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01/15/2002: "Appendectomy Surgery"

Can I have additional thoughts without an appendix? Or how I spent my Winter Vacation.
By David Tilsen 12/30/2001


Sunday, December 23rd, 2001.

Woke up early, had lots of plans, did not have to get back to work till wed the 26th. Lets see, run cable for television to the bedroom, hang shelf for new TV there, catch up on my e-mail lists, last minute present wrapping. Vikes are playing this evening, given the way they are playing this year, don’t want to focus too much on the game just have it as one of many activities happening. Yup, going to be an ok day.

Barb got up early also, made me a great breakfeast, sausage, pancakes, fruit, ate it right up, that is when the tummy ache started. Just did not feel good. Well maybe I ate too much, calls for me to lie down for a while. Ok guess I need to listen to watch the Sunday news shows.

After a diet of Beat the Press, Mace the Nation, Cokie, George and Sam, I was really feeling sore and nauseous, but I pressed on. Eddie woke up and said he would be glad to help run the cable. Boy was he sorry! It turned out I could not do too much, he did all the crawling under crawl spaces, and I mostly stood in different rooms and yelled back and forth. Anyway mission accomplished, Cable installed, shelf hung, TV on wall and working. Me ignoring the pain in my belly.

Barb and I talked about he plans for the next two days. Even though our household is Jewish, barb really enjoys Christmas meals, and gifts so we all make a point to make these two days real nice for her. She is planning to make Koledormers (kind of a Norwegian cabbage roll) for the main dish on Monday, and Tuesday will be our traditional game dinner as Eddie got ducks geese for us this fall. Somehow none of it sounds that good to me.

Skipped dinner, went to bed, watched the Vikes embarrass the entire state on national TV on my new television, and tried to sleep. The pain was getting worse. Was this more than football fan agony?

Monday December 24th

Could not sleep. Often was doubled over with pain. Got up and tried to read, made myself some tummy tea. Eddie came home about 1:00 and we watched a really violent movie about vampires and blood (Dusk till dawn). About three he went to bed. About six Barb got up and saw me in bad shape. (I think I vomited) I told her I was having the same kind of pains I had had about three months ago and we had thought then it had been the flu. She said we should go see Tom (our longtime family doctor). I agreed that was a good idea. She called and they said to come right in. We got there about 10:00.

Tom was concerned but was not sure what it was, took blood, x-rays, white count elevated, but nothing conclusive, he said he wanted me to have a CT scan so off we went to the hospital which is where they keep the things.

Spent two hours in pain in the ct scan room drinking the funny tasting orange juice every half hour to get the tracer in my system. Then they do the thing. It is the easy part.

Then we sit for another hour, it is probably about 3:30 PM by now, and we have spent the whole day sitting in waiting rooms, Barb read her book, but I was in too much pain to do anything.

Another doctor came in and told me that I had appendicitis; I would need to go over to the emergency room, get admitted, and meet with a surgeon. Wow, this was getting serious but there was nothing to think about, we just did it.

After another hour and a half or so, we were meeting with the surgeon who had just looked at the scan. He said that he has one more “procedure” to do and that I was next. The anesthesiologist came in, hit me on the head with a hammer, and I was out.

I don’t remember much about that evening, only that they told me that the Appendix had ruptured and was leaking bad stuff into me, and that everyone was glad that they had gotten this thing out of me. I believe I remained in a drug induces stupor for most of the night.

Tuesday December 25th, 2001
Lots of needles everywhere, tubes, oxygen, IV, CPAP, yup, I am either in a hospital or back in college. Surgeon drops in, says he is concerned about infection, and wants to monitor my white count for 24 hours and give me lots of IV antibiotics, I think I nodded.
Got to know the nurses. The floor is run by RNs. Most of them 3 to 5 years out of college, ages 24 to 28. A few are older, but most of them are on loan from another department that is slow because of the holidays. I think about being cared for by people my kids age. It is actually comforting, I have a probem with privacy, (catheters and such) but they are so no-nonsense that I am not permitted to make it a problem. I guess it is their professionalism. I wonder if they are taught that or if the good ones learn it. Probably a little of both.

We wait for the doctor to show up. I keep asking for him to get some news. I keep being assured that he will come and see me “soon”.

I start to feel better or at least conscious, they tell me that they want me start urinating, and moving my bowels on my own, (or at least passing gas). I work hard at it but no success. Straight Cath time, eichhhh. Coughing and sneezing are really painful. Lots of people taking “vitals” every hour or so. Again I think about how much of their job must be keeping records or all of the tremendous amount of data. Orders collected from doctors, data collected from patients. Etc. Never realized it before, I start building data models in my head to manage this data.

Cantor Ableson from Temple Israel comes by. I have no idea how he knew I was there, later he told me they monitor the admits, I had no idea they did that. I am really appreciative and comforted by his visit. I think again how much I like being a member of Temple Israel.

Wednesday December 26th

We wait for the doctor to show up. I keep asking for him to get some news. I keep being assured that he will come and see me “soon”.

I finally to start to urinate on my own. It feels like a victory to shout to the world, only I do have enough sense not to. The nurse tells me it is a real good thing.

They tell me to go ahead an eat solid food. I eat lunch, some kind of stew.

We still expect the doctor sometime soon.

Then they bring me a full dinner. Chicken, mashed potatoes, dressing, salad. I eat most of it.

Almost immediately I feel bloated, like I ate too much. In fact that is what I tell the nurse. She says she will put in a call to the doctor.

Evening vitals are getting worse, temp up, blood pressure up, heart rate up, white count up. Pain increasing, pressure on my abdomen increasing. They again say they will call the Doc, and they increase my pain meds.


I do not see a doctor anytime on Wed.


Thursday December 27th
Early AM
Bloating gets worse. Abdomen distended, pressing on diaphram, cannot take a deep breath. They tell me they will increase my pain meds, and call the doctor again. The only things they are allowed to do.

About 1:00 I am convinced I am really crashing, I ask to see the “charge nurse” the closest thing to a supervisor that there is in the middle of the night. I told her that they must get a doctor to give them some orders for me. She said she would try to get ahold of someone. I remember saying, “There is no try young Jedi there is only do.”

She and the RN say that they talked to someone who said the needed to put a NG (nasal gastro) tube down my throat to my stomach to suction out the stuff in there. It doesn’t sound pleasant, but it does sound like doing something, so I say “Make it So”.

This is an incredible ordeal, involves tears, pain, several tries, and mutual comforting. It finally gets in at 2:30 (according to the chart). Immediately the pressure is relived and I can breath again. I ask them what is next. They again say they have no orders and need to wait to hear from the doctor.

Although I can drink water, there are two major problems. One it feels like razor blades on my throat on the way down past the tube, and two, as soon as anything gets into my stomach it is immediately suctioned out by the suction. I can watch the sip of water swallow, squirt out, swallow squirt, swallow swallow, squirt squirt. Swallow pause swallow swallow, squirt pause squirt squirt. Yep this is not getting any fluids into my system. I think about my mother getting seriously dehydrated from too much Lasex, and wonder how I am getting fluids replaced. I try to will myself to stop sweating.

I mention to the Nurse everytime I can that they need to hang a bottle of saliene and plug it into my IV (which is only being used for my antibiotic at this point) so I can get some fluids. They tell me they must wait for orders from the doctor, a doctor who we have not heard from for over 36 hours at this point.

I seriously think I am going to crash and die here. I remember calling Tom’s number on my cell phone and telling his service who I am and that I am in the hospital and need to talk to him. Mostly I think about the long fight my mother had from the time she went into the hospital with a rash, to come out only a few months short of death. I am wondering if I will hang on that long, or if this night was it. Basically I am not in a good place.


Early morning call from Barb, I tell her I had a bad night, and that they put this tube in me. She says she will be right over. Then I look up, and at the foot of my bed is an Angel. It is Tom. He is looking at me. I croak something about needing help, and not getting any fluids, and having medications that I only have orders to take orally but need to get into my systems. He listens well. He tells me he needs to read my chart and he will be right back.

He does come back. He is very good. Makes it clear to the nurses that they must get a doctor who can give them orders (apparently for some reason Tom cannot, I never did ask why) within an hour. He says some other things, and tells me he will keep in touch. I feel very relieved but I still think I am dying.

Barb shows up, then a doctor, took him almost two hours after Tom’s ultimatum (which was one hour). He said he never heard of me, but he works in the same clinic with my surgeon who apparently is out of town on vacation. He does not look very happy, I hope he is mad at his colleague and not me. He says the word “toxic” several times to the nurses, then says he needs to read my chart. A few minutes later the nurses come in and hang a bottle of saline and tell me it is being set for a very large amount of liquids. They give me a stool softener and tell me I cannot get the tube out until I have a bowl movement. This is quite an inducement.

It also comes out that since no doctor called in yesterday, there were not labs ordered, so we do not know what is currently happening with my white count.

Barb really pins the surgeon to the wall. Are you monitoring the case? “well now that I know about it?” What is your plan? “To get an X-Ray to see if there is a bowl obstruction” What next? “I don’t have a plan beyond that” When will you have a plan, when will we see you again. Etc. etc.

I am immensely grateful to Barb for this. I believe that if anything is going to save my life then it will be getting some attention from this doctor.

I think about my father’s heart surgery. About how important it was to him to find a surgeon that he had a connection to. We call former clients, business associates, etc. to find a heart surgeon who was introduced as a friend or a friend of a relative or a relative of a friend. At the time I thought it was unnecessary use of privilege, and was not sure it resulted in any better care. Now I am not so sure. In fact, If I had been a person to the first surgeon, not just the last “procedure” before his Christmas holiday there is no way he would have left town without turning my case over to someone. It is becoming more and more apparent that that is exactly what he did.

I got up a walked many times that day, because I knew that getting this tube out of my thought was important to survival, and that required a bowl movement, and walking was the only think I could think of to make that happen. Walking was painful, trying to have a bowl movement was painful, and swallowing was painful.

I was successful about 3:00 that afternoon. I insisted they page the doctor right then. About an hour later they came in and took the tube out. They then told me I could have nothing by mouth until at least the next morning. Eddie was there and I thought he was going to see me cry. My throat was in desperate need of something cool and wet, but they said no. A mistake had been made in allowing me to eat and drink when my system was not ready, and they were going to take it slow. After I thought about it I agreed that it made sense, but I would have killed for a glass of ice water, or orange juice.

Improved through the rest of the day. I began to feel like I would make it.

Friday December 28

They gave me a clear liquid breakfast. Juice, jello (which is neither clear nor liquid) coffee (which has caffeine which I cannot have) and milk. The juice was wonderful. I left the rest.

I continued to improve throughout the day. Had another clear liquid lunch and dinner (same with some broth added).

Saturday December 29

Real Food. Peanut butter toast for breakfeast. Really starting to feel human.

Took a shower, brushed my hair.


About 5:00 in the afternoon they let me go home. Hey look, there is a new TV in my room. Cool.

Extended footnote (since I no longer have an appendix)

I am at home on Monday the 31st. I am still pretty sore, but mostly the incision, and my throat. I am starting to think about other things then just my body getting well. I am thinking about our medical establishment though.

The hospital I was in was an Allina hospital. There was a lot of news this year about Allina, including an investigation from the State Attorney general, that lead to sever cost cutting being imposed and a breakup of Allina into smaller companies. They major costs of a hospital stay seem to be
1. Technology (sure glad they have that CT/Scan)
2. Personnel (They wards seem to be run by RN’s with little authority to do anything without orders from a doctor. This puts a lot of responsibility on doctors who do not have much direct personal realationship with the patients. This appears to create frustration for patients, nurses and doctors.
3. Pharmacy (I am not sure why this is such a great cost, but was recently told by an expert in the field that it is).

The hospital just did not feel like a healing place. Time it totally suspended for the patient, I had very little control over what was going on. It was easy to be passive and just allow them to do their stuff to you, but at the same time, passivity is dangerous if the system for making decisions is flawed, and it seems to be. I am involved in the design and implementation of complex systems, and my experience is that one person can easily overlook a detail or a problem, and that many minds on a problem is almost always better then one. I also believe that rigid hierarchical structures tend to underutilize the insights and expertise of technical, but involved members of the team.

Three things I needed that I did not get.
1. Reasonable food that would have been approved of by any nutritionist I have seen.
2. Un-interrupted sleep.
3. Information.(how about access to my labs and my chart without an argument?)

These do not seem to be impossible achievements.

I have been longer winded here then I intended, but have also skipped much I wanted to say. Seems like a reasonable balance. If anyone wants to talk more about any of the issues raised in this epistle, drop me a line.

David Tilsen