Saturday, March 23, 2013

Romy's Appendix Ruptures: Day One

Here is the story of Romy's appendix bursting, as I write it from the hospital. . .

The story of Romy's appendix bursting actually starts a little over one year ago. One day, in February last year, Romy woke up with cramping and pain in his abdomen, so we called the nurse at the Tang center who told us to go to the E.R. So last year, I took Romy to the E.R. at Alta Bates to get it checked out. After some blood work and a CAT scan, they told him he was just constipated. Even though the pain was predominantly on his right lower side of his abdomen, they told him to take a laxative and go home. So that's what we did. He was still in a lot of pain for the following day, and the worst pain he ever experienced, but eventually it subsided after a few days.

Earlier This Week:
Somewhat suddenly earlier this week, Romy started feeling a lot of the same cramps and pains in the same spot in his abdomen. At first they were very mild, so we thought perhaps he was constipated again. Romy took a laxative, with very similar results, but the pains did not go away this time as they did before. However, since the pain was pretty mild, Romy made a next-day appointment with a doctor at the Tang Medical Center at UC Berkeley instead of going to the E.R. We thought it was a case of irritable bowel syndrome (again) because lately Romy had been eating a lot of gluten-full foods - birthday cake, beer, and more beer on his birthday weekend. For most of the week after, he was able to go to school, teach physics class at Dominican, and even go on a picnic Thursday night.

When Romy saw the doctor at the Tang Center on Friday, the doctor was semi-concerned. She understood that it may have been constipation, but since the pain was in the right side, she ordered a white blood cell count, which came back slightly elevated. She told him to go to the Urgent Care Clinic or the E.R. again to get an X-ray and another CAT scan because it may be appendicitis. She said that although he only had a few symptoms, she wanted to be on the safe side, and urged him to go to the E.R. She also gave him some pro-biotic pills to help his intestines get better in case it was actually just constipation again. However, Romy was apprehensive to go because of the horrible experience last year where he went through all of the same stuff and they told him to just go home and take a laxative. Romy took the pro-biotic pill hoping it would go away soon, but decided that if it didn't go away by the next morning, we would go to the Urgent Care Clinic or the E.R. When the pain still did not go away, and in fact got a bit worse, we went to the Urgent Care Clinic Saturday morning.

Day One (today):
We got to Urgent Care just when they opened Saturday morning. When Romy saw one of the doctors there, they again urged him to go the E.R. because they did not have a CAT scan machine. So we went to the E.R. shortly after seeing the second doctor at Urgent Care. At this point the pain that Romy felt was very bad but no different to what happened last year. After hours of waiting in the E.R. while Romy went through a CAT scan and blood work, they called me in to see Romy. The E.R. doctor said he was being admitted, and that his appendix was pussing and that they would have to remove it after first sucking out the puss. He was getting scheduled to have the puss sucked out and then get the appendix removed later that evening. For now, we just had to wait until the surgeon was ready. Romy would have to spend the night in the hospital after the surgery, but he would get released the next day.

Romy in Emergency Room
Romy was admitted to the emergency room on Saturday morning after going to Urgent Care at the Tang Center.

Now here comes the screwed up part! About 30 minutes later (after I already wrote an e-mail to Romy's thesis adviser that he couldn't go into work because he will be getting his appendix removed that day), another doctor comes in. This doctor said something we could not believe. He asked us to confirm that Romy had a CAT scan taken for the same reason one year ago in February. We said yes. Then he kind of smiled and said that the previous doctor had looked at the February 2012 CAT scan by mistake and ordered the puss and appendix removal based on the FEBRUARY scan!!! It was only after they realized they were looking at the old CAT scan (which was supposedly just constipation!?), that they recognized how bad Romy was that day. The new CAT scan revealed a badly ruptured appendix. His appendix was ruptured so badly that they canceled the puss suction and the appendix removal. All the doctor could say was that the new CAT scan was very "messed up." Puss, scar tissue, and fluid everywhere. He said that puss removal could not be performed because there was no centralized regions where the puss was and that it was so messed up in there the surgeon would probably not be able to image the needle correctly with ultrasound. He also said that removing the appendix at this stage would not be clean, and that most likely it would require part of his colon to be removed as well (similar to what happened to Marty in Iraq when his appendix ruptured over the period of one week).

We then asked him, basically, WTF!? He asked us why we didn't come in earlier, since he suspected that Romy's appendix must have ruptured a day or so previously. We explained that his pain was relatively mild and that we thought, based on last year's ER visit, that it was just constipation and would end up going away. He then insinuated that what happened last year was most likely related to his appendix, but then also tried to cover for the other doctor by telling us that appendicitis rarely goes away by itself (this is bull shit as we later learned). He changed the plan of action to a course of antibiotics, pain killers, and IV so that Romy's body could heal the ruptured appendix on its own. He told us that Romy would have to stay in the hospital, receiving antibiotics, for at least a week. Only after the rupture could organize itself, will they clean it out. Then they will let it heal a bit more, and remove it after a 6 week time frame.

The doctor and nurses moved Romy to a semi-private room on the top floor of the hospital.

After receiving this new information, he ordered Romy to be put in a semi-private hospital bed, where he will have to stay for about one week. So soon Romy was carted upstairs into one of the rooms, and they hooked him up with an IV and antibiotics and some pain killers. I wanted to stay with Romy, so after he got settled, I drove home to pack some clothes and pillows so I could stay overnight with him. I packed everything so I could live in the room with him. When I got home, I called Marcel, who had a ruptured appendix and surgery when he was little. Nicole and Marcel came to the hospital with me to visit Romy and talk to him. Marcel said that a few years before his appendix ruptured, he felt intense cramping, but that it too, went away after a few days. Two years later, out of the blue, the same cramping returned but got very intense and didn't go away. When he got the the hospital (this happened while he was living in the Czech Republic), the doctor took the appendix out by cutting him open. He took 7 days to recover.

Based on all the information and events that happened today (and especially Marcel's story), we think the first time around must have been the beginnings of Romy's appendicitis. The ER was extremely busy that day (there were not enough chairs in the ER to accommodate everyone - people were sitting on the floor!). The CAT scan machine was not working properly that day either, so they kept having to call in a technician, and almost sent Romy by ambulance to another hospital. But after 5 hours or so of waiting for a CAT scan, when the doctor finally got one, he probably looked it over quickly. Due to it being busy, we figured he must have been tired and overlooked appendicitis based on Romy mentioning he recently switched to a gluten free diet. Crazy how a fresh new look at that February CAT scan by the first doctor today was met with a radically different diagnosis. If only Romy's appendix was removed a year ago, none of this would be happening today. Based on Marcel's story, it is possible for appendicitis to go away temporarily on its own. That probably what happened to Romy a year ago. It seems strange that they diagnosed constipation back then, since Romy had regualar bowel movements the entire time. How could that doctor overlook something like this?