Action, meet Consequence

I’m currently recovering from having half of my large intestine surgically removed. Even staring back at that sentence, it feels surreal. Reality still hasn’t sunk in yet.  You always think that it’ll never happen to you. Or, if it does, it won’t be so bad. Courtesy of an on-and-off relationship with laxatives, a few weeks ago I found myself needing emergency surgery.  Life has not been good lately, but the reasons don’t really matter right now. What’s important is that I wasn’t coping. I want to make it clear that I know laxatives don’t affect calorie absorption or weight loss beyond water/waste weight. It’s never been linked to my food consumption - there’s no correlation between calorie intake and laxative use. For me, it’s a form of self harm. To spend a day or two writhing in pain, going between bed and the bathroom. If it didn’t hurt, it wasn’t enough. It’s been an on-and-off issue for a long time, sometimes going 6 months to a year without touching them. But throughout July, I was taking heavy amounts of bisacodyl 2-4 times a week. Now, after these past few weeks, I never want to experience gastrointestinal pain again.   One morning, I woke up at 5am in excruciating pain. A 6/10, peaking to a screaming-crying 9/10 every 5-10 minutes. The worst pain I had ever felt. I hadn’t even taken laxatives for about a week, which was my first indication that something was seriously wrong. I considered an ambulance a couple of times, but that felt like an overreaction. S was going to be here at 11 for supports, and surely it could wait until then. Part of me actually thought (hoped) it might stop. At the emergency room, it took a while for them to figure out what was wrong. Was it my appendix? Ovaries? To be fair, I didn’t disclose my laxative abuse immediately. It could be entirely unrelated, and I didn’t want to embarrass myself. Silly me.

Part of my bowel had twisted around itself, and the tissue was dying. A volvulus. When they first told me it was a cecal volvulus, I just sighed, and finally told the doctor about the laxatives. 

“Yep, that’ll do it.”

Even after that, the surgeons went back and forth.  “It’s a cecal volvulus” “No, you might just be really constipated, we’ll monitor you overnight” “It’s definitely a volvulus, you need surgery now" The lead up to the surgery was scary. They talked about the possibility of a stoma. But at that point, I would’ve done anything just to make the pain stop. In the morning, I went in to surgery. I needed a right hemicolectomy. They removed a total of 33cm (13”). And because they need a large opening to actually get it out, they couldn’t do keyhole surgery, so it was a full open laparotomy. From end to end, the incision measures 17cm (6.7”), ignoring the curves. So I'm going to have one hell of a scar. Unfortunately, that was not the end of it. While in the ICU after the surgery, my blood pressure was getting dangerously low. My hemoglobin levels kept dropping. Until the next morning, when it all came to a head. My blood pressure hit the dirt. Six nurses rushing in, clear the room, hit the alarms, get the doctor. They gave me two units of blood, more albumin, more fluids. It feels dramatic to call it a ‘near death experience’, but I honestly thought I was dying.  What a stupid way to go. Even then, I hate to admit, I couldn’t help but think “so this is how anorexia will kill me, and I’m still going to die fat”. But there was no panic. No ‘please help me’. Just a quiet “thank you for taking care of me”.  I felt an overwhelming sense of calm. Apart from a regret that I was going to die ‘fat’, I felt ready. I was happy that it was a result of my anorexia that would kill me, even if I wasn’t at my thinnest. I always thought I would panic when facing death. That I’d be scared and try to fight and bargain and plead, that I’d be suddenly full of regret for my actions. But I just felt calm and truly ready.  And that’s kind of terrifying now to know. I am 32 years old, and I am ready to die.  After 45 minutes, they stabilized me, then confirmed on CT that I was bleeding internally. So, back to surgery to fix the leak, along with five more units of blood.  I was in the ICU for five days, followed by a week on the surgical ward. I spent the first 2-3 days vomiting dark ‘coffee grounds’ blood. I couldn’t sleep, it was so constant. They would usually have an NG tube placed to aspirate the stomach contents, but when I woke up with one after the second surgery, apparently they had to hold me down to stop me pulling it out, and eventually agreed to remove it.  The pain was intense. I didn’t think the post-surgical pain could be worse than the volvulus itself, but I was wrong. The first time getting back on my feet had me in tears. But each day, it got a bit easier.  They only had me on liquids for less than a week, though I needed a bit of a push to start attempting solids again, even though it was the best way to get my bowels working again. I was so afraid it would make the pain worse. Everything felt like lead in my stomach. It felt like everything was so swollen, there wasn’t any space for anything.  It took about 10 days before my bowels starting moving again. I won’t go into too much detail, but the first week was incredibly painful and difficult. Things have since settled down, but they said it’ll take a few months before I find my ‘new normal’. Because the large intestine, pulls water out of the stool, BMs will be more watery. It'll take some time to figure out how things will be different, and a lot of it is 'wait and see'. I’ve been home for a couple of weeks now, and I’m struggling. The pain is mostly manageable with over-the-counter painkillers at this point, but I’m so incredibly exhausted. I can barely bring myself to get out of bed. Apart from it being a major surgery, and open vs keyhole, I think needing the second surgery has also affected how long healing will take, not to mention being at a sub-optimal weight and intake. I have been eating a little more since I came home than I was beforehand, but still no where near where it should be. Even for protein intake, my dietitian said that healing from surgery I should be getting about 80g a day! I rarely even hit 25g. It's been a main focus with her for quite a few months now. I still can’t bring myself to work supplement shakes into my daily intake, even though I know they would help.  My weight has been dropping since I stopped drinking. This past Tuesday, I hit 6 months sober, so I guess I have that going for me.  For a quick recap, I initially gained a lot when I first started drinking in 2016. I spent a long time bouncing around the 60's range. Around 2020, when I first started cutting back on the alcohol, it started slowly coming off. Just a couple of kilos each year, nothing drastic.  Since I stopped drinking completely, it’s picked up speed. When I had my last drink, I was 62.5kg (137lb, BMI 18.8). This week, I hit 52.1kg (114lb, BMI 15.7). Over 10kg now. I felt like I was doing okay with it before the surgery, but now, I’m really feeling the effects. I'm trying to process everything that’s happened in the past few weeks, and I can’t shake this nagging thought, knowing that I’ve done this to myself. The nights have been the hardest. When the world is quiet, there’s nothing left to do, I’m worn out both physically and mentally, and it’s just me and my thoughts. I knew the risks. I knew this could happen. And I did it anyway.  My body will never be the same again, inside or out. And it’s all my own damn fault.  This isn’t the first time I’ve been hit with the permanent effects of anorexia. I’ve had osteoporosis since I was 21, and have already begun to lose height (at my last DEXA scan, I was 182.1cm). I don't bounce back in the same way I did when I first got sick. Not to mention the myriad psychological effects after 15+ years of this.  But this, this is the most drastic. It’s not even just the scar. My bowels will never work the same again. It will effect me every single day for the rest of my life. And while it could’ve been worse, and I was lucky to avoid needing a stoma, it’s something so needless, something that could have been easily avoidable.  I did clear the house of laxatives within the first week of being home. I don’t think I would’ve touched them again anyway, but best not to find out. Even in that last month when I was using them heavily, I was often vomiting them up. I would take them over the course of an hour, have sugar-free mints to suck on in between, anything to try to combat the nausea. It was like my body was trying to tell me something, but I refused to listen.  For now, my GP wants me to get bloods done more often. Although most of it was my large intestine, they did remove 10.5cm (4.1”) of my small intestine, where nutrients are absorbed. So she wants to keep a closer eye on things, because it can be unpredictable. Beyond that, I’m still not sure what the future will look like. Some questions I’m too afraid to ask (will it increase my risk for other bowel issues in the future?), some things it’s just ‘wait and see’.  So, I guess that’s it. I really fucked up this time. 

xxBella