I have some free time on my hands this week so I've been going over the events of the last nine day that led me to where I am today - still alive and getting well again. This recounting includes reviewing lab data, imaging, and notes in MyChart, recalling doctors post-operative conversations and doing some digging on WebMD and Mayo and Cleveland Clinic websites. It's been something of a revelation for me.
Last Tuesday began like any other workday lately. I got up, had breakfast, showered and dressed, then headed down to my office to work. Because my wife is on mandatory overtime through the end of the year her in-office requirements are waived so she was also working from home that day, which would not have been typical as she tended to work Monday through Wednesday in the office and Thursday and Friday at home. Sometime around mid-morning I started to feel some abdominal cramping. Nothing major right away and I brushed it off as gas pains, but they didn't relent, and in fact just got worse. Eventually I found myself in the bathroom trying to get something, anything to pass through my colon but no dice. My wife offered to take me to the ER but I declined, still thinking whatever it was would pass. But no, it just got steadily worse and worse, I vomited a few times, and within an hour of so I was thrashing around in bed, moaning and sobbing through the pain. Luckily, my wife is smarter and less obstinate than I am about these things and she called an ambulance.
I don't remember much about the ambulance ride, didn't notice if they used a siren or not. I remember being cold, very very cold, and the road being nothing but washboards. Last Tuesday was a very busy day in the ER, so busy there were no beds available when I arrived. They put me in a reclining chair in a hallway with no triage or evaluation that I can recall, but to be fair I was only lucid some of the time and out of it the rest. I'm not normally one to cause a scene, but I absolutely caused a big one in that hallway, my speech and behavior were so extreme that the ER nurses were asking my wife what drugs I was on. She was having none of that, though, and told them point blank they were barking up the wrong tree and had better get me some medial attention because it wasn't going to get better without it.
It turns out the condition I experienced, mesenteric ischemia with intestinal infarction, is relatively rare and can be quite deadly. Only about 200,000 people in the US go through it every year. If not treated within 6-12 hours of onset the mortality rate is about 70-90%. Folks like me with a coronary artery disease comorbidity have an elevated level of risk.
When I eventually got into an ER bed and had an initial evaluation, they told me flat out my vitals were horrible and my labs were worse. At some point a nurse did validate what I was going through, telling my wife the doctor said it's one of the most painful things a person can experience. Eventually the doctor came in and said I needed immediate surgery and without it I would die. I deferred to his authority and concurred with his diagnosis. My blood pressure was up to 255/140 with a pulse of 40. My body temperature was around 92 degrees, but I was sweating so hard the thermometer stickers they put on my forehead kept falling off so they had a hard time getting a good reading on that, even with an oral thermometer. I was septic and going downhill like a runaway bobsled.
Once the medical team decided on a course of action things moved pretty fast. They needed imaging so at that point they finally decided to start treating the pain. It took every last measure of will power and strength I had in me at the time to hold still enough for the nurse to get some Dilaudid into my IV. That took the edge off enough for me to get some level of control over myself again and off we went for a CT scan.
Generally speaking, vascular issues like clots and vessel blockages are primary causes of this condition. My CT scan showed some stenosis in the main vessels feeding the bowel, but the consulting vascular surgeon decided that did not appear to be the cause of the ischemia, which is actually a very good thing in terms of long-term prognosis. Instead, the whole thing started 14 years ago when I ignored, then endured similar abdominal distress until my appendix ruptured. It took a long time, but eventually scar tissue from that surgery completely encircled the bowel, cutting off the blood flow. Then just for good measure, the small intestine collapsed at that spot and two parallel sections twisted around each other creating a complete intestinal blockage. Picture a ring bologna hanging in a deli window and that was my gut.
Pre-op was kind of blur, and all I wanted was the pending anesthesia that had become the only light I could see at the end of my tunnel. As they rolled me off to surgery, I wondered if I would make it out of the woods, but somehow the fear of continued pain pretty much wiped out the fear of death. I was ready for it to end one way or another. I'm neither proud nor ashamed to admit that now, it just was what it was at the time.
I am not a religious man, though as a natural born seeker I've studied religions my whole adult life. Religions are manmade institutions and while I respect any faith that passes the muster of being based on altruism and empathy and compassion, rigid dogma and doctrine are not for me. I have a personal relationship with my personal conception of what I consider a universal deity, and that's enough for me.
We call this time of year the season of miracles. You simply can't deny that otherwise unexplainable things happen from time to time, and when the outcomes are especially good we call them miracles. I've always been reluctant to attribute them to divine intervention. Today I find that reluctance at an all-time low. I do believe in miracles, and I believe that forces beyond my comprehension can intercede on my behalf. I believe it because this is not the first time I have been in dire situations that against the odds turned out as well as I could have hoped. I believe in miraculous intervention now because I choose to believe it, and because it's a much more interesting and exciting possibility than random chance or coincidence have to offer.
Happy holidays, my friends. I wish you all the depth of gratitude for life that I feel today, and an abiding faith in love and humanity and our capacity for kindness and generosity. Cling to the ones you love like your life depends on it, because indeed it often does. Peace be with you.
