Last week father was hospitalized for a carbuncle surgery. Until last week, I had never heard of carbuncle before. A carbuncle is a red painful cluster of boils that are connected to each other under the skin. Dad’s carbuncle was the size of a palm located on his spine. The doctor said that management of the carbuncle by antibiotic was no longer good enough. Dad required surgery to clean the carbuncle and remove the pus and abscess. Only then will the wound start to heal.
Though the carbuncle surgery was simple by itself and did not pose any complication, the general anesthesia (GA) that is required for the operation made the operation risky for him because of his age. There was a risk that he may not wake up from the GA.
We had no choice but to sign the consent sign despite knowing the risk because not doing the surgery was not an option since there was a risk of sepsis (blood poisoning should the infection spread to the blood stream) which is a life threatening medical condition.
On the day of the operation we gathered at the waiting room as dad was wheeled into the operating theater to get him ready for the surgery. However after about an hour a doctor came out to inform us that the surgery could not be done. The reason was because while preparing him for the surgery, they discovered that dad had a total heart block. So we went back to the ward and waited all day and the next for the cardiologist to come and explain to us what that meant.
The cardiologist explained that a total heart block meant that there is a problem with the heart’s electrical pulses which causes the heart to beat more slowly. Dad’s heart rate is around 40 beats per minute. Wikipedia defines heart block as follows “A heart block is a disease in the electrical system of the heart. This is opposed to coronary artery disease, which is disease of the blood vessels of the heart.” The doctor likened this to a house with water and electricity supply and it is the electricity supply that is disrupted, not the water.
That is why they could not do the surgery by GA as it may cause the heart to stop beating altogether. The cardiologist consulted with the team in charge of the carbuncle surgery to discuss whether doing the carbuncle surgery using local anesthesia was possible but it was ruled out. So a temporary pace maker was suggested. The cardiologist was however concerned that the pacemaker wires would get dislodged and therefore fail to do the task it was meant to do when dad was turned around for the surgery since the carbuncle was on his back. He expressed this to the other team of doctors who said that dad would be turned on the side.
Why a temporary pace maker? About two years ago, a doctor raised the possibility of having a permanent pace maker installed when dad’s slow heart rate was discovered. However, we were told that having one installed would not be of benefit to him. The reason is because dad is bed ridden. To a person who is walking about doing normal activities, having a permanent pacer would be beneficial because even standing up may cause dizziness due to the slow heart rate. However, dad is mostly either sitting or lying down. Having the pacer installed may require extra care and management and we were informed that in that sense it may not be of much benefit to him.
So, dad was installed with a temporary pacemaker for the operation. This procedure took about 15 minutes after which dad was wheeled back to the ward to wait for the carbuncle surgery. During that wait, dad was not supposed to move his right leg at all in case the wires get dislodged. (His left leg and hand is paralyzed from a previous stroke)
Apart from the fear of the wires getting dislodged, there was a risk that once the temporary pace maker was removed, the heart would “throw a tantrum” and the heart rate would slow down even more because the heart has gotten used to the newer rate as set by the pacer and the longer the temp pacemaker is in place, the higher this risk.
Eventually, dad had the carbuncle surgery and the temporary pace maker was removed. Dad had trouble passing urine after the surgery so a catheter had to be put in place. This was in addition to the stoma (a surgically created opening on the abdomen which allows stool to exit the body), the fresh wound from the carbuncle surgery and the removal site of the temporary pacemaker plus the many injections dad had to receive antibiotics intravenously. Dad was in a lot of pain. Poor dad.
Dad vomited a few times of the second day after the surgery, he also had a fever. Thankfully, the fever cleared and the vomiting went away and dad was discharged. The doctors said we have to manage the wound dressing for the carbuncle surgery site ourselves because allowing him to stay on in hospital increases the risk of infection for the elderly and those with low immunity. The wound would have to be dressed daily for 6 months and hopefully it heals nicely without any infection.
Dad is now back in 2nd sister’s house where he stays. We have engaged a professional nurse to do the daily dressing for the time being. Thank you God for keeping dad safe. Thank you to all the doctors and nurses who attended to dad during his hospital stay. Thank you to sister in law who took turns to look after dad too. Thank you to all those who prayed for dad’s well being.
What a week it has been. Fortunately the kids were on a one week school break so I could take my turn to sit with dad at the hospital.
We are glad that dad has gotten through the surgery which was a high risk surgery for him due to his age and because of the complications of the heart and the GA and temporary pacemaker in place. On another brighter note, it has been a while now that dad seems much better mentally. It appears as though he has recovered a lot from his stroke related dementia and is able to converse with and recognize us most of the time now.