The World’s Worst Roller Coaster
Durham VA Medical Adventures, Part 3
So there I was. In the ICU. Again. I had a hose in my nose, a drainage tube in my side, and IVs in both arms. The biggest issue is that I had evidence of an upper GI bleed. Evidence that I added to every time I went to the bathroom.
During this time, I was all over the place. There were times I felt better, almost good even. Then I would get light headed, my heart rate would spike into the 120s, and I would generally feel like shit. It was like being on the world’s worst roller coaster. And the up and down would continue.
CT scans did not show an active bleed. I was scheduled for an endoscopy with the GI doctors. The goal was to get a picture of exactly what was happening in my system.
So on the 2nd of July I went back under anesthesia and had my first endoscopy. Yeah, I said first. The GI docs went through my mouth and into my GI tract to get a picture of what was happening. The silver lining in all this is that they couldn’t do the procedure with the NG tube in, so it came out. And that was amazing.
When GI got in they saw what they believed to be the source of my problem. I have ulcers and lesions from my stomach to my small intestines. We would discover later that I had H pylori bacteria in my gut. H pylori is common - about half of the population has it. Most of the time, the bacteria is inert. For some lucky folks (like me) it becomes active. The active H pylori, combined with my habitual NSAID use due to chronic migraines I suffer from as a result of blast injuries in Iraq and jumping out of planes 100 times, caused what one GI doc described as a “nuclear bomb” to go off in my digestive tract. The ulcers were most likely the source of the bleeding, especially two particularly gnarly ones in my duodenum.
Despite seeing all the damage, GI did not find an active bleed. The general consensus on the part of the team was that whatever had been happening had stopped. I received my first two units of blood to replace what I had lost and my HGB (the amount of blood in your system, usually around 15 in adult men) was up to 10.0. I wasn’t out of the woods, but I was doing better.
I thought.
On the 3rd I was downgraded to floor status. While I remained physically in the ICU, my care was transferred from the ICU team back to general surgery. I was able to move freely and worked with PT and OT to verify that I was moving okay. I walked laps around SICU and even went up some stairs.
During all this activity I found myself feeling wobbly on my feet, lightheaded, and my heart rate again greatly elevated. I assumed it was because I needed to get my strength back. In hindsight, all that was happening because I was still bleeding.
Because I felt better I became what Barb calls “Spicy Jeff.” I demanded regular food, and told the doctors I was ready to go home. The drain was no longer getting anything significant out, so I wanted that gone too. I was done with the hospital and ready to leave.
I woke up on July 4th fully expecting the doctors to come in, tell me that I was going home, and then pull my drain. I was profoundly disappointed when Dr. Rucker (the chief resident) told me that I would be staying at least one more day. They were concerned about the drain not getting anything out, and wanted another CT scan to see if it was still properly placed. So. More wait and see.
Barb came shortly after rounds and I told her about what Dr. Rucker said. We took another walk around the ICU. I was again lightheaded, again my heart raced. We got back to the room and I rested on the bed. We watched some TV. A few minutes later I told Barb I had to go to the bathroom. She stood up and pulled the blinds to the room closed (being in the ICU is like being in a fish bowl - everyone can see in). The toilet was in a literal cabinet at the back of the room. It was already out. I stood up and took a step towards the toilet.
The next thing I remember is there being about 20 people in the room, and the lights being very, very bright. I was on the floor, which was weirdly cool and comfortable. I felt very sleepy, but nurses kept waking me up. My nurse for that day, Judith, was asking me questions like what my name was and where I was. I answered her, but it must not have sounded the same to them as it did to me, cause they kept asking. They got me to the bed. I had four nurses at each arm, all of them desperately trying to find a vein to draw blood.
There were waves of nurses and docs coming in and out, and animated discussions taking place. People were calling chief residents and attending physicians. All trying to figure out exactly what the fuck was happening.
What happened was this. As I walked to the toilet, I crashed into the side wall of the room and fell straight back onto the floor. I was unconscious before I touched the floor. Barb, who had her back turned as she held the curtains, heard the commotion and was able to reach me just in time to catch me and lay me down gently. Had she not been there, or been on the other side of the curtain, my head would would have cracked like a cantaloupe.
My HGB had dropped down to 6.9, meaning I had half the blood volume I should have had. My white blood cell count had gone back up to over 20, meaning there was still an active infection.
At this point it became clear that what I was dealing with - and had likely been dealing with the whole time - was two separate problems, both complex but solvable. There was the perforated appendix and resulting abscess and infection (which was driving my high white blood cell count as my body tried to fight the infection) and a still active, but very elusive, GI bleed caused by ulcers somewhere in my upper GI tract. And there were lots of ulcers to choose from. Either of these problems alone would have been a challenge. The two of them stacked on top of each other caused what one PA called “a super shitty Rubik’s cube” that had to be solved by the doctors. And fast.
It is hard to overstate how touch and go all this was. My body was in shock and was shutting down. I was so weak I couldn’t lift my arms. I felt more sick than I have ever been in my life. Before I went in on the 24th of June I had never had a surgery. Never been in a cast. I broke my collarbone when I was 3, but I barely remember it. I was a paratrooper for 10 years. I ran for fun. I have been trained to endure almost anything, up to and including capture by enemy forces. I am a tough guy, and I don’t say that with pride, just clarity. I spent my whole life healthy. Exceptionally healthy.
And now, I wasn’t.
Spicy Jeff was long gone. I wanted to stay in the hospital as long as I needed to feel better. I was more scared than I had ever been, even under fire in Ramadi. Barbara was by my side the whole time, literally holding me up as I fell. I was reminded just how incredibly lucky I am to be married to this force of nature.
I was in bed for all of 4th of July weekend. A CT scan showed that my abscess was getting larger, not smaller. That meant that the drain wasn’t working properly. Plans were made to have IR reposition the drain, or perhaps use a bigger tube. That seemed to explain the infection and high white blood cell count.
Another endoscopy was scheduled with GI. It took a bit of time to round up the team. It was a holiday weekend after all, and the VA was at minimum manning. Tests and procedures that would have been a matter of course on a normal day were delayed or unavailable. When GI gathered, I went back to the OR and under anesthesia.
This time, GI discovered that the two ulcers in my duodenum were bleeding. The ulcers were stapled and cauterized and the bleeding stopped. I returned to my room in the SICU and received more blood. At this point I had received 7 units of blood. The human body has between 10 and 12.
After the two units of blood my HGB climbed back up and was near 9. I was still in bed, but feeling a bit better on Sunday the 5th. That afternoon, I went to IR to get the drain replaced. It was a procedure that turned into a non-procedure. When IR saw the drain, the doctor immediately pointed out that it was secured incorrectly. It had twisted and kinked, blocking drainage. The drain was unkinked and straightened, and drainage immediately began to flow. A CT scan (I was literally already in the tube) confirmed that the abscess was almost completely gone. The drain was re-secured and I went back to SICU. One part of the Rubik’s cube seemed solved.
When I got back to the room, I sat up to tell Barbara something. Almost immediately my head started swimming and I began to feel out of sorts. I told Barbara that I felt like I had the day before. She called for the nurse, and they immediately ran labs. My HGB - which had seemed stable and rising - began falling again. It appeared from the symptoms that my internal bleeding had reappeared.
The resident that night, Dr. Stogner, began working the phones. She was pushing for IR to perform an embolism - essentially using a balloon to block one of the blood vessels supplying the GI tract, stopping the bleeding. I received more blood. The goal was to get my HGB above 9 and stabilize it there. The SICU team was worried that IR wouldn’t do the embolism if my HGB was below 9.
IR asked for a special CT scan called Computed Tomography Angiography that gives 3D images. This is the best way to detect active internal bleeding. The CTA showed no active bleed, however. IR said that they were uncomfortable doing a procedure that would cut off the blood supply to part of the GI tract if there was no direct evidence of an active bleed.
So the decision was made to wait and see. GI pointed out that there could have been some blood still in my GI tract, or perhaps some oozing from the freshly treated site. I got 2 more units of blood, bringing me to 9 total since my return to the hospital. For all intents and purposes, I received a full blood transfusion. I now have the blood of at least 9 people in my body. To all of you who donate blood, thank you. For those that don’t, hit up the Red Cross. Without that blood, I would not be here.
By Monday the 6th my HGB was slowly climbing up. I felt well enough to leave the bed for the first time in 48 hours. I had my first visitor since my return trip to the hospital. I had resisted having visitors because, frankly, I didn’t want anyone to see me like that. Our Pastor Cameron Barr came to visit that Monday, and we all had a wonderful talk. He lifted our spirits and gave us hope after what had been a pretty bleak weekend. I was so restored that I had clear fluids for dinner that night (broth, tea, etc.). I handled it well, and it felt like my body was slowly, very slowly, returning.
By Tuesday I was able to start solid food. That breakfast was glorious, but not as much as lunch. For lunch I got a cheeseburger, and honest to goodness cheeseburger. Burgers are my favorite food and while it wasn’t technically the most accomplished burger I ever had, it was the BEST.
My HGB continued going up. Whatever had caused the bleed seemed to have resolved. The fix was holding. The Rubik’s cube was falling into place. And with a working drain, my white blood cell count returned to normal as the abscess continued to drain. All the colors were coming together.
On Wednesday, I was downgraded to floor status. I was disconnected from my arterial line (which monitored my heart rate and blood pressure from literally inside one of my arteries), and most of my IVs. The drainage tube stayed in to do its important work. Alex came to visit, the first time I had seen any of my kids since this all started.
On Thursday, Dr. Rucker gave me the good news. I was cleared to go home. There were quite a few administrative details to work out, but in the early afternoon I was wheeled out into the blazing North Carolina summer and got in my car with Barb and headed home. I saw Elizabeth, who gave me a hug and told me how much she loved me. Both very non-Elizabeth things.
Tana (who was one of our very real guardian angels in this - more about that next time), brought Justin home from music camp around 4. For the first time in weeks I got to see him. He ran and jumped into my arms. I technically wasn’t supposed to lift more than 10 pounds, but I scooped him up and he gave me a big bear hug. Justin’s autism makes him especially sensitive to touch, but he hugged me for several seconds. The tears flowed.
The Rubik’s cube was solved. Or at least, solved enough.
In the days since I have worked to rebuild strength and capacity. I am taking lots of medications, including a suite of antibiotics designed to wipe out the H pylori. I lost 20 pounds in 12 days. My body is weak and it will take time to get back.
And.
I am here. I am grateful. I never want to go to the hospital again, except for a checkup.
I have been trying to make some sense of all this. And I will talk about that more tomorrow.
Today I am here. And every day we are here is a good day if we know where to look. If we look to the helpers. If we look to the people who love us. If we look at who shows up for us in our worst moments. If we look inside and find our own strength.
I have survived much in my life. Too much honestly. I just want quiet now. And to give back a portion of what I have received.
I am here. I am grateful.
May it ever be so.
PS. Some final thoughts tomorrow. Be well. And keep pounding the rock. Believe me, that shit works.