What to expect when you’re not expecting appendicitis

When I staggered into the emergency room, bent in half and moaning in agony with every breath, I was met with a completely empty desk. No one in sight except for a handful of patients in the waiting area chairs.

After the appendectomy

I figured someone would hear me and come out to help—I was managing my pain about as discreetly as a someone who’d fallen backwards into a wood chipper—but the desk appeared to be abandoned. Eventually, I noticed some movement behind a frosted glass partition. I very un-Minnesotanly moan-yelled for them to help me.

By now all eyes in the area were on me, a few recoiling slightly from the persistent sounds of abject human suffering. When the E.R. clerk finally ambled out, the woman standing a few check-in stations down, also being helped by no one, pointed at me and said “He can have my spot.”

On a recent Monday afternoon, my appendix did a mic drop that took away a week of my life—and several thousand hard-earned dollars I’d earmarked for revelry and other non-traumatic activities. Having never had major surgery in my adult life, I wasn’t prepared for any of it. Initially, the when-to-get-your-ass-to-the-hospital stage of the process wasn’t handled elegantly, and things went full-on shitshow from there.

I’d been under the impression that appendicitis pain came on fast and furious. Not so, at least in my case. My appendicitis started as a mild tummy ache Sunday afternoon, which escalated to the high side of unpleasant for about an hour Sunday evening and then dropped back to being annoying for the entire night and following morning.

At 11:30 a.m. Monday, everything rapidly went to hell. The pain level in my abdomen went from a ‘3’ to a ‘6’ in a short period of time. It felt like I needed to cut the biggest fart plume in history for relief. I moved to the toilet to give my fart muscles all the operating space they needed. In 20 minutes, zero farts had escaped and my pain shot up from ‘6’ to ‘11.’

I say the pain was ‘11,’ because I have never felt pain of that severity in my 47 years of pain-feeling. I assume there must be more painful events—I’m told kidney stones are no picnic—but in the near aftermath of the saga, I’m having trouble imagining how I could have endured worse and stayed conscious.

After an additional 20 minutes or so of vocal suffering on my couch, it finally occurred to me that the event was not going to pass and I needed to go to the hospital.

Having to move under your own power after you’ve sat around allowing your pain to hit ‘11’ is fucking agony, incidentally. After calling my girlfriend, Liz, begging to be picked up and driven to the E.R., I lurched down to the lobby of my building and quickly realized that I couldn’t wait. The pain was all-consuming and increasingly terrifying. I needed medical attention now. Hennepin County Medical Center’s (HCMC) Emergency Room is only three blocks away from my building, so I started a bent over, zombie-like walk/shuffle with an accompanying “uuuuuuggh” with each breath. People on the sidewalk gave me a wide berth.

It was the day after a seven-inch snowfall. The sidewalks were garbage and the wind and the cold were of the “why do I live here again?” caliber. I hadn’t given much thought on how to dress when I’d left my condo, I hadn’t even bothered to tie my shoes, but thankfully I’d had the wherewithal to grab my peacoat, which had a hat and gloves in the pockets or that walk would have been even worse.

I hit every light on the red, of course, because fuck pedestrians. That’s about 20 seconds of green light, then a 15-second countdown of the blinking “Don’t Walk” signal, then perhaps the world’s longest yellow light and finally the red before I could continue—times three intersections.

Reaching HCMC, I was more than a little perturbed to discover that the doors where I’d seen ambulances parked outside for so many years were meant for emergency personnel only. People walking up to the E.R. in blinding agony under their own power in bad weather had to walk half way around the building to the pedestrian entrance.

Which brings us back to the E.R. desk, being manned by a guy with the same unhurried casualness of a third wave coffee shop barista. I reported that my insides were trying to implode, which caused the clerk to perk up slightly and take me back for admission information. He sat down, got comfortable, took a swig of his drink, calmly asked me for my ID, and then asked several medical history questions, typing my replies in the computer at about 12 words per minute. He took a phone call. He chatted with a coworker, which I believe was work-related, but I was well beyond recording and processing information around me that didn’t relate to me getting urgent medical attention.

I’m going to stop the narrative for a moment and talk briefly about functioning in the normal world while wracked with pain. Most people have no doubt experienced this at some level. While your whole world is laser-focused on making the agony stop, the rest of the world slows. People move slower, react slower, talk slower, and, for incomprehensible reasons, continue to have thoughts and tasks that don’t relate to stopping your pain immediately. For the person in pain, this is maddening. The politeness and patience elements of the social contract quickly fray.

My world was reduced to a single goal: stop the pain. I could have shit my pants and not cared. Someone could have stolen my wallet, choked a puppy or worn a “Make America Great Again” hat and I would have not acknowledged it. Suffice to say, this man was not operating at a satisfactory pace for my goal.

Liz arrived while this was going on and was put in the uncomfortable position of watching her boyfriend suffering extravagantly and being able to do nothing to help. She would be stuck in this terrible position for the next three hours. Even during the fleeting moments when I managed to open one eye to see what was happening around me, I could tell it was not easy for her. I looked up once to see her sitting bent over, with her face in her hands.

Finally, someone with a wheelchair arrived to take me to the actual E.R., where the drugs are. This was my first glimmer of hope in what now seemed like hours of life-ending pain. In truth, I estimate barely an hour had transpired since the pain went berserk while I was on my toilet.

The E.R. showed a little more urgency for my well-being, but not a lot of teamwork or productivity. Three people appeared, all nurses I believe, to ask me the exact same medical and recent history questions I’d already answered for the clerk, plus additional questions, then left. Shortly, three completely different nurses showed up, asked me even more questions, some of them the same as before, told me a doctor would see me soon, and disappeared.

Over the next hour, I think I had 15 staff visit to ask questions and tell me things, only three or four of whom I saw more than once. It was an E.R. cabaret and I was starting to wonder if any of these people were communicating with each other.

More importantly, no one had sprinted in and injected me with elephant tranquilizer from a bazooka-sized syringe, something I would have traded all my earthly possessions for without hesitation at that point. What I’ve learned since is that, after the 1990s, when everyone got opiates for every trifling owie, hospital staff are more cautious about dolling out the good stuff these days, what with the current addiction crisis in the U.S. Unfortunately, this means that people who’d happily knock themselves out with a ball-peen hammer rather than spend another second with their pain have to wait just a little longer for relief while a chin-scratching evaluation confab is held.

After writhing on the gurney, suffering multiple interviews for about 30 minutes, with no mention of drugs, I finally asked “Can I have something for my pain?” I even added a “please,” because I’m Minnesotan. They assured me it was on its way. On its way from where? Do they not keep opiates in the emergency room? Is someone running out to the opiate shed? How far is that? Give it to me in yards.

An I.V. was stabbed into me, blood was drawn, I got a shot for something or other (who cares?) and then, finally, a syringe filled with dilaudid appeared. After about an hour and a half of the worst pain I’d ever known, I was pretty excited. They injected me… and nothing happened. And nothing happened.

I’d been under the impression that injections are suppose to have almost immediate effect. Isn’t that the point of shooting drugs straight into the circulatory system? Push it into the juiciest available vein, it travels up to the heart, which then fires it back out into the body at three feet per second. Even reaching the teeny tiny, most far-flung capillaries should take less than a minute, right?

After about 15 minutes, I reported with a note of consternation that there had been no improvement with my pain. Just a barely perceptible warmth and numbing in my head and hands. The pain was still at ’11.’ They told me to give it another 15-20 minutes. I thought to myself, “I’ve taken Tylenol by mouth that’s worked faster than this, motherfucker.” (When you’re two hours into the worst pain of your life, everyone is a motherfucker.) But I was in no position to debate the theoretical circulatory dispensation of medication, so I closed my eyes and sank back into my pain pod, moaning pathetically. Liz held my hand lightly.

Eventually they wanted to roll me away for a CT scan and an x-ray, but even they had to admit that was going to be impossible in my current whimpering, helpless state, so I was given a second bump of dilaudid. Finally, after another 15 minutes, my pain went from ‘11’ down to a barely tolerable ‘9.’ I was no longer moaning with every breath, but I was still in no condition to even open my eyes to communicate, much less move and follow directions.

Things get fuzzy here. I don’t know if more pain meds were administered or the stuff in my system finally took hold, but eventually my pain slowly lowered to a ‘6’ and I was wheeled away to photograph my guts.

After a CT, x-ray and an ultrasound for good luck, everyone agreed it was my appendix. It had to come out right away, but there was a catch. When had I last eaten? I’d had a light lunch at 11 a.m. They won’t perform surgery on people (if they can help it) until they’re at least eight hours away from their last meal. Six, if they’re in a hurry. Anesthetization makes people barfy and there’s already enough on one’s plate after surgery without throwing cascading vomit into the mix.

It was only about 3 p.m., four hours since lunch, so I had to wait. The respite from the worst pain the human race has ever known had made me more social. I made a point of telling everyone who visited me to discuss the surgery that I had not vomited since June of 1993. No really, I was kind of famous for it. I celebrate my Barfversary every year. They could totes operate now and I’d be fine. They seemed skeptical and so we waited.

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By this stage, I was in full medical doodad regalia. I had like six or eight sensors attached to my torso, arms and ankles, three or four leads on my chest for the bee-boop machine, an IV, and one of those non-invasive oxygen tubes up my nostrils. If I’d been shaved hairless, I’d have look like someone that had just unplugged from the Matrix.

My powers of anti-nausea persuasion must have made an impression, because at about 4:45 p.m. I was told I was going into surgery at 5. Six hours after eating, bitches. A small commotion ensued. I was unplugged from 57 machines, transferred to a different gurney and wheeled to a prep area. With much grunting and expletives, I was able to strip to my bare ass and wriggle into a gown under my own power. I even managed to limp across the hall for a pee. My pain was at about ‘7.’

I got a shot of something to counteract the much-hyped anesthesia nausea (where’s the trust?). An intense, drill sergeant-type nurse, who seemed to be boss of the staging area, came in a few times to check on my progress and update me on surgery logistics. I called my parents to update them. My mom told me she loved me. Norwegian-Minnesotans will understand the gravity of this shocking, almost unbelievable expression of affection. Was there something they weren’t telling me?

A minute later I was in a big room that definitely did not look like the surgical theaters on “House.” This was more like a surgical garage, large enough for several surgeries to be performed at once. I was pretty high at this stage, so there’s a chance none of this happened.

A mask was placed on my face and I was out.

I’d been warned that I might wake up while I still had a breathing tube down my throat and not to freak out when they pulled it out. Thank Christ, the tube had already been removed when I came to. That’s all I needed after the afternoon I’d had. I was still on the gurney in the surgical garage. There was goop on my eyes, but I could see I was not alone. A nurse was across the room engaged in some task, but keeping an eye on me.

I let out a little, phlegm-y cough. “Leif, can you please cough a couple times for me?” she called. “Helps get that gunk out.” I did this and tried to wipe the slime out of my eyes. Someone handed me a paper towel.

After lying there for a while, it occurred to me that a selfie was in order. Pictures of people with wires and tubes coming out of their chest and face are Facebook gold. I asked for my phone, took several shots and reviewed them. I looked like I’d been dead for a week, then reanimated using a whiskey-based compound. I tried again, managing a weak smile.

I was eventually transferred to a room where Liz was waiting for me. Most people go home the same day they get their appendix sucked out, but my surgery had been relatively late in the day, so they decided to keep me overnight.

It wasn’t long before three doctors visited to talk about how the surgery went. I learned my appendix had ruptured and I’d come a whisker away from a very serious situation. They were able to complete the procedure via laparoscopy, as opposed to opening me up for a good old-fashioned gutting, but only barely. One doctor became very animated while explaining all the shit that was wrong with my appendix, like he was describing an exciting sports moment. “Man, I wish we’d taken a picture,” he concluded.

Everyone cleared out, I convinced Liz to go home at 10 p.m. and I was alone, and not in distress, for the first time since noon. My first thought was how much all this was going to cost me.

That night was relatively easy. It took hours for the anesthesia to completely wear off, which bled into a schedule of acetaminophen and ibuprofen. My pain level was at a ‘1’ pretty much all night. I shuffled to the bathroom under my own power like a badass, twice.

Tuesday morning, I was feeling pretty great. Yeah, Monday had been one of the worst days of my life, but I seemed to be bouncing back fast. I am, after all, a remarkably resilient 47-year-old with a virtually unblemished history of good health. Apart from a procedure at birth, and having all four wisdom teeth yanked out at one time in college, I’d never had serious surgery. I’d never broken a bone. I hadn’t puked since June of 1993. I was pretty much Wolverine.

The doctors were also impressed with my pain level, independent movement, and lack of fever, nausea and vomiting. We all agreed I was good to go. Secretly, I’d been envisioning a CVS-length medical bill receipt, getting a foot longer every minute, and I wanted to get the hell out of there. I was home by 11 a.m.

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I napped, watched TV, learned from reading the discharge paperwork that I was supposed to have been sent home with Oxycodone, Liz took me back to the hospital to get that, then I made us dinner. I was starting to get uncomfortable at 7 p.m., so I took my first Oxy and settled in for some Netflix. At 8 p.m., not only was I not feeing better, but I was pretty sure my pain was getting worse. I called the hospital to seek direction.

Hennepin County Medical Center is Minneapolis’ leading Trauma 1 hospital. There are many people working there that are kind, on the ball and smart. None of those individuals answer the phones, however. The people on phone duty are nearly all charmless, incapable of follow-through and would seemingly prefer to spend five minutes dicking you around than 30 seconds helping you.

The first person to answer the phone said she could not help me unless I knew which unit I’d been in the night before. Couldn’t she just look me up in a patient database? I heroically recalled that I was in the Red Building, 5th floor. She had no idea what that meant. Patients and visitors are expected to decode the hospital’s color-number location scheme, but staff are apparently oblivious. After a long period of describing what I’d been admitted for, I was transferred to the Medicine Unit. They had never heard of me and also seemed incapable of looking me up in a patent registration database. A little more sleuthing and it was concluded I had been in the Rapid Treatment Unit. They transferred me there.

Jackpot. They knew who I was. Phew. However, they could not advise me about my swiftly increasing pain over the phone. Only the E.R. could do that. I was transferred again. The E.R. said they could not advise me about my swiftly increasing pain over the phone. Only the Rapid Treatment Unit could do that. Quiet cursing ensued.

This episode goes on for two more phone calls and I-don’t-know-how-many-transfers to people who wouldn’t or couldn’t help me. I’d love to recount the blow-by-blow of my ridiculous, frighteningly dysfunctional and ultimately failed attempt to get even a morsel of help from HCMC over the phone, but this piece is already too long. At about 9 p.m., Liz drove me to the E.R. and we started from scratch.

As instructed by the single somewhat helpful person I’d reached during my phone odyssey, I’d taken a second Oxy at about 8:30 p.m. and my pain was still getting worse. I was up to about an ‘8’ by the time I limped up to the, once again, unmanned E.R. reception desk. After a short wait, I called out and a woman who appeared to have burnt out on the job six months earlier reluctantly came out to help.

Soon I was back on an E.R. gurney, hosting the familiar receiving line of nurses and doctors who, with rare exception, came, left and were never seen again. Maybe 10 people or more. Multiple requests to these people for pain meds were met with responses like “OK, I’ll let them know,” and then nothing. Who the fuck is “them,” motherfucker? Yeah, we’d reached that stage.

Hours passed. I was eventually given pain meds and another CT scan. It was decided that I had an ileus, which is “a disruption of the normal propulsive ability of the gastrointestinal tract.” Symptoms include constipation (check), abdominal distention (check), and “moderate, diffuse abdominal discomfort” (check, plus a million). Moderate my ass.

There is no treatment for an ileus. You just cut off food and liquids and wait until it fixes itself. I needed to be admitted back into the hospital for a few days until my guts started working again. I imagined a single, epic piece of medical bill receipt tape, descending from above like soft serve, accumulating in a man-sized, cone-shaped pile of financial ruin.

At about 1 a.m., Liz asked one of the third-string E.R. nurse cabaret when I might be transferred up to a room. I was exhausted, nodding off constantly and having weird dreams from the pain meds. Also, Liz had work the next day, but refused to leave until I was in a proper bed, being tended to by slightly more attentive people. In a chastising voice, the nurse explained that HCMC is a busy hospital and all the beds were full and there was no telling how long I’d be waiting in the E.R., so shut the hell up, snowflake. (He didn’t say the last part, but it was implied.) Barely five minutes later, I was told I was being taken up to my room, so I guess we squeaky-wheeled that shit.

The transfer and admission questions carried on till 2:30 a.m. Liz finally left and I passed out.

I spent the next three days being the best patient ever, if I may say so. Every morning at about 7 a.m. my doctor would come in, we’d chat how the previous day went and outline how we would approach the coming day. Then he’d leave and bring in the whole team for a status update with the lead doctor on the unit. These conversations were a little weird.

When you’re in the hospital, there are frequent and graphic conversations about your bodily functions, often attended by two to seven strangers. In my case, there was much concern and inquiry about the Fart Counter and the Poop Report. These were the measures of progress my bowels were making. There’s nothing you can do here except smile, participate and try not to use the words “fart” and “poop” around the doctors (“passing gas” and “bowel movements,” seemed to be the accepted nomenclature), though it was tempting.

I’d start my days with new IV bags of fluids and antibiotics, plus whatever pills I was due to take. From there it was a blur of people coming in to hand me more pills, withdraw blood, take my vitals, deliver more ice chips (the only thing I was allowed to consume) and ponder why the IV pump was beeping that time. I’m not sure I’ve ever been around an IV pump that wasn’t at least occasionally, if not constantly, squawking for reasons no one can understand.

Exactly 38 hours after I was banned from food and liquids (except water to help swallow pills), I was allowed a soft food lunch. In the previous 12 hours, the Fart Counter had rocketed into double digits and I’d triumphantly logged two, albeit weak, notches on the Poop Report, plus a bonus deposit in the wee hours that morning. I was very proud. “I can’t wait to tell the doctors at 7 a.m.!” I texted Liz. The soft lunch went so well, I was allowed a solid food dinner.

The next morning, with overwhelming evidence that my bowels were back in business, I was sent home. In what I assume was a tactical choice, medical bills were never seen nor mentioned during this period, probably in the interest of not causing another medical emergency. But the dread of their arrival was already filling me with anxiety.

I’m your average, always hustling freelancer and a frugal man of modest means with some savings. I’ll probably get through these bills without having to move into Liz’s basement, eating nothing but soup for year, but I’ve joined the countless ranks of Americans who are suddenly saddled with debt through no fault of their own. It terrifies me to consider having had something more serious than the removal of a bit of entrails and four nights of care.

I now await the prolonged, hair-yanking health insurance hassles, which have already begun, that can make this episode merely depressing expensive instead of shockingly ruinous.

The takeaway here is that no medical procedure is minor, financially-speaking, in this era of healthcare. Even Wolverine needs a doctor now and again, so you’ll probably find yourself dealing with a rebellious bit of anatomy sooner or later.

Also, don’t ignore mysterious abdominal pain for 24 hours. It’ll cost you.