The smell of hospitals in winter.

... and the feeling that it's all a lot of oysters, but no pearls. 

Variations on a theme: 

He's now stayed on floors 1, 2, 4, 6, 7, and 8 at Duke University Hospital. Missing 3, 5, and 9.

Best ED room ever. It was so huge! So, if you have to go to the ED, I'd recommend going at around 4 AM on a Wednesday. 

Pre-op for the cystogastrostomy - saying goodbye to the 23 cm. pseudocyst filled with a gallon of cysty swampy disgustingness. 

Post-op: waking up and feeling good! We were blissfully unaware that the next day he'd be febrile. And then nauseous. And shorty thereafter, re-admitted to the hospital. 

One of the four times (so far) we came through the ED to be admitted to the hospital. You know what takes forever in the ED? That's a trick question, because the answer is EVERYTHING.  

Another ED visit. 

Feeling awful on our not so romantic, poorly-timed vacation to the mountains. 

I think that basically covers things to this point? Jonathan's pseudocyst was GIANT. It developed as a reaction to his really, really bad bout of pancreatitis at the end of October, and they had to wait to do anything about it until it walled itself off. But by the time they were able to do the cystogastostromy (I probably spell that differently every time), the cyst was taking up a large part of his abdomen and it had become impossible to keep down anything - even water. That's a problem. He hasn't really eaten a normal meal (without immediately throwing it all up) since October 21st.

So anyway, yeah the pseudocyst was giant and it prevented him from being able to eat. It also killed part of his pancreas. It is located in the body of the pancreas (which is between the head and the tail - heyo! I bet you didn't see that coming!), which is also not great. Because that means the head and the tail are still alive, but the part in the middle is not much alive. So the tail might try to hang on and keep kicking and keep making digestive juices, but it may or may not be able to send those juices down to the head. And if not, that's a problem because digestive juices hanging out in the abdomen = bad. That's kinda what happens when you have pancreatitis. Your body starts trying to digest itself. So the docs are hoping that the tail just gives up the fight and dies, which is fine because you only need 10% of your pancreas functioning at 100% capacity to be ok. And they seem confident that the head/neck portion of Jonathan's pancreas is doing ok. So it's a watch and wait thing. If the tail decides to stay alive, and if the damage done to the body is enough that the tail can't communicate with the head, then Jonathan would be looking at open, somewhat major surgery to remove the tail. But the docs said that would be like 6 - 12 months away. Are you thinking what I'm thinking when I say 12 months away? Another Christmas in the hospital? SIGN ME UP! (That's sarcasm.)

In related news, on the last MRI they finally saw some gallstones! Oh happy day! They'd never seen stones before, so they were pretty surprised, but they've also had pretty bad imaging before because he's been so inflamed. Gallstones are one of the leading causes of pancreatitis, and the news made Jonathan light up because it's exactly what we were hoping for. Yep, we've reached the point of hoping for gallstones. But the reason is that stones are a relatively easy fix. Do a laproscopic cholycystectomy (robot surgery to cut out the gallbladder) and you're golden. So we're waiting for that. That'll be something that surgery does, not GI, so it requires a separate consult and they get to decide when they want to do it. Jonathan currently has a "hostile abdomen" because of the cyst, inflammation, and ongoing procedures to debride the cyst and try to prevent sepsis and all that. So it's not a surgeon's ideal environment to cut into. But we also have some pressure behind cutting out the gallbladder because it's just a matter of time before one of the stones in the gallbladder escapes and causes problems in an already really compromised pancreas.

And that's just about everything there is to know about Jonathan's pancreas.

The bottom line: Jonathan's pancreas hates him. And the pancreas is a sneaky, sneaky non-organ. And it totally makes sense why that one surgeon joked that in med school she learned some kind of saying that ended with, "And please don't let it be the pancreas."