Those were the words Nurse Lydia typed in a text message to my dad as I lay shivering under a pile of heated blankets in the recovery room in the bowels of Tan Tock Seng Hospital on 10 June 2020.
I had just undergone a successful medical procedure known as a percutaneous radiologically guided gastrostomy (PRG).
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| The PRG tube where it exits my abdomen. |
It's a very fancy label for a very simple idea.
My radiologist Dr Sundeep looked at a live x-ray video feed of my abdomen. A tube was passed through my nostril, down my throat, and into my stomach (the technical term for this is nasogastric tube), and air was pumped into my stomach through the tube. This inflated my stomach like a balloon, so that it pushed away the surrounding organs such as the liver and colon, giving the radiologist a clearer field in which to operate.
The inflated stomach also came close to the abdominal wall. All the radiologist had to do was insert some sutures to tie the stomach lining to the abdominal wall to minimise the distance between them, then poke a hole from the outside of my abdomen to the inside, right through my stomach lining. He then threaded a feeding tube through the hole.
The feeding tube is kept in place by a tiny balloon inside my stomach, which is bigger than the size of the hole in my abdomen and therefore prevents the tube from falling out of me.
Why the procedure was technically challenging was because of my anatomy. My body is much smaller than that of a normal 22-year-old, but my organs are full-sized and have to cram into a much tinier space than they should. This had caused my liver to lie in front of my stomach during a pre-op computerised tomography scan, completely obstructing the approach from the front of my abdomen and making the radiologist unsure of the feasibility of the procedure.
If my liver didn't give way to my stomach, the radiologist would've been unable to reach my stomach to insert the feeding tube into it. They would've had to abort the procedure and done an open surgery instead, which would have involved heavy use of general anaesthesia and incurred lots of attendant risks to my safety.
The hope was that, when gas was pumped into my stomach, it would be able to push the liver away and expose itself clearly. There was a scary moment during the procedure when it looked like this wasn't going to happen. The medical team first pumped a tank of compressed carbon dioxide into my stomach through the nasogastric tube, but it didn't respond. My liver lay happily in the way still.
Then the medical team switched to "good old air", as the anaesthesiologist Dr Chan quipped, by connecting the external end of the nasogastric tube to a manual resuscitator (basically a rubber bag filled with atmospheric air) and getting someone to squeeze the resuscitator by hand. Poof! My stomach blew up nicely and my liver slid obligingly to the side, accompanied by running commentary from a relieved Dr Sundeep whose eyes were glued to the monitor showing the live stream from the x-ray machine.
Once this happened, the medical team went into action.
"Push 100mg of glucagon, STAT!" Dr Chan shouted. Disclaimer: I don't think he ordered 100mg. I made up that part because I can't remember exactly what he said, but 100mg looks quite impressive. Also disclaimer: I don't think he shouted, but in my favourite medical drama The Resident, the doctors are always shouting with great urgency and it's very exciting to watch, so I chose to describe Dr Chan as shouting to dramatise my account of the proceedings. In the same vein, I added "STAT" to the end of his dialogue to spice it up a bit. The doctors on television say "STAT" at the end of every sentence and it sounds so badass.
I felt the slight burn of medicine entering the intravenous plug in my right hand and before I knew it, my hearing had gone wonky. It was like I was listening to the medical team's chatter through a long, metal pipe. My eyes started to grow heavy and I struggled to remain conscious.
I observed with a detached sense of fascination a bedside monitor displaying my vital signs. "Damn," I thought. "My heart rate, blood pressure, and oxygen saturation are all really good and holding steady. Am I a tough little mo-fo or what!"
Someone said: "Ok Jonathan, I'm going to inject some local anaesthetic into your tummy area now. It's going to sting and burn. Ready? 1, 2, 3, ouch!"
I was so distracted wondering about the wisdom of a doctor saying "Ouch!" when injecting a patient that I hardly noticed the sting and burn. I mean, it did sting and burn, but it wasn't too bad.
At some point, Dr Chan shouted something about morphine and a bunch of other chemical names, and I started losing the battle to hold on to consciousness. "I'm feeling very drowsy," I complained to Nurse Lydia who was standing within my field of view (I was immobilised by a veritable forest of restraining straps so I couldn't see much). Earlier, she had told me that she would be there throughout the procedure, watching over me and making sure I was okay. She told me to just close my eyes. I did so with relief, and promptly went under.
That's not to say I was totally out of it. I soon heard someone saying my name, and I came back to full alertness almost instantly. "We're putting in the stitches now," said a voice. I groggily acknowledged, then fell asleep again.
My respiration must have suffered at some point because I suddenly felt a hand clamp my ventilator mask over my face, somewhat inaccurately because the mask missed most of my nose and spewed air everywhere. I'm very proud to report that I had the wherewithal to instruct the owner of the hand to "move the mask down" because "my right nostril is not covered". I heard someone say thanks before I drifted off again, feeling much more comfortable with the respiratory support.
The next time I woke up was when I heard my name being called again. "It's done," said Dr Chan. I was transferred from the procedure table to a hospital bed, and wheeled a great distance. "You're a good patient. Very compliant and didn't struggle," said Dr Chan along the way. I didn't respond but I was quite pleased to hear this compliment.
Finally, I rolled into the recovery room. I passed many other post-op patients. All of them were ancient, like my parents' age. I felt a little weird at this observation.
All things considered, I wasn't feeling too bad. I was sleepy but mentally alert. The morphine and chemical cocktail Dr Chan had concocted for me had reduced my pain level to 0. The only thing was, I was freezing. My jaw chattered and I shivered a bit. Nurse Lydia was very observant. She noticed and promptly had me swathed in thermal blankets. Then she sent the text message to update my dad on the successful procedure.
Hospital
Many people fear staying in hospital, but I'm a veteran of hospital stays so I don't mind having to be warded. Hospital stays can result in some quite interesting and funny occurrences.
Take for example my admission. I checked into the hospital on 9 June 2020, the day before the procedure, so that the doctors could ensure I was fit.
One of the tests they wanted to run was an arterial blood gas measurement, which involves taking blood from the artery in your wrist that causes your pulse. The junior doctor that came to do the extraction managed to hit my artery on the very first try, which was great because it minimised the painful poking and prodding I needed to endure.
But he was kinda clumsy, and high-pressure blood sprayed out of me and spurted everywhere: into the collection vial, all over my hand, his hands, my hospital gown, my bedsheet, and the floor. I felt like a pig in a slaughterhouse, or a bad guy in a John Wick movie.
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| Within an hour of checking in to the hospital, my pristine new bedsheet had become stained with my crimson life-juice. |
At least the doctor was apologetic about the mess he made.
After the successful PRG procedure, I stayed in the hospital for two more days to recuperate, and was discharged on 12 June 2020.
I may not mind being warded, but I'll always have problems sleeping in hospitals. The nights I had to spend in the ward were pretty miserable. There was a poor old man in the bed across from me who looked very ill, and in the dead of night, the nurses would draw the curtains around him and spend hours doing goodness-knows-what to him. His bloodcurdling screams would echo round the building, and amazingly, he had the stamina to keep this up constantly until the nurses left him alone. The night after my procedure was the only night I could tune him out and get a good sleep, thanks to the able assistance of Dr Chan's drugs.
Another patient, who looked like 猪八戒 from the Chinese legend 西游记, was the opposite of noisy. He was admitted in some sort of catatonic state. He slept and slept and slept. One morning, the nurses wanted to wake him up to clean him and give him his breakfast.
They called his name. No response.
They patted him lightly. Nothing.
They rubbed his left nipple vigorously, sending shockwaves undulating across the fats on his torso. Still no luck.
Eventually, some woman standing by his bedside in civilian attire, who seemed to be a girlfriend of some sort, managed to get him to sit up and eat the hospital-provided meal. He still looked quite dazed. His eyes were glassy and he didn't answer when anyone spoke to him.
But as he ate, he underwent a miraculous transformation. His eyes focused, and he was able to answer the nurses. Out of a plastic bag, the presumptive girlfriend produced, of all things, a braised pork trotter. The man, every trace of catatonia now extinguished from his demeanour, tore into the trotter voraciously.
He was never the same after that. He was still there when I was discharged, but he looked much healthier than he had been when he came in. He was fully alert, responsive, and was always either playing with his phone or talking to the presumptive girlfriend.
Truly a medical miracle!
My daily life
What's the practical effect of the PRG feeding tube?
Well, to put it simply, it has allowed me to leave behind the mortal burden known as eating. Yes, I no longer am bound by the need to have meals to stay alive.
You see, the muscles in my face and throat were getting weaker and weaker by the day. This meant that eating was becoming a dangerous pursuit, as I was under a constant threat of choking or inhaling food and drink and causing a lung infection. I was also taking an inordinate amount of time to finish my meals. My dinners stretched to about 2 hours every day. Such time expenditure wasn't very sustainable, and I was very upset to imagine what better things I could've been doing during that time.
Now, instead of slaving over solid food, I subsist on a milk diet: 800ml of Ensure Plus each day. I take 400ml in the mornings and 400ml in the evenings. The milk formula is poured straight through the tube into my stomach.
This amount of milk formula was calculated by the dietician to be adequate for my daily nutritional needs. The beauty is that the formula is manufactured with the intention that it should be able to function as someone's sole source of nutrients, so it's perfectly balanced and contains literally everything necessary for my body to survive healthily.
So I don't even have to eat anything. Of course, I won't totally stop putting stuff in my mouth, 'cuz that would be just pathetic. After coming home from the hospital, I've still been drinking a Pepsi a day, and that won't change until the day I die. The great thing about the tube is that it's made of plastic, which means it doesn't react with anything and I can eat and drink whatever I want without worrying about whether it will affect the tube. I've eaten chicken rice chilli with no problems.
One part of my body that has benefited immensely from the new diet is my bowels. Funnily enough, even though my diet is now almost completely milk-based and liquid, my faeces has become the best quality that it has been for years! It's hard, dry, and big. Really big. And consistent. I go every day, and every day it's the same.
My first love: RuneScape
Nowadays, my "meals" go as follows.
First, my caregiver uses a syringe to suck stuff out of the tube and stomach. Sometimes, there will be some residual curds from the previous load of milk. There might also be gastric fluids or other leftover detritus from whatever I ate or drank in the preceding few hours. This step is important because if a lot of stuff is left behind in the stomach and I try to take in the next load of formula, I could get bloated or regurgitate.
Next, my caregiver pours the 400ml of formula into the tube via the syringe. Finally, 50ml of water is poured into the tube to flush it.
The entire process takes about half an hour. This means I suddenly have so much more free time.
On 4 June 2020, I posted on my social media channels my intention to obtain Level 99 in Fishing in RuneScape and put on the Fishing skillcape while recovering in hospital using the RuneScape Mobile app. To prepare for that plan, I bought and redeemed a bond, which is an in-game item bought using virtual currency which gave me 14 days of access to the full version of the game known as membership.
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| My social media post on 4 June 2020: RuneScape has been a pillar of my life since I was in primary school. I have dedicated hours every holiday season to improving my character. But I was always free-to-play. I never became a member because I never had enough money of my own. Besides, I was a good student who never had the time to play during the school terms, so buying a subscription would have been a waste. This changed today. I bought a bond for 19m in-game coins a couple of days ago after receiving news that next week, I am scheduled to undergo a simple yet elegant medical procedure which, if successful, would dramatically improve my quality of life. It would be a momentous occasion. Being a sentimental soul, I wanted to have a similarly remarkable milestone to match in my parallel, virtual life on RuneScape. Despite my account being more than a decade old, I have not reached the maximum level in any of the skills in the game. As I said, I usually play infrequently so I never had enough game time to train my skills fully. So I planned my remarkable in-game milestone to be: attaining the maximum level of 99 in my favourite skill, fishing, then buying and wearing the special members-only cape that this achievement unlocks. Today, I laid the groundwork for this plan by redeeming the bond, becoming a member for the first time ever. This membership lasts for 14 days. With access to more powerful training methods at the Fishing Guild's Deep Sea Fishing Hub (pictured), I quickly increased my fishing level to 98. I will continue to accumulate experience points over the next few days until I am just short of the threshold to cross to level 99. And if the doctors manage to pull off the life-changing procedure next week, I will fire up RuneScape Mobile while recovering in my hospital bed, cross the threshold, then acquire and put on that sweet, sweet fishing skill cape. |
The next day, I updated the plan to merely buying and wearing the skillcape in hospital because I'd already obtained Level 99.
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| My social media post on 5 June 2020: I never thought I would live to see this glorious day. Yesterday, I posted about wanting to achieve level 99 in fishing in RuneScape while recovering from my medical procedure scheduled for next week. But I ended up achieving it today instead because of a sudden burst of experience points that was awarded to my character by the game for finding and handing in some "strange rocks" to the museum. No actual catching of fish involved! Pictured here is the server-wide broadcast announcing my milestone to everyone who was online then. I still plan on having a special moment in the hospital, just that now it will be me buying and putting on the fishing skill cape immediately rather than having to finish getting level 99 first. The 99k coins I will need to pay the guildmaster for the outfit are already in my coin pouch. So it is a double celebration: today, 5 June 2020, I got my first level 99 ever in RuneScape; if all goes well, virtual me will don the fishing skill mastery cape for the first time ever on the afternoon of 10 June 2020, after real me has undergone the procedure. |
As it turns out, I couldn't log into RuneScape Mobile while in hospital because there was a very uncomfortable intravenous plug embedded in my hand which made tapping my phone screen quite unwieldy.
So I bought and put on the skillcape on 13 June 2020 instead, when I was back home from the hospital.
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| The cape which certifies that I have achieved mastery in the Fishing skill! |
| The skillcape comes with its own unique cosmetic animation, called an emote. |
I then used the remainder of my 14-day membership to immerse myself in the real RuneScape, which I had never before experienced in all my decade-plus as a free player.
Walking through the servers reserved for paying members, I shed tears of joy at seeing actual fellow players running by. It took me back to the heyday of RuneScape, in the 2000s, when the servers were almost always brimming with players. I flashed back to the previous time I played RuneScape after being discharged from hospital. It was 2008 and I had just recovered from having a titanium rod fused to my spine to correct my severe scoliosis. I was so happy to be able to play again after a marathon two-week-plus hospitalisation that I literally peed myself because I didn't want to leave the computer.
The servers for the free players of RuneScape these days tend to be sparsely populated, which makes me sad. It might seem weird that there are so many more paid subscribers than free users, but data from the developer of RuneScape shows that more than 90% of players are members. This is due to the niche nature of the RuneScape community. It's not a game that appeals to a mass audience. The gameplay mechanics are repetitive and grindy and the pace is largely sedate. Those of us who've stuck around through the years have more or less become loyalists and staunch supporters, which means we're more likely to want to buy the proper gameplay experience.
The free version of RuneScape is more like a trial, but no one wants to try RuneScape nowadays. It's boring and doesn't give instant gratification, so modern consumers (you know, those with the attention span of a housefly) shun it for the flashy colours of Roblox or the heart-thumping excitement of Fortnite.
Anyway, have a look at this 8-minute-long video to take a break from all this reading.
Did you make it through the whole clip? You didn't, right? You housefly, you.
I think this video encapsulates two points very nicely.
- This is what I mean when I say RuneScape isn't for everyone. Notice how I was running up and down the same stretch of forest repeatedly? Doing the same action over and over is a typical way of training skills in RuneScape.
- But it also hints at why I love the game. Being disabled in real life, I literally can't do almost everything, not even basic things like jumping or cooking or catching animals. RuneScape allows me to do all these things and more. In this clip I'm practically doing jungle parkour! I can also cook, hunt, farm, and fish! Normal people play video games as a form of escapism where they kill enemies or monsters, because obviously you're not allowed to go around murdering stuff in real life. I'm just happy to be able to do mundane stuff that you probably take for granted, like climbing over fences and shovelling animal poop (yup, that's an activity in RuneScape).
Over the past few days, I've discovered that my nights have become rather long. Previously, I would struggle over my dinner until around 10pm, then be too exhausted to do much else. But now, I take my evening dose of formula at 6pm, then have the entire night free to do whatever I like.
It's an amazing feeling. It's like I've been liberated, a phoenix rising from the ashes of my past life. The PRG tube has given me my life back. The past couple of nights, I watched one-and-a-half-hour-long RuneScape videos on YouTube about the history of tutorials in the game. A senior content developer of RuneScape critically examined the design of the various iterations of the RuneScape tutorial through the years and from his analysis, I learned about concepts in user experience design like cognitive load and A/B testing, after which I was inspired to read up further about the topic and found this very insightful and timely article. So geeky, right? But such things do interest me, just that I never had the time to explore them before.
And having played RuneScape every night since coming home, I was loath to give it all up just because my 14-day bond had expired. I reasoned that now that I don't have to waste time on meals, I will have more time to work on my various personal and school projects during the day, and therefore more free time to play during the night.
So I checked out the pricing of the membership packages. It's S$13.99 per month, but there's a discount for buying more than a month at a go. A yearlong package costs S$128.99, which works out to S$10.75 a month. (In fact, membership gives me full access to RuneScape's retro counterpart Old School RuneScape as well. I have a character in that other version of the game under the same master account that I sometimes play to take a break from the main RuneScape. So I'm actually getting quite good value here!)
I checked my earnings for last month: I made well over S$500. I bought a one-year membership subscription so I don't have to worry about losing membership status for the next 12 months. I'm always buying nice things for others. It's high time I bought something nice for myself. And unlike food, which turns into poop immediately the next day only to get flushed into the sewers forever, this subscription guarantees me a year of fun anytime I want.
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| The user interface design of the process of buying stuff is really smooth. Looks like all that A/B testing was worth the effort. |
I convinced myself that this purchase makes sense, and cross-checked my thinking with a trusted friend who concurred after doing some quick calculations (you know who you are *winks*).
Besides, what better way is there to celebrate coming through a "technically challenging" medical procedure unscathed and with a new lease of life?
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