Part 3 — While I was out…

Okay, I’ve crashed, picked myself up, found a taxi and taken it to Bali International Medical Clinic. The clinic is a popular place for ex-pats and tourists in Bali, if you can describe a clinic as “popular”; however you describe it, BIMC is a hell of lot less scary than Sanglah Public Hospital. Next, I make that short, quick trip from consciousness to that other place.

My friend Steve is called by BIMC and informed of my condition and then, the BIMC staff send me to Sanglah Public Hospital — this is the medical equivalent of being rushed at high speed from the best frying pan in a good modern restaurant to a tenament block (American for housing estate) fire in the bad part of town…

Anyhow, this is the first near death experience: I arrived at Sanglah around 5:00 or 6:00 in the morning with:

• a ruptured spleen
• a fist-sized rip in the left part of my diaprhagm
• damage to my small bowel
• damage to my colon
• half of my stomach pushed back against my kidney and liver
• half of my stomach pushed up against my lungs and heart
• my kidney slightly turned around
• both my lungs bruised and messed up
• open book injury of the pelvis (pubis symphysis disstosis) and soft tissues
• my left arm (both radius & ulna) and pinky finger fractured
• one of my vertebrae lightly fractured — an “L5 lumbar vertebra transverse process fracture “
• 75% of my blood (3 litres) already lost — if I were a car, I’d be “running on fumes” .

Also, I don’t know the time or much else — the records have been thrown away — but I do know that I underwent 6 hours of work (Richard Pryor would’ve called it, “Woyk”); that my stomach was opened up by a bunch of fellas I like to call the Sanglah Surgeons… sound a little like Keystone Cops, don’t they?

They worked for hours — I’ve been told six hours but I’ve also been told six surgeons so I’m a little fuzzy on the details there — was it six guys for six hours or six guys working together for one hour, or six guys working for one hour, one by one?

I wanna know.

The Sanglah Surgeons pronounce the operation a success and say I’ll be out of hospital (or intensive care) in ten days. The BIMC contact, Lisa, disagrees and recommends to Steve that I be immediately medivac’d out to Singapore.

But, before we say “goodbye” to our Keystone Cop Sanglah Surgeons, I need to acknowledge that these chaps did, in fact, save my life. Well done fellas. Pardon me if I don’t come to visit or even send flowers and a thank you card.

The Medivac folks ask Steve to “guarantee” the flight with cash… something to the tune of forty grand… wait, let’s focus on that figure for a moment: forty grand — wahoo, someone’s making money in the medivac biz.

In the end, my medical insurance company, represented by a fine lady named Vivian, steps up to the plate and does me proud by guaranteeing the medivac flight without bankrupting Steve… thanks fellas. Side Note: Medivac only costs the Insurance Company twenty grand — half price compared with the rest of us… someone’s a scumbag.

December 25th, 2004

Medivac. Damn, I’m a little pissed off that I missed this — a big-assed Jet flies me and Steve into Singapore at high speed. According to Steve, very high speed: he says he never saw a landing like it. Whoosh, screech, slam and on the street. No messing around whatsover. Having said that, I doubt anyone’s going to recommend medivac as a way of journeying to Singapore…

Oh, and one important note: If Steve & Lisa had not been there for me, I would have not gotten that flight to Singapore.

If I hadn’t gotten that flight to Singapore, I would have died in Sanglah Public Hospital.

Thank you Steve. Thank you Lisa.

Next stop: C.C.U. Everywhere else in the world, as far as I know, this is called ICU for Intensive Care Unit. Mine was called the Critical Care Unit. Go figure. ICU is probably a registered trademark… who knows?

The surgeons in Singapore do not in anyway resemble the Keystone Cops…

…and, by the way, Medicine in Singapore is big business. Education & Facilities are top of the line but if you’re not insured, don’t go. Nothing’s cheap in Singapore but the life saving biz is probably the most expensive of all. That and cars. Cars are very expensive in Singapore. And housing. Of course, there’s also the famous brand name products. So, Lifesaving, Cars, Housing & Famous Brand Name Products. In other words, everything’s expensive in Singapore — medicine is no exception.

So, I’ve arrived at Mount Elizabeth Medical Centre, Singapore. My medical condition is noted as stable but critical. I’m admitted to CCU and treated with ventilatory support (a machine to help me breathe), invasive monitoring (they make holes and stick pipes in me to get my vital readings) and antibiotics for sepsis. Actually, I’m not sure if I had sepsis at this time or if the antibiotics were to prevent sepsis. I think preventative simply because sepsis was not yet mentioned in the reports.

Merry Christmas.

December 26th, 2004

I develop a “left massive pleural effusion” — this means I’ve accumulated a bunch of excess fluid my pleural cavity — the space between my lungs and chest and the other layer lining the chest wall. Thus, they insert a chest tube to drain the liquid.

Happy Boxing Day.

December 29th, 2004

I have no records of anything happening for a couple of days but on the 29th, the surgeons are worried about a continuing abdominal (stomach) infection and decide to open me up again.

The 29th turns out to be a very, very busy day.

This is my second laparotomy; which is, by the way, the medical name for a surgical exploration of the stomach. From the scar I see, the doctor cut me open from just under the ribs down to just over the pubis. This is one of those messy operations operations you’ll occasionally see on TV (usually at dinner time), where the doctor will look, poke and grope around inside the patient. Yup, they’re up to their elbows in me — no turning back now.

The surgeons discover:

• the tail of my pancreas is damaged (dead / necrotic tissue)
• dead tissue in the place where my spleen used to be
• dead tissue behind my left kidney and my colon
• the Sanglah Surgeons’ stitching in my diaphragm had broken open (the medical or technical term is dehiscence), re-stitched in Singapore
• the Sanglah Surgeons’ stitching in my lower stomach had broken open, re-stitched in Singapore
• my arm and pinky finger fractures were pinned on this day.

Note: Steve says that it was so dirty inside me, it was like the Sanglah Surgeons hadn’t bothered cleaning out the rice field… cat hair, trash, grass, etc.

So, now you know that between the 25th and the 29th of December I had my second near death experience. Without that second laparotomy and the subsequent repairs, I’d be dead. ‘Nuff said. Also, the Indonesian word “lapar” means hungry.

December 30th, 2004

It’s time for my tracheostomy. Lovely. For those of you who don’t know or who are unsure as to what I mean by a tracheostomy, it’s when they cut a hole at the bottom of your throat and shove into the trachea (windpipe) a short stationary tube. This tube keeps my airway open.

Later, when I was conscious, this hole in my windpipe would also allow the insertion of a smaller, more flexible tube with a suction device to be pushed down into my bronchial tubes and lungs in order to drain and clean them out. Some people reading this might not have noticed the pain. That flexible-tube-lung-draining thing hurts. Hurts like a motherfucker. I’ll take the crash. Lose the spleen. Have my stomach slit open from ribs to balls but no fucking way am I doing that draining tube shit again. Fuck it. Scary, Gross & Painful. I was unconscious for most of what happened. But among my memories of pain (and I have a few), I remember the flexible tube… mainly because you have to be awake and coughing for it to work. Talk about torture.

As I said, that pain is later. Right now, I’ve got other problems:

• I require total parenteral nutrition — meaning food by tube.
• Pneumonia
• Pleurisy (liquid in the lungs)
• Transient Renal Impairment (meaning my kidneys are temporarily on the fritz) caused by hypotension (abnormally low blood pressure).
• Sepsis
• Acute tubular necrosis (sounds like an album by Dire Straits) — dead or dying tissue probably also in the kidney area.

Sepsis, ah, sepsis. Never heard of it before. Heard the word for the first time after I woke up. Sepsis. Sounds like septic. Can it be so bad?

Short Answer: yes!

Long Answer: bacteria enters the bloodstream from an infected area of the body or after an injury or surgical procedure. Once in the bloodstream, the bacteria begin to multiply rapidly, spreading toxins throughout the circulatory system. Now, you’re developing chills, fever, tachycardia (rapid heart rate), tachypnea (rapid breathing), and a high white-blood-cell count. Then, if you don’t respond to treatment (or, worse, if you’re left untreated, you can look forward to septic shock or sepsis syndrome — a potentially fatal condition characterized by a dramatic drop in blood pressure and damage to or failure of various organs, particularly the kidneys, heart, and lungs.

This is the third, last and most dangerous near death experience. In more personal terms, on this day my infection is spreading like wildfire and I’m in the process of dying. I’m not brushing with death. Or courting death. It’s not that death has become my constant companion. At this point, I’m dying. Hoohah. In fact, of all people that suffer sepsis while in hospital care (ICU), one-third die. Sepsis is a stone cold killer.

There is, however, a drug treatment that may improve your survival chances. It’s a brand name drug called Xigris (manufactured by Eli Lilly & Co. — the same guys that gave us Prozac). In the US and UK, you can only get it once you’re diagnosed with “acute sepsis” — acute is when 3 major organs have failed. In the UK, you can only get it if that particular hospital had the budget for the drug and no-one got it before you. A “Survive While Stocks Last!” kind of deal. On its own the drug is interesting and controversial enough for a whole bunch of pages — I suggest you go google it if you want to know more.

At this time, it’s enough to know that Steve was told about the drug and then asked to decide if it should be administered with the warning that it would cost around twenty thousand dollars and that Steve himself would need to come up with that amount in cash.

Twenty thousand dollars. Cash. Wahoo, someone’s making money in the medicine biz.

Steve told them to go ahead but, once again, my Insurance Company stepped up to the plate, guaranteed the treatment and I got my drugs without Steve being bankrupted.

Thank you Steve. Thank you Insurance Company. Thank you Eli Lilly & Co.

Treatment with Xigris, by the way, does not guarantee survival. And, according to Steve my chances for survival with the drug were one in three. (Can I get a whoop, whoop? Alrighty then.)

January 17, 2004

I leave CCU by the front door (as opposed to thrown out the rubbish chute in a body bag) and head up to the General Ward. I’m on wheels, by the way, not under my own steam. The worst is behind me and I’m home free, except for the following few hiccups:

• pneumonia
• coagulase negative staphylococcus — a type of round, parasitic bacteria known to cause pneumonia and septicemia
• diarrhea
• infection around the hole for my lines
• pleurisy, right lungAll said and done, it was easy… a relative walk in the park.