Aug 15 • 22M

I Almost Died

Newsletter 2022-08-15

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I almost died.

I’ve made that claim in countless newsletters, but this time it’s absolutely true. The incident began with what I thought was a mild case of trapped gas and ended with emergency surgery and multiple days in the hospital. As I type this, I’m lying in a recovery room with an IV still in my arm. I can’t sleep, so I might as well write. I have a problem in more ways than one.

It all started Tuesday night. I was hanging out with my wife Lola in our bedroom. It was a typical romantic evening where we had a few drinks and watched TV. We’re a wild bunch. I noticed some abdominal discomfort, but I didn’t think much about it. It certainly wasn’t worth bailing on a date night over some gas, and besides, successfully forcing it out seemed like a good way to kill the mood. The way to a woman’s heart is not aggressive flatulence.

We went to bed a little after 11 p.m.. I woke up at midnight. My abdominal discomfort had progressed to outright pain, so I went to the bathroom to take care of business. (This email is going to have way, way too much personal information, but if you want the full story of how I nearly shuffled off this mortal coil, you’ll have to tolerate some specifics about how the human body works.) Weirdly, the bowel movement didn’t relieve the abdominal pressure at all. Since I couldn’t sleep, I went downstairs to pace around where I wouldn't wake up Lola. I Googled my symptoms, and it seemed like my most likely diagnosis was trapped gas. It wasn’t dangerous, but it was painful enough to make you think you had a more serious condition, like a hernia or heart attack. I followed all the tips to relieve the buildup. I sat in different positions. I walked. I did a bunch of awkward yoga poses in the dark. The pain didn’t exactly make me more graceful. The only things I didn’t try were eating high fiber foods and drinking a bunch of water because both seemed like they would make me throw up. I doubted barfing would improve my evening. The pain was bad enough that there was no way I could fall asleep. I just kept repeating the same ineffective steps over and over again. It was that or go to the emergency room. It’s not like I was going to spend money on my health.

Finally, around 3:30 a.m., I accepted reality and decided to drive myself to the hospital. I can’t stress enough what a big deal that is for me. I have really good insurance—the births of all of my kids were free, which is why we have so many—but it massively dings me for trips to the emergency room. Each one costs me a $500 copay. Immediate care, by comparison, is only $40. The latter, though, didn’t open until 8 a.m.. The pain was bad enough that I, the cheapest man in the world, decided it was worth the extra $460 to get care four and a half hours early. Also, it was a calculated risk. I thought immediate care might just send me to the emergency room, forcing me to pay for both. In a way, going straight to the emergency room was a $40 discount.

I drove myself to the ER. Our suburb has a small hospital, which is usually able to see us right away. When the nurse asked me to rate my pain, I said it was a seven or eight out of ten. She had me change into a hospital gown and gave me an IV. That seemed excessive, but I don’t know what I expected. I guess I just wanted them to give me a pill that would unleash an earth-shattering fart and let me fall asleep. Instead, they rolled me down the hall for a CT scan. My pain was concentrated in a narrow line to the left of my navel. The ER doctor thought I might have diverticulitis. That was definitely not where I wanted this night to go.

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An hour later, the doctor came back with the results. Nothing showed up on the CT scan, and he was able to rule out nearly everything serious. It wasn’t diverticulitis, a hernia, appendicitis, or a kidney stone. In fact, according to the best imaging technology medical science had to offer, I was perfectly healthy. Officially, my diagnosis was a shrug. Unofficially, it was that I was a big baby. Clearly, I, an otherwise healthy thirty-seven-year-old male, had come into the emergency room in the middle of the night and rang up a massive copay just for funzies. The nurse gave me the liquid equivalent of ibuprofen, and the doctor told me to stick with over the counter pain medicine. I was only supposed to come back if I had bloody stool. That was $500 well spent.

I felt pretty stupid when I got home. A man’s two greatest fears when going to the doctor are as follows: 1) Nothing is wrong; 2) Something is wrong. When the diagnosis came back as a null set, it proved the problem was all in my head. I could have taken ibuprofen myself right at the start and still gotten a full night’s sleep. Instead, I arrived back in my bedroom at 6 a.m. having almost not slept at all. The over the counter stuff dulled the pain enough that I was able to fitfully doze for the next four hours. Then, I logged in to work. Normally, I wouldn’t have bothered, but I had invited over two other couples that night. I didn’t want my boss to find out I was too sick to work from home but not too sick to drink vodka and play Space Base. Let no one ever again question my commitment to board game night.

I actually went through with it. Wednesday night, the other couples came over, and we played till 11 p.m.. I was not exactly at my best. At one point, I knocked over an entire glass of soda on another player’s board. It was a jerk move, and, worse, I damaged my own game. Cardboard doesn’t grow on trees. I was in a substantial amount of pain every time the ibuprofen wore off. I was taking three pills at a time, the equivalent of a prescription dose, and it was barely keeping me upright. Still, if I was medicated and kept a small amount of food in my stomach, I could manage. When everyone was leaving at the end of the night, I didn’t have the energy to stand at the door and see them off. I had to sit down on the couch. Against all odds, I made it through the evening, and, thanks to the over-the-counter painkillers, I was even able to sleep through the night. Maybe things were turning around.

They were not. When I woke up Thursday morning, it hurt to walk. My legs were fine, but moving jostled my abdomen with every step. The pain had migrated to below my navel on a broader front than before. Unfortunately, staying in bed wasn’t an option. I had an MRI scheduled, ironically for a completely unrelated reason. My wrists have been bothering me off and on for two or three years. Right before we went on our trip to Europe, they got especially bad. They hurt so much that I couldn’t do a single rep in the gym, which had never happened before. In the past, taking it easy on my wrists for a week or two usually fixed the problem, but this time the pain lingered. I felt like my wrists were going to break when I did something extreme like lifting a light piece of luggage out of the overhead compartment or reaching into my pocket while sitting down. I was living too hard. Finally, I booked an appointment with an orthopedic doctor. He said that my right wrist just had tendonitis. I was banned from upper body lifts in the gym for four to six weeks. That was unfortunate because, even when I’m in the weight room every day, you can hardly tell. I’m not a hard gainer; I’m a non-gainer. As for the left wrist, the doctor was quite concerned. He said that he could physically feel the tendon snapping back and forth across the bone, which apparently is a bad thing. He scheduled an MRI at a stand-alone clinic to verify what was going on. He expected that I would need surgery. The MRI place called me four times to verify that I would make it to the appointment. It was a little obnoxious. Then, the day of the appointment, I could barely walk. I resisted the urge to cancel. I refused to be a liar times four.

I painstakingly hobbled my way into my van and drove to the appointment. I was just as slow walking around the clinic. When the MRI technician asked if I had ever had an MRI or CT scan before, I was able to say once, and it happened to be yesterday, but for something else entirely. She was surprised that they sent me home from the ER without a diagnosis, but she was there for my wrist, not my abdomen. The best she could do was give me yet another shrug and proceed with the wrist scan. This was a very different ordeal than the day before. The scan of my abdomen involved a very short imaging tube and only took about two minutes. The scan of my wrist involved a full-length tube and required me to sit perfectly still for twenty-five. I wasn’t sure I could do that with the pain in my abdomen, but I was already there, so I gave it a shot. Somehow, I made it. Then I limped back to my van.

My best theory for what was wrong with my abdomen was still trapped gas, even if the ER doctor hadn’t specifically endorsed it. “Suck it up, Buttercup,” isn’t exactly a lot to go on, medically speaking. On my way back from the MRI clinic, I swung by a pharmacy and grabbed a generic form of Gas-X and a laxative. I figured my best shot at feeling better was to blast everything out of my system. I’d start with the gas, and if that didn’t lead to an improvement, I’d purge the entire contents of my digestive tract. I took the maximum dose of the gas pills right there in the parking lot. Then, with the pain continuing to mount, I ran some more errands. If I was going to die, at least I’d leave the earth with a completed to-do list. I drove to the orthopedic doctor, this time for my twelve-year-old, Betsy, who needed bigger specialty insoles for her running shoes. Next, I stopped by her school to give them to her. Finally, I went home. The pain was bad, but I was optimistic. I still believed salvation was one big fart away.

I did finally pass some gas, but it didn’t help. It just moved the pain lower in my abdomen. I’m not sure if you’re familiar with how the human body is laid out, but the pain was starting to reach some regions I strongly preferred it would have left alone. I logged into my day job and worked for all of an hour. It was too much. I stepped away from my computer to take a quick nap. I crashed on the couch. When I woke up thirty minutes later, I was in the worst pain of my life. It was completely debilitating. I’d rate it a ten out of ten, at minimum. Even more problematic than the intensity was the location. It was now directly on my bladder—and on the part that drained it. As a guy, this was my worst nightmare times 100. I couldn’t even tell if I had to go to the bathroom or not because the only thing I felt was pain. I did go, and it didn’t make the situation any better or worse. The pain was constant. I hobbled to my van and drove to immediate care. I thought I might die, and honestly I didn’t dread it. It seemed like a pleasant alternative to whatever was happening to my bladder.

At immediate care, there were four people in line ahead of me. Then a fifth guy walked in. Apparently he had checked in before me but had been waiting in his car. Even in matters of life and death, I’m not a line cutter. Meanwhile, I was doubled over in pain in my seat in the waiting room. I now thought I had the world’s worst urinary tract infection or possibly a kidney stone, even though the ER doctor had specifically ruled out the latter. I wasn’t exactly subtle in my suffering. Finally, one of the other patients in the waiting room said maybe I should go to the emergency room. I agreed. I had been at immediate care for all of twelve minutes, and even that wait had been too long. I needed help now.

The drive from immediate care to the hospital was about two miles. I could barely do it. It was hard for me to look out the front window of my van when all I wanted to do was get in the fetal position. If I had waited another twenty minutes, I wouldn’t have been able to drive myself. I called Lola on the way there and told her to leave work. Whatever happened at the hospital, there was no way I was going to be able to drive myself home. When I got to the emergency room for the second time in two days, I had to put my head down on the reception desk while I checked in. Thankfully, the receptionist was able to read the context clues. She got me into a room in the ER extra fast. I put on a hospital gown and curled up in a ball on the bed. I begged the nurse for drugs. I sounded like an addict, but I didn’t care. Somewhere in there, Lola showed up. I’m a little hazy on the timeline at that point. I was in so much pain I was shaking.

It was another twenty minutes before the nurse returned to give me an IV. Those were, without question, the longest twenty minutes of my life. At least they weren’t messing around anymore. They didn’t waste my time with liquid ibuprofen. They went straight to fentanyl. The ER doctor—a different one than on my first trip—ran the same battery of tests as before, with the addition of a urine one. Producing a sample for that was one of the hardest things I’ve ever had to do. It took me two extended tries to get my bladder muscles to relax enough to release anything. Immediately afterward, I had my third CT scan in two days. After that, Lola and I waited. I got another dose of fentanyl to keep me comfortable, but I developed abdominal cramping, which managed to break through all the drugs. Finally, the doctor came back. I had appendicitis, one of the conditions the other doctor had specifically ruled out the day before. In all likelihood, my appendix had already ruptured. It would have to come out that day.

The second ER doctor, who from now on I will refer to as the good doctor since she basically saved my life, got in touch with the surgeon. She said he was very strict about the patient having no food in their system for six hours before surgery. I had made myself eggs at 10:40 a.m.. I knew the time because Lola had texted me then to see if I had been able to eat. She was worried about me, or possibly just checking in to see if she could cash in on my life insurance policy yet. Looking back, I can’t believe I was in the house by myself with a ruptured appendix. If I had lost consciousness, it would have been hours before anyone would have shown up. I don’t think the pigs would have run next door for help, though they might have eaten me. At least then the kids wouldn’t have had to feed them that night. The good doctor said that anything I ate or drank would reset the clock for another six hours. I told her that, after the eggs, the only thing I’d had was a small cup of water while we waited for the test results. She told us to throw away the cup and not say a word about it. She was a very good doctor.

A nurse wheeled my bed up to the pre-surgery room. He assured me that an appendectomy wasn’t a big deal. It would only require three small incisions. Recovery would be quick and easy. I would be able to go home that night. Then the surgeon came in. He told a very different story. Yes, it was an outpatient surgery for some people. I was not one of them. My appendix was so swollen that it was pushing on my bladder, which explained the extreme pain in that region. I was in septic shock. Since arriving at the hospital, I had developed a fever, and my white blood cell count was through the roof. My bone marrow was throwing out everything it could muster, even if it wasn’t all the way ready. A different doctor later said it was the equivalent of being in a world war and getting to the point where you send twelve-year-olds into battle. We were in a Berlin 1945 scenario. If I were sixty or seventy, I would have already been dead. But at thirty-seven, I had been able to drive myself to three different medical facilities over two days, host a date night and a game night, and run a full morning of errands. But I paid for it.

The nurse wheeled me into surgery. One second, I was joking around with the staff (I felt very good on the painkillers). The next, they were wheeling me out of surgery. I found out afterward that the operation had only taken thirty minutes. That didn’t mean I was going home any time soon. What the surgeon found inside me was less than promising. My appendix had swollen to many, many times its normal size before bursting. It had accumulated what was basically a hardened poop ball on the open end. The follow-up doctor said it was the biggest one they had ever seen. Yet, somehow, the first ER doctor had missed it on the CT scan. There were reasons for that. One of them was, of course, my fault. I’m skinny with little visceral fat, which means all of my organs are squished very closely together. It’s like a family photo where you have to squeeze thirty-five cousins into the shot. Hashtag Catholic family problems. The resulting image was less than clear. The other problem was that my appendix was in the wrong place. Instead of being on the right side of my body, mine was in the middle directly behind my bladder. I don’t know if it was always there or if that’s just where it shifted when it swelled up, but that’s where it was the day the surgeon defeated it in single combat. When I told the first ER doctor about my pain, I didn’t describe any on my right side. Since that’s where appendixes are on normal humans, and since he couldn’t see anything on the surrealist painting that was my CT scan, he ruled out appendicitis. My white blood cell count wasn’t elevated at that point, which means my appendix probably hadn’t burst yet. I could have had one of those simple outpatient procedures and been back on my feet in no time. Instead, I went without medical care for thirty-six hours until it exploded, leading to excruciating pain and a much, much longer recovery time. Protip: If your official medical diagnosis is a shrug, get a second opinion. It could save your life.

Recovery has been rough. It’s now been three days since I started this newsletter. For whatever reason, I’m not writing as fast as usual. The surgeon installed a port in my side to drain the fluid in my abdomen. At first, they said it would have to stay in for five days, but today the doctor said one to two weeks. Apparently my body has to stop producing poison if I want to take it out. I’ll get right on that. I’m on a lot of antibiotics to try to kill the infection. I’m not on much pain medicine, though. I’m back down to the over the counter stuff. I have a prescription for the real deal just in case, but I’m going to try not to use it. I got out of the hospital Saturday morning, and I’m now securely in my own bed. Things don’t hurt as long as I don’t move. Looks like I’m now stationary for life.

As unlucky as I was to initially get misdiagnosed and released into the wild, I was also extremely fortunate with the timing of everything. Had my appendix burst a few days earlier, I would have been by myself in Texas. If it happened a few days later, Lola and I would have been in the middle of nowhere on a lake deep in Wisconsin. In both cases, I would have been isolated from most of my family, and I shudder to think of what the flight or drive back would have been like following surgery. Instead, I managed to fit my medical emergency into a brief three-day window when I was home during the busiest summer of my life. Needless to say, we missed the kid-free weekend of booze and boating we had planned for Friday through Sunday. Our friends weren’t sad that they missed out on the logistical nightmare of dealing with my crisis, though. Hope they enjoyed the extra empty beds. I’ll make up for lost time next year.

The surgeon said it will probably be six to eight weeks until I’m back to “normal,” whatever that means for me. Abnormal at my full potential is more like it. I’m going to be out of the gym for a very long time, but being thin nearly got me killed, so maybe that’s for the best. I feel invincible and extremely fragile at the same time. During a legitimate medical emergency and in the worst pain of my life, the only person who took me to get help—twice—was me. At the same time, I feel like my six-year-old could now beat me up. Granted, Waffle is pretty tough, but that’s still a big step down in competition. It’s going to be a long road back, but at least I’m on that road. You have to be alive to complain.

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A big thanks to all of you for sticking with me, especially my paid subscribers, who make all of my free and premium content possible. When I looked back, I discovered that I posted the first teaser for this newsletter at 3:11 p.m. Thursday. That was pre-surgery, when I was high on fentanyl and in the middle of septic shock. You guys really are my highest priority. Also, props to me for the lack of typos in that post.

Anyway, that’s all I’ve got for now. Catch you next time.

James