Lessons Learned From An Unexpected Brush with Mortality

Photo by Aron Visuals on Unsplash

I’m 45, healthy, a 5-time marathon runner. My “maintenance” weekly workout usually consists of 15 to 25 miles a week spread across 3 to 4 runs, up to 60 minutes of yoga throughout the week and 2 or 3 body-weight workouts. I have no history of significant illness. I get the flu shot every year.

That I landed in the hospital for 11 days because of complications from a stomach flu is still hard for me to understand and accept. I’m very thankful to be here to write this.

On Christmas Day 2018 after lunch, I developed a stomach flu. By the next evening, I had a seizure because I was so dehydrated from the flu. I ended up unconscious and in an ambulance on the way to the emergency room.

I ultimately spent 11 days in the hospital, 8 of them in the ICU. I remember absolutely nothing from the evening of Wednesday, December 26th until I woke up in a hospital room on New Year’s Day. I don’t remember getting in the car, getting sick in the car, the ambulance rides, or the emergency rooms. That whole gap was filled in by family and friends.

What still shocks me is how a stomach flu knocked me over that hard, that fast. I’m chronicling this in hopes that others can learn from my experience… and it’s therapeutic for me to write about it.

If there’s one thing I hope everyone remembers from this, it’s simple:

Don’t wait to go seek care. It might seem inconvenient to change plans at the time, but even if you’re healthy, even if you’re a competitive athlete, a serious illness can get much worse faster than you think.

What I Thought About, What I Learned

I thought about many things after I woke up on January 1st:

• Illness can take us by surprise, even if we’re healthy.
• Logically, we all know we are mortal; but only experience lets us see it.
• The goodness in family and friends comes out in a crisis.
• There is good in our imperfect healthcare system; and it’s important to know how to navigate it in crisis.
• It’s imperative to have basic plans in place so others can help you with care and your life.

How It All Started

We had rented an AirBnB in Bear Valley, CA for a few nights with plans to go skiing. My wife and 2 young kids (ages 4 and almost 3) were with me, along with my wife’s sister, her husband and two of their daughters.

On Christmas Day, December 25th, I felt a little ill before lunch. Not long after, I threw up and couldn’t hold food or liquid down for at least a few hours. I skipped dinner and just sipped water and diluted Sprite, then went to bed.

On the 26th, I felt well enough to go outside with the kids in the morning and play in the snow, but not well enough to ski. My wife took them both up to the ski lodge while I stayed at the condo. I ate chicken soup at lunch, drank water and some Gatorade, and was starting to feel better. My youngest daughter had a 24-hour stomach bug a little over a week earlier, so I figured it could be the same thing.

36 Hours: From Bad Flu to Unconscious in the ER

I remember little that happened after lunch on December 26th. My family said that by late afternoon I was looking pale, had a fever and was shaking.

My wife and sister-in-law decided to pack up the cars around 7:00 pm. We left the condo around 9:00 pm.

20 minutes later, my wife was startled to see I had thrown up again and was having a seizure. I’d never had a seizure before.

I was in bad shape. Unconscious. Unresponsive.

My wife stopped in the middle of Route 4, jumped out and shouted to her sister and brother-in-law for help. Luckily, they were right behind us. My wife and brother-in-law pulled me out of the car, grabbed blankets and jackets, and lay my on my side on a snowbank. Out of 6 people with a cell phone, my 14 year-old niece was the only one with even one bar of signal.

My sister-in-law got 911 on the line and helped stabilize me. Her younger daughter tried to calm my 4 year old daughter. She had seen me get sick and watched them pull me out of the car. She was crying, asking what was happening to her daddy. Our older niece set out flares to warn approaching cars and kept an eye out for EMTs.

We were in a remote area on Route 4. It took 25 minutes for EMTs from Bear Valley Fire to arrive, and another 8 minutes for an ambulance to reach us.

That must have been the longest and most trying 33 minutes for my wife and family who were with me. They had to do their best to care for me, keep our two young girls calm, and just hope and pray as they waited. And this was just the beginning for them.

The ambulance took me to the closest emergency room at Mark Twain Regional Medical Center in San Andreas, 45 minutes down the road, but the ambulance company’s insurance didn’t allow for any passengers to accompany the patient, so I was transported alone. My wife and family completed the EMT’s paperwork and hurried to Mark Twain.

I finally arrived at the ER around 11:00 pm that night, almost 2 hours after my seizure. The nurses and doctor got me stabilized, started me on fluids and oxygen, and began running tests, including x-rays, CTs and MRIs. I remained unconscious the whole time.

Although they didn’t have a diagnosis, they knew my sodium levels had crashed to well below normal, causing the seizure. During the seizure I had likely aspirated, leading to fluid in my lungs that caused pneumonia.

The Long Trip Back to San Jose

The attending physician there had the humility to realize they needed to move me to a larger, better-equipped hospital. Plans were made for a medivac back to San Jose, but in an unusual twist, the whole Bay Area had fogged in that night.

My wife faced a terrible choice: Put me in an ambulance for a 2 to 3 hour ride, or have them medivac me to a hospital in Davis, Sacramento or somewhere else far from home. The doctor felt confident I was stable enough for the ambulance ride.

Around 3:30am, they put me in an ambulance for transport to Good Samaritan Hospital in San Jose, 130 miles away. Again, no one was allowed to ride with me. Not that I remembered — I was unconscious and would be for days.

While I was in the ambulance, they had to figure out what to do with the kids. They also called other family — my parents, my in-laws, my sister. They met my wife’s brother (who lives in Central Valley) at 4:00 am so he could take the kids. This is where I realized how much my whole family mattered, and how beautifully they came together to help. They each played a part.

The Harrowing First Few Days in the ICU

Around 6:00 am, I arrived at Good Samaritan. It’s my go-to hospital where both my kids — and my wife — were born, just 15 minutes from our home. The ER staff did more tests and put me on a respirator to make sure my airway remained open. Fluid had been building in my lungs and my limbs were swelling. They did an x-ray, an MRI and a spinal tap.

My wife hadn’t seen me for hours. I can’t even begin to imagine the anxiety she felt, not knowing how I was doing. My wife and her brother-in-law got to Good Sam around 6:45am. Everyone else had gone to her brother’s house.

At some point in the ER on the morning of December 27th, I had a second seizure that may have lasted as long as 30 minutes. My wife, brother-in-law and others held me down to keep me from hurting myself.

I was admitted to the ICU later in the day. They pumped me full of three antibiotics and one antiviral medication. On December 28th, I was put on a feeding tube. I was kept in an induced coma to prevent me from waking and pulling tubes or IVs out. I was given fentanyl (an opioid) and propofol (the “twilight” drug), one reason I don’t remember anything.

My muscles, either from the seizures, a lack of calories, or both, began releasing enzymes into the blood, causing rhabdomyolysis. My CK level (which measures the enzymes) spiked to over 49,000 by the morning of December 29th. A normal CK level is below 200. The enzymes are toxic to the liver and kidney. They can cause all kinds of problems, including renal failure, and muscle or nerve damage.

A CT scan on December 30th showed a small blood clot in my lung. The virus may have gotten into my lungs earlier when I aspirated and led to bleeding. They still don’t know what it was.

Many of my lab measurements — particularly immune system measurements like white blood cell, red blood cell, hemoglobin and CD4 helper cell counts were continuing to drop. My liver enzymes were elevated. My temperature spiked to 104. My immune system seemed to be fighting a losing battle.

My rapid deterioration and multiple symptoms concerned the team of ICU doctors, including two pulmonologists, an infectious disease specialist, a neurologist, and a nephrologist (the last one treats kidney conditions).

The infectious disease doctor began testing for a wider range of possibilities. E. coli, salmonella, norovirus and several influenza viruses had been ruled out. He checked for West Nile and Hantavirus, coxsackievirus (one variant causes hand-foot-and-mouth, the other is far worse), rat poison (cyanide), spider venom, narcotics, mumps and measles.

The doctor sent blood samples for testing again CDC panels, but nothing came back. He even added HIV to the lab panel with my wife’s permission. Her comment to the doctor: “If it makes you happy, go for it. But if that’s the issue, then my husband and I have bigger issues to discuss.”

This had to be so traumatic for my family to watch. There wasn’t a lot the doctors could do directly other than treat the pneumonia and make sure I was getting fluids to flush out the toxins. But my immune system fought back. The medical team remarked that I was incredibly lucky to be in strong enough shape to fight my way back.

A Slow Recovery, At Last

My lab results started improving by December 31st. My temperature was coming down to 98 or 99, my sodium level was returning to normal, and my CK levels were starting to drop. They started to try and wake me up slowly. Of course no one likes having tubes down their throat so my instinct was to try and pull them out. I don’t remember any of this, but they ended up fully restraining me so I wouldn’t hurt myself. At least I was fighting.

Early on New Year’s morning, I was able to follow simple commands like squeezing my hands and moving my toes. My brother-in-law had taken the overnight shift. He saw me respond and cried in relief. Later that morning they pulled the ventilator and feeding tube out. I was apparently already awake, but on enough medication that I don’t remember it.

In the 6 days since this had started, my body had forgotten how to breath. The respirator had taken over the job. I didn’t know that was possible, but I had to be coached for hours on how to breath. My family helped and watched anxiously.

I came to the afternoon of January 1st when they were giving me ice chips to eat. I have hazy memories of my seeing my wife there, and my parents who had flown from Florida soon after they got the call on December 27th.

My family had to fill in the gaps for me. It was a lot to take in, to even believe. I felt overwhelmed by what had happened, and by the outpouring of support and love from my entire extended family and friends.

I had no idea what was happening in the outside world. One of the first comments I remember was from my wife’s brother: “Sorry, David. Trump is still President!”

My first words were “Where’s my phone?” Maybe I wanted to check if it was really January 1, 2019 and see if Trump was really still president. Or I’m just addicted to my phone like many of us.

I spent another two days in the ICU recovering and beginning to eat real food while they weaned me off most of the medication. Family and friends visited, kept me company, brought me food and coffee from the outside world, and delivered my iPad so I could watch Netflix.

The remarkable ICU staff did whatever they could to help me to recover and be comfortable. One of the unfortunate complications was the small blood clot in my lung, so I’ve stayed on blood thinners even after leaving the hospital.

I spent another two days in the regular care unit until physical therapy was sure I was strong enough to go home and lab tests confirmed the blood thinners were working.

I was incredibly fortunate in many ways — to have even survived the first 8 hours from the 911 call; to recover quickly without any lasting issues; to have such loving support from family and friends, many of whom dropped what they were doing and spent days helping me and my family; and to have such amazing care, and insurance that will cover most of the costs.

Even if we’re healthy, active and feel like we’re in the best shape of our lives, our own mortality is ever-present. It might show up as unexpected illness, an accident, or an undetected genetic condition.

None of us can predict when or where we might come face-to-face with mortality. But we can prepare — even though none of like to think about it.

I’ve thought a lot about what I learned, and what I’d tell others:

• Be aware of your mortality. If Marcus Aurelius’ Meditations (the Kindle version is free) or Seneca’s Moral Letters are too heavy, pick up The Daily Stoic. It’s easy to take your health for granted. The reality? It’s fleeting and fragile. Reading about and acknowledging it helps you prepare.
• Don’t wait to go seek care. Even if you’re healthy, eat well and exercise every day, a serious illness can get much worse — faster than you think.
• Plan who will be responsible for your health if you’re unconscious. You’re way better off designating someone ahead of time than leaving it to chance. My wife and I have power of attorney and advanced healthcare directives in place, so she was able to make decisions and sign documents on my behalf.
• Share your key information with a loved one. My wife was able to access important information because I shared my phone passcode with her, and she has emergency access to my LastPass password manager account.
• Program those emergency contacts into your phone. This will matter if you’re by yourself and something happens.

I’m lucky to be alive and healthy. I’m thankful every day. I’ll explore some of my thoughts in more depth in future posts — including what I learned about navigating the healthcare system in an emergency. I hope my journey and experience helps to put your own health and mortality in perspective.