One Hundred Feet Deep in the Valley

I thought it was pine nuts. In the context of the two years since my stay in the hospital, that seems silly. But the circumstances were different back then. Right around one A.M. on an August morning, I woke up with a constant pain just above my stomach and below my heart. I could find no relief in walking around, changing beds, inducing vomiting or other less graphicly descriptive methods. This had happened once or twice before over the course of a few years and time ended up being the only remedy for the pain to go away. As to the cause, the only commonality seemed to be a possible pine nut allergy. Two years ago however, time was ineffectual. That morning, I ended up in the ER. What came after was a weeklong saga that has led to two years of processing reality and the cumulative trauma of small experiences and ordeals. Only after the fact did I learn how close disaster came. I had my breakdowns, mind you. What I did know made that easy. What I didn’t know would have made it all so much worse. As of my posting this, we are at the two-year anniversary and despite a desire to commit those events to record, I have rarely achieved more than a false start. I can easily talk about it now without getting too emotional, whereas before I held onto those events like a secret shame. I can be a point of contact for anyone dealing with similar medical ordeals. My wife and I are sharing our experiences with other families facing what we did. But it took two years to get there and it’s still an open wound. Here we go. For the record. THE MORNING That morning, I waited for my general practitioner’s office to open at eight. I called first thing and by no fault of their own, no open spots were available. A key thing for you to remember, gentle reader, is all this occurred at the height of the Omicron variant of Covid-19. I hopped on the internet looking for a GP that would both take my insurance and have an opening. The second one I called met the criteria and I booked an appointment for nine A.M. The doctor had a pleasant bedside manner and could at least tell me he didn’t feel like I had a burst appendix. He suspected an inflamed gallbladder. Alas, he did not have the needed imaging equipment to give me a more definitive answer. Amidst the options he listed, a visit to the emergency room seemed the most practical. I texted my wife the plan and she did her due diligence to verify which ERs took our insurance. As a side note, insurance and medical bills are their own kind of trauma. I won’t get into it now but trust me on this. It’s not anything you want to deal with if you’ve never had to before. With Omicron grasping hospitals with its wretched hands, the choice came down to a large hospital in Dallas proper or one a little closer out in the suburbs. Sadly, the closest one to me had closed the year prior for financial issues. Another one not far down the road ended up being the most viable option. By ten A.M., I was in the ER. THE WAITING ROOM Stepping through the doors of the ER felt like crossing the threshold into an expanse where time meant nothing. The waiting room itself sat half empty at first but quickly filled with those needing attention. Omicron was such that actual ER beds were full and unless things were truly dire, ambulances would arrive and wheel their patients into the waiting room, to join everybody else. Time was an illusion. Here, there were only personalities. An elderly couple who had been there long before I arrived sat in the row of seats in front of me. The wife was there for support while the husband dealt with heart issues. Their wait became that much more painful to watch as the hours ticked by. Omicron left the gentlemen to wait for a bed. On multiple occasions, the couple discussed leaving for another ER, but the staff stressed that he may not survive is he left. If sitting and waiting wasn’t bad enough, everyone around him could see and feel his dignity quickly disappearing. I have no care to define that further out of respect. There was a woman who came in via ambulance dealing with incredible pain. Every few minutes, she'd have an outburst calling for help and wanting someone to come to her. I can't fault her given she apparently suffered from an obstructed bowel. My father tells me those are excruciating to the point or inducing severe nausea. The poor woman had that in spades and as dignity faded for her too, we all bore witness. Then there was a gentleman who wasn’t sick at all. He wanted the free waiting room coffee. When he wasn’t drinking coffee, he was expressing his beliefs about mask mandates, the vaccine and essentially everything else you could roll into that. Outside those hospital walls, I distinctly remember people preaching that Covid was a hoax and that the hospitals were lying about their numbers. Security arrived to ask him to calm down or leave since his presence was only causing problems. This only exacerbated the trouble but some of us were so tired or worn out with the need to be there, we didn’t notice when he was gone. I have to express my wonder at the desk staff who dealt with all these personalities. Between that and others accusing them of not doing anything, they kept their heads remarkably well. The waiting room couldn’t empty until there were open beds in the ER proper. Those couldn’t open until rooms in the hospital wings were free. Something else to keep in mind, the need for ventilators had not gone away. Whole rooms in the ER were dedicated to those machines and the patients being kept alive with them. These were places of induced comas and darkness, morgues in waiting for some if I judged the expressions of the nurses’ faces correctly. Eventually it was my turn to have a bit a triage. An ambulance paramedic had been pulled in to help and I listened to their discussions about how IV lines are run differently between the ER staff and paramedics. I sat and waited in a small room with a computer during a second round of triage while I watched the events unfold in the hallway. A woman waited to be discharged and three different staff members said she needed to wait for it to be official. She already been there in that chair for an hour. Frustrated, she pulled out her own IV and left of her own accord. Once my own triage was done that second time, I reentered the void that was the waiting room. My parents had come as did my wife and we waited together. Sometime later, they called me back for an ultrasound. Then it was back to the waiting room and another round of email updates to my supervisors at work. Right around seven P.M., nine hours since arriving, they had a bed. I presume now that nine hours was pretty good time. THE EMERGENCY ROOM Note that I say “bed”, not “room”. They put me on a bed parked next to the nurses’ station. The first nurse I spoke to was friendly and I recited my ongoing saga once again as I pretty much had it down to a practiced speech. Since one A.M., I had no sleep, no food, no water. Such as it was, the pain was constant. Sitting up and hunched over with the most uncomfortable comfort I could attain. People watching is normally a fun activity, but rarely have I been somewhere so morose. Paramedics rolled gurneys of the injured to the waiting room. Nurses entered the dark ventilator rooms where I could see people flat on their backs, motionless and tied to a machine. I could hear another gentleman talking to his daughter, saying he didn’t know her and he was being held against his will. I gathered he may have been dealing with either Alzheimer’s or dementia based on what I could hear. He was a threat to himself and clearly others. They may or may not have strapped him down due to his falling out of bed and hurting himself. He may have even broke his leg in the fall. Somewhere between eight and nine P.M., they moved me into a room shared with three other people. One I believe to have been unconscious the whole time. The second barely said anything. The third was the woman with an obstructed bowel, still calling for help and writhing in pain. I'm not likely ever to forget this woman's name. She shares her first name with one of my best friends and her surname happens to be the same as the acronym for one of the conditions that contributed to this whole mess. I'm sure she possessed a lovely personality, but her pain brought out the worst. Despite medical warnings, she kept demanding morphine. When she couldn't find her phone or the call button for the nurses’ station, she accused the staff of stealing them or placing them out of her reach on purpose. In reality, she kept dropping them. This poor woman kept sliding out of the bed making her calls for help more frequent. This was her pattern, and it repeated the entire night. Add to that a loud tolling from the alarm of a heart monitor going off every fifteen seconds. That was my night, the longest I’ve ever experienced. I sat up in bed fatigued and audibly assaulted on all sides. That silly hunched position remained the only one to relieve any of the pain. Finally, they gave my neighbor some morphine. Finally, they turned off the alarm. Finally, they gave me something for my pain. The only noise that remained was the strapped down gentleman yelling for help. My neighbor yelled at him, telling him to shut up because she was trying to get some sleep. I could only muster one to two hours of sleep myself before the pattern started once more. All that packed in day one. DAY TWO When the nurse pulled back the curtain to my little piece of “heaven” in that room at the start of day two, she found me sitting up and hunched over, elbows planted on knees, palms bracing my jaw and fingers sprawled across my face. She could see my exhaustion and she could hear the cause. The pattern moved ever forward. She asked her questions. I answered them politely because she had enough to deal with and I had little energy to do otherwise. She was thankful and took care of me best she could. The order of events that morning are a blur thanks to the exhaustion, but I do remember having an MRI done. If you’re lucky enough to never have had one, it’s usually a claustrophobic tube of magnets. The process is uncomfortable and noisy as hell. Yet, I found myself falling asleep during the test, only to wake up because of my snoring and not the sound of the machine. To be away from my cantankerous neighbor was bliss. God bless her, but it was. I actually had some decent rest inside that cacophonous machine. My dad had joined me at my bedside to keep me company. He’s a helpful soul and always has been. One has to be in order to survive a career in geriatric care as long as he did. Samaritan than he was, he helped my neighbor into a better position on the bed. He kept finding her phone. He kept retrieving the call button she claimed the staff kept putting out of her reach. We tried to let her have privacy, but she seemed intent on continuing her expressions of annoyance and frustration. And she made sure that everyone in the ER knew it. Somewhere in the blur, I spoke to another imaging technician. They wanted a new scan with a different machine. They were pretty sure my gallbladder needed to come out, but they wanted to check for gallstones and other issues. Never mind, there was still the monster in the closet I’ve not discussed with you yet, gentle reader. They said not to eat or drink which placed me somewhere in the thirty hour plus range of having nothing on my stomach. Then it was back to waiting. They did bring me "food" a good while later. I ate it because I wrongly assumed they ordered it for me and I was allowed to eat. The imaging tech's expression of annoyance said otherwise. I would have been happy not to eat the dry BBQ chicken and cherry Jello flavored by pineapple juice but that wasn’t what was communicated. Frankly, I just wanted sleep. Around eleven A.M., they told me they had a room for me. I also discovered that this hospital had two wings. I was going to one. The second wing was filled completely by Omicron. By one P.M., they plopped me into a wheelchair, and we made our way up, passing rolling hospital beds connected to ventilators which were hooked up to patients. Five or six people covered completely in layers of PPE surrounded the mobile bed, destination unknown. Mine I knew. The room was mine and mine alone. Quiet permeated the hall and no one screamed for any reason. The nurses, though still exhausted from long shifts and frontline stress, made more frequent trips. They gave me something more manageable for the pain and really, the rest of day two ended up much more of a relief. That night, I finally had some sleep. I don’t remember much of the in between. THE THIRD DAY Having gone through the food situation, any misunderstanding cleared up. The morning of the third day, a Wednesday in fact, I found myself plugged into the third imaging machine in as many days. This one fascinated me the most as I could feel the special dye go through my IV and course through my body. I remember it being frigid. The screen above me showed a vague outline of my upper body but as the dye coursed through my circulatory system, my interior workings were seemingly being drawn in real time on the monitor. All this to see what was working and what wasn't. Back in my room, I did my best to record lesson plans and videos for my English classes. This was only the second week of the new school year and being out already felt like a bad look, never mind I couldn’t help but carry some misplaced guilt. That's the day the reality started to crash in waves. Not from my anxiety about missing work or what have you. Not from the guilt of needing to be in the hospital or how this was affecting my family. No, reality struck when the doctors told me what needed to come next. The expectation to that point had been that my gallbladder needed to be removed. I’ve had surgeries before. They weren’t a big deal then. However, after three runs of fancy imaging and the large medical bills to come, the true issue was that monster I alluded to earlier. My liver. The liver is king and centerpiece of several organ systems, one being auto immune. When you have any sort or surgery, the liver takes it quite personally. If you, or specifically it, are not in good shape and health, your liver could just up and decompose. Thats their term. Decompose. My liver is not in good shape. Thirteen or so years ago, amid another medical ordeal and hospital visit, I was diagnosed with Non-Alcoholic Serato Hepatitis. The long and short of it is that I had early stage cirrhosis of the liver and they couldn’t pinpoint why. One doctor put it simply by saying I had the liver of a 65 year old woman. Not sure why he chose that comparison specifically, but I went for another opinion. Thirteen years ago, my liver was in bad shape regardless of what you compare it to. Fast forward to this gallbladder situation, and my liver was worse. Blood tests didn’t look good. My skin had started to turn yellow with jaundice. Multiple doctors feared that removing the gallbladder could result in complete liver decomposition, meaning I would need an immediate transplant. That particular hospital did not specialize in gastrointestinal medicine, nor did it specialize in transplants. They could do the gallbladder surgery since as surgeries go, its mostly routine. However, if there were any liver complications, chaos would ensue to a potentially fatal degree. The best option at the time was to transfer me to a hospital that could deal with said complications, but that meant finding a hospital with an open bed. During the Omicron surge. The waiting game continued. THE FOURTH DAY If this story feels front loaded, it is. The bottleneck of getting to the ER and that first night left the some of biggest scars. Loud noises, especially tones and chimes, jarred me especially for at least a year. I lost fourteen pounds during my stay and rapid weight loss is never healthy. The wait itself is traumatizing. Rarely is the trauma of loved ones spoken about. My parents always worry they’ve never been able to do enough for me. My wife is the strongest person I know but once there is that moment to relax, the flood waters come. By this point, I hadn't seen my daughter in four days and she only knew a small part of the story. She had a breakdown at school and visited the counselor's office. Their solution was to give her a box of tissues and have a seat. That was it. No easing words. No strengthening or support. I appreciate that there are limits to what can be done, public school or not, but come on. It still makes me mad two years later. Thankfully, news came in the middle of the fourth day that a bed opened up at one or the best liver transfer hospitals in Dallas. This after at least three hospitals had stated they couldn’t take me. By that afternoon, I was staring out the back window of an ambulance driving through rush hour traffic. The bright spot in it was catching the ambulance drivers off guard with how tall I was. My feet with the yellow hospital socks were dangling off the gurney and I laughed. Somewhere, I still have those socks. I should. Paid enough for them. The room at hospital #2 was smaller but I had a nice view of the Dallas skyline. The nurses were great and by all measures battle tested. Omicron or not, they were going to see things through. This was the kind of attitude and confidence I needed to see. I spoke to the first doctor that night and the hope was to get the surgery scheduled for the next day. But it was back to waiting. Everybody could see my condition but me. THE FIFTH DAY Friday came as did the surgeon. He was the first to explain the facts of liver life in their fullest with a true emphasis on the decomposition dangers. They didn’t know yet when the surgery would be, but I was to avoid food and water since it could be at any point. I've had better Fridays and mine was about to get more interesting. Out of the blue, word came and they had me rolling down to OR prep in a flash, There in the final room before going to the operating suite, I had my own breakdown. My fate was out of my hands. In writing this, I needed to pause. Even after two years, even after all the processing, there exist the things that absorb all the kinetic energy and eliminate all the potential. I didn't realize it at the time, even as the weight of reality sat on my chest, but that was only the beginning. As open as I'm being here, forgive me if I don’t share the conversation with my wife before going in or the silent prayer running through my mind as they hooked me up to monitors and put straps around my arms to keep me immobile. The anesthesia was hot going in or so I remember. They told me to count back from ten, but I don’t recollect even starting. Nothingness. Not even dreams. The first thing that hits me post-surgery was a blur of voices and being in a haze. The anesthesia faded and my wife was thankfully the first face I saw. Hell, I was thankful I woke up. As it has since been told to me, everything broke my way. My liver didn’t give up the ghost. They could use the less evasive surgical robot rather than cutting me open. I didn’t need any blood which was in short supply to begin with due once again to Omicron. My gallbladder was literal sludge but they removed the dead organ without incident. And I woke up. Despite all the positives, recovery isn’t fun, between the onset of pain and the fact my body just tangled with a robot, presumably armed with the sharpest blades medically possible. God bless the nurses and all their help. Bless them doubly for trying to preserve my dignity even as it rapidly drained away. DAY SIX AND EVERAFTER After fallow ups and chats with a whole gaggle of doctors, I was told that my liver was now in an advanced stage of cirrhosis. There’s a whole scale for the condition of one’s liver and at my worst, I was dangerously close to crossing that transplant line. It’s come down a bit, but I’ll be watching it till the end of my life. The team informed me I could go home that very day. The first thing I did was hug my daughter and crawl into bed. To distract myself, I prepared to teach online because I couldn’t leave it well enough alone. Yet again, I felt guilty that I was letting people down. In the post-surgery haze, my mind took on as much guilt and dwellings on mortality as it could. I think I project self-assuredness fairly well. But anyone who truly knows me, is aware I am an extremely anxiety ridden individual. To be clear, that is not anxiety with a capital "A" as I've never been professionally diagnosed. I truly wish to be respectful to those who have been. Post surgery, I had no anxiety. My mental and emotional state had bottomed out so much, that it punched through the bottom floor into depression. Again, that is not depression with a capital "D.". Never in my life had I had been at such a low, buried 100 feet deep in the valley. I can't say I dealt with it in the healthiest of ways. For most of the last two years, I convinced myself I'd be lucky to see the age of 60. I was reticent to share that thought as it tended to upset people, either eliciting anger or sadness. Right now, I’m a belligerent 44. A self-imposed doom's day clock based on a shit liver is not a sustainable psyche to possess.

Am I better? There are things I’ve had to remove from my life, simple joys that create risks that build over time. There are major decisions I had to make to maintain my long term well-being. Mitigating the small and large risks isn’t too much to ask for the sake of being alive. Most importantly, I can say I've processed and I am still processing. I’ll be processing from now to the very end. However, the depressive funk is rare and the anxious haze has returned to factory settings. If I continue to work on myself in terms of physical health, I'll be able to blow past 60. My liver specialist has confirmed as such. I have gratitude. For those who have checked on me. Those that still check on me. For those that reach out. To those who acknowledge me. To those who have made me believe they are a part of the legacy I have left on the planet. Being the hermit I tend to be, every bit helps to pull me closer and closer to the exit of the valley.

Two years is a long time to process and the fact that I can write this is a milestone.