“All right. I’m admitting you to the hospital via the emergency room.”
These are not exactly the words I was expecting to hear late on a Friday morning in summer. It was August 26, 2016, to be precise. It was the day before my boss’ birthday, and I was supposed to go into the office that afternoon to record a group video message to him. And, besides…
“Can I go make arrangements for my dog first at least?” I asked.
The doctor, who was an Indian woman currently giving me the stern look worthy of a disapproving Indira Gandhi, shook her head. “Would you like to die?” she asked, matter-of-factly.
Well, that was not good news.
I tried bargaining, but she was firm. She couldn’t exactly detain me against my will, but she urged my compliance in the strictest of terms. I tried to tell her why it was important that I go into the office briefly and arrange for someone to look after my dog. She was having none of it.
“Will anyone die if you don’t go to work?” she demanded.
“Do you have friends you can call to go take care of your dog?”
In retrospect, it shouldn’t have even been a question, but even up to that point I was trying to deny the obvious. I was dying. I probably even should have been dead. But, like too many stubborn men, I had put off paying attention to the warning signs for way too long. And, like too many men, it wasn’t until whatever was going wrong with me affected my junk that I finally paid attention.
See, by this point, I had been rapidly gaining weight — nearly 45 pounds since the beginning of the year. I knew this and still know it now because I’d been tracking my weight since September of 2013, in an effort to lose some. In that first entry, from September 13, 2013, I logged a morning weight of 227.8 lbs. Even at 6’2”, that’s a BMI decidedly in the obese range already, and although I’d been taking steps to lose weight and tracking things diligently, my body decided at the beginning of 2016 to give me a hearty, “Screw you and your diet efforts!”
Hell, I’d stopped eating red meat entirely the October before. Wasn’t I supposed to start shrinking because of that? I was only eating poultry. I was doing fast days. Hell, there were weeks when I only had energy bars for lunch, and still I was swelling up like Violet Beauregard at Willy Wonka’s chocolate factory.
By late August, I’d actually been sleeping sitting upright in my office chair rolled into my bedroom for a few months, wrapped in a comforter, because I could not breathe when I lay down. I could barely walk — not only because my legs were so swollen, but because almost any effort sent me gasping for air. The dog suffered because of it. We used to go up and down the neighborhood and around several blocks. Now, I’d sneak her outside and ten feet away to do her business, then right back in.
Now you’d think that a rational person would have taken any one of those things as a sign and gone right to the doctor, but I had two strikes against me in that regard. First was that whole natural male stubbornness.
“Oh, it’ll get better.”
“Oh, I’m not that sick.”
“What? I feel fine!”
Second was a bit more personal, but I’m sure a lot of people can relate to this. I suffered a severe case of what is technically called iatrophobia — fear of doctors — although, in my case, it wasn’t so much a phobia as it was a deep-seated mistrust, and it went straight back to a series of events that affected me deeply in my teenage years.
I won’t go too much into it here (out of respect) except to say that my mother fell victim to a mystery illness. In retrospect, it may have been lupus, or not. But the very short version of a too long story is that she died when I was way too young after a series of doctors seemed to basically scratch their heads and try a ton of medications. Ultimately, I think their ill-informed attempts to treat her symptoms rather than find the cause are what killed her. She’d been injected with steroids, given pain-killers and anti-inflammatories, poked and prodded and, mostly, ignored.
I specifically remember her complaining to me once that she had told her (exclusively male) doctors many times that her symptoms got worse whenever it was her time of the month. She told me this not very long after I’d learned what “time of the month” was in Sex Ed in the first place, by the way. But her male doctors just told her, “Oh, it’s all in your head.”
Yeah, I can hear the record-scratch for a modern audience on that absolute mind-boggler of a sexist statement, but nobody would have caught onto that in the late 80s. Of course hormones have an effect on medicine and how you’re feeling and everything else. Incidentally, to this day, most medicines are only tested and normalized based on men.
See, women get excluded from clinical trials because of the idea that they might one day get pregnant, so there’s no data whatsoever on the effect a lot of meds might have on women. Lather, rinse, repeat the vicious circle.
Anyway… I lost my mom and my dad lost his best friend and partner, and so I really never went to doctors. I can count on less than one hand the times that I ever did as an adult, whether I had health insurance or not — and too many of those times were bad experiences.
Prior to this visit, in fact, I had a nightmare adventure visiting an urgent care center that shall remain nameless (except: Not Kaiser) because of a sore finger, where I was utterly misdiagnosed with gout, and then they lost my blood samples after I left. Oh yeah — in order to get to that urgent care, I had to convince the insurance company, which had misplaced my primary care hospital nearly forty miles from home, that I in fact did not live in Huntington Beach, but in North Hollywood.
Good thing for me that I had mostly been healthy enough to feel immortal, right?
So this is why your humble narrator slept sitting up for a few months and tried to deny that he was in real trouble, and didn’t seek medical care until, as mentioned above, things started to affect his favorite things — which were those bits between his legs.
* * *
If you’re an average male, your scrotum is about the size of a plum, depending on the weather. If you’re gifted, maybe a lemon, and if you’re a freak, a baseball. If you get up to stuff like pumping or inflating… well, you shouldn’t, but even then, that was nothing on what happened to me.
Imagine a nice, big cantaloupe. Now try to hold one of those between your thighs and walk. Also, try to imagine that this surprise set of elephant nuts is trying to strangle your penis. No — it’s trying to make your penis disappear, which makes it really awkward when it’s time to pee.
That was me on the Saturday night before I wound up in the hospital, when I insisted on driving all the way over to the West Side to see a friend’s staged reading of their musical in progress. How or why I did it, I have no idea — but fortunately the friends of mine in attendance who saw me and to whom I confided the truth had some advice for me.
“You should be in the goddamn hospital right now.”
Yeah, I guess I should have been. So the following morning I went to urgent care where, ironically, I met my primary care physician for the first time because he happened to be on rounds. I don’t think he was all that happy to see me. But, as I said in the intro, I’m sure that his first impression was not a good one: “I hope this fat sack doesn’t expect me to pull a miracle out of my ass when he hasn’t bothered to even show up despite being insured.”
Honestly, I totally deserved it if that is what he thought.
Of course, what really happened was that he ran a couple of tests — as it turned out, for an infection and an STI — prescribed some antibiotics, and sent me on my way. Probably standard procedure, but possibly also a different kind of test of me. I’d pretty much confessed my iatrophobia to him on first sight, and he didn’t seem impressed by that.
But a funny thing happened on my part when Dr. Williams came into that room. My fear of doctors vanished. He was a nice guy. He seemed to be a bit annoyed with me but, at the same time, was not at all judgmental. He listened. He explained. Nothing scary or nasty happened. He was clearly there to help, and there was a course of action. Maybe everything was going to be okay.
So I filled the prescription, headed home, and hoped for the best.
By Wednesday, my scrotum had gotten even bigger — what’s next up from a cantaloupe? And I wasn’t breathing better, and wasn’t feeling better, so I called Dr. Williams. He scheduled an echocardiogram for Friday morning, so that’s where I went. And it was after that test that the cardiologist gave me the life-changing news.
“You’re going to hospital now, or you’re going to die.”
Well, all right then…
* * *
How hearts fail
If this were a one-person show instead of a book, this is the point when the sound of a heartbeat would fill the theater and the lights would go to black, then the heartbeat would gradually get slower and more labored as slides projected in the darkness with a voiceover.
Congestive heart failure happens when the heart cannot pump enough blood to meet the body’s needs. Congestive is exactly what it sounds like: traffic gets backed up, so your blood cells can’t get to where they need to go. Symptoms include fatigue, diminished ability to move around, shortness of breath, and swelling.
Guess which of those symptoms I had. Yeah, it’d be all of them.
In my case, my doctors told me that my heart function was at 15%. In a normal person, it’s expected to be 55% or above. So, while 15% isn’t as bad as it could be against a hundred, it’s still pretty bad. This percentage represents the ejection fraction — that, is the amount of blood that the left ventricle actually manages to squirt upward per beat. In a sense, this is your heart’s money shot, and the higher the better.
On top of this, I also apparently had a bit of mitral valve backwash. That is, blood that was trying to make it up and out that left ventricle was pouring back down instead. End result: Fluid gathering, first in my legs, then in my ass, finally, washing up into my torso and back down into my scrotum.
In retrospect, I think that the doctor who had admitted me was right. I probably would not have lived more than another week if I hadn’t gone into the hospital right that moment. As it was, I spent about the next ten hours in the emergency room, in a private room on a gurney, hooked up to a Furosemide IV.
Furosemide is a powerful diuretic. A diuretic makes you urinate — and that I did, about every fifteen minutes for most of that weekend. Now, since they were monitoring fluid in and fluid out, I had to use a plastic urinal, and I couldn’t count how many times I filled one of those things over the next three days. All I do know is that I walked out of that hospital 45 lbs lighter than I’d been when I walked in.
* * *
As a patient, I’d only been in a hospital one other time in my life — the first sixteen days after I was born two months premature, so I don’t remember any of it. I was a frequent hospital visitor as both of my parents were dying, though, so I did not have great associations with the places.
Ironically, my original ambition had been to be a doctor, although I just didn’t have the math aptitude to pursue a scientific profession. I also volunteered in a hospital in high school and then worked in two during and just after college, and these experiences did not help enamor me of the location, either.
Hospitals are full of sick people and they never really quiet down. I had learned that one firsthand working as a security guard while I was in college, when first the swing guy didn’t show up and then the night shift guy didn’t show up, so I worked a twenty-four hour shift. Hey, it was a small hospital.
Did I mention that the fine people I worked for at the time screwed me out of the ridiculous overtime on that one, by the way? Although in retrospect I could have screwed them back fifteen ways from Sunday in a lawsuit. But I didn’t. (I didn’t work for the hospital, by the way — it was a contractor that staffed multiple hospitals, and the people who ran the company were dicks, in the modern and film noir meanings of the word.)
But I do digress…
I found the entire hospital experience that summer to be surprisingly… pleasant, actually. And yes, that was a surprise to me. I actually had two IV lines in me — one in my left hand and the other in my right arm — and the biggest surprise there was that they didn’t bother me at all.
I had always wondered how people could put up with having needles in them for a long period of time, and now I know. Part of the reason, of course, is that an IV isn’t a needle in your arm, it’s a cannula, which is a very thin and flexible tube that’s actually inserted via a hypodermic needle. I didn’t realize this until they finally pulled it out and bent it.
In a lot of ways, being in a private hospital room is a lot like being in a very fancy, although very boring, hotel. There’s also a magnificent staff available 24/7 to wait on you, and a parade of doctors. When they need to do tests or take X-rays, one of the wonderful nurses will give you a ride, either flat on a gurney or in a wheelchair. There’s even cable and WiFi!
One of the most interesting changes I’ve noticed in medicine from my days working in hospitals is how much everything has become geared toward modesty, which is a sad side-effect of America’s returning puritanism and sexual repression that began in the ‘90s. Even when my doctor was examining my scrotum out of necessity — cantaloupe, remember? — I still had on my underwear and a gown, and he only uncovered what he actually needed to see. This was also true when they did an ultrasound on the same place in the hospital — the tech was basically groping around under a towel.
Now, I’m not a particularly shy person, so these kinds of concessions don’t really mean a lot to me, but if you’re the kind of person who avoids medical care because of modesty, it looks like that issue has been minimized if not all but eliminated. Of course, I never had to have a catheter, so there wasn’t any reason for doctors or nurses to poke around down there in the first place. In fact, they told me to keep my underwear on when I changed into the hospital gown.
That part wasn’t so pleasant after three days straight, by the way.
* * *
Not that bad, really
The hardest part of the experience was that first day, really, and mainly because I spent about ten hours in the emergency room before they took me up to the hospital proper. By the time I got up there, the kitchen had closed and I hadn’t eaten anything before the test, so by that point it had been well over twenty-four hours since I’d had food. “Dinner” on the first night consisted of graham crackers and juice, although I was limited during my stay to a maximum of 1.2 liters of fluid per day — which ain’t a lot.
The food for the rest of the weekend really made up for all of it, though.
This is something I thought that I would never say or write, but I actually have fond memories of that weekend in the hospital. Maybe it was being the center of attention — a little bit — but it was also an enormous sense of relief. My health had been going downhill since at least the previous Thanksgiving by that point. Now, suddenly, people were doing something about it and I was feeling better.
One of the most memorable encounters of the weekend happened on Saturday, though, when I first met my cardiologist, Dr. Manela. Keep in mind that this was a Saturday, and the doctor walked into the room wearing a kippah. If you’re a goy, you might know that as a yarmulke, but the key point is that despite the doctor being very Jewish, he’s dropping in on me on the Sabbath, and those two little details really gave me confidence. Long story, which I’ll probably tell elsewhere, but while I’m technically Catholic while raised as a very secular Protestant who ended up a total atheist, I’m also very, very Jewish culturally because all of my closest friends growing up were — so I tend to trust Jews more than I trust any other religious group, because they truly are concerned with life. That, plus they don’t try to convert people, which is a big bonus.
That was exactly the reason that such an observant Jew was able to work on the Sabbath and meet with me, by the way. See, there’s this great little bit in their rules that says, “If what you’re doing will save a life, then you go and work your ass off, and don’t even pay no never mind to whether it’s the Sabbath, or whether it’s kosher.”
Who’d a thunk it — a religion that uses logic. Wow.
The news that Dr. Manela came to give me was this: “Hi. Your heart failed.” And he was then truly shocked by my lack of shock. In fact, he even pointed it out, telling me that most of the time that he told people this, they freaked the hell out. My response to him was that I tended to react that way to bad news, because the only logical response was to say, “Okay, that’s a thing. Now what do I do to fix it?”
I think he appreciated that answer — a little bit then, but a hell of a lot more as time went on, more on which later.
Saturday was also the day that I met one of my weekend nurses who, more than anyone, was really responsible for making my stay a fantastic experience. He was nice, he was caring, he was funny, and he really took his time to explain to me what was going on, and to just sit down and talk. I don’t even remember whether I told him about my whole iatrophobia thing, but I definitely told him about the circumstances (read: swollen nutsack) that brought me there in the first place, and on Sunday he asked me, “Uh… can I see it?”
Keep in mind that he’s straight (sorry, boys), and his interest was strictly professional, but it was actually really endearing. I mean, honestly, in America, elephantiasis is probably not something he’d see every day, or any day, and, while that was not the cause of my produce department sized funbag, it was still an interesting end result, at least.
Like I said, I’m not shy, but this led to one of the most fascinating conversations I’ve ever had. Yeah, we’re talking about my balls, there they are somewhere inside of all that, and how’s your wife again? Definitely a bonding moment.
* * *
About my dog
Now, the observant and animal-lovers among you are probably still wondering one thing. “What about your dog?”
Thanks for asking.
Her name is Sheeba and when I went into the hospital she was eleven years old. While she kind of acts very independent, she’s actually a lot more clingy than she pretends to be, especially to me and especially after her older sister, Shadow, passed away in September 2014. She doesn’t exactly have separation anxiety, but she doesn’t do well on her own.
That’s a kind of interesting side-effect of my day job, which I haven’t mentioned yet. For the last decade, I’d worked for the Dog Whisperer, also known as Cesar Millan, and it was a dog-friendly office. So Sheeba and Shadow always got to go to work with me, and Sheeba especially did so after Shadow was gone — practically every day. But the downside of that one was that when I had to leave her at home alone because I was kind of busy trying not to die, it was not good for her.
I did manage to contact one old friend who knew her from about a decade ago, then give her my keys to go drop in for feeding and walking. The problem was that Sheeba didn’t remember her, so fled and hid behind the bed. So switch-up to a friend Sheeba had dealt with more recently, and he managed to actually get in there and walk her and feed her.
Still, when I came home on Monday, it wasn’t pretty. Sheeba practically exploded when I finally came back, she had blown her coat all over the place, and had torn down and chewed up the metal blinds in my bedroom. My absence was clearly a traumatic experience for her, and if there was a downside to my hospital experience, this was it.
I suppose, though, it was better to come back to her three days later than to have never come back at all.
* * *
You gotta have heart…
Your heart is a muscular organ. It’s neither your largest nor your smallest. Those honors belong to your gluteus maximi (in your butt) and the stapedius (in your ear) respectively. However, it’s certainly the most important. You could live without your largest and smallest muscles, although you probably couldn’t walk or hear. Without your heart (or a mechanical replacement) you die.
The heart’s job, which begins about six weeks after conception and ends about eight minutes or so before your death (in most cases), is to move your blood around your body. Your blood has several jobs. One is to bring oxygen to your cells and take carbon dioxide away. Others are to fight infection and close up wounds. It’s also the medium in which nutrients and hormones get around, being distributed from the source organs in your digestive and endocrine systems.
If you have an average resting heart rate of 60 beats per minute, then it will beat 31,557,600 times per year, more or less. Live to the age of three score and ten years mentioned in Psalm 90:10, and it will beat over 2.2 billion times. (Ooh… the atheist just quoted the Bible. Yeah, I’m allowed to do that. It’s a pretty important literary source.)
Ironically, the only other muscles in your body that work as hard or harder are the two diminutive muscles in your inner ear, but only because they are constantly responding to everything that you hear. By the way, some humans still have muscles in their outer ear that allow them to actually move them. I happen to be one of those rare humans who does, and I can wiggle my ears like nobody’s business. That has nothing to do with anything, but it’s fun to brag about and it’s always amused my dogs.
But I do digress…
The average human heart is the size of its human’s fist, and it weighs about 11 ounces. This is far less than the human brain (3 pounds), lungs (1.9 pounds) and liver (3.5 pounds). This is also far, far less than the weight of your skin, which is your biggest organ, clocking in at a probably surprising but impressive 16% of your weight. In my case, that’s 27 pounds now. It used to be 44. Also surprisingly: despite my rapid weight loss, I did not wind up with any extra dangly skin bits.
But the point of all these facts and figures is this: This not particularly large organ that weighs just less than a can of soup and which hides behind your sternum (the bit that connects your ribs) and between your lungs (the left one of which is smaller to accommodate it) starts working before you’re born and cannot rest for a second until you die. When it’s doing its job right, you hardly notice it. But when it isn’t…
Oh yeah. You’ll notice then. The only question is whether you’ll pay attention to what your heart is telling you and live or, like me, ignore the obvious and nearly die.
I’m really fond of the “live” option, personally.
* * *
There was only thing that had kept me out of that hospital room and out of my doctor’s office: Stupid, useless fear. There’s a famous line in Frank Herbert’s Dune that is a recurring motif because it’s the mantra of a religious order and it begins like this: “I must not fear. Fear is the mind-killer.”
I’d update that in my case to say that Fear Is the Killer. It kills ambition, it kills progress, and it can kill people. It can prevent us from achieving what is possible and from learning who we are. It stops us from moving forward and locks us in a safe, little box that might as well be a coffin. Fear is the mother of prejudice and the father of hate; the creator of division and the birthplace of ignorance.
The opposite of Fear is Love, and Love is the mother of Hope, Harmony, and Humanity.
Once I got over my fear, amazing things took place, way beyond mere physical healing. See, a funny thing happens when you face one fear and nothing bad happens. You start to face more of them, one after the other, until you’re killing fears left and right.
The incredible doctors and nurses of Kaiser Permanente helped put my heart back together, but then I took that ball and ran with it because I’d been given the greatest thing in the world: A second chance at life.
I think that I’ve lived more in those days since I got out of the hospital than I had in the entire time leading up to them. It’s a great feeling, and now I’m going to tell you how to do it for yourself, but the journey out is a story best begun with the journey in.
* * *
Read an excerpt from Chapter Two