Monica Bolduc

First post: Jul 8, 2021 Latest post: Aug 24, 2021
In late September, 2020, Monica had some pains in her left side and upper abdomen. This pain was abnormal and kept her awake at night, prompting an emergency room visit that discovered a mass in the epigastric region. The mass had caused her pain and nausea, and worsened with any activity. Upon testing, the mass was determined to be a tumor of unknown make. Monica's journey brought her to the University of Minnesota for more thorough examination of the tumor. This examination required hospitalization, as an endoscopic biopsy did not determine enough about the tumor for conclusive result. Monica endured an open surgery for a biopsy of the tumor, which was found to be a Plexiform Neurofibroma, benign but wrapped extensively around the aorta and offshooting mesenteric arteries. The positioning of the tumor and it's many tendrils made it extremely risky to remove surgically.

There was an extensive wait for further care plans for the tumor, and many questions to be answered. Over the months, tests continued, Monica recovered from her open surgery, and her daily life changed.  She could not have much activity in her days, as the pain from the tumor would incapacitate her. Sleeping on her left side became impossible, and she had some days where she could not find comfort both physically and emotionally. Despite a desire to be employed, she knew she could not hold a job because of how limited she was; her example would be to tell people, "Vacuuming the apartment would put me down for the whole day." For a girl as determined as she is, this made her feel dismayed. 

After much waiting, repeated tests, and doctors visits, the University of Minnesota unfortunately reached the limits of what they could do for her. This was devastating to Monica, who began to lose hope that her life could ever return to normal. With the options from the U of M exhausted, Monica was given a referral to the Mayo Clinic for next-level care. Visits were scheduled, tests were run, and hope was found anew as she was informed that they were able to operate on her to remove the tumor. After a delay due to Monica contracting COVID and recovering, her visits to Mayo were resumed.

On June 10th, Monica received surgery for her tumor to be removed. The operation was a success, with most if not all of the tumor successfully taken out. The process was very slow and meticulous, requiring the joint efforts of an expert abdominal surgeon and vascular surgeon. Over several hours, the tumor was removed from around her vital vessels and organs, and closed successfully without incident. The surgeons commented on how difficult it was to remove, even for them.

In the days following the surgery, Monica had continual nausea with bilious vomiting. She felt weaker than she had been following her previous open surgery, and had a difficult time with drinking water, as it would provoke nausea. On the 12th of June, Monica had a sudden feeling of pain in her abdomen, followed by increased weakness. Her husband noticed that she began to lose color, breathe rapidly, and show more distension in her abdomen than she had previously. Monica's heart rate became rapid, her oxygen levels dropped dramatically, and her blood pressure began to sink. Her husband recognized this as Shock, and called for the nurses immediately, who rapidly moved Monica to the ICU, and then into emergency surgery. Monica was found to have a rupture of the Superior Mesenteric Artery, which resulted in her losing over 3 liters of blood within the span of 25 minutes. Surgeons quickly repaired the rupture, and left her incision site partially open with a sterile covering and woundvac to drain excess fluid from her.

Monica spent the next 5 days in the ICU, where she was continually monitored and worked with. She made great strides at recovery, worked hard to walk, and stayed determined. After her stay in the ICU, she was closed all the way up and moved down to a general Med/Surg floor to complete recovery. Unfortunately, in the days that followed, Monica again developed increased distension in her abdomen, this time from a large buildup of infected fluid, which was eroding at her incision from the inside. This infected fluid had come from a leak in her small intestine, and possibly from a perforation in a large ulcer discovered with endoscopy. The infection had dissolved the repair of her incision inside her abdomen,  and had started to seep out between her sutures.

Monica has since had 4 drainage ports installed into her lower abdomen to siphon out the fluid, which has been difficult. She had an NJ tube placed for feeding, which was removed when it was discovered that feeding through the tube produced more fluid to be infected. She has continually fought this infection with antibiotics, drainage, and constant dressing changes around her incision. Sleep was difficult for her for some time, until a stable regimen could be established.

On the 6th of July, Monica received a CT scan with contrast of her abdomen. This scan was both of the GI tract with swallowed contrast, and of her vasculature with IV contrast. The scan of the GI tract again showed no definitive location of the leak in her small intestine, but the vasculature scan found that a pseudoaneurysm had emerged on her Celiac Artery, which prompted an emergent stent placement to prevent rupture. The procedure went well.

Monica is currently continuing recovery, which at this point is a matter of patience and perseverance. Her care plan is to continue IV nutrition, drainage of her abdominal fluid, antibiotic administration, and no oral intake to heal the leak she has in her intestinal tract. What was originally planned to be a week in hospital has turned into a month. Emotionally, she has remained strong, though some days have been harder than others. She remains faithful, even in the midst of her hardship, and has praised God for the good He has done for her at every step forward and at every setback.

- Nathan