Grave memories 3 – lithotripsy

Eva at Číž-Kúpele in 2005, after lithotripsy, after third cancer – she never got better than this

Lithotripsy – that is, ‘breaking stones’ – the next stage in the story of how I came to take Eva to her final resting place at Číž-Kúpele 1300 kilometres from home. And it’s becoming a long story (see Grave Memories 2 – sewing butter).

Our new gastroenterologist was concerned about the frequency of painful episodes that Eva was experiencing as a result of chronic pancreatitis. The ERCPs (endoscopic retrograde cholangiopancreatography) had been painful, and had not succeeded in dislodging the pancreatic duct stones. ‘I think you should go to Brussels,’ she advised. ‘Professor Devière is one of the world’s specialists. I’m sure he can help.’

We set off early on an icy February morning, and succeeded in getting trapped by snow before we arrived. Fortunately we could phone and the professor would wait for us. That seemed a good sign. And when we arrived, he was duly there. Apart from the tussle with the hospital administration to register – not an easy business when you go from one country to another; the Belgian hospital wouldn’t trust our insurance to pay. Finally, though, they relented. And Dr Devière could examine Eva. She was sent off for an immediate MRI and within a very short time, we had the images. Dr Devière said she was a candidate for lithotripsy, or extracorporeal shock wave lithotripsy (ESWL) to give it its full name. ‘Usually it takes two or three sessions. We have to admit you here.’

OK. But we weren’t really prepared for what ESWL was. We did learn that Dr Devière was one of the world’s experts, and I actually read some of his publications on the topic (publication – I could give the full links but they might not be accessible to readers; these are). A few days later Eva was admitted to the Erasmus Hospital in Brussels, and the treatment began. Eva said she had to lie face down on a table with a large hole under the abdomen. Once the equipment was set up, the session began and lasted about an hour. According to Eva, the specialist technician administering the shock waves said about 6000 waves were delivered in the session. I remember feeling numb (or dumb) at the sheer number. Maybe that’s why I don’t remember the other details she told me when I visited: at some point a stent had been inserted, probably during an ERCP. I know that she did not complain of pain, but of discomfort. Lying still for a scoliotic patient on a hard surface for so long was hard to bear. She did say the lithotripsy was less traumatic than the several ERCPs she had had.

But it didn’t work. So Dr Devière tried again a few days later. Same result. And then again. In all, over her almost three-week stay at the hospital Eva endured six sessions; so around 36,000 shock waves hammered the pancreatic duct stone but could not break it down. We began to wonder at the possible damage such an amount of shock might do elsewhere. Eva’s abdomen certainly showed tell-tale bruising from all the shocks. Dr Devière was disappointed – it showed in his face: Eva seemed to be his first unsuccessful case. Eva too was disappointed but phlegmatic – she had already undergone so much.

Apart from the initial few days in Brussels, I was travelling back and forth to the Belgian capital every couple of days to visit her. She would usually get up and we would wander down (she sometimes on wheels) to the hospital cafe for tea or coffee (probably coffee for me), and look in on some of the shops there. But after the sixth session, there was no point in continuing the lithotripsy. We returned home. Check-ups over the next year revealed no change.

By this time medical treatments had already become something of a near daily routine, and they were to get harsher. Eva had already been ‘successfully’ treated for throat cancer through surgery and radiotherapy. And it had returned.

However, a further emergency admission to hospital two years later with the same severe pain symptoms as on the first occasion led our gastroenterologist to err on the side of caution and so speedily dispatch Eva by ambulance to Brussels. I couldn’t travel in the ambulance, and so had to follow by car, without the ambulance’s advantages. Thoughts of ‘oh, no, not again,’ probably went through my head. By the time I arrived, Eva was waiting in a hospital bed in an individual room in the emergency department. We got word that they would take her into the operating room later that evening. But the waiting and waiting was emotionally draining.

Eva was whisked away for an MRI and a CT, among other tests. Results showed the pancreas was not irritated: there was no new problem here. But there was a large gallstone. They removed it. ‘They could have done this at Maastricht,’ said Dr Devière. But I understood our gastroenterologist not wanting to delay by doing all the scans in Maastricht (they do them so much faster at the Erasmus Hospital), and then to discover that Eva had to be sent to Brussels anyhow. Risk-averse, yes, but maybe not a bad strategy when you had to treat someone with Eva’s considerable complications. However, the MRI scans showed considerably less stone in the pancreatic duct than two years before. We had the two MRIs, before and after, to compare, and you didn’t need to be an expert to see it. So Dr Devière could mark Eva down as a partial success after all. And he continued to send a Christmas greeting for the next couple of years.

The stone had been broken at least partly, but so was, equally partly, hope. Heart not yet.

To be continued.

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