I was to see a surgeon, Dr. M, for surgery on pancreatic cancer, and received my initial diagnosis in early February.
Dr. M has the cool demeanor of a typical surgeon, but also has a bit of a playful side. He explained to me in a truly cool surgeon way that it’s best to wait a few weeks between the last anticancer drugs treatment and the surgery so that the effects of the anticancer drugs will disappear, and that in my case, since the cancer is in the head of the pancreas, I will be undergoing a pancreaticoduodenectomy to remove the duodenum, pancreatic duct, gallbladder, and bile duct at the same time as the head of the pancreas. After that, he said with a smile that with this surgery, I won’t be able to eat delicious food for a few months after the surgery, so I should eat what I want now, and that it’s a good idea to gain weight before the surgery. The surgery was scheduled for February 29th, and I decided to follow Dr. M’s advice and travel with my wife in February, eat what I want, and then go to the surgery.
Apparently, a pancreaticoduodenectomy is one of the most difficult surgeons’ surgeries, and it usually takes about 8 hours. The pancreas is located behind the stomach and intestines, outside the peritoneum, so for this surgery, they would make a large incision from the solar plexus to the side of the navel, then cut open the front of the peritoneum and remove the duodenum, as well as the back of the peritoneum and remove the head of the pancreas. Just imagining cutting open the front of the body all the way to the back is frightening, and I was told in advance that the mortality rate due to surgical problems is about 2-3%. Also, when I watched a video of a YouTuber who had this surgery, I heard that before the surgery, a tube to inject medical morphine, which is used for postoperative pain relief, is inserted into the spine, which was very painful, and that the postoperative pain was also quite severe, so I was nervous and said goodbye to my wife in front of the operating room and headed for the surgery.
I lay down on the operating table and was told to bend my back as instructed, and when I did so, the doctor did some work on my back, but I hardly felt any pain. When I asked, “Have you finished inserting the tube into the spine?”, I was told that it was already done. “You’re very skilled,” I told him, and I was relieved to see that the first procedure, which I had heard would be extremely painful, had gone perfectly without any problems, but then the general anesthesia began and I lost consciousness completely.
When I woke up next, I was in a bed in the ICU. Dr. M and my wife were looking at me. I was told that they had removed all of the cancer from the pancreas, but that there was some cancer cell wrapped around the portal vein, a large vein about 1cm in diameter that runs near the pancreas, so they had to remove and suture part of the portal vein, which meant the operation took about 10 hours, which was longer than expected.
Perhaps because the anesthesia was working, I didn’t feel much pain and I lost consciousness again, but when I woke up next, I was bothered by the tubes all over my body and realized that it was difficult to turn over in bed. There were IV needles in both hands, two tubes in my stomach to drain pancreatic juice and ascites that had leaked into my body, and a tube in my ureter to drain urine. A tube was inserted into my back to administer medical morphine, and a tube was also coming out of my nose to drain the fluids that had accumulated in my stomach, and these tubes made it difficult for me to turn over in bed. However, I didn’t feel much pain and was awake in my ICU bed when a nurse came in and told me to try turning over in bed first, so I did, and then she asked me to try raising my upper body. Once I had somehow managed to sit up, she told me to get off the bed and walk. I had heard in a YouTuber’s video that patients start practicing walking the day after their surgery, so I thought this was it, and when I stood up and tried walking, I was able to walk surprisingly easily.
The YouTuber I saw said that even though she was told to walk the next day, she still couldn’t, so I thought that so far I was doing well. I walked around the ICU a few times and the nurse praised me for doing an amazing job, so I got carried away and started turning over in bed and sitting up repeatedly. It seemed that once I was able to walk in the ICU, I would be transferred to a general ward, so I was moved straight to the general ward. I met my wife, who was waiting for me there, and told her that it hadn’t hurt much and I’d been able to walk easily, but as we were talking the pain gradually got worse, and from then on I was reminded that post-surgery pain is no joke.
The most annoying thing was that the tube coming out from my stomach into my nose was irritating my throat. It was similar to the tube that had been inserted into my bile duct the previous time, but it seemed that my throat had been somewhat damaged by the thick tube that had been inserted into my trachea to ensure breathing during the 10-hour operation, and the tube from my stomach irritated my throat, causing me to frequently cough up phlegm. If I tried to cough to clear the phlegm, the cut after the operation would hurt like hot cakes, and even holding in a cough was painful in its own way. I couldn’t sleep properly at night because of the irritation in my throat, and every time I turned over in bed I had to fight with intense pain. I was told to walk every day, so I would get out of bed and walk about five meters to the bathroom to brush my teeth after meals, but just that required so much effort that I was out of breath. I was told it would be better for me to sit up and not lie down as much as possible, so I tried to keep my back upright as much as possible, but after 10 minutes it became too painful and I had to lie down.
The morphine injected into my back was set to dispense a fixed amount, but there was a button that the patient could press to increase the amount if the pain was too severe, so I pressed the button many times a day, but I still couldn’t bear the pain, so I asked the nurses to give me oral painkillers.
My wife came to the hospital almost every day, encouraging me to persevere, saying that this kind of pain would get better little by little every day, but the first few days were intense pain.
However, after a few days, the pain definitely decreased little by little, and at first I could only walk 5 meters to the bathroom, but after 3-4 days I was able to walk about 30 meters and weigh myself.
The most dramatic relief came about a week later, when the tube that went from my stomach to my nose and the tube that was inserted into my ureter were removed.
After that, I was able to walk around the ward several times and sleep soundly at night. As a result of daily rehabilitation, I had recovered enough to be able to walk 10,000 steps a day one week after the surgery and was even able to slowly do squats, and thanks to this, I was able to be discharged from the hospital on the 11th day, even though it would normally have to stay in the hospital for at least two weeks. My post-operative recovery was probably much quicker and easier than most people’s, but I still don’t want to experience the pain and difficulty of post-operative care again. My weight, which had risen to 81 kg before the surgery, had dropped to 75 kg by the time I was discharged, and for a while after I was discharged I was out of breath just walking, but this experience gave me a good idea of why elderly and frail cancer patients hesitate about whether to have surgery.