Gut failure could happen to anyone. It might be the result of cancer, a clot, accidental injury, inflammatory bowel disease or surgical complications. Or maybe, like 18-year-old Dylan Donohoe Sherlock, you were born with bowel issues.
Whatever the cause, if your intestines are incapable of processing and absorbing the fluids, electrolytes and nutrients from your food, you must be fed intravenously. Patients on what is known as total parenteral nutrition, administered through a central line into the chest, are complex cases. The lack of a specialised, inpatient unit in the State to treat and rehabilitate them is, clinicians say, resulting in more than 12 avoidable deaths a year and serious complications for others.
“These patients literally die because of the lack of proper services,” says Niamh Rice, director of the Irish Society for Clinical Nutrition and Metabolism. The society has been campaigning for 10 years for a national unit of expertise to support the estimated 100 people a year who develop severe intestinal failure. Some will go on total parenteral nutrition temporarily; for others it is long term, which they can do at home with the right backup. Across the Border, there is a unit in Belfast with 12 beds serving such patients among a population of 1.9 million; in the State, with a population of 5.1 million, there is none.
Donohoe Sherlock can’t remember life without being on total parenteral nutrition. Initially, a problem with his bladder was spotted in a pregnancy scan and, within two days of his delivery by Caesarean section in Dublin’s Rotunda Hospital in September 2004, he was transferred to Crumlin hospital and fitted with a bladder bag. His mother, Mandy Sherlock, recalls how as a baby he regularly had a distended stomach, bouts of projectile vomiting and was in and out of Crumlin. At age two, he was admitted to the hospital for bowel failure and remained there for the next 18 months.