I Almost Died. This Is What I Learned

It was Thanksgiving day. Cindy and I were preparing to have friends over for dinner. My right arm had been swollen since the previous evening. It looked slightly purple when compared with my left arm, and it reminded Cindy of Popeye’s arms. It was inflated and taut like a balloon, and unexplainably ripped.

This was what I thought a deep vein thrombosis (DVT) might look like. A DVT is a clot in a deep and major vein of a limb. I remembered hearing stories of people getting DVTs from long-haul flights, and then later dying when the clot migrated to the heart, lungs, or brain during exercise.

We went to a local emergency room (ER). They prioritized my case and I was seen by a doctor very quickly. It turned out that I did have a DVT. I had a massive blood clot in the main vein of my arm, starting in my chest, under my collar bone, and extending all the way down my arm to my wrist. The doctor told me that it was an unusually large clot. We cancelled Thanksgiving dinner.

I was diagnosed with veinous thoracic outlet syndrome (VTOS). Only about 1% of the population ever develops thoracic outlet syndrome, and of those, only about 3% suffer from the veinous type. That means that only about 3 in 10,000 people ever get this. That’s about 0.03% of the population!

Below is a detailed and technical explanation of the fourteen days I spent in hospital, followed by a more flowing list of experiences and learnings. If you would like to skip straight to the experiences and learnings, then scroll down to the subtitle I’m grateful for everything.

By OpenStax College — Anatomy & Physiology, Connexions website, Jun 19, 2013., CC BY 3.0, from Wikimedia

In VTOS, the subclavian vein that drains blood from the arm becomes blocked where it passes through the passageway from the armpit to the lower neck (see diagram). For some people, the passageway becomes blocked due to congenital abnormalities. In many cases, including mine, the blockage is caused by highly developed muscles inside the shoulder, which press the vein down against the first rib. This is why many athletes who use their upper-bodies and shoulders extensively, such as professional swimmers and baseball pitchers, tend to get it.

I do CrossFit, which includes a lot of gymnastics. Even for a CrossFit athlete, I have unusually strong shoulders. I am able to complete a slow pull-up on either gymnastic rings or a pull-up bar and then slowly transition over the top and do a dip. This is called a strict muscle-up, and I’ve been developing the required shoulder strength and flexibility for years.

Just after I learned how to do a very slow, strict ring muscle-up

The long-term solution was to remove a large piece of my first rib, an operation which is called a rib re-section. Because of the risk of pieces of the blood clot traveling to my lungs and causing a pulmonary embolism, which would be immediately life-threatening, removing the blood clot and stopping it from forming again was top priority.

I was admitted to the hospital and immediately put onto a high, therapeutic dose of an anticoagulant drug called heparin, delivered through a drip. Anticoagulant drugs, also called blood-thinners, reduce the risk of new blood clots forming, and help the body to naturally break down existing clots.

Over the next fourteen days of hospitalization, I experienced four Interventional Radiology procedures, each lasting from ninety minutes to five hours, two ultrasound assessments of the veins in my arm, an echocardiogram (echo for short), which is an ultrasound imaging study of my heart, and the aforementioned rib re-section operation.

I was given the echo to check that I didn’t have a hole in my heart (called an atrial septal defect; ASD), which is a relatively common abnormality. We all have a hole between the the two upper chambers (atria) of our hearts when we are born, but the hole quickly closes up in most people. If I had had a hole in my heart, and if pieces of the clot were later dislodged during a clot-removal procedure, those tiny pieces of clot could go through that hole, and up in into my brain, causing me to have multiple strokes. Luckily, I didn’t have an ASD, so they could confidently proceed with the Interventional Radiology procedures to remove the clot.

The inside of my right bicep. One of the catheter insertion points

Interventional Radiology (IR) is a discipline in which catheters are used, along with x-ray blocking dyes that are added to the blood plus an x-ray machine above the procedure table, to enable a radiologist to dynamically view what is happening inside the body as catheters are maneuvered therapeutically. This diagnostic method is called contrast venography, and is the best method available for assessing veins. When the radiologist pushes a pedal under the table, dye is injected and the low-dose x-ray video is switched on. Everyone in the room, apart from the patient, is clad in suits of lead. My radiologist wore a tartan-patterned lead-suit.

IR procedures performed on me included at least three episodes of aspiration thrombectomy, which is removal of clotting using a suction device, at least two episodes of thrombolysis, in which a soaker-hose in the vein is used to douse the thrombus (a fancy name for clot) with a clot-busting drug such as tissue plasminogen activator (tPA), and one episode of angioplasy, in which a special catheter with an inflating tip is inserted until it reaches the constricted part of a vein (technically called a stenosis), before being inflated to stretch the vein open.

I was on three drips at the same time in the Cardiac Care Unit

I spent 40 hours, the maximum time allowed, with a catheter in my armpit and tPA soaking the clot under my collar bone. During that time, because I was on such a powerful blood-thinner, I was continually monitored in my own room and by my personal, one-on-one nurse. I was in the Cardiac Care Unit (CCU), which is a special form of Intensive Care Unit where, normally, patients are monitored following open heart surgery.

During my stay at this county hospital, I spent significant time in six different bed locations, in five different departments. I was given many drugs (you don’t need to remember the following list), including tPA, heparin, enoxaparin sodium, fentanyl, morphine, hydromorphone, oxycodeine, hydrocodeine, midazolam, hydroxyzine, ondansetron, and hyoscine. After surgery, I was able to self-administer hydromorphone through one of my intravenous lines by pushing a button. This is called patient-controlled analgesia (PCA).

I had many intravenous (IV) lines attached to my body, always to my left arm since my right arm could not be used. At one point, there were three IVs in my arm, one of which had been in place for over seven days. I was continually monitored by an electrocardiography machine (ECG) with at least five leads attached to my torso.

One configuration of three IV lines

After surgery, attached to my body were at least two drip lines, several ECG leads, a container attached to the end of a drain tube coming out of my surgical wound, a blood oxygen sensor attached to one of my fingers, a blood pressure cuff on my left upper arm, and an intermittent pneumatic compression device attached to each of my calves, pumping them repeatedly to prevent the development of DVTs in my legs.

For the rib re-section operation, I was knocked completely unconscious, and monitored by an anesthesiologist. I don’t even remember her putting me under. Unfortunately, I forgot to ask them to keep my rib for me.

For the IR procedures, they gave me an intravenous cocktail of fentanyl, a powerful anesthetic (sedative) and analgesic (painkiller), combined with midazolam (brand name, Versed), a powerful anxiety-reducing sedative. Even though they re-administered this up to five times during the procedures, each time I started to feel pain again, I was able to stay conscious and somewhat alert for much of the time. I chatted with the doctors and nurses; we actually had a lot of fun.

I happened to visit the ER in a hospital run by the county. Although my insurance would have covered one of the excellent — and much more expensive — local private hospitals, I received exceptionally good medical care at this state-run hospital. Being a teaching hospital, the attending vascular surgeons on my case were both professors at Stanford Medical School (SMS), and were therefore world-class. The other surgeons were fellows from SMS. In the USA and Canada, medical fellowship is an optional period of training that follows residency. The nurses and radiologists were outstanding.

Cindy slept by my side

Cindy (my wife) lay by my side throughout, sometimes literally. After carefully navigating all the tubes and wires, she slept one night on the bed with me in the CCU. This seemed to disturb the head nurse. After the nurse learned of it, Cindy had to sleep on a recliner that they brought into my room. Cindy visited me every day, bringing me food and giving me bed baths. I am deeply grateful for her love and care.

I did have some issues with this old county hospital, which was founded in 1876. At one point I was housed in a very dated section of the building, where the single-pane windows and insufficient air conditioning led to the room getting unbearably hot in the mornings. There were also a disproportionately large number of people who were either homeless and/or chronically addicted to drugs, particularly in the department with the greenhouse windows. I don’t mind spending time with these people, and I acquired several great new stories because of it, but some of the experiences were ones that I would have preferred not to have had whilst I was running this medical gauntlet.

I heard a doctor say to one of my roommates, “The echo shows that you have very abnormal heart functionality, which is something we usually see that in people who chronically abuse crystal meth.” After the doctor left, the guy in the bed next to him said, “You heard the doc. You need to cut that shit out, man!”

After discovering that one of my roommates was intent upon watching an endless stream of conspiracy-theory videos on his phone with the volume turned to maximum, and that someone in the room was vaping marijuana, and also knowing that the morning would bring a sweltering heat, I requested to be moved to the other side of the building, and into a two-person room. In that room I met Tony, who had asked to be moved from a room in which his roommate had been verbally abusing the nurses. Tony and I became good friends.

Ten pounds lighter, and wearing my 15–20 mmHg compression sleeve

Ten pounds lighter, I’m now at home, gradually recovering, and weaning myself off the opioid pain medications. I keep my arm under compression using a compression sleeve. After a DVT, it’s important to keep the limb compressed and elevated as much as possible, to reduce the chance of developing a condition called post-thrombotic syndrome (PTS). Between 15 and 25 percent of those who have a DVT in an upper extremity go on to develop PTS, which is characterized by currently incurable chronic pain and swelling of the limb.

I’m also on an anticoagulant drug called Xarelto (rivaroxaban) for three to six months. This is to allow my body to focus on breaking down some possible remaining old clots on the walls of my right subclavian vein and brachiocephalic vein (see diagram above). I hope I don’t get injured, because there is no antidote for this drug in the case that I start bleeding profusely. The doctor also told me that if I bang my head, and it starts to bleed internally, I will probably die. I’m taking a complete break from riding my motorcycle.

So that’s what happened. Now I’ll tell you about some of the experiences I had, some of the things I learned, and some of the ways I have changed during this challenging time.

At an outpatient visit

I’m grateful for everything

During my time in hospital, and even after returning home, I have found that I have a deep appreciation for everything that I experience. I am grateful for the feeling of cold on my skin, for the texture of clothing, and for the space between things. I seem to be in a continual state of celebrating reality. When I watch TV shows and movies, I find myself enjoying every moment of them as if they are created from a sequence of masterpiece paintings. My mind is drinking in my experience from moment-to-moment, savoring it, and cherishing it. I don’t know why this is happening, but I hypothesize that it’s because I could have died.

Bonjour has a magic power

While in hospital, Cindy told me about a book she’s reading called Bringing Up Bébé, about how the French raise kids. She told me that when French people say bonjour to each other, they’re not just conveying the literal meaning, which is “good day”, they are, in fact, acknowledging the existence of each other. The deeper meaning of bonjour—or bon soir—is “I see you.” In the many long walks I took around the hospital, I made eye contact with everyone and said hello. This practice seemed to spread warmth and happiness, and I felt more connected and at home. Since I have returned from hospital, I have continued to practice.

We are surrounded by beautiful stories

At one point in my stay, I was transported in a wheelchair to the ultrasound department so that they could assess the level of clotting in the main vein of my right arm. When we arrived, the porter turned my wheelchair so that my back was against a wall on one side of the room facing a woman in a wheelchair on the other side of the room, so that we were facing each other.

The woman opposite me was calling loudly for help and seemed to be in a lot of pain. The porter asked me if I wanted the curtain to be closed, so that I could not see the other patient. I said no. When the porter had left, I started a conversation with the other patient.

She told me that she was homeless, and that she had been in hospital due to an infection that had developed because the back of her calf had been rubbing against her wheelchair. She told me that the doctors had discharged her too soon, and that the infection had come back. Her leg was purple and swollen, and covered with variegated veins.

She said that the doctors were refusing to give her pain medication. She got on well with one doctor, but not with another. I suggested that she ask to only work with the doctor that she liked. “They work as a team,” she told me.

She told me that on the streets they all stick together and take care of each other. She had spent many years taking crystal meth in order to dull the emotional pain of all the trauma in her life, including that of her traumatic childhood. She told me about the problems with her heart because of the crystal meth abuse.

When she was a child, her brother molested her, and he has continued to do so for all of her life. Even after she got married, he came to her house and begged her to have sex with him.

She told me that she had been gang raped many times, but that it was her own fault because she had been so high on drugs that she didn’t know what was happening. I suggested an alternative, and equally valid, perspective: that these men were responsible for taking advantage of her when she was unconscious. She seemed to understand and value this new perspective.

She started telling me about a man who was going to take her off the streets. I imagined that she was partly imagining that I was that man, and as I asked more questions, I realized that this was purely a fantasy, probably designed both to give herself hope and to bolster a sense of self esteem.

As the nurse wheeled her into a room for her ultrasound, now apparently no longer in pain, she said that she liked my accent and asked where I was from.

I could push this button to inject morphine directly into my vein

Modern medicine is miraculous

I used to be very skeptical of modern medicine. I believed that it was overly focused on alleviating symptoms without determining and resolving the underlying causes. I thought that it was overly reductionistic, and incompatible with a holistic worldview.

During the fourteen days I spent in hospital, I paid close attention to everything that the medical professionals were doing, I asked a lot questions, and I googled as much as possible.

I came to appreciate the extreme level of technology and scientific achievement that is captured in the practice of modern medicine. It is actually extremely well regimented and based in the scientific method. Perhaps this has changed in the last few years, but there also now seems to be an ability for the doctors and nurses to hold knowledge lightly and to appreciate that nothing is known for certain, and that often many factors contribute to any particular sign or symptom.

It seems that modern medicine has grown up as I have grown up. At least the way that I saw it practiced in this hospital, it seems like a powerful, holistic, humanistically-tempered science. I feel extremely grateful for modern medicine.

Thirty-minute hourglass that I’m now using to time movement breaks

How to avoid getting a DVT

I’ve learned a lot about the vascular system and deep vein thromboses in the last few weeks. It’s actually amazing that blood makes its way from the heart, through the tiny capillaries in the lungs, back to the heart, through tiny capillaries all over the body, and then back to the heart again.

Deep vein thromboses occur when the blood starts to clot in a vein on it’s way back to the heart from those tiny capillaries in the limbs. The main mechanism that prevents blood clotting in the veins is the consistent movement of the blood back towards the heart.

The left ventricle of the heart pumps oxygen-rich blood into the arteries, but this rhythmic pressure is applied very distantly from the veins, and on the other side of millions of minuscule capillaries throughout the body. In these capillaries, the blood delivers nutrients and oxygen to the cells and collects waste products and carbon dioxide from them. When the nutrient-depleted blood leaves the capillaries, it enters the larger and lower pressure veins.

The blood only keeps moving in the veins because of this distant pushing of the left ventricle of the heart, combined with many one-way valves, the pumping effect our muscles, and sometimes gravity. Gravity can work both for and against veinous blood return.

To get back to the heart without clotting, the veinous blood depends on the combination of all of these factors working in concert. Since blood consists of 90% water, its consistent flow also depends on good hydration.

If a blood clot does does form in a vein, it’s usually a life-threatening medical emergency. The clot must be removed, and the conditions that led to the clot must be ameliorated. If the clot breaks loose, then it could travel through the right ventricle of the heart and into the lungs, where it would get caught in the tiny capillaries there, producing what is called a pulmonary embolism, which is an even greater medical emergency.

DVTs are most common in the legs, because these veins usually have to return blood a long distance up them, fighting against the downward pull of gravity. Even after surviving a DVT in a leg, one in two or three patients will suffer from post-thrombotic syndrome (PTS), in which important structures such as the valves in the veins are damaged and scarred so that they don’t work properly. There are many people who suffer chronically from PTS.

With all of that said, it’s really important that you do everything you can to never have to deal with a DVT. Here are some things you should consider doing regularly to achieve this.

  • Stay well hydrated by drinking lots of water and consuming minimal diuretics such as caffeine and alcohol.
  • Get up and move around frequently, say every 30 minutes. The pumping effect of your calf muscles when you walk actually helps to pump blood up your legs. If you work at a desk, I recommend the Pomodoro Technique, in which you work in 25 minute intervals before taking a five minute break.
  • If you work at a desk, you could also get a sit-stand desk so that you vary your working position frequently throughout the day.
  • Exercise every day, using as many of the muscles in your body as possible. I recommend high-intensity interval training (HIIT) and CrossFit.
  • Regularly elevate your legs above your heart to increase veinous return. You can do this by placing your legs vertically up a wall, as if you’re sitting on the wall. This is also very relaxing.
  • Get your blood tested to make sure you don’t have a clotting disorder.
  • If you’re overweight, then work on reducing your weight. Obesity is a major risk factor for DVTs. I recommend a low-carb or ketogenic diet, and intermittent fasting for effective and healthy fat loss.
The wounds from surgery

The power of welcoming what comes

When I practice Vipassana meditation, it’s all about increasing awareness of the subtle sensations in my body, and developing equanimity for them. Equanimity occurs when there is no reaction to the sensations, no grasping for the pleasant sensations, no attempting to prolong them, and no aversion to the unpleasant sensations, no trying to push them away.

This is in stark contrast to how our unconscious mind deals with these sensations that are continually arising in response to our circumstances. Our untrained or unconditioned unconscious mind is continually fighting with the sensations, trying to control them. What this looks like for most people is a continual battle with the external circumstances of their lives, with people and with situations.

We see people railing against reality, complaining, blaming, and playing victims. The more I have practiced Vipassana meditation, the more I have been able to be aware of the sensations that these external circumstances invoke inside me, and the more equanimity I have been able to develop for them.

So this time in hospital was a perfect test of my progress. How equanimous am I really? How well can I ride the train of life? How surrendered am I in each moment to what reality brings to me?

I didn’t do perfectly, but I did better than expected. I didn’t bitch and moan. I didn’t complain, and I didn’t fall into victimhood. Instead, I actually experienced the whole thing in a way that led to a deepening of my understanding. I was able to surrender into the experience, and to trust that this whole thing was for my greater good, and that somehow this experience was leading me toward the life that I continually choose in my emotionally-compelling fantasies.

The life that I calmly choose is coming to me, piece by piece. Each day I see increasing evidence of it. And as that happens, each time something happens that seems to not be what I chose — such as this fourteen-day, painful hospitalization — I am able to step back and trust that somehow it is what I chose. I am able to take full responsibility for my life.

I’m proud that I could do this even when it felt like my bladder was going to explode because of a post-surgical urethral stricture that prevented me from urinating (more on that later). I’m also proud that I could do this when I learned that my arm might never recover, as I discuss in the video below.

After I discovered that my arm might never recover

The importance of standardization

For much of my hospital stay, I was on some form of anticoagulant drug. Anticoagulants are drugs designed to stop blood clots from forming. The most common intravenous anticoagulant, and one that I was given a lot of, is heparin. Heparin was discovered in 1916, and is on the World Health Organizations List of Essential Medicines, which means that it’s one of the most safe and effective medicines available, and that it should always be available in medical centers.

I needed to be on a relatively high, therapeutic dose of heparin for weeks on end. Since the heparin was being continually added to my blood through an intravenous drip, and since an overdose of heparin can be fatal, it was critical that the amount of heparin in my blood was carefully monitored. Too low, and my blood would not be thinned enough. Too high, and I would die.

The standard protocol with these high doses of heparin is to set the amount on the infusion pump, a programmable pump that the drip line passes through, and then to check the amount of heparin in the blood after six hours and then every six hours after that. Each time the blood-heparin level is measured, if it’s above a certain threshold, then the amount of heparin being delivered is reduced for the following six hours by programming the infusion pump. If the level is below a different threshold, then the amount of heparin is reduced for the following six hours. The programming of the infusion pump is so critical that the a second nurse must always check the change made by a first nurse.

Once the heparin level has been measured to be between the lower and upper thresholds two times in a row, then the blood-heparin level only needs to be checked once per day, each morning.

The basic protocol seems to be extremely well documented and understood. The nurses would come to my bed every six hours to draw blood, including throughout the night. There were times when — I think because I was dehydrated — it was really hard to draw blood. Sometimes a nurse would stick a needle into my veins two or three times before going to get another nurse to try. Other times they brought someone up from the lab who was more skillful at drawing blood. Sometimes they would use one of the IV lines in my arm, so they could avoid jabbing me again.

The veins in my left hand, bruised and covered in holes.

After the surgery where they removed my rib, the medical staff were putting me back onto heparin, and it took them more than a week to get me to a therapeutic dose.

First my blood-heparin level was too high, so they reduced the heparin, and then six hours later it was too low, so they increased the heparin. This process went on seemingly endlessly, and this is when I started to notice the differences in the procedures that they were following for the blood draws.

Sometimes the nurse would stop the heparin drip thirty minutes before drawing blood, sometimes five minutes before, sometimes immediately before, and sometimes they left the drip running. One time a nurse stopped the heparin drip, flushed that IV line, and then took the blood from the same line that the heparin had been infused through. She came back thirty minutes later saying that the draw must have been contaminated by the drip line because the heparin level was impossibly high.

Another time, a nurse inserted a needle into two different veins, but couldn’t get any blood to flow. She went to get another nurse, who did manage get retrieve some blood, but that nurse returned ten minutes later with bad news: the amount of blood in the vial was slightly too little. So we had to start again.

I became aware of how important it is to standardize measurements like this. The heparin should be stopped a specific amount of time before the blood draw, the blood draw should be taken up-river (down my arm towards my hand) from where the heparin drip was attached, and the blood vial should be filled to the line. Apart from the time when the blood was taken out through the heparin drip line, the up-river rule was strictly followed.

Feeling a little frustrated, partly because I was exhausted, I talked to one of the doctors about the issues I saw with the non-standardization of the data sampling method. I’m not sure if that had any effect, but it felt good to notice and to take some action. The take-away is that even though modern medicine is amazing, it can also be fallible.

To get basic service, treat people like shit

At one point I was in a room with another patient who was behaving very negatively. The nurses and physical therapist kept trying to get him to stand up and go for a walk, but he treated them really aggressively, shaming them, and muttering put-downs under his breath.

They were trying to help him to not become bed-ridden, but he was treating them as if they were selfishly trying to get something out of him. After a burst of negativity, he would say, sweetly, “I’m really sorry,” but would then launch into another round of attacks. I imagine that he must have been severely and chronically traumatized.

One time, after the nurse seemed to have finished working with him, I called for her, and she came straight around the divider curtain to talk with me. I started to give her a summary of what the surgeon had told me earlier in the morning. I asked her, “Do you want to hear about this?” She said, “Oh yes, please tell me!”

Then the other patient started screaming. He was making sounds like someone was torturing him. I noticed that the nurse didn’t flinch. After a moment, it felt strange to be having a polite conversation while the other patient was apparently dying. I pointed in his direction and asked, “Is he okay?” She said, “Oh yeah. No problem. Carry on.”

We had a long conversation, and then she went to leave the room, passing by his bed on the way. He shouted at her, “Hey Little Miss Talkative! I wasn’t finished with you!”

She replied, “Oh, I’m sorry, I didn’t realize.”

“I needed to piss and you walked away!” he yelled at her.

“The pee bottle is right here.” She said, presumably pointing to the bottle hanging on the side of his bed.

“It’s too late now, I’ve pissed all over the bed! And it’s all your fault. Now I’m lying in a puddle of piss!” he complained.

The nurse said something about going to get help to clean it up. She didn’t return, and he seemed to forget about the urine in his bed. I strongly suspect that he had been lying about that, trying to make her feel bad for ignoring him, or for giving me attention.

This is when I realized why the button to call the nurse didn’t seem to work in this room. Unlike in other rooms, when I pushed the button in this room nobody came. He must have trained the staff to ignore calls from the room.

It was very clear that while the medical staff were giving this patient appropriate and sufficient care, they were not giving him any more than they absolutely had to. Overall, he probably received much lower quality care than those who treated the staff kindly, respectfully, and appreciatively.

Vinegar is powerful stuff

One of my roommates was relatively quiet, but had a very loud relative who would come and visit him. Everything she said was expressed with a booming shout that filled the whole room.

One day, I think she was talking to someone on the phone, and she said: “They’re going to test you for TB? You need to get your blood clean before they test you! You need to drink vinegar! Got it?! Vinegar. That’s spelled VINGR. Write it down. VINGR; vinegar!”

I have no idea what that was about, but it made me laugh.

I’m ready for the zombie apocalypse

Towards the end of my stay in hospital, because I had paid such close attention to what the nurses and doctors were doing, and because I had asked a lot of questions, I realized that I had received a basic medical training.

I now know how to use many of the basic medications, how to start and maintain and IV line, and how to manage a drip system. I think I now have a basic grounding in medical technology so that I could care for myself or others, if necessary, in the event of a zombie apocalypse.

But more seriously, I’ve become so interested in medical technology that I’ve started to study chemistry and biology again, something that I last did when I was fifteen years old. Although I don’t want to become a medical doctor, I want to learn as much about medicine as possible.

I have a new appreciation for my urethra

Eight hours after leaving surgery, I tried to pee into a bottle, and immediately felt extreme cutting pain inside my urethra. It felt like I was trying to pee out razor blades. I called the nurses and asked for help. They said that they might need to give me a urethral catheter. I said that I would try to pee myself first because I was scared of the pain that I imagined that a urethral catheter would produce, especially if trying to pee was so painful.

The nurses helped me to stand up, which was challenging because I was still affected by the general anesthetic. Then they left me standing next to the bed holding the pee bottle. I stood there for about twenty minutes, trying to pee. In the end, I gave up.

The nurses then checked my bladder using a portable ultrasound machine and found that it contained about 500 milliliters (ml). Healthy adult bladder volume is between 300 and 400 ml. Over the next couple of hours, the pressure in my bladder increased further and it started to hurt a lot.

Eventually, the nurses got the go-ahead from the doctors to give me a urethral catheter. I felt terrified of the pain, and also embarrassed to have two nurses performing this procedure on me.

It seemed to take them so long to prepare the catheter. The had to unwrap each piece and lay it down on a sterile surface. I watched each step, in a delirium of pain as the pressure kept building. It felt like my bladder was going to explode.

As they inserted the catheter, I was taking deep breaths, and I almost cried. The nurses were doing a really good job of soothing and reassuring me as they inserted the catheter. It was surprisingly not very painful.

Then the pressure started to reduce. I felt an enormous amount of relief, and waves of calm washed over me. I have never enjoyed my bladder emptying so much in my life, and I may never experience this again. The nurses measures 1,200 ml (1.2 liters) of urine, three to four times normal bladder volume.

An hour or two later, I was able to pee normally, without a catheter, with relatively little pain. Apparently, a common side-effect of the general anesthetic is that is causes a urethral stricture (a blockage), which is renowned for being one of the most painful, and also life threatening, conditions we can experience.

Needless to say, I now am deeply grateful for my functional urethra.

Don’t store your cooked chicken in a hot tent

When I was in the ER, a guy came in needing to have his stomach pumped because he had literally eaten too much Thanksgiving dinner. He was in extreme pain. Celebration had morphed into medical emergency. There was another guy who had been admitted because he sliced his hand open while peeling potatoes for Thanksgiving dinner.

In the ER, there were several people who had been driving under the influence, and who were being both monitored by the medical staff and watched over by police. Actually, during my whole time in hospital, I saw many patients who were being guarded by police officers, presumably to be taken to jail once they were well enough.

Weirder stories surfaced once I was admitted. There was a young, homeless, Vietnamese man staying in the same room as me. Cindy and I learned a lot about him and his condition by listening to his conversations with friends, conversations in both English and Vietnamese.

Apparently, several days before Thanksgiving, he had acquired a whole cooked chicken that was past its sell-by date. He then stored the chicken in the corner of his tent so that he could eat it on Thanksgiving day.

After eating the chicken, “I had to come in because my balls were hurting so bad I couldn’t take it.” He reported to his friend. It sounded like he was suffering from something that went way beyond normal food poisoning, and had developed some kind of sepsis. “I could have died!”

“The doctor told me that I didn’t get sick just from eating the chicken. I also breathed the germs inside the tent. It smelled really bad!”

Cindy and I really enjoyed listening to him. He seemed like such a sweet, innocent soul, with a pure heart. In one phone call with a friend, he was asking her to bring him oranges: “Do you think you could bring me an orange? Maybe two oranges?” It was so sweet and so sad. I heard him having conversations with his friend about his drug use and how he was trying to stop doing it.

The funniest and saddest part is that he didn’t seem to understand what happened to him, and how to prevent it in the future. He said that his big learning was that, “I’m too old to eat food that is past its sell-by date.” Cooked chicken, especially if kept frozen, has a reputation for being edible indefinitely. He didn’t seem to realize that the problem was, in fact, caused by incubating the cooked chicken in the hot tent for several days. Of course, the deeper issue is that he’s homeless.


So there you have it. Phew, that took a long time to write. That was a random selection of experiences from my stay in hospital. I hope you learned something from it.

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