20220326 : peg tube replaced

Yesterday morning, one of my old physical rehab doctors - their head of the department actually, visited me in the morning.

He did a cursory assessment lifting each limb, pressing the various muscles and hopefully understood what he can only understand.

After all that, he told me that my PEG tube was looking very bad and I should get it replaced.

I thought about it. It seemed like a genuine advice.

The first time it was replaced after 14 months. Its already 16 months since, and it is looking bad.

I thought about it. I am already in the hospital. Yes I am recovering from pneumonia, but I am doing nothing else.

Besides, lungs are pulmonology department and stomach is gastro department. Shouldn't interfere much.

So I sent a message to his assistant to go ahead.

You can't change the pipe when the tank is full.

So yesterday night was the last feed. I was kept on empty stomach after with IV fluids only.

This morning they wheeled me down to the gastro procedure room. There are 4 of them actually and a common big recovery room.

It was very crowded this morning. Folks were running everywhere and shouting at one another regularly. 

I normally enjoy this. Just observing everyone and their expressions etc.

Not today. I had not been fed for a long time and had too much antibiotics running in my blood. I was tired. I just wanted to get it over with soon.

So I waited. I am assuming there was some token system. But I could not figure it out.

It just seemed like whichever attending person made the most noise got it first.

I was at a disadvantage. I couldn't make the required noise and my wife, I later learnt, was battling the morning traffic.

At one point, I overheard one of them coordinating with another seemingly authoritative nurse, saying "op first, ip can wait"

I am thinking, what logic! Shouldn't they give priority to in patients over outside patients!

I was in the queue for what seemed like ages! In the real clock, it must have been ~ 3 hrs.

Finally, it was my turn.

I heard them ask and confirm with the coordinator whether consent form was given for sedation and they said " yes"

I froze!

Somebody had come in the morning asking for consent and I thought it was consent for the procedure and I had asked my nurse to sign it .

They had permission to administer general anesthesia. 

With pneumonia, it would be fun to go under!

One of the doctors, who had done the procedure last year recognised me.

He declared I was very fussed last year and have to put the old style peg tube and needed to sedate me.

I had made a fuss last year. They had put the new style tube and I had kicked up a storm and they had to redo the procedure 2 days later to put the old style one.

Because the new style is much shorter, very different in operation and my nurse then had a said it was very inconvenient. I had figured, if she was struggling (a reasonably qualified and experienced nurse), it would be the same story with all other home care nurses.

So I had kicked up a fuss and got it changed.

I didn't think it would come back to haunt me.

After speaking with each other, he turned to me and asked if my wife was outside. I indicated no.

Then he said to me, "sir the new style is much better and it is a easier procedure. The one you want is a longer procedure and we have to do an endoscopic insertion and will give me anesthesia. Which one do you want?"

Two thoughts came to mind.

1 - the two departments didn't speak with each other, otherwise they would have known my lung condition and pose that question. That's scary!

2 - I am like an addict for the anesthesia experience. I was wanting my fix for a while. If I indicated "old", they would do it. They had the signed consent form. I could experience turning off the world and everything for sometime.

But I was very tired by now and just wanted to get it over with. Rational mind prevailed.

However, changing my mind completely without apparent reason and I can't say why - would throw them into a doubtful spin.

I assessed the risk. Them given the choice, I knew which side they leaned - it was a busy morning. They would want to get rid of me quickly.

So I gambled. I indicated "anything".

I think they were relieved.

They took my bed in - they said no need to be shifted to the procedure table for this type.

One guy inserted what they referred to as "guide wire" through the existing peg tube. Its a thinner version of a brake cable.

 At some stage I flinched.

 It touched the stomach. He didn't stop. Pushed it further for what seemed like 3-4 inches further.

The other held it firmly in place and said "sir, there will be a little bit of pain now. We have to take the tube out"

I nodded "ok".

 In my head it was "oooooooooooooooookay"

Then I was expecting some complex instrument and process.

He just yanked it out. With his hand..

He didn't look like Arnold Schwarzenegger. Nor did he use his leg for counter pressure.

Anyone of us could have done it anyday carelessly. Scary! 

There would be with a hole open in the stomach. Reminded me of Jim Carrey in the Mask .

They took it off, held the guide wire all along, wiped whatever juices came out, inserted the new tube through the guide wire, applied betadene, applied some gel on the part that had to go in, pushed it in, injected 10 ml to inflate some baloon, put some gauze and tape and said done.

I think the actual procedure was 3 minutes.

They asked me I was ok.

I showed a thumbs up.

In my head I was screaming "I am cheated! I Waited 3 hours for 3 minutes of entertainment! I am disappointed! I want a refund!"

But they took me out.

After 30 minutes of even more frustrating wait, I was brought to the room.

In the world of peg tubees, I have acquired a shiny flashy new car today...