50/50 (Part Two, Part One is below)

My memories resume when finding myself in a similar discomfort as to when I presented in the ED. It was the next day early in the morning and I was in the familiar setting of a hospital, although with an unfamiliar vantage point of being in the bed. The nursing staff reported that the case was uneventful. A cleaver term meaning that there were not any complications. They told me that the doctor would be rounding sometime after eight o'clock. This perplexed me, as in the medical training world rounding begins, at the latest, at half past seven. Surgeons on the other hand, being cut from a different cloth than other physicians, often times begin their work at a half past five in the morning, leaving the remaining day to preform the task that they enjoy the most.

When my surgeon did finally arrive, he stated the facts as I have in my previously posting. He stated that he would like to keep me for at least two days due to the extent of the infection in my belly. Often times only a short observation is preformed in uncomplicated appendectomies. However as I have illustrated, mine was not a case without complication. He left me to tend to the duties of an inpatient, namely eating, drinking, and restoring my constitution.

It was in this very morning that I discovered that my body and I were like great friends who for one reason or another had suffered a deep conflict and parting of ideas, and were now reacquainted only to find that we had a difficult time speaking to one another on the same intimate terms as before. Instead of the normal sensation of having a full bladder, this was replaced with diffuse pain throughout my belly. This was the same for the need for a bowel movement, moving gas through the bowel, hiccuping, coughing, sneezing or any movement at all. All communication came though the same sinister messenger of diffuse crushing pain.

Of course in modern medicine we still make good use of narcotics, but they bring their own set of discomforts namely: nausea, vomiting, illius, and retention of urine. For better or worse, I experienced all these sensations at various times and at any given point. During surgery I also made the acquaintance of a Foley catheter, an apparatus with which I would rather not have another meeting.

To add to my great displeasure, as if this were possible, if you kindly remember my comments from before regrading oral contrast, I had not yet had the wonderful affects of this mysterious liquid work through my system. This was only, at best, 48 hours after the first dosing. As the liquid worked its way through the maze of my paralyzed bowels, it further plunged me deeper into the flaming inferno I now called my life. Nor did I have the strength, and perhaps I lacked the will, to deal with this as a gentleman or woman would in the matter of cleanliness. It was several days before I was able to rid myself of the effects of the oral contrast, but I will not discuss this further.

The days that ensued were much the same: walk a few times to show progress to the staff, watch cable TV without knowing what was I was seeing, and call the nurses for their care and medications. However, let us not forget the most important reason preventing my return to the comforts of home, IV antibiotics. After the requisite two days had passed, my surgeon requested that I stay an extra day, but I felt I could preform the same tasks at home in a slightly more comfortable and private setting. That same day, the fourth of June, my Love kindly returned me to my home.

Life at home was not much different than it was in the hospital. I still had TV, medications, and the same uncomfortable relationship with my body. I had upgraded the nursing staff to a very attentive and loving wife. I weighed ten pounds more than I did when I when into the ED on that first day. I want to make the point that I weighed more than less because it is not known to the public that of each liter of fluid one receives in a hospital, two - thirds will remain in your tissues. I too had this water retention, which I made quick work of over the coming days. I added lactobacilli to my diet in the form of pills and yogurt to help colonize my bowel with healthy bacteria while I decimated the rest with the antibiotics.

I did little more for the next three days but sleep, try to eat, and attend to my basic human needs. Each day was met with less pain and more mobility. We had limited guests, as we were quite the bore. I received a priesthood blessing, giving me the power for a speedy recovery. Our friends made us the splendid game seen at the top of the posting.

When the time came to cast off my pajamas and

return to wearing regular clothing I found that I could not fit my belly into my pants due to the swelling that had taken place. I used a secret that pregnant women often employ before abandoning all hope of wearing their regular jeans. This involves a small rubber band placed in the loop of the jeans and the loose end being placed around the button. I found that this prevented much discomfort while wearing my pants, as well as preventing pressure on my tender belly.

It is now time for me to return to my labors. The rotation director has been kind in my absence, and we are making arrangements so that this rotation is not counted against me. I now can do all that I was doing before, although I am finding that I am experiencing several side effects due to the antibiotics which I will be taking for a number of days yet.

In reviewing this tale, the reader may wish to place blame on the first physician who saw me on the first of June. I would ask that this not be the case. It is true that there were signs of evil lurking in my body at the time of her consult. However acute appendicitis is a wandering target, and appears in an atypical fashion more often than a typical one. On that first day the pain was all in my upper gut. Focusing on that most obtuse symptom likely led the physician astray. It has also been mentioned by my love, Bryn-Erinn, that I am too stoic and I should have let my emotions of discomfort fly more during the examination with her. In all, all doctors will make mistakes. It is true that my course would have been much simpler had I had the procedure on the first rather than the second day. But how many times have I, to this date, made similar mistakes or will make similar mistakes? And if I, who was deserved, hold no grudge nor contempt, it would seem odd to me for the reader to hold such ill-regard.

50/50 (Part One)

In medical school, I attended a lecture on acute appendicitis. The appendix, as we commonly call it in today's culture, true name is the Vermiform appendixis, meaning the worm. The ancients felt that this fine earth dwelling creature most resembled this unusual organ. In said lecture, it was mentioned that about half of people who presented with acute appendicitis would die from the disease in the times before antimicrobial treatment. Among the surviving half, a large portion would depervess, and some would form chronic/contained abscesses, which would resolve over time or break open and kill the poor unfortunate soul. Before the time of antibiotics, surgery didn't provide a benefit, as the wound was "dirty" (a dirty wound is one considered to be contaminated with bacteria, in this case stool being an excellent source for bacteria), and the complications of wound infections would kill those who survived the surgery. Now, with our modern medicine, the death rate in the US is less than 0.1%.

Several years have now passed since that lecture, which brings us to the morning of June the first. I had just completed a very nice two week vacation. I spent a large amount of my time studying for the USMLE step 3, which I had planned to take at the end of this month so I could apply for my unlimited license - yep in the next six months I will have my DEA number, and the ability to practice medicine unsupervised. It was intended that I would begin my ED, or as others would say ER rotation on Monday. However, at two o'clock in the morning, I awoke with bit of a cramp.

Now the readers must forgive me for my precise account of details of the following days. During this time I was in a delirious state of mind resulting from infection and medications. This being said, I remember that the pain (my only discomfort at this time) which awoke me was thought to be a gas pain. The night before I was hungry (the last time that I would have that sensation, and I'm still waiting for its return) and I found some cottage cheese. It smelled and looked right and I ate it with great satisfaction. Unbeknownst to me, well at least until after I had finished my snack, Bryn-Erinn informed me that it was over two months old and that she didn't realize it was still lurking in the refrigerator. A point that I neglected, as I didn't look at the expiration date before consumption.

Now, this being known, it does not surprise the reader, nor myself at the time, that I might have a bit of a bellyache the morning after devouring said cottage cheese. I walked and stretched trying to move what I thought was a foul ingestion through the gut. However this was not to my advantage, and the pain grew in severity. I did however empty the contents of my stomach, but it oddly did not make me feel better. In spite of this, it was slightly reminiscent of another post which one may find on the 13th of January of this same year.

By five that morning the pain was so bad that I had emailed the rotation director of the ED and told him that I would not be able to come in on my first day, but that I would try to be ready to join his ranks the next day. I later discovered that in this hope I was over zealous and nature had a different course for me. To my surprise my belly became stiff as a board, or as we say in medical circles, "rigid". By nine o'clock that morning, I asked Bryn-Erinn to drive me to the Southdale ED to be evaluated. At check-in I was relieved to see that my "vitals" (heart rate, temperature, blood pressure) were all in the normal limits, and thus my concern was not increased. The staff doctor was delayed due to a heart attack patient, and I lay on the gurney in room six for 90 minutes before being seen.

The doctor's exam confirmed my own self-exam, and I was guarding, another way to say that I was holding my belly rigid to prevent any movement of the tender insides. This most often suggests paraneal inflammation, which is rarely a good sign. I was sent to the CT scanner to have my insides investigated, but the findings were not impressive. On the report it stated that there was some pelvic fluid, but otherwise nothing of note. Similarly an ultrasound was preformed, which did not show any stones in places they aught not to be. My blood work also returned without a clear source of the pain, showing that I had an inflammatory process as indicated by my increased WBC (white blood count). However the good doctor overlooked the elevated bilirubin, which to the more astute practitioner, would have suggested that I was sicker than what her studies were finding.

After a very long day, I was sent home without a diagnosis. I begged for some narcotic pain medicine, as at that point it was only the large doses of morphine that were keeping me sane. She gave me a modest supply and I returned home to face the shards of glass imagined within my belly. I do not remember the next 16 hours. I know that I took the pills to keep the pain under control, but each pill would cast me into a most unrestful sleep. The hours passed quickly, and the next day arrived. When I awoke, Bryn-Erinn had left for work. I'm sure that she gave me commands to call her for anything, and she would rush back.

When I did finally arise from my bed, the pain was somehow worse than the day before, as if this was some sinister plot derived for me from a person without a heart or soul. I took my temperature, which showed that I had a temperature greater than 102. And although not observed by me, Bryn-Erinn later commented that when she found me, upon her return, my heart was beating so fast that it looked as if it was in my neck. I again emailed my rotation director and conveyed the details of the day before, and I again told him that I would not be present to his instruction.

Not wanting to disturb Bryn-Erinn, as this is how logic occurs in the delirious male mind, I patiently waited at home, not moving, waiting for her return. I also called my clinic mentor, Dr. Sick, to confirm that I should go to the ED again, as the ED stated clearly on their paper work that I should not return within the next 48 hours. If this would seem odd to the reader that I would have such doubts about returning to the ED in such a state, again, I emplore you to understand that I was, at this time, in a delirious state of mind and normal human logic did not apply.

At the triumphant return to the Southdale ED they greeted me with open arms and a wheelchair. They confirmed that my temperature was elevated, and my afore-mentioned heart rate was 140. To my benefit, my blood pressure was still in a good range, although this is always the last to fall. My pain had migrated to the right side of my lower belly, except for the times it would lash out in anger and involve the whole of my lower belly. The obvious displeasure of my insides had become quite an agitation to my diaphragm, and I had intermittent hiccups which would only add fuel to the raging fire I had once called my gut.

The physician on this day was quite involved with the very matters that were never explained to us previously. In the interim the nurse had me drink oral contrast for the second day in a row in preparation of a possible CT scan. Not common knowledge, but known to the nursing staff and clever house staff in various hospitals, oral contrast has a way of slicking the gut that few other compounds are known to do in this world. It was once said that only manual disimpaction is superior to the action of this powdery liquid.

After three hours of waiting, watching my heart rate never dip below 120, the physician came and examined me. He damned the nurse for giving me the contrast, and with only the briefest of interview and the quickest of exam stated that I need surgery of that very day. He ordered ertapenum, but he called it by the name of Invanz.

I would wait another two or three hours on that gurney in a room that I don't remember before the surgeon appeared. He stated that we were in the line up for the operating room, but that the line was long. He hoped before seven o'clock that evening, but it could be longer. He checked on me from time to time, almost to rival the nurse staff, with the exception of checking on my blood pressure hoping that I would not drop it before they could save me.

Finally it was time for the operation. I was in the waiting room to the OR, writhing in discomfort, trying to find a position to relieve the misery in my abdomen. However from that time forward is a blank in my memory. It is for sure that I met the anesthesiologist who gave me a cocktail of drugs to wipe that time from my memory. In due order, from my experience: I received a gentle kiss by the lovely Bryn-Erinn; moved into the operating room; put to sleep; had a breathing tube placed; my belly cut open and placed on display; and the offending appendix removed. Bryn-Erinn tells me that I was still in distant travels in my mind when she last saw me exit the operating room that evening, but everything had gone in my favor. The surgeon later confided in me that my belly was full of pus, and a small sample was obtained for laboratory examination, not that it was likely to reveal anything more than what would be cultured from a common stool. Had I not received that life saving procedure, I would have ended my existence in this realm in no more than two sun rises, and undoubtedly been overcome by septic shock.

As for the remainder of this tale you will need to continue on to part two.