Waiting game. Again. I hate this game.

So, once again, Bob is a great, big ol' conundrum of issues . . . right now, someone needs to figure out if the excessive wound drainage/possible infection of the back incision is the priority, or is it the colorectal issues, and I'd hate to have that job, as we've seen countless times, decisions made about Bob's care, only to have them backfire due to unpredictable events . . . Still, I vote for the colorectal issues, based on what I've been observing over the past several weeks, and in talking with the stream of docs coming in and out of Bob's room today. He hasn't been able to eat much of anything at all, even on a "good" day, since the surgery, even the few days when he felt like he had somewhat of an appetite were quickly squelched by feeling so bloated and nauseous after just a few bites . . .

I told someone (maybe everyone?) that if one more dietician or nutritionist shows up in Bob's room, I'll have a fit. We know what he has to do. He knows it, more than anyone. He physically cannot do it. Let's figure out why.

Today, another x-ray was done on his abdomen and based on that, and the x-ray and CT scan done yesterday, we're told by the attending doctors that there's a bowel obstruction. Great! I think. Something concrete! Then I go and do the stupid, which is ask questions about the bowel obstruction. What is causing the obstruction, and where is it—y'know, that kind of stuff. . . we don't know, and we don't know are the answers we're given. So, what do you do about it? I ask. Right now, just wait a day or so, see if it corrects itself. Oh really? Like majick?!? Sounds like hoodoo to me, but at this point, I'm not entirely opposed to hoodoo. Funny, though . . . it hasn't corrected itself in the month that this has been going on, I say, I mean, it's not like this just happened yesterday. It's been ongoing since Bob's surgery. He has not been able to eat much at all for four weeks . . .

A PA from the orthopedic team comes up, takes a look at Bob's incision on his back, says doesn't look to terrible, don't think we'll have to reopen it and clean it again. Just let it drain on its own, get some antibiotics in, treat the suspected infection . . . Less than an hour later, a resident with the orthopedic team comes in, looks at the incision, says, Oh, that's draining a lot. We'll definitely need to go and open that up, clean it out, probably be sometime this afternoon—Doc Rockstar will have the final say—he should be up later today to take a look . . . . I've given up taking notes a long time ago, peeps.

In the meantime, I ask, since no one can make up their minds whether or not the incision is bad enough to re-do, how 'bout getting the colorectal team in here and assess the bowel situation? That, in my mind, is top priority, though we have yet to see anyone from that team. Bob hasn't been able to eat for a month, his nutrition status sucks, which affects his body's ability to heal in the incision site—we're told this over and over and over again—and I say over and over and over again, he physically cannot eat, hasn't been able to since the surgery over a month ago. That is not a recent development and it's no secret; it's gotten worse over the past few days, but his ability to eat without incredible discomfort has been with him since the surgery. I though it would be a given that they'd be involved already, but so far, by mid afternoon, we haven't seen anyone from colorectal. I call Bob's nurse in, ask her to please call for them. . .

A good friend of mine who works at the U (she's got insider knowledge—kinda the Deep Throat of the U—so I can't give her name or department, for fear of blowing her cover . . .), made a visit to Bob's room this afternoon. We went for a cup of coffee, she heard the latest, then made a call to the colorectal surgeon's office on our behalf, had his nurse get a message to him that he really needs to see Bob and give his two cents . . . momma was right—it's not what you know . . . I also place a call to Bob's primary doc, just to let him know Bob's back at the U, very sick, and maybe he could come act as general contractor for the holy mess going on again?!

In the meantime, Doc Rockstar, the orthopedic surgeon, shows up in Bob's room, hears what's going, on, says that based on what's he's seen, read, observed, consulted other teams on, etc. etc., they'll likely bring Bob back to OR, open him again, clean the incision, maybe employ the use of a wound vac (a device/treatment which I'm not going to attempt to explain other than that it's supposed to help heal a wound in areas that have proven difficult with other measures; check out the link), since the incision is in such a difficult spot to heal, for many reasons—the location, Bob's nutritional status, the blood thinners . . . . However, the wound vac is also not without its issues, so they'll have to assess the situation carefully. Another doc has been added to their team, a plastic surgeon whose specialty is pelvic surgeries and wound healing in these areas (evidently she works with a lot of patients, people who are paralyzed, for example, who have had complicated, difficult surgeries and subsequent issues with healing).

I ask if it's imperative that the incision be opened up right now, because in my opinion, the GI issues are more critical. He said he's already been consulting with the colorectal team, and agrees that those issues need to be addressed first. The incision isn't obviously, visibly infected, Bob is now on antibiotics, so he should (there's that should again . . . ) be safe for at least a few days . . .once again, I say, just for emphasis, that Bob's worse off now, a month post-surgery, than he was prior to it, if that's at all possible . . .

My insider friend calls me and says she learned from his nurse that the colorectal doc has been in surgery all day, a 10 hour job—10 measly hours?!?! CAKE walk, I say! Tell him to get his ass in here now, someone else can take over his job! (total joke, peeps). And, by the way, can anyone tell me why colorectal docs are so freakin' busy?!? Any time we've seen Bob's surgeon, dude's always in scrubs, either going to or coming from surgery. Then again, maybe I don't want to know. But I do know that I've never seen this doc in street clothes. Always scrubs. Which likely attests to the fact that abdominal surgery, no matter the duration, really effs (tryin' to clean it up, peeps) up the body.

He does make an appearance, at the end of the day (5-ish). Great doc, the colorectal dude. He listens intently, tells Bob it's good to see him again, but one of these days, he'd like to see him outside of a hospital bed. Tells Bob he's a ground-breaking patient, as the 10-hour patient he was working on in OR was someone who'd also had a heart attack just before a serious, necessary surgery, had to be postponed until they could figure out what to do. What they did to prepare Bob for his surgery was what was they ended up doing for that patient, the IV drip of Integrelin prior, aspirin throughout . . . unfortunate, that Bob had to be the sacrificial lamb for that procedure, I say. True, very true, he responds. Maybe they'll name a building after Bob when all this is over.

Anyhoo, after looking at the incision site, he says yes, it does appear to be infected somewhat, but that the GI issues are really what's causing serious issues right now. His take is that he really wants to wait to do anything drastic with Bob. That the CT and x-rays show a blockage of some kind—could be physical, stool, perhaps, that just can't pass because the bowels have yet to "wake up" from the surgery. Could be adhesions from surgery, that form within the bowels . . . he recommends IV nutrition as soon as possible, get some nutrients in Bob, as it's been too little, too long. Give it a day, hold off on all food/fluids by mouth, give the guts more recovery time, and see if the situation eases up on its own . . . worst case would be having to go in surgically to find out exactly what's causing the blockage and go from there. If the ortho team does need to go and open up Bob's surgical site again, he gives them his blessing to go ahead and do it, as it won't have any serious consequences on his GI issues . . .

I get it, I totally, completely, utterly get it, that Bob's a complex, complicated patient, with so many layers of issues to address, all often dependent on and affecting the others, oftentimes baffling the experts who have seen anything and everything. I know in my head, that there are no easy answers. Doesn't make watching him suffer any easier. Did I mention that all of this has gone on nearly a year now? Just tonight, Bob said to me, "If someone had told me, a year ago, that I'd be in this condition, I'd have told them they were nuts. Would never have believed it. A year ago, I was flying high . . . "

Few weeks out, marks that year-long milestone. An anniversary I don't care to celebrate.