside the abdomen. I had an operation to repair the perforation and clean up the peritoneal cavity. It was necessary to bring my small intestine out through the abdominal wall as an ileostomy, while we waited for the swelling and inflammation of my gut and any scar tissue to settle before joining the ileum and colon.


Most of my dreams are illogical and not related to my real life. But this particular nightmare may indeed have been symbolic of what I knew I was in for. The probable scenarios were not pleasant, but I intended to treat whatever happens as a commando course - a challenge.


On April 14, I had the surgery to reconnect my ileum to my colon, and close the ileostomy. As my condition was not a straightforward one, the procedure was performed by a team of excellent senior surgeons as well as experienced anaesthetists. My personal physician was also in the operating theatre.


The surgery went well. The post-operative discomfort lasted a mere few days. I am still recovering and will take a few more weeks to recover fully.


In theory, I can then go back to normal life. But I have had so many medical and surgical complications before that I prefer to visualise the worst case scenario and hope for the best.


The potential problems that I may encounter in the future include intermittent intestinal obstruction with abdominal pain and vomiting which may evolve into perforation or gangrene of the gut. I may need further surgery, more of my gut may need to be resected. I may not have enough gut left to sustain my nutrition by eating and I may need to be fed through the vein. I may also end up needing a permanent ileostomy. There are several other rarer but no less unpleasant scenarios which may follow the present surgical adventure.


None of the above complications was within my surgeons' control when they operated on my already battle-scarred abdomen.�As I described my nightmare in my journal at 5am on Jan 25, I reminded myself that no one promised me life would be fair or devoid of suffering.


I stopped seeing patients during the period of my illness because of the potential social embarrassment which might occur with ileostomies. I continued with my administrative duties from my hospital room. I got to know many of the nurses personally and one day I will write a column about this group of dedicated, skilled and caring women. A short mention does not do them justice.


Fast-forward to this moment: It is three in the morning as I write, having been awoken because of coughing which caused pain at the site where the ileostomy had been closed. The operation had gone well, but I have a premonition that my troubles are not over yet.


But life must carry on. Worrying about potential complications which may occur a few months or many years down the road is a waste of energy. After all, no one knows tomorrow; no one even knows the next moment.


Granted, my next moment is more unpredictable than for most; I personally think that that is an advantage. It helps put life in perspective for me. What should be done and can be done now, I always try to do immediately. My game plan is to try to do my best within the constraints I live under.


Using boxing as an analogy, there will be times when I am knocked out, the referee counts to 10 and I cannot get up. I will crawl to the ringside, lick my wounds, haul myself up, recuperate and return to the ring another day. At some point, after a severe knockout, I will no longer be able to enter the ring again. But until then, I will keep trying until I have completed my duties, or at least as many of them as I can.


For now, I am looking forward to the end of the present ordeal. It has been an interesting though not particularly pleasant experience since Jan 8. But as my friend Gino once told me, 'what does not kill you will make you stronger'.


I think I have emerged psychologically more resilient just as I hope the present poor economy and the threat of a flu pandemic will force Generation Y to become tougher.


The writer is director of the National Neuroscience Institute.

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