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Au Revoir, Appendix

Posted Apr 09 2009 7:15pm


Yesterday evening, with very little time to prepare for the parting, I bid farewell to my appendix via emergency surgery.

I spent the entire day, beginning at 3:30am, whining in pain about how my belly hurt. I woke up in the middle of the night to a tight and crampy stomach and immediately attributed it to the Mexican food we had for lunch yesterday. Throughout the day, it got progressively worse (though it managed to subside long enough for me to enjoy a U of L victory!) and my differential diagnosis evolved from food related gastroenteritis to menstrual cramps back to food related issues to ovarian cystic rupture and finally to appendicitis.

This leap of intuition came when I awoke from a nap with a start (silly baby with his crying) and the sudden movement jolted every pain fiber in me. I called Patrick into the living room where I was lying very, very still on the couch and said, “ Run down the symptoms of appendicitis.”

“Periumbilical pain migrating to right lower quadrant. Marked loss of appetite and fear of food. Significantly worse pain with movement so patients keep extremely still. Sometimes patients feel pain on the right when the left is palpated. Usually presents 12-18 hours after onset of symptoms.” He recited the list like it was tattooed on his hand and as he did, I checked off my symptoms, one after another. “Why do you ask?”

“I think I have appendicitis.”

We discussed it, tried to rule it out, failed, and decided to call my surgeon father for a phone consult. He asked all the questions and told me that if I were his patient, he’d operate based on history and physical findings (that I told him), but these young docs nowadays like to get CAT scans for just about everything. He said that if I went to the ER, they’d get a CAT scan and white count, which wouldn’t tell them anything, and they’d end up operating on me based on history and physical findings. I tried not to laugh at him, not only because it would hurt his feelings but also because it hurt to laugh, and hung up to continue the discussion with Patrick.
The discussion was short-lived, as Patrick’s next suggestion was to feel my belly himself. I tried to roll over on the couch and found that I could barely move for the pain. He tried to touch me and I nearly went into orbit. Ahoy, ER!

But which one? We have new insurance and so had to figure out what hospitals I could go to and what we were going to have to pay. (Answer: go anywhere you want and open your wallet, because they pay, like, nothing. Ouch. How bad can appendicitis be, really? Maybe I could tough it out?) Finally, we picked a hospital, called our friend Kelli to help out with Colin until my mother-in-law could get here and hobbled out the door. It was 6pm.

Getting to the ER added another check on the symptoms column: every bump caused significant pain. Check! Finally we arrived and I limped, crouched over, into the ER. Patrick signed me in while I collapsed slowly into a chair and started sweating. I thought it was longest wait in the history of mankind, ten whole minutes, and finally they called me back. While the nurse asked me if I was allergic to anything, I attempted to vomit the lining of my stomach into a bin. I have never wished I had something to throw up so much in my life, but I had nothing to give and so nothing came, try as I might. The nurse was taking my temperature and blood pressure as I retched, so my intake sheet recorded a fever of 104 and a blood pressure of 84/50. GAH, people. GAH, I say!

I got into a room, got undressed, and had my vitals retaken. (Temp of 100.0 and BP of 90/62. Much better, not dying.) The ER doc came in almost right away, did a pretty complete history and physical and declared that he wasn’t convinced and so ordered a CAT scan and white count. The white count was elevated (13,000, for those keeping score) but the CAT scan was questionable. He sent it out to a radiologist to read. Over an hour passed with no news from this mystical off-site radiologist. I had received pain medicine by then, and so was strong enough to ask every nurse that walked by if there was a report back yet. Finally, the ER doc came back and said the radiologist thought it was negative for appendicitis. GAH! But he thought otherwise, so he called the surgeon anyway and would let him make the call.

Enter blustery, arrogant, smiley surgeon. He’s loud and confident, a little pushy, and has already alerted the OR that he’ll be doing an appendectomy tonight. He asks me all the same, expected questions, does the same exam, and says, “let’s do it.” Music to my ears. Take the damn thing out and make me feel better.

Suddenly, things moved very fast. I was whisked away to the surgical wing and prepped for surgery. My socks were removed in favor of pressure pumps on my calves. My hair gathered and head capped. The longest step of the process was going to the bathroom, requiring the aid of a nurse and Patrick. They were ready, so I kissed Patrick a few times, handed him my wedding rings to keep safe while I was asleep, and was off. Then I was in the OR, the lights bright, the room cold, and I attempted to make idle chit chat with the anesthesiologist, surgeon, and nurses. Finally, they put oxygen on my face so I stopped trying to talk. I felt a finger on my throat as the anesthesiologist injected the medicine into my IV. I blinked slowly once.

I blinked slowly again, trying to figure out where I was. My mouth was incredibly dry and I was shivering. I found that I couldn’t quite talk, but that there were people all around me, attending to me. I decided that they were also talking to me, so I tried to pay attention. They said something about things going well, no problems, talking to my husband. I didn’t understand. I croaked out “Patrick”, to which they said he was in the waiting room talking with the doctor.

Oh. Right! I had surgery. Yes. That explained this whole thing.

“How’d t go?” I slurred.

They assured me all is well and I’ll feel better soon. I took their word and drifted back to sleep.

Then I was moving. Stopped. Shivering so hard I smashed my hand into the rail. Being lifted, then dropped. Covered with a bunch of warm blankets. I woke up a little more when I was warmer and felt Patrick putting my wedding rings back on. He handed me a cup of ice water and I thought that I had never loved him more in my life. I then promptly forgot about him and everything else for the next few minutes while I drank everything I could reach and then demanded more.

Once I was rehydrated a bit, Patrick filled me in. Everything was fine and my appendix, the clear villain in this story, had been removed. He’d spoken with both of my parents and to his mother, who reported that Colin was sound asleep. We discussed what to do in the morning, decided that Patrick would stay the night with me, and then I was asleep.

Since then everything has been going well. I am quite sore today and have trouble with any movement that requires abdominal muscles (so, basically, moving) but when I’m stationary, I feel fine. I am home, have had some quality time with my sweet baby that I missed all day yesterday, last night and this morning, and am doing my best to avoid having to take pain pills. The recovery seems to be progressing nicely and I am looking forward to tomorrow, when I’ll surely feel better. I am now ready to avoid doctors and hospitals for at least a few years, at least from the patient perspective. Though I feel that I will positively rock out any future questions on appendicitis that I might encounter in the future.

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