I arrived in Lois’ room at 6:15 this morning and the surgical team of residents came in at 6:35 this morning. Here’s what we learned:

• yesterday they did a culture from the abdominal drainage tube and there was no infection.

• The PeT Scan to check for other problem areas where the carcinoma might be growing will be delayed for several weeks because they don’t want to risk getting a false reading due to everything that was done during this recent surgery. The resident thought it might happen in a month.

• Lois will have a Cystogram where dye will be sent to her bladder via the catheter and then x-rays will be taken to see how the bladder is functioning. They are especially looking for any possible leakage where the bladder was repaired where the carcinoma was attached.

• The surgeon, Dr Wilkinson, should be in later.

• If her bowels move today there is a good possibility Lois will be able to go home Wednesday.

Yesterday Lois rested a lot. Getting used to the oral pain meds will take some time. She did walk an extended route four times yesterday. Because of the holiday, there were some split shifts and the man pain med Lois should’ve had at noon was two hours late. It took some time to get ahead of the pain following that. That occurred just Kari and Joy and their families stopped in before heading home and I wasn’t paying attention to time.

Lois was able to eat some more yesterday and then dealt with the sensations of the digestive system dealing with solid food. She didn’t get nauseated but sure felt queasy for a while.

We had a number of visitors yesterday and that was appreciated.

Several people have emailed and called concerned about how I’m doing and my answer is, “I’m doing as well as can be expected.” This has all been a shock and there are so many unknowns that its very frustrating. In many ways I’m responding to this crises the same way I respond to others even thought its very personal. I’ve been staying at a local hotel that offers special rates for families of those hospitalized. It’s a room with two beds and Peter had stayed with me many nights. I’m quite sure Joy, Peter and Kari are in collusion to make sure one of them is here all the time. They’re adults so I can’t really tell them what to do but I am concerned about their lives and families and jobs.

Monday, May 26

It’s 1 pm. Lois is sitting in the chair after a walk and is comfortable. If she complains about anything its discomfort in her lower back. We’re not sure if that’s because she’s spending so much time on her back or because of the surgery.

We’ve had a busy morning. Lois’ sister, Mary, who arrived Saturday, visited until 10 this morning and then left for her 4 hour drive home. Shirley Will and her Dad stopped by, and Joy and Tony and Kari and Jeremy along with all the kids spent about an hour taking turns in Lois’ room before they headed home. (They stayed at a local hotel this weekend and let the kids enjoy the pool. Tony and Jeremy took major responsibility for the kids.) Peter is probably arriving this afternoon.

Somehow during all the commotion, the Nursing Assistant helped Lois take her first shower since Wednesday and that helped her feel a lot better.

Yesterday we started doing all her meds by mouth except the IV antibiotic which they tell us she’ll be on for seven days following surgery. The pain medication works better when it goes through ordinary metabolism, but sometimes Lois feels a little queasy after taking it although she has not been nauseated. She usually falls asleep for about 20 min within 20 min of taking pain meds and is then awake and able to carry on conversation until the next round in four hours.

The drainage tube discharge and urine output continue to be encouraging. Vitals are good although they are now becoming concerned about blood pressure running 155-165 over 55-65. The systolic number is higher than optimum. No fever but they continue to push a bag of IV antibiotic every five -six hours.

Lois just finished a small container of ice cream and has talked about asking for a grilled cheese. Food is beginning to sound good again and that’s a good thing.

That’s the news for now. If we learn anything significant, I’ll post again.

It’s 6:45 am and I’m sitting with Lois waiting for the Drs to show up. It’s a holiday weekend and even the nurses don’t know what to expect.

Yesterday was Day Two following surgery. Many of you know that Days Two and Three are much tougher than the first day after a major operation. Lois did OK most of the day but as the afternoon and early wore on, the pain level increased. Her last injection of pain medication was at 6:30 am yesterday. They are giving her tylenol with codine when she asks for it (or as often as its allowed) and she also has a morphine pump which she uses each time she moves from the bed to the chair or goes for a walk, etc.

In spite of the discomfort Lois pushed herself to walk five times yesterday. Each time she added to distance until the pain level came up last night. The final “walk” before she went to sleep for the night was mostly standing by the bed walking in place. We were able to get her comfortable laying on her left side and she says she slept well.

The resident for the surgical team just stopped by. The incision is looking good and they will write diet orders to “advance as tolerated” which means Lois can begin to eat more. The Drs are encouraged by the increasing urine output and the color of the drainage tube discharge which has gone from very dark to a light pink. I was given permission to walk her as much as she can tolerate and I can help her move from the bed to the chair anytime.

The Dr also will be taking her off the “morphine pump” and changing to pain medication by mouth which does a much better job of managing pain because its processed through the digestive tract. (Some of you know that pain medication injected through the IV only lasts for a little while since its not metabolized but just washes through the system and is quickly collection by the kidneys.)

Lois’ sister, Mary, from Minnesota drove in yesterday and will be staying through Monday. Cheryl came from Martinsburg and our family is still here.

Psalm 121 from The Message

I look up to the mountains; does my strength come from mountains?
No, my strength comes from God, who made heaven, and earth, and mountains.
He won’t let you stumble, your Guardian God won’t fall asleep.
Not on your life! Israel’s Guardian will never doze or sleep.
God’s your Guardian, right at your side to protect you—
Shielding you from sunstroke, sheltering you from moonstroke.
God guards you from every evil, he guards your very life.
He guards you when you leave and when you return,
he guards you now, he guards you always.

Its 7:45 am. and Lois is resting after rounds – five different Drs have been in to see her and they removed the dressing from the incision. All the staples are holding and there is no visible infection at the incision site! She says she got some rest during the night, but there were lots of interruptions for labs, changing IV bags, emptying the drainage tube receptacle, and checking urine output.

Still nothing by mouth except ice chips. We are still waiting for the bowel to wake up so she can start a liquid diet. They are pushing extra sodium and potassium; giving pepcid to keep down stomach acid, and she gets an IV antibiotic every six hours. She says she doesn’t have a lot of pain – still staying ahead of the curve. Oxygen level is less than optimum so they have the minimum amount running. The Surgical team thinks the urine is looking better but they are still a little concerned about the amount of output so there will be another increase in IV fluids.

Lois has a great attitude toward everything and is pushing the nursing assistants to get her up – yesterday she walked to the nurse’s station twice and sat in the chair three different times.

Kari and Jeremy brought Sarah (20 mo) yesterday and she sat next to her BaBa in the bed. Joy and Tony brought Brently (2 mo) and he enjoyed laying at the foot of the bed. Joy and Tony’s older boys are also up here but only Brady (6 in August) came in to hug BaBa. Peter has been staying with me but will probably go back home this afternoon to be at church tonight and tomorrow.

Several comments have been made asking if we believe God could do a miracle and the answer is a resounding, YES! Here’s our understanding of Scripture:

From the opening of The Story in Genesis it is plain that our God is a God of miracles. He reveals Himself to the Israelites when the waters of the Red Sea part for them to cross on dry ground. Every 8 yr old in Israel could tell the story but it was and is a story about God. God parted the waters. God provided the manna. God brought down the walls of Jericho. God. And the theme is continued throughout the Old Testament. Did the people of Israel deserve those miracles? No. They were/are a sinful, rebellious people who over and over again reject God and turn to selfish, idolatrous ways.

In the New Testament, Jesus is insistent that the miracles He does are not to bring attention to himself but to His Father who sent him. We often wonder about all the miracles Jesus undoubtably did that we know nothing about because Jesus modeled perfectly what it means to honor and glorify the Father

Think of the stories which surround each miracle. In each one we learn how desperate the situation is and then, unexpectedly, God steps in. And God the Father is praised and exalted because this life is all about God not about us.

I’ve shared all this so that you’ll have a better understanding that our family believes this is all about God. Not about Lois or me or any of us as individuals. We don’t deserve anything from God and have done nothing to merit His favor.

Do we ask for a miracle? Yes – if it is His will. But we will continue to be humbly obedient and steadfast in striving to walk in the way so wonderfully laid out in the Word no matter what happens.

In many ways, Lois and I have already experienced so many miracles that we are amazed at God’s work. He has given us three children who have grown into capable, thoughtful adults who are living in an understanding of the Word. Our daughters have brought two men into our family who we love as if they are our own sons. We have five incredible grandchildren who bring laughter and hope for another generation of committed Christ-followers. These are miracles we see and live with every day. That gives us great hope for yet other miracles but only if the attention, adoration, glory and honor are directed to our God.

Lois is sitting up in a chair right now. The medication (and prayer) is doing a great job staying ahead of the pain. She is quite drowsy but will wake up and carry on very lucid conversations.

The abdominal drainage tube is working so well that the collection bag has to be emptied every couple of hours.

They’ve reduced the amount of oxygen and expect to wean her off that by the end of the day.

The only thing Lois can have by mouth are a few ice chips. In order to keep electrolytes in balance, they just hung a bag of Potassium Chloride along with a pretty aggressive antibiotic.

There is some concern about urine output – its borderline the past 8 hours – so the Dr has ordered extra fluid. We are all watching carefully for signs of leakage or infection where the bladder was repaired.

Last night Lois and I had an hour to talk and pray together. Words fail to express our appreciation for all your prayers, calls, emails, and visits – both for us and the whole family. We’re amazed at the outpouring of love and concern.

This morning we learned that the Dr ruled out an epidural for pain management following the surgery due to the fever which they can’t get to stay below 100. That means we’ll be using narcotics to control pain and they will make Lois very sleepy most of the time for the next couple of days.

I was able to stay with Lois in pre-op until they took her into surgery. Joy and Kari each had a turn with us as well. The surgery started late due to the epidural decisions and another surgery running late so they didn’t actually start the procedure until 1 pm. They finished up about 5:45 and then Lois was in recovery for 90 minutes. Lois was out of recovery and back in the room she left this morning by 8:30 pm. I’m writing this from her room while at the same time, reminding her that she can push the button for more pain medication every six minutes.

The surgeon spoke to us at 6 pm and this is what we learned:

• The mass in and around the cecum was larger than anticipated but they could’ve opened her up and found her full of cancer. That was not the case. They removed the large tumor/mass along with about 2 feet of large intestine.
• The surgeon was able to reattach the large and small intestines and no colostomy was required.
• The mass had tentacles which reached her pelvic region and involved much of her right ovary so they removed that ovary and the right fallopian tube.
• The mass had also attacked the bladder so they took part of the bladder and repaired the hole.
• There was no mass in the pelvic area, however there was some fluid collection and they inserted a drainage tube at that site.
• All the lymph nodes in the abdomen looked inflamed and they were removed.

Possible complications

• A leak or infection in the bowel where they reattached the small and large intestine.
• A leak or infection in the repaired bladder.
• Infection at the incision which is 12 inches long and runs vertically from just below the sternum.
• The fluid in the pelvic region did not explain the fever. That is still somewhat of a mystery and will be the cause of a lot more tests. . . .

What we have to look forward to:

• Seven days in the hospital – the first couple of days will be mostly pain management.
• 6-8 weeks at home to heal and work with the oncology team on possible plans to tackle the carcinoma in the liver. (The surgeon did visually inspect the liver but didn’t touch it. He could see the larger of the three tumors and one small tumor.)
• Chemo and/or radiation to attempt to reduce the size of the tumors in the liver.
• A PET scan to try to determine the status of a very suspicious but small spot on the lower lobe of the right lung.
• Possible surgery on the liver (but not for 4-6 months).

The family’s priorities:

Managing pain. Although Lois did not complain of any pain prior to the “flu” on Sunday, she will have pain now – not only during recovery from the incision, but from all that has been moved around and removed from her abdomen. They also suspect that taking out the mass in and around the cecum was kind of like hitting a bee hive with a baseball bat and hoping that the hive hanging on the next limb won’t be upset. In other words, they’ve prepared us for the possibility that the tumors in the liver could become aggressive.

Quality of life. We’ll put a lot of effort into making certain every day includes family, laughter, and grandchildren. We’ll make as many memories as possible. Lois will continue to fully participate in decisions regarding her care and we’ll vigorously protect her dignity. We will not withhold any information from her and she will make as many decisions as she wants to make. We will not sacrifice quality of life for future unknowns.

Plans for dealing with the carcinoma in the liver. We will work with an oncology team to determine the best method for dealing with the cancer in the liver without sacrificing quality of life or causing unreasonable pain. We recognize the risks associated with the reality that all the blood in the body continuously passes through the liver which is full of cancer.

This is probably more information that most of you want to know so I’ll close with this: Lois is in good humor, her color is good considering what she’s been through, and she is drifting in and out of sleep. She is responding to simple questions and says she isn’t in pain.

As of 10 pm CST on Wednesday, we are still waiting on the pathology reports from the biopsies taken yesterday. However we have learned a lot from the battery of tests. Here are the bullet points which may differ slightly from what some of you have heard if you called today because the chief surgeon came in and talked with us this evening. He was able to pull a lot of pieces together:

• There are multiple tumors and/or masses which are all attributed to the large mass around the cecum. (The cecum is the junction where the small and large intestines meet and where the appendix is located.)
• The mass at the cecum is both inside and outside the colon.
• There is a collection of fluid in the pelvis which is most likely fluid from the mass. Or there is a possibility that its another mass. At first they referred to this as an abscess but they are reluctant to use that term now after further study of the CT Scan.
• There are three tumors in Lois’ liver. One of those tumors is in the middle of the liver and has doubled the size of the liver. There are two other smaller tumors on either side of the larger one.
• Surgery is scheduled for Thursday at 10:45 and is expected to last 4-5 hours plus one hour of prep and at least one hour in recovery.
• For this surgery, they will deal only with the mass in and around the cecum and the fluid/mass in the pelvic area.
• Although they expect to send Lois back to her same room, there is a good possibility that she will go to Surgical Intensive Care.
• The surgeon is quite confident that he can reattach the small and large intestines but there is some possibility of a colostomy.
• Post-operative care in the hospital is expected to last seven days.

By dealing with the mass at the colon and in the pelvis, the medical team feels Lois will be able to heal from this surgery and prepare to start Chemo in 6-8 weeks. They want to try to shrink the tumors in the liver to a size where surgery is an option. Right now the tumors are too large to even consider surgery at the liver.

I’m writing this from a hospital room at the University Hospital in Iowa City where my wife is a patient. We would appreciate prayer.

At midnight Sunday morning, Lois woke up very chilled and having cramps in her stomach. We thought it was the flu as several family members (including me) have had the 24 hour variety in the past week. Lois did have a high temp of 102 which we could get down to 99 with Tylenol every four hours. Monday afternoon she was no better and Joy called her good friend, Reagan, who is a Doctor and described the symptoms. Reagan advised us to go to the emergency room.

The local emergency room did some initial blood work and hit the panic button. Lois was severely anemic, her white count was quite high, her liver functions were poor and, the cause of the panic, her hemoglobin was at 5 (normal is 12 and they start giving transfusions if the number is lower than 8). The obvious conclusion was that she was losing blood from her G.I. tract but a stool sample showed nothing.

Giving a unit of blood is the best way to get the hemoglobin up but transfusions are a big deal in rural hospitals. After consultation, we decided University Hospital was the best choice.

We arrived in Iowa City by 8 pm. Monday night. The E.R did a lot of tests and agreed Lois needed blood and admitted her. They also decided on a course of action so during the night they not only gave her one unit of blood, they had her drink “Go Lightly,” the wonderful stuff to prep for upper and lower G.I. scopes.

Everyone is very concerned about where she is losing blood. Since 7:30 am there have been 5 different Dr’s in here asking mostly the same questions. Right now we are waiting for another set of x-rays and at any time they could come and get her for the upper and lower G.I. scopes.

They just took her temp and she continues to have a fever – 102 right now and they’re giving her Tylenol.

Tomorrow should be a day of making decisions.