My appendix experience

I don't often feel the need to journal my experiences for posterity, but these last few days have been quite the outlier among my human experiences.

Earlier this week I was helping my in-laws pack up their home in Texas to move closer to their grandchildren. Around noon on Tuesday the 27th, for my first food of the day, I ate a cookie bar that had been sitting on the counter (mostly covered) for the past two days. Pretty shortly afterward, I felt some pain in my gut that I diagnosed as gas. "Ah," I thought, "that's what I get for breaking my fast with something so carby."

The gas pain got more annoying throughout the day, and didn't seem to change when I ate a real meal a couple hours later. I slept about three hours that night, but then woke up and spent most of the rest of the night changing positions and trying get myself to fart it out, to no success.

Wednesday we were driving the ~10 hour trip to Iowa, and I was supposed to drive most of the way in one of the cars. At some point in the first few hours I got some pepto bismol at a gas station and took a couple doses. I thought maybe it calmed my guts down slightly, but it didn't seem to do much. The pain kept increasing.

About halfway through the drive I started to doubt that I was dealing with gas, and wondered if I had somehow developed some kind of severe constipation, even though I had managed a small bowel movement the night before. Maybe there was some hardcore blockage behind that bit? I started to really regret the pepto bismol, which would only make the constipation worse. I didn't eat anything the whole day, the idea of food was not attractive at all.

I handed off driving for most of the trip, only driving for 3 or 4 hours total. The plan was to drive to the Iowa house and empty the vehicle before driving the hour or so back to my house near Omaha, but a couple hours before arrival, the pain was starting to get pretty bad, so I requested to be dropped off at my home first.

My plan was still to try to deal with constipation: I knew we had magnesium citrate, which would turn any hard poops in my intestines into mush. As soon as we got to my house I rushed to the master bathroom, chugged the full dose of magnesium citrate, and tried to empty myself, but with no luck. If anything, my guts felt a little worse.

After 30-60 minutes, the pain was starting to get pretty debilitating. My guts were throbbing. There weren't any positions I could take that would relieve it, no stretching my legs apart or laying on my side would help at all. My vision started to warp, it was the first time I've experienced "not seeing straight" because of pain.

Presumably due to proximity, the pain affected my groin, giving the aching sensation of having been kicked in the balls, but without fading away over time.

The only other pain I've felt to compare this to would be some of the awful earaches I had as a young teen, which were awful and lasted for hours. These pains probably ranged in the 8-9 range on the pain scale. Experiencing that level of pain in my guts didn't seem like much of an improvement over feeling it in my head.

Later I tried to think if I've ever actually hit a 10 on the pain scale, debilitated to the point where I couldn't even form words. Maybe that time a piano bench full of books landed on my big toe and burst all the blood vessels? But that 10 probably only lasted five to fifteen seconds before dropping down to an 8 or 9.

I messaged my mother "Could you diagnose appendicitis" and then spent about 30 seconds looking up Appendicitis#Diagnosis on Wikipedia.

Out of other options, unable to drive, and with my wife not able to drop the kids and drive me to the ER, I told my wife that I was calling 911 and she should let the paramedics into our room when they arrived. I called 911 at 19:39 (7:39 PM). I put on some clean clothes and laid on our bed on my back with my knees bent until they arrived.

They took vitals and got my story – "thought it was gas, then constipation, now it's really bad", and then got me into a cart and into the ambulance. They asked me what hospital I wanted and I said Methodist, having had a good experience there when dealing with hypertension in the last year. And really, who wants to juggle medical records and doctor interactions and paperwork across multiple health systems.

Those ambulances don't have fantastic shocks. It wasn't the driver's fault, but I could really feel all the bumps in my guts. I was just trying to ride the pain and give any diagnostically useful answers that I could when people asked me questions. I think I had to repeat a couple answers to the paramedics because they had trouble understanding my clipped speech in the vehicle.

The paramedic in charge must have been new to the job. She seemed nervous and didn't want to make the call to the hospital on the way back, but another older paramedic made her do it. Same vibes I remember from having to call a customer during my early weeks of software support at ISoft and explain them something that I didn't really understand myself.

They got me into an ER room and a nurse saw me quickly. I gave them the story "thought gas, thought constipation, hurts real bad, check for appendicitis?" in the same "ride the pain, say diagnostically useful things when asked" mode.

They reasonably wanted blood and urine samples, but my deep bouncy veins caused the same problem they always do, and even the expert nurses weren't able to get a needle into them, so they called the IV ultrasound cart, which takes a little bit to show up.

They gave me a cup to pee in. Sliding off of the bed to get to where I could pee was a bit rough. I peed into the cup and managed to stop before it overflowed, and got the cap on. At this point I could feel my stomach churning and got my mask off in time to start puking up the magnesium citrate syrup and water onto the floor. I tried to holler for a bucket or something between pukes but couldn't be very loud. At least my food-free puke was relatively easy to clean up. The nurse threw some towels on it when she came in, and someone with a mopping device cleaned it up a little while later.

My parents showed up at some point around here. I wasn't able to pay much attention to them, but it's always nice to have extra for "respectable middle-class, definitely not a drug-seeker" reinforcement around. Not to mention the chance that they might catch or remember something that I would miss under the circumstances.

When the ultrasound showed up and they got an IV into my arm, they took the blood sample. Some time not long afterward they offered me IV Tylenol, which sounded great. I was ready for any pain medication and if there was something that would work without me taking an opiate, that was fine with me.

I mentioned to the nurse that I had never had opiates before and was happy to start with the IV Tylenol. It started to work pretty quickly, I think it might have been 10-20 minutes before my pain started to drop from the 7-9 range down to 4-5. I became able to hold a conversation with my parents and could think about things besides just hanging on.

I felt good enough to get up and walk to the bathroom and pee, though it was more work than I expected. Even with the painkiller, urinating hurt more than I expected, mirroring the weird gut/groin connection from earlier.

The blood report came back with elevated white blood cell count, which I knew from my 30 seconds of Wikipedia research was an indicator of appendicitis. The doctor spoke in a calm, steady voice and would inject absurd humorous statements into his sentences. I suspect that tone helps keep an even keel in an ER setting.

They scheduled a CT scan to take a look at my appendix. I think it took maybe 30-40 minutes before they took me up to get scanned? The ER doctor came in a little while later and said "well, I'm afraid we're going to have to take you out back and shoot you." He had eyeballed the CT results and saw a pretty clear case of acute appendicitis. He couldn't schedule the surgery until after a radiologist checked it over and confirmed though.

After the appendicitis diagnosis, they offered me opioids: Dilaudid (a brand name of Hydromorphone, a morphine derivative), and Oxycodone. I was still feeling fine from the IV Tylenol so I said I'd stick with that for now. The nurse asked me if I would be willing to take opioids later if the pain came back, and I said yes, definitely.

It had been about 3 hours from getting to the ER to getting the diagnosis. After a little while someone in radiology gave the official "looks like pretty normal guts, except for the obvious nasty appendicitis" diagnosis, and they could schedule surgery. They put me on the plate of a surgeon who was on call, but not in the hospital that night. They weren't sure when the surgery was scheduled – the doctor could come in that night if it was urgent enough, or I might get scheduled for the next day.

They took me from the ER to my room in the surgery department some time around midnight. Somewhere between 2:00 and 3:00, I woke up in pretty bad pain. The IV Tylenol had worn off and my pain was back up to 6 or 7 and climbing. I spent a few seconds debating trying to ride pain a while longer but that didn't last too long. I hit the call button and told the nurse about the pain and then spent a while (maybe ten or fifteen minutes? Hard to say) moaning while she got the drugs ready and did whatever software interactions were necessary to make the good drugs pop out.

She gave me Dilaudid via IV. It didn't have the immediate pain-reducing effect I was hoping for, but the pain did slowly drop over the next 20 minutes or so. After about 30 minutes I did notice some lightheadedness, but it didn't seem like a high particularly worth chasing, and I was way too tired to try to take notes on the minutia of the effects. I suppose most people get hooked on those types of opioids not so much from the high, as much as how they feel awful when they try to stop taking it.

But it only lasted a few hours, and some time after 5:00 I woke up in pain again. This time the nurse gave me an oxycodone pill. Even though it wasn't via IV, it still seemed like it had fully kicked in within 20 or 30 minutes. Unlike the Dilaudid, the effects lasted a long time – I didn't feel any increase of pain for at least 8 hours after that. I'm sure effectiveness varies from person to person, but as far as I'm concerned, oxycodone is pretty great stuff.

My surgery was scheduled for 15:00 that day (Thursday), and the only other painkiller I asked for was some tylenol about 30 minutes before pre-op. The single doses of Dilaudid and oxycodone were the only opioids I needed/got during my stay.

Once the morning came and I learned that my surgery was scheduled for the afternoon, there wasn't a lot for me to do, though honestly I was so worn out and catching up from the sleep deficit of the night before that I was fine just laying there and napping. I got up to pee once or twice, but discovered that moving around was only asking for pain that would take a while to fade away, so I quickly got accustomed to staying pretty flat on my back.

Even though the oxycodone worked well, I could still feel a constant throbbing around my lower abdomen. It wasn't debilitating, but it was a constant reminder that there was something inside of me that was going to kill me if something didn't kill it first.

My diet orders were "NPO", which apparently is an acronym for some latin meaning "nothing by mouth", but I interpreted as "nothing pre-op". Not an issue for me, food had zero appeal.

My mom was able to watch the kids so my wife could come visit me for a couple hours before pre-op. I didn't feel up to having the kids energy around at that point, but it was great to have my wife there. I had been away helping her folks move since 6 days earlier, and we hadn't been able to properly kiss when I rushed in the door a couple hours before calling 911.

They rolled me down to pre-op about an hour before surgery was scheduled. The anesthetist came in and prescribed a cocktail of drugs to reduce the odds of me feeling awful or puking after waking up. I think two of them were to reduce the power of my stomach acid. They must have worked, I didn't feel any nausea afterward.

I suppose sitting in pre-op waiting to get wheeled into surgery would have been a natural time to feel anxiety about the surgery, but I had fully internalized "either this thing comes out, or I die an awful death", so it wasn't like there was any chance I was making a wrong decision, and I didn't feel any fear or nervousness. After 30 minutes or so they wheeled me in.

The surgery room looked surprisingly warehousey. I think the floor was concrete. Bright light overhead, of course. The nurse who wheeled me in seemed like an old hand and gave me a quick run-down of what would happen. She wheeled my cot next to the surgery table, got them to the same level, and had me scootch my way over onto the table and get myself centered.

"Ooh, you were trained to be modest," said the nurse, when she discovered that the lower half of my open-backed hospital gown was tied shut, as she reached underneath me and untied it.

Before putting the mask on they told me it would give me oxygen, which seemed somewhat disingenuous since I was pretty sure the anesthetic was the most relevant stuff. I think I was out within one or two seconds of the mask going on.

I woke up back in my room some time around the neighborhood of 17:00 with people getting my bed settled and taking my vitals and such. I was able to ask them a few questions and felt slightly proud for being reasonably cogent, having seen videos of people acting super-high while coming out of anesthesia.

The answer to "is there any chance of me going home today" was "no", which was slightly disappointing since the surgeon had made it sound like going home the day of the surgery was at least theoretically possible. I didn't feel like complaining though. The awful throbbing in my front was gone, but I was really tired. They gave me a cup of chicken broth and told me to sleep off the anesthesia. I said my pain level was 0.

I woke up around 21:30 with a much clearer head, still feeling great. I messaged some friends to give updates, and asked for another cup of broth. After a couple hours of catching up on communication I turned on Omnibus and went back to sleep.

The surgeon saw me briefly in the morning. Everything seemed fine, my abdomen felt pretty sore if I tried to flex it and I couldn't do anything close to a sit-up, but it didn't really hurt and I reported my pain as 0. It took a while for the "is he officially discharged yet?" dance to conclude, but eventually I was out the door and catching a ride home.

Laparoscopic surgery is pretty cool! I only have three small holes in me. Twenty years ago a good friend of mine had his appendix removed, and he got the traditional long straight scar. I'm hoping the smaller footprint gives me a quick recovery, though I'm still moving fairly slow a day after getting home now, and getting up from laying prone is still a small ordeal.

My experience with Methodist Hospital was great. Like my last visit, all the nurses and doctors seemed on the ball and actually cared about doing well for the patients. They were all cogs in a giant bureaucratic machine, but it didn't seem like they felt it prevented them from doing a good job. Everyone seemed friendly and competent.

I praise the Lord for the good health care I have access to.