In 2003, I was told the pediatric neurosurgeon who had done my previous surgeries had moved to adult hydrocephalus and wasn't available. I was given a new surgeon, we'll call him Dr. S.
In the Spring of 2009, I had survived student teaching in art education the previous year (2008). I was getting ready to graduate in May.
Of course, six weeks away from graduation...My shunt decided to stop working at the worst possible moment.
On the morning of April 7, 2009 - I woke up to my shunt obstructed. I was vomiting everywhere, stumbled around as I was unable to walk and my head tilted to the right as cerebral spinal fluid filled up inside my skull. This also causes an incredible amount of pain because of the intracranial pressure inside the skull.
I was 27 and as an adult, I had a little more control over my body. I could get dressed and walk a little. With previous surgeries as a child, I would have to be carried into the hospital.
I was taken to the ER at the hospital I had always gone to. However, upon arrival I was told my doctor Dr. S wasn't there and someone else would have to do my shunt revision. Dr. RH was assigned to my case.
As I may have mentioned before, a vp shunt are different parts to it. For example there is the valve, the ventricular catheter and the distal catheter that runs down the side of my neck into my stomach. See picture here
I arrived at the ER early in the morning. One person came to put an IV in my hand. Several attempts were made and the person wasn't successful. The needle was dropped on the floor and they left and never returned. Hours later, I was then moved to a private room in late afternoon. I was dehydrated having not fluids in my system for over 10 hours. I was also in a lot of pain. I was wheeled in to the Operating Room fully awake with no IV in my left hand. My shunt is on the right side.
There was a debate about where to put the IV. I had suggested the left hand and was told:
"The vain in busted and we can't use that one."
I suggested my right hand.
"No we can't do that because the side your shunt is on. Maybe we can put it in your left foot.''
I was horrified by this suggestion.
Putting it in my neck wasn't an option either. I had IV's placed in my neck when I was a baby. This wasn't done again as I got older.
Then someone said:
"What about the wrist?"
Again, I was horrified by this suggestion. I had no choice though....
An IV needle was inserted into my left wrist. In my right hand, I was squeezing the hand of someone in the room as it was very painful.
Then I fainted.
Before surgery, the anesthesiologist is suppose to see you and ask you to open your mouth this way they can properly measure what size intubation tube to use.
I never saw anesthesiologist before going into the OR.
The intubation tube used on me was too large.
In my previous surgeries the only side of my head that is shaved is the side they are working on. For example, my shunt is on the right side of my brain and only that side of my head is shaved. See previous surgeries.
Pay attention to the following Operative Report:
Procedure Date: 4/7/2009
Preoperative Diagnosis:Ventriculoperitoneal shunt failure with hydrocephalus
Postoperative Diagnosis: Ventriculoperitoneal shunt failure with hydrocephalus
Operation:
Right Sided Proximal revision of vetriculoperitoneal shunt
Anesthesia: General
Estimated Blood Loss: Minimal
Complications: None
Indication for Surgery:
This is a patient who underwent shunt placement a long time ago and now presented with headaches. She had a CT scan that shows clear increase in the size of the ventricles as compared to previous imaging studies. Therefore, a decision was made to offer revision of the shunt system.
PROCEDURE:
The patient was brought into the operating room and was intubated and anesthetized by anesthesia. She was positioned on the operating room in supine position, and the patient's right side of the head was shaved and the left side as well, the right side of the neck was shaved and then prepped and draped down to the abdominal area.
There were two scalp incisions, 1 on the right side, 1 on the left side, and the bur hole had been placed in the left side. Both incisions were opened, and the shunt system was identified. The proximal part was disconnected, and there was no spinal fluid flow of the proximal catheter. The distal runoff was fine and therefore, the decision was made to keep the distal part of the catheter in place and replace the proximal aspect. The ventricular cathether was removed carefully, and the new ventricular catheter was placed through the same hole and it was then connected to the valve.
Before connecting it to the valve, there was clear CSF flow out of the ventricular cathether. The connection was then secured with Vicryl sutures, and the area was irrigated with antibiotic solution.
Again, it was closed using 2-0 Vicryl sutures. The skin was closed using running nylon sutures. The area was then irrigated with antibiotic solution. The patient was extubated and brought to the recovery room in stable condition. Preoperatively, the patient received 1 gram of Ancef, and a verbal order was given to continue this for 24 hours after surgery. A verbal order was also given to start DVT prohylaxis with low molecular weight herparin within 24 hours after surgery.
DD: 4/07/09
The intubation tube was too large for me and I stopped breathing after the surgery. Not sure how I survived my shunt being moved to the opposite side of my brain.
I opened my eyes to feel my lungs burning. I tried to take a air into my lungs and the oxygen stopped in my throat as I could still feel the tube there. I gasped that I couldn't breathe, a nurse came in to give me oxygen. When she told me to breathe, I still couldn't take in air as I could still feel the tube there. I gasped again tears running down my face as I was finally able to get some air into my lungs. Then she left.
The only time I saw the attending doctor (Dr. RH) was when I was in the OR. I never saw him again afterwards.
Then a nurse came in to discharge me. My mother asked:
"Where's the doctor? Doesn't he want to see her.?"
The nurse replied: "He's in surgery right now."
No one gave me instructions on what to do when I came home. I wasn't given antibiotics or anything. This is different from what was written in the report.
I returned home and was having severe headaches and had problems waking up when sleeping.
We told the hospital about this and we were told:
"Well, if it happens again, let us know.''
Suspicious...
I would think that if a patient who just had a shunt revision surgery complained about severe headaches and problems waking up from sleep that would be a serious problem.
I called Dr. RH and my phone calls weren't returned.
About week after I was home, a white substance was leaking out of the wounds in my scalp. I returned to the hospital and it was determined I had an infection. I was then given antibiotics.
Again, the surgeon wasn't available, and the nurse practitioner was the one who saw me. Again, we asked to see someone. A physician assistant came to see me. We looked at my X Rays and he said: "Everything looks good to me."
Frustrated, we took the copy of the X Rays on CD and left.
I continued having severe head pains and again returned to the hospital. Now the doctor who I was assigned in 2003 was now back at the hospital. I was examined and X Rays looked at again. I had some issues with balance and walking and Dr. S determined everything was ok I was sent home again.
I didn't return to see Dr. S or that hospital again.
I returned to school after being away for three weeks. The semester ended two weeks later. I drove myself crazy trying to get everything done before the semester ended. I was still having severe headaches and had to leave class one day because the pain was very bad.
In May I graduated with my Master's degree in Art Education. Then in the fall, I found another hospital and a new neurosurgeon.
This doctor, Dr. I, couldn't figure out what was wrong with me either, he was willing to take my case.
In 2009, after my surgery, there are some people who were yelling at me saying I needed to be more responsible about my shunt.
As if I had control over when my shunt gets obstructed.
It was explained to these people that I have no control over my medical device and condition.
It just stops working.
Anyone who has a shunt or knows someone with a shunt would tell you the same thing.
After 2009 I wouldn't have surgery again until two years later.
