My Surprise Emergency Surgery

Newsletter 2023-07-24

I’ll warn you up front: This story gets a little gross. If you’re squeamish and would rather skip it, just know that I was hospitalized for three days but survived. I suppose you could have assumed that last part because I emailed you today, but that doesn’t necessarily prove anything. Someday, hopefully in the distant future, but, given my recent track record, more likely on some random Tuesday afternoon not too far away, someone else will send out a final, posthumous newsletter on my behalf. Maybe it’ll be from my wife or kids or great great grandkids or beloved but long suffering robot butler. I want to live long enough to let my bad behavior contribute to the eventual machine uprising. Whenever that final email comes out, I hope you’ll be kind to the messenger, whoever it is. The appropriate response will be, “Sorry for your loss,” not “I found another typo.”

Disclaimer over. I assume by now the faint of heart have had time to flee to safer content. Those Hardy Boys books aren’t going to read themselves. For everybody else, it’s time for the good stuff. Let’s talk about my butt.

Until this week, I underestimated how much of my life I spend sitting down. Apparently I’m on my rear end around the clock, including when I sleep. I made this discovery Tuesday night when, suddenly and with no foreshadowing, my butt started to hurt when I put any weight on it. My first inclination was to ignore the issue. I’m a guy, after all. Even the things I do for fun cause pain. That includes martial arts, lifting weights, and writing for public consumption. Emotional pain counts, too. The discomfort Tuesday night was different, though. I wasn’t doing anything remotely enjoyable or deliberate to cause it. It was bad enough to wake me up and keep me from falling back asleep. I rotated from one position to the next in a vain effort to find relief until I realized I was literally spinning in circles. Not wanting to wake up Lola, I went downstairs to sleep on the couch. The last time I did that, my appendix was about to explode. I only had one of those, though, and it was long gone, so I thought I was in the clear. Surely this was something simpler, stupider, and much more embarrassing. I was right on all three counts.

After some sleepless googling, I decided the most likely source of my discomfort was a hemorrhoid. While I can’t tell this story without disclosing at least a few unfortunate details, I’ll spare you where I can. There was nothing sticking out of the most obvious place to check, but I could feel something hard below the surface of the skin on my left butt cheek. Hemorrhoids can be internal, so I assumed I had found my antagonist. According to the internet, which is never wrong, one over-the-counter treatment is ibuprofen, which reduces inflammation. I definitely took the exact dosage recommended on the bottle and not one pill more. On an unrelated note, my favorite unit in the metric system is “a handful.” Half an hour later, the medicine finally took effect and I was able to fall into a fitful sleep. In my book, a problem deferred is a problem solved.

The next day was uncomfortable to say the least. It was one of my in-office days, so I drove to work. I sat in a computer chair for eight hours and walked during my breaks. Every action I took throughout the day was tinged with butt pain, which makes white collar toil extra enjoyable. The physical irritation would only abate if I sat weirdly forward and balanced my weight in exactly the right way. I’ve been in a perpetual slouch since 1992. Leaning ahead and using my back muscles all day hurt nearly as much as whatever was going on down below. On my way home, I grabbed every over-the-counter hemorrhoid treatment my local pharmacy had to offer. Life in your thirties is awesome. Then I hit the gym and hosted my usual weekly board game night. That’s also what I did last year before my appendix went boom. This time, I managed to make it through the entire session without spilling anything on a game. That’s the important part. Bodies heal, but cardboard can only be thrown away. That night, I again only got to sleep with the most powerful cocktail of non-prescription drugs I could find in the cabinet below the sink. Things were going well.

According to Google, which is just as good as a medical degree if not better, a hemorrhoid only needs professional medical attention if it lasts longer than seven days. I woke up on day two determined to beat this thing well before it hit the one-week mark. I was working from home that day. I swapped out my computer chair for one that hurt my butt less and settled in for a long day of grinning and bearing it. Fortunately, there were no video calls, so I didn’t have to bother with the grinning part. By that afternoon, I had actually convinced myself things were getting better. I was learning to move and sit in ways that engaged my butt as little as possible. I could go entire hours barely noticing that there was pain down there at all. Maybe I didn’t even need a butt. A whole new world was opening up to me. I again went to the gym, where I actually didn’t have a bad session considering that I had to hover over the seats on most of the machines rather than sitting down on them. Clearly this was a sensible and sustainable lifestyle. I should definitely be trusted with handling my own medical care in the future.

I woke up Friday morning drenched in sweat. Lola asked if I had a fever from my mysterious backside problems, which we had of course discussed. Marriage in your thirties is wild in all the wrong ways. I assured her that I wasn’t sick. I figured I must have accidentally pulled the comforter over myself in the night, even though that shouldn’t have made me shed water like I was in a sauna. The rest of that day can best be summarized as “not good.” The drive to work hurt. The drive home was excruciating. Everything in between was just the pain escalating from one end of that scale to the other due to my extreme activities, like sitting and sitting some more. No position change could save me. Existence was agony. When I got home, I felt around the unspeakable region blindly with my fingers. The hard area below the surface of my left butt cheek that I first felt the day before seemed to have doubled in size. I still went to the gym. My alleged hemorrhoid was on day three, not day seven, which meant this was still a me problem, not a doctor one. On the way to the gym, I dropped my oldest daughter off at a sleepover, making sure that my butt touched the driver’s seat as little as possible. If the last year has taught me anything, it’s to always finish all my errands in the midst of major medical emergencies. At the gym, I made it halfway through my workout before I gave up. If my butt so much as grazed the seat on a weight machine, I wanted to cry. I wasn’t going to make it a week. It was time to see a professional.

Immediate care closed in an hour. I took a quick shower and rushed over. I walked into an empty lobby. It turns out nobody else wants to seek out almost-but-not-quite emergency medical treatment at dinner time on a Friday. The exhausted medical staff was probably hoping to ease into their weekend. Instead, I waltzed in at the last minute to make them look at my butt. I checked in and then stood, afraid to take a chance with any chair. When I went back to see the nurse practitioner, she had me undress and lie on the exam table so she could take a look. Keep in mind that I had yet to actually see what was going on back there. I’m not that flexible. I pondered taking a picture of the area in question with my phone, but I didn’t want that to be automatically uploaded to the family cloud. This would be the first time anyone had laid eyes on whatever this was.

The nurse practitioner looked at my butt for approximately three seconds. She swiftly covered me back up.

“I’m sending you to the emergency room,” she said.

It wasn’t a hemorrhoid at all. It was an abscess. The fact that it was on my butt instead of literally anywhere else on my body was strictly coincidental. It had nothing to do with straining while pooping and everything to do with hostile bacteria that got under my skin and were now breeding out of control. In the nurse practitioner’s medically precise terms, the abscess was big, and it was angry. That’s why the pain had been ramping up exponentially over the previous hours. It had gone from not existing at all to being the size of an egg in just three days. If left untreated, it would eventually kill me. Before antibiotics, people died from this sort of simple infection all the time. In fact, King Louis XIV was killed by a similar but not-quite-identical abscess. Lola had watched a documentary about him just days before. The universe was trying to warn me and I didn’t even notice. Fortunately, I live in 2023 America, not 1715 France. I would be fine as long as I got swift treatment instead of going about my day in extreme pain while seeking no medical treatment whatsoever. Who could have guessed that my traditional strategy of ignoring the problem was once again the wrong one? I drove home and met up with Lola so she could take me to the hospital and share more facts about dead French kings. It was going to be a fun night.

Within a few minutes of arriving at the emergency room, I was on a bed in the back. A nurse started an IV. I had been fighting this with Tylenol and ibuprofen. The ER staff jumped me straight to fentanyl and morphine. They weren’t messing around. Next came the CT scan. The treatment for an abscess is straightforward. It needs to be lanced and drained. Mine, however, was so big that the doctor was afraid it went deeper than it appeared. Here’s another one of those uncomfortable detail sections. Feel free to skip the next sentence or two. The abscess was under the skin of my left butt cheek and didn’t actually connect to my anus in any way, but it was close enough that cutting it open and draining it might slice through the muscles in the region, leading to devastating consequences. The doctor didn’t want to get out his scalpel until he knew exactly what he was dealing with. It’s like they always say in the medical industry, measure twice, cut once, bill three times.

Getting the results from the CT scan took a while. As I waited, I did my best to sit very still. That’s when I took my traditional hospital selfie for social media. I get admitted often enough now that I have a system. Behold the smile of a man who just got the good drugs.

If I was perfectly positioned on my side on a full dose of fentanyl, I was fine. But here’s the scary part: When I moved, the pain would cut through the strongest opioids known to man. The abscess very much wanted me to know that it was there. When the doctor came back with the CT results, he didn’t have good news. The abscess was huge and deep. Like an iceberg, most of it was below the surface. The only way to get it out was if I was under general anesthesia. The doctor scheduled me for an operation with a specialist first thing in the morning. Then he admitted me to a room upstairs. I was in for a long night.

As soon as I was situated in my new digs, a nurse started me on a course of antibiotics. Those of you who have been reading these emails for a while know why that’s trouble. We’re nearly at the one-year anniversary of the time I really did almost die. Last August, I went to the ER when my appendix was on the verge of rupturing. The doctor on duty that night missed it and sent me home. I returned to the ER a day later in septic shock. You can read that charming story here. I needed emergency surgery and round after round of powerful antibiotics to pull through. That nuked the contents of my intestinal tract, leaving behind only a feisty little guy called c. diff, who causes catastrophic diarrhea. I dealt with that for months through all kinds of ineffective treatments until I finally got a fecal transplant, which fixed the issue. The only catch was I couldn’t take antibiotics anymore. If I did, I would kill off the new good bacteria and c. diff would come roaring back. With the abscess, not taking the antibiotics wasn’t an option unless I wanted to end up like a certain French king. I watched the clear liquid flow from the IV bag with thoughts of all the bathroom trips yet to come. Then things got worse.

The abscess refused to go quietly into the night. It was still struggling to expand, even as the antibiotics entered my bloodstream. The growth pushed into places where there was clearly no room for it, causing terrible pain to blossom in every direction. The fentanyl and morphine couldn’t keep up. When you take them intravenously, they hit fast and disappear even faster. Then you have to wait until you can get more. In between doses, there was nothing to take the edge off. I slept fitfully when the drugs were in my system and not at all when they weren’t. Moving sent spasms of excruciating pain throughout my body. At one point, I stood up to go to the bathroom. The brief trip left me drenched in sweat and on the verge of vomiting. I know my cardio isn’t the best, but that was bad, even for me. After that, I vowed to never move again. Once I got back in bed, I remained frozen like a statue, which brought with it its own kind of pain. I was running a fever. I found out days later when going over my discharge paperwork that I was actually in septic shock. I gave up on sleeping that night and instead watched the clock. Salvation in the form of surgery was scheduled for 7 a.m.. I looked forward to it like a kid on Christmas Eve who fully expected to wake up to find a brand new pony. Naturally, time slowed down. The minute hand moved backwards.

Finally, the appointed hour arrived. A nurse wheeled me down to the waiting area outside the operating room. The surgeon wasn’t at the hospital yet but was expected in any minute. That was a little disconcerting. I like to think of surgeons as detached, unreachable gods who descend down from on high. I don’t want to picture a guy who, after fighting traffic for thirty minutes, casually sets down his Starbucks cup and car keys so he can start cutting. Nonetheless, that’s reality. The surgeon arrived and gave me a rundown of what to expect. I didn’t ask many questions. I just wanted to be unconscious as quickly as possible. Once they administered the general anesthesia, I would blink my eyes and all my problems would be over. That’s not quite what happened.

An instant after I shut my eyes, I woke up in another room. The pain was gone. That wasn’t just the drugs talking. Draining the abscess fixed everything. That’s what I thought in the moment anyway. I spent another full day in the hospital. The second night was easier than the first. Not being in septic shock makes everything a little more pleasant. I was finally released around noon Sunday. Right after surgery, I thought I was out of the woods. But when I went through all the discharge instructions, I realized I’m still at the entrance of a very deep and dark forest. I can hear the wolves.

I’m going to have an open wound for a month. Sealing it up would trap all the nasty stuff inside. It has to be allowed to drain while healing naturally from the inside out. That means dressing and redressing the wound every day. Let me pause here to wow you with a detail that’s equal parts terrifying and heroic. Every single day, someone has to pull old gauze out of the cavity in the side of my butt and jam new gauze in. The process is absolutely awful for me. It’s even worse for Lola. That’s right: She has to do it all for me. If only I had eyes in the back of my head and also elbows that bent backwards. When Lola said the “in sickness and in health” part of our wedding vows, I don’t think she envisioned repeatedly stuffing medical cloth into a massive cavity on my backside. I owe her the world and then some. When the nurse explained the deeply unpleasant task before us, Lola didn’t even flinch. I guess she didn’t mind the idea of staring at my butt every day. She’s seen worse, like my face.

That open wound means no more jumping in lakes for a long while. In a few weeks, we were scheduled to visit our friends Rocco and Phoebe in Wisconsin for their annual adults-only get together on the water. Last year, we missed it because my appendix exploded. This year, I’ll still be convalescing from the abscess surgery. I’m positive Rocco and Phoebe will accuse me of making this up. I wish I were. Lying would be a lot cheaper than all these medical bills.

I need to call my c. diff doctor first thing Monday morning to figure out where we go from here. The last time I talked to her, she thought I had moved past that stage. She closed our virtual meeting with the words, “Have a nice life.” Less than a month later, I’ll be calling her again, back at square one. The moral of the story is never wish me well.

As for the cause of the abscess, it wasn’t the answer I expected at all. I love my final conversations with surgeons. It’s like getting to the last chapter in a mystery novel where everything gets revealed. Sunday, the surgeon told me that the abscess was much bigger than he initially thought. Rather than being the size of an egg, it was closer to the size of his fist. The fact that it grew to those dimensions in just a few days makes me a little woozy when I think about it. The surgeon theorized that this all happened because of an infected hair follicle. It had absolutely nothing to do with any part of my excretory system. The only reason the absence formed on my butt cheek rather than somewhere else is because that’s part of the human body that gets hot and sweaty, especially during the summer. This is truly the dumbest thing to almost take me out. Going forward, I’ll be getting laser hair removal treatment over my entire body just to be safe. Not that it will help. In the last twelve months, I’ve had four unrelated surgeries for completely different reasons. Whatever goes wrong next won’t have anything to do with rogue hair follicles. If I had to guess, I’d say my toes will be the next ones to try to kill me.

There’s a silver lining to all of this. In my paid newsletter Thursday, I groused about how we were going to be down to one vehicle at a time for the next two weeks without a loaner to make up the difference. It was going to take significant juggling to get everyone where they needed to be. I solved that problem by having a major medical emergency. I won’t be going anywhere for a while, so Lola can have our one remaining van full time for the duration. I can’t help but think there might have been a cheaper way to get around that conundrum. I guess we’ll just have to see if a full weekend in the hospital costs more than paying for a rental car for fourteen days. I’m not looking forward to crunching those numbers.

The timing is less fortuitous for my writing career. The release date for my children’s book, You Can’t Be a Pterodactyl, is Tuesday. I really have a knack for scheduling my disasters. Maybe there’s an upside there, too. Everyone knows signed copies are more valuable when the author is dead. Based on the last year, how long do you really think I’m going to stick around? Grab a signed copy now before they run out. Get one here.

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

James