One Man and His Peg

Roch received the best of care from medical and nursing staff at the Royal Brompton. He spent the night following the surgery in the Intensive Care Unit and the subsequent two days in a High Dependency ward. On the Friday, Kate and I were given a tutorial on pump feeding by a nurse from Nutritia Care, who supply the equipment and feeds and the nurses on Victoria ward, back in the Fulham wing, showed us how to administer bolus feeds.

The latter are feeds through a special syringe, directly into the stomach through the PEG. There was some confusion at first, as Roch had been transferred to Victoria ward from ICU as a ‘Nil by Mouth’ patient and so had been given no solid food at all. On the Thursday morning we watched as the nurse set up a pump feed, which she explained would administer nutrition over a period of ten hours. They had tried to feed him through the peg in ICU but he hadn’t been able to tolerate much. We were puzzled – surely the idea had been to supplement his diet using the peg? Not to replace food with peg feed? Poor Roch was very woebegone as he had had nothing to eat since Tuesday at tea time on Foulis ward. We waited for the dietitian to appear, who confirmed that there had been a misunderstanding and directed that Roch be given three bolus feeds a day, to supplement his diet, giving him an extra 900 calories per day – but that he could eat as he wished in between. That was a relief, although I watched the bolus feeds being administered with a sceptical eye. How on earth was I going to manage that? It all seemed frighteningly alien to me, although I tried to look confident in front of Roch. In fact, on Thursday he was not himself at all, pretty miserable and very, very tired. Not surprising, given the general anaesthetic. The Consultant was sympathetic and explained that he had, basically, been ‘stabbed in the stomach’ so really not unusual to feel crap. Within 24 hours, in fact, he was feeling a lot better and by Friday he was desperate to get home. A number of factors, however, had to come together for discharge to happen. All afternoon Jenny and I waited with him.

The dietitian had to come to confirm the feeding regime and the physiotherapist had to see him to determine whether, following the few days in bed, it was safe for him to transfer to the wheelchair for the journey home. Medication also had to be arranged from the pharmacy and of course he had to get the all clear from the doctors. Finally, and this was the big question on everyone’s lips – had he evacuated his bowels since the procedure? As long as the answer was no, it looked like he was staying put. One by one, the pieces began to come together but then, despite jubilation over a successful evacuation, news came that they wanted another X-ray. This was because the previous X-ray had shown too much air in the stomach. After the X-ray we waited for the doctor’s verdict and the medication. Bags packed. Eventually we got the all clear. We got home at 8pm. Jenny supervised my first ‘flush and feed’ and then left us to it. Life would never be the same again.