Wednesday, 28 November 2012

Time heals all wounds

I hate waiting.  I simply can't stand waiting for pretty much anything - lines in the airport, test results, advertisements on TV, everything.  I can't even stand waiting for diseases to get better, and that's exactly why I chose surgery.   Do you have high blood pressure?  Well your doctor can give you a pill that may work...but you won't know for several weeks.  If it doesn't work, he can give you more.  Or less.  Or a different drug.  Or another drug.  Will that work?  JUST WAIT A FEW MORE WEEKS.  On the other hand, do you have gallstones in your gall bladder?  I can take that out.  Colon cancer?  I can cure that!  Perforated stomach ulcer?  I can fix it instantly.  So because it's been 11 days since my last post, I figured my next update should be about waiting.

Appendicitis almost never shows up during the day.  I have no idea why, but it seems no one EVER comes to the ER at 10AM with appendicitis.  Everyone likes to wait until the middle of the night before coming in.  I can't understand how or why they do this, because I've had appendicitis.  And let me tell you, it SUCKS.  It feels like you're being stabbed in the gut with a huge, dull, rusty sword.  And the longer you wait, the higher your risk of the appendix rupturing.  When that happens, it becomes an entirely different disease.  People with mild appendicits usually go home within 24 hours.  People with ruptured appendicitis, however, typically are in the hospital for a week, and some even die.  I only waited about 4 hours before I went to the ER, and my appendix had already nearly ruptured by then.  So how the hell can someone wait a day or even longer before seeking medical attention?  God damn it people, listen to your bodies!  Sorry, sorry.  I digress.

The ER called me a few days ago at 1 AM (of course) to tell me about a 34 year old woman who had just flown back from week vacation on a tropical island.  She had been doubled over in abdominal pain for her entire trip, but she had waited until she got home before coming to the hospital.  Naturally, her CT scan showed ruptured appendicitis.  Greeeeaaat.  After explaining the situation in detail, I took her to the operating theatre where I found this:

Ok, it really wasn't that, but that's what it looked like had happened inside her.  Her appendix had indeed ruptured, there was pus everywhere, and everything was inflamed and stuck to everything else.  I cleaned up all the pus and I managed to chisel her appendix out of the intense inflammatory response (all done laparoscopically, much to my satisfaction).  After a very difficult case, I went out to the waiting room to talk to her husband and his father, who were waiting anxiously to find out the results.

After I told them what I found, her husband said, "That's about the same thing that happened to me!  Remember, Dad?" 

Wait...what?

My mouth probably agape, I stared in disbelief as his father recounted how his son, this woman's husband, had also had ruptured appendicitis when he was a kid on a skiing holiday.  He had also waited a week before seeking medical attention because he didn't want to cut the ski trip short. 

So even though she had been complaining of pain all week, and even though he had been through the exact same thing, they never went to the hospital.  Granted, most people can't diagnose appendicitis that easily, but MOST of us would go to the damned hospital if we were doubled over in pain FOR A WEEK like she was.  Just like her husband, she spent a week in the hospital before she finally went home.  I saw her in my office a few days ago, and she's doing much better.


They say "Time heals all wounds."  But that doesn't quite apply when it comes to surgery.

8 comments:

  1. Hey Doc,
    I love your stories. Started following from FML, etc etc etc.
    But you know all this.
    I mean, you're the doc right?
    Anyways

    I was diagnosed with appendicitis a while back and I thought I'd share my experience as well.

    It started at about 3am as I was hopping into bed. The lone glow in the dark star above my bed (don't judge) started wobbling which kinda peeked my curiosity. I thought maybe it was the beer. But nope. It slowly started spinning until I felt like I was on a roller coaster. Or a spaceship. SOMETHING FAST. Well I of course planted one leg on the ground to try and gain my sense of direction but nothing. And then the stomach pain.

    I headed to the restroom thinking I could puke up whatever this was. Except the puking didn't stop. Hour after hour of puking and then dry-heaving (rice and beans was a bad choice that night) I finally headed back into bed and SOMEHOW managed an hour or two of sleep.

    Seeing as we were moving that day I was woken early and given the choice of helping the family move or "be a little girl's vagina". I chose the latter. Which probably saved my life in hindsight. But as I was saying, I laid in bed in some pretty bad pain for a couple hours and then eventually at 4pm begged my current girlfriend to drive me to the clinic.

    Sometime in between the nurse stabbing me several times in the arm trying to find my dried up veins and the doctor curiously examining my ruby red piss, I found a certain sense of calm and slipped into an hour nap again. When I woke they told me it was appendicitis and that I had to go to the ER.

    On the way there it kept running through my head. Is it really? They're probably wrong. I should go home. Damn this is gonna be expensive if I'm (and the clinic) a dumbass. But on we went regardless.

    I was admitted rather quickly due to several family members working in the hospital and was promptly diagnosed as "80% certain". Oddly enough that quickly changed. Now calm down, I didn't explode or anything. But the doc had asked me to partake in a simple test.

    "Give me five jumping jacks".
    And I did. There he stood amazed. And then he informed me he was now 40% sure.
    "Son," he told me, "Either you don't have appendicitis, or you have the testicular fortitude of a god."

    Well after the scans and such he came back and informed me it was indeed my appendix and that surgery was imminent. In walked the groggy anesthesiologist and *pop* right in my arm he stuck me. As I faded away all I could remember was how I really hoped he wasn't as tired as he looked.

    I woke up feeling much better, only slightly sore and ready to leave. I was told later that I was mere hours from being that pussy, inflamed mess you aforementioned. Thank you for all that you do Doc.

    And oh, I suppose that means you can call me Hercules... ;)

    ReplyDelete
  2. I have no idea what sets these things off but I can't help thinking that asking someone with a potentially point-of-nuke appendix to do jumping jacks (I take these to be what I would call "star jumps") is asking for trouble.

    Welcome back Doc!

    Glad you make it in time Hercules!

    ReplyDelete
  3. I once had suspected appendicitis so off to the hospital I went, 5 hits of morohine later i still didn't know what was wrong. Turns out I didn't have appendicitis, I had gastro (they didn't know what it was).

    ReplyDelete
  4. Man, I was in and out of the ER last January because of crippling abdominal pain. I was terrified it was appendicitis (it wasn't), but I wasn't taking the chance.

    And ER docs are twats. I waiting 30 hours to see one, doubled over in pain in a plastic shitty waiting room chair. He made me wait some more in a room, before med students came to see me. They decided the best idea would be to start with some blood tests (smart). They'd ruled out appendicitis the first time I was in the ER. They said they'd be back soon with results. So I hung around in the room for an hour and a half. The ER doctor comes back. Asks me why I am there. I say I am awaiting blood tests. Then tells me he discharged me already, here's a prescription for 5 days of 5mg morphine. I asked if I could have something before leaving like the med students were planning, as I live an hour and a half away from the hospital, and he told me no, since I was discharged, I had to go back through triage if I wanted a pill/an injection.

    Dad drove me home. In the car, I blacked out from pain. There was a message on my parents' answering machine. "Oh, hey, you just left the ER, I just realized you were supposed to have the blood tests anyway. You left five minutes ago, so just come back."

    He called the EMERGENCY CONTACT instead of my own bloody cell phone.

    I wanted to get my Dad to drive me back so I could bean him with a chair.

    ReplyDelete
  5. I had appendicitis when I was 10 (just a few days shy of my 11th birthday, actually). I ended up going in early in the morning too. I remember my stomach hurt most of the evening before, but I figured it would go away. Then my mom came in to wake me up for school the next morning at 6am and found me curled up in pain, as I had been for several hours.
    She took me in to the hospital immediately, where I then had to sit in triage for another few hours. I was always a very polite, quiet kid, so even though I was in serious pain I was trying not to make a fuss... Which is kind of exactly the opposite of what you need to do to be taken seriously in triage. The nurse assumed it wasn't that bad because I wasn't crying and carrying on. When I finally was admitted, the doctors decided it was a) fake, and I just wanted to get out of school, or b) menstrual cramps, and I was exaggerating the pain because I was unfamiliar with cramps.
    I am so thankful that my parents stood up for me and insisted that they take me seriously. It was hours and hours before one of the doctors came around to the idea that it might be appendicitis. And lo and behold... When he came out after the surgery, he told us that my appendix had been moments away from bursting.
    I think plenty of people wait, like I did, because they assume it's no big deal and it'll go away. Why make a mountain out of a molehill and go all the way to the hospital? Then early morning rolls around and they realize they haven't been able to sleep all night because this REALLY hurts - time to go to the ER! I have no explanation for that couple though. I personally find it hard to enjoy a vacation when I'm worried about dying of sepsis, but clearly that's not everyone's reaction.

    ReplyDelete
  6. I second the notion that the pain of appendicitis can mimic a really bad period. I don't know if I maybe have endo or something, but in the early stages of my appendicitis just felt like a case of the cramps. I would not assume that chronic appendicitis and acute present the same way. My case was weird: I had fevers for the three Saturdays prior to my operation...yes, just the Saturdays...some kind of delayed-stress reaction, maybe? And I was only doubled over for about the last 48 hours before hitting the ER. So not all the abdominal pain time is necessarily doubled-over time. It was just before finals and I was worried about missing class. Appendix never perforated, but I was told it was severely enlarged (even more than you would expect for a 'normal' case of appendicitis) when it was finally removed. The doctors weren't sure about the diagnosis; I waited almost exactly 21 hours between walking into the ER and being on the OR table.

    ReplyDelete
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