I hate to be a pest, but...

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tags: story diagnosis appendectomy Paul Sandos Spence Thompson

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Right on time, an hour after I was handed the oversized Styrofoam cups of water, Jackie shows up and takes me to the CAT scan area.  Now, again I have to compliment Mount Sinai Hospital. The CAT scan area is part of the ER, a 30 second walk from where I was sitting.  At the St. Joe's ER two years previous, when I needed an ultrasound for a torn hamstring, I had to follow some colored line on the floor that led me to the imaging room.  The line seemed to twist and turn all over the place, and took me far, far away. In the Mount Sinai ER, everything is much closer at hand.  Well, at least the imaging room is.

The CAT scanner is massive, and looks like a white donut.  I laid on my back, and was slid into the big donut by way of a conveyor belt.  Before I entered it, Jackie needed to set me up with an IV, that had something in it needed for the scan.  She warned me that in rare cases, and up to seven days later, I can have an allergic reaction to whatever I was being given.  And she added that even now I may feel some heat and tingling in my arms and body, as the elixir worked its magic.  

During my short hospital stay, I was told so many cautions and things to look out for, it was impossible to remember them all.  When you factor in: I am sick; I am sleep deprived; I haven't eaten all day; I am nervous; I am old(-ish) and my memory sucks; I am all alone.  It becomes an impossible situation to remember everything.  I do feel that any information about allergic reactions up to a week later should be part of the printed documentation I was given the next day, when I was released.  (More on all of this, and how I feel Mount Sinai can improve their patient Discharge Summary, later.)

The scan took place without incident, and after helping me get up, I was told I  would have to wait a bit for them to interpret my results.  So I went down the hall to where I was seated before, to begin my latest wait.  (Getting me back on my feet took some effort.  Because of my pain, moving was uncomfortable, and Jackie had to help a bit.  I am literally twice as big as her, so it was sort of like trying to flip a giant turtle off of his back.  Interestingly, I felt she was surprised I couldn't move better: "You are still young," she told me.) 

When I arrived back at my previous sitting area in the hall, I found my old seat was now  occupied.  And guess who the new occupant was?  It was Granny Munchausen!  Not wanting to wait at the end of the hall again, I decided to loiter around, standing, in hopes a prime seat would free up.  This is when I heard Granny Munchausen explain to someone in blue scrubs, that if she had to rate her current pain level, it was *at least* a TEN OUT OF TEN! She delivered this assessment speaking plainly, as if she was reading items off of her grocery list.  I couldn't believe my ears. A ten out of ten? What was wrong with this woman? In my book, a ten out of ten means you are about to pass out from pain, and cannot speak coherently.  At this, I decided to forget about getting a prime spot, and to go and wait at the end of the hall.  I walked away shaking my head. (This was probably for the best: Imagine having two nutters, me and Granny M, sitting in close proximity to one another?  It could have created some sort of Insanity Vortex liable to  swallow up the entire ER!)

Not long after taking my seat, Dr. Emily Chang came by, and told me based on all of my symptoms, but especially the scan I just had, they were going to admit me to the hospital, with the diagnosis of an acute appendicitis.  She said that if it ruptured it could be very serious, and that surgery before this might happen was recommended.  As fate would have it, some members from the Surgical Team were presently in the ER for another matter, and they could come speak with me momentarily.  So with that I was brought back to the original examination room I had been in a couple hours beforehand. 

In my mind, waiting again in that examination room, I felt relief and satisfaction.  Now I was "IN" with a capital "I", "N"!  I had unlocked Achievement #4 and #5: Being diagnosed, and being admitted to the hospital.  Furthermore, my diagnosis was the same thing Nurse Friend Heather had suspected I had all along, which was somehow reassuring.  My anxiety went from pretty bad to just sort of bad.  And the nervousness I had about slipping through the cracks did a sidestep to the next most worrisome thing: The treatment to come, and whether my appendix might burst in the mean time *and kill me*!  But really, I wasn't *that* worried.  If my appendix did burst, I figured, I was in a hospital already.  For once, I put my phone down, and just waited, sitting back on the inclined examination table.  I felt contented, and wanted to give my mind a break.     

In no time at all, three people from the General Surgery Team entered the room.  It was tight quarters, now.  There were two men, and one woman.  To my right was Dr. Paul Sandos, who would end up doing most of the talking.  On my left was Dr. Spence Thompson, and Meghan something or other. (I am not sure if she was a doctor.)  Paul is a surgical resident, which means he is a medical doctor that is receiving specialized training in the discipline of surgery.  He looks a bit like a black and white photo I have seen of a young J.D. Salinger from inside a book cover.   He seems like a good guy, and a smart guy.  And, like many doctors, I am pretty sure he thinks he is a lot smarter than everyone else.

Paul has me lie back on the examination table, and presses on my belly in different places, as we talk.  He asks questions, I answer.  Pressing and prodding. Asking and answering.  Dr. Emily Chang had already told me they thought I had appendicitis, so the cat was out of the bag, but I guess the Surgical Team wanted to do their own examination, too. After a fair bit of pressing and prodding, Dr.Paul Sandos found his favorite spot on me to press; at least it seemed to me like it was his favorite.  Dr. Paul Sandos zeroed in on the only spot on my abdomen that was truly tender and elicited a response.  This spot was my aforementioned Panic Button, directly above my appendix.  

He tells me, based on all of the evidence, and supported by this hands on examination, they are confident I do indeed have appendicitis.  Again, I had already heard the news, but I don't want to spoil the big reveal, for Dr. Paul and the team.  I can tell as he delivers this news, he wants to have one more go at my Panic Button, but I pull my shirt down before he can launch an attack.  Wagging a finger at him, I admonish him "Oh, no you don't, Doc!"  (Of course I am making up this last exchange.  But I truly don't think he was worried about causing me discomfort, and certainly didn't *mind* pressing my Panic Button.  Repeatedly.  Which, honestly, is reasonable.  He needed to see my true reactions.  Granny Munchausen is proof that you can't go simply on what pain level the patient *tells* you they feel.  A good doctor needs to observe behavior and reactions, too.) 

At this point, Dr. Spence Thompson, who seems like he is the Alpha Dog here, and has been sitting back, very comfortably, with his legs splayed wide open, jumps in and says "Do you want to see the scans so you know what Paul has been talking about?"  He has sandy blonde hair, and an accent of some type.  I am one of those morons that confuses Irish, English, and Ozzie accents, among others.  I just don't have an ear for it.  So I will just say he is one of three I just mentioned. Possibly. But definitely not from Canada or the US.  Dr. Spence Thompson makes me think of a gunslinger that outwardly looks all comfortable and relaxed, sitting back, but all-the-while his eyes are taking in everything, and at any given moment, if needed, he can  spring forward, ready for action (that he knows he can handle!) with his gun drawn and a finger on the trigger. 

"Yes!" I say.  I *do* want to see the scans. I am one of *those* patients.  I want to see my insides, and want to know what is going on.  As I mentioned before, I like to learn new stuff, about everything, but one of my favorite topics is: Myself!  Also, in regular life I already feel kind of doctor-like; I think I am smarter than everyone else, too!

There is an LCD screen to my left, and when Spence presses some button, a black and white scan becomes animated.  It is my abdomen, and the CAT scan camera must have rotated around me, because you can see my torso slowly spin in all directions.  On my right side, he indicates, is my appendix.  It looks to me like a black and white, fuzzy, log of cat poo.  Apparently good ol' Spence can read more into it than me, and he says it is *obviously* inflamed.  

All this time, Meghan has said nothing; she seems to be the junior member of this team.  But, according to Spence and Paul, the standard treatment for appendicitis is an appendectomy (that is, surgical removal of the appendix).  We could try just treating it with antibiotics, but this is not what they recommend, *at all!*

But here is what I am thinking, at this moment: These guys are part of the Surgical Team.  They have a built-in bias, *obviously*.  So, of course, they *want* me to do surgery.  It isn't fair to say, but I feel like they probably view surgery as the solution to just about everything in life. Like blood-letting used to be. Or like duct tape is to some people.  Or the Heimlich maneuver. (I am not joking about the Heimlich maneuver.  One of my favorite podcasts, Radiolab, did a segment about it. Apparently the inventor, Dr. Henry Heimlich, went a little bit crazy and saw his invention as a sort of cure-all for many other conditions beyond just choking.)   

Dr. Paul elaborates on treating appendicitis with antibiotics alone.  He explains sometimes it fails from the get-go, and sometimes it works at first, but then within a year, you end up needing surgery anyway.  It seems, even these days, surgery is the gold standard.  I say "I wish I had time to mull it over" (that is google it, and read up) and Spence tells me "In fact, you do."  This is because it is too late to do surgery today, even if I wanted to do so.  So instead, I can be admitted today, get an IV in, pumping me full of antibiotics, sign surgery consent papers tonight, and because surgery won't happen until tomorrow, I can do all the googling and thinking over I need.  And I can say no to surgery at any point, right up until it begins.  

This is music to my ears.  Fact is, my gut tells me these guys are right, and surgery *is* the best option.  But I am coming into this blind.  I want to get on my phone, do some googling, see if the numbers they told me about success and failure are legit, and explore if there are other options that were not presented.  I want to, in short, *inform myself*. I am a cautious person, an anxious person, and to be frank, a suspicious person.  While the Surgery Team gave me a good feeling, there is a lot I don't like about the way medical industry, if you will pardon the pun, operates.

Here is an example: Circumcision.  I feel very strongly that this is an unnecessary surgery, 99% of the time. Much more, even.  And doing this surgery can be a bad thing, and in rare instances can even maim and kill a small, defenseless, non-consenting child.  It is screwy that surgeons and religious people do this grotesque act.  Period.

Here is a less extreme example: Caesarean sections.  I feel fairly strongly that frequently, this is an unnecessary surgery.  It is nothing like circumcision, in that I do see a medical need to have C-Sections as an option, in some instances.  But, in my mind, these are rare instances.  Yet, this procedure is done commonly.  To the point where it is a racket, in my opinion.  A very lucrative racket, perpetuated by a medical industry that exploits the fear and shame of parents at a vulnerable time.  I know near the birth of my own daughter, who came two weeks "late", there was tremendous pressure put on my wife and I to sign on for a C-Section.  Many scary things were said, by doctors and one surgeon, and even our own midwife.  We held strong.  And my wife gave birth naturally, in the way for which her body was designed. Today we have a perfectly  healthy 10 year old girl.  

Not all surgeries are alike, however.  And some are more valid than others.  For what it's worth, I did my googling later that night, and soon discovered everything the Surgical Team told me was accurate.  Surgical removal of an inflamed appendix is the way to go, and I felt I was in good hands for my coming surgery. 

This writing above is one chapter from the long form article "3 Days and 2 Nights".
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