Living Without a Gallbladder

I feel healthier than ever as I type this. But two weeks ago I was in the worst discomfort of my life and couldn’t figure out why until I eventually drove myself to the nearest urgent care and ultimately had a cholecystectomy — my gallbladder was removed.

This was major surgery, the first (and hopefully last) of my life. What I thought was severe heartburn that would pass was in fact pain from gallstones and a nasty infection surrounding my gallbladder. It never dawned on me that I could have a serious medical issue but in hindsight I had experienced similar abdominal discomfort on 4 or 5 occasions over the course of 18 months or so. It typically lasted less than two hours and I would simply lay down and breathe through it. I was naïve and assumed I had a much lower tolerance for pain than I actually do.

I thought I was taking ace care of myself — I was (and am) in the best shape of my life. I hadn’t even had a cold or flu in years and apparently didn’t even remember what it felt like to have a fever. But I did have a fever and an extremely high white blood cell count as my body fought to contain a nasty infection.

I learned a lot over the past two weeks. Here’s how it all played out…

Precursory Attack –> Normality –> Bedridden

I woke up with a start Wednesday morning. It was 4:30 on Halloween and I felt a sharp pain in my gut. A housemate had just recovered from a stomach virus that was highly contagious and I thought… uh oh. I rolled over repeatedly but couldn’t sleep until the pain subsided a couple hours later. I worked from home fearing the symptoms would return, not wanting to get my colleagues sick and laughing at myself for suddenly being all hypochondriatic. It passed.

I went on with my life and returned to the office after a good night’s sleep followed by some networking event, more sleep, Friday work, yoga and drinking with friends. On Saturday we moved our office and then I went to the USC vs. Oregon game (thanks Clint). I got home around 9:30 and watched a movie. But by 11, the pain returned with a vengeance. I couldn’t watch the end of the movie and tossed and turned until I found a position that wasn’t too uncomfortable. I drank a ton of water.

I barely slept Saturday night and Sunday I felt sick and tired enough to not be able pay attention to football on the TV. I just wanted to sleep until the discomfort — whatever it was — passed. I found that I could lay with minimal discomfort on my left side and snoozed in 15-minute increments. I’d rotate from my bed to a couch to the hardwood floor in an effort to stave off the discomfort. My stomach was distended. By Sunday night I couldn’t stand up straight and my housemates asked if I should go the emergency room. “If this continues in the morning I’ll go to urgent care,” I snapped, imagining that nothing could be a worse idea than the ER on a Sunday night. I drank more water. I ate Tums, Pepto Bismol and Pepcid AC. I took a warm bath and washed my face — it would be Wednesday afternoon before I’d bathe again.

I woke Monday at 7 to move my car so it wouldn’t get towed (street cleaning) and found that I could barely walk without pain. My path was laid out before me — it was time to seek help but urgent care didn’t open until 9 so I lay back down and dozed off, searching for the nearest urgent care facilities on my phone. I could lay on my back and feel virtually no discomfort.

Urgent Care

I drove to the nearest walk-in urgent care. Access Medical Group, adjacent to Marina Del Rey Hospital about two miles away, was covered by my “catastrophic” PPO plan and several doctors were listed. I didn’t realize it at the time but in retrospect I was quite feverish. I breathed carefully and slowly, awkwardly and uncomfortably walked from the parking lot to the first door labeled “urgent care.” The doctor, Jonathan Rand, wouldn’t see anyone until 10. I asked the receptionist if any other doctors were available sooner but not feeling up to walking door-to-door I resolved to await my fate w/ Dr. Rand — after all, waiting is to be expected with urgent care. I could slouch in the chair in the waiting room and semi-doze off without feeling much discomfort. Finally, the doctor saw me. I told him my symptoms and suggested that maybe I had some sort of intestinal blockage. After an old-school x-ray revealed “stuff” — what appeared as a light cloudiness — in my intestine he agreed. He’d need to admit me to the hospital and insert a tube down my throat to try to “loosen things up.”

It seemed a most vague and presumptuous diagnosis but at that point I was just happy to begin the process of treatment and healing, whatever that entailed. I felt ready to “enter the system” so to speak. Rand let me lay on the examining table while I waited for a room to open up for me at the hospital. Perfect — just in time to take a 10:30 conference call. I consider myself a lucky motherfucker and this call also came with impeccable timing — a secret project I was working on was postponed and just like that an impending deadline was wiped out. Perfect timing. I asked Rand if I’d have better luck getting admitted to Cedars Sinai or elsewhere and he said that anywhere else I’d need to be admitted via the ER. I asked if I’d be in for a while and he ensured me that I’d be locked up for at least a few days. I started getting skeptical about Rand and his seemingly fatalistic presumptions. I was moved back to the waiting room and finally around noon was told to walk across to Marina Del Rey Hospital and admit myself.

Diagnosis

At this point I still had no idea that I had a fever, not to mention a serious infection attacking my innards. By the time I was leaning on the receptionist desk at Marina Del Rey Hospital I half-expected them to slip a wheelchair under me. But it doesn’t work like that. At least not until you hand over your insurance card and fill out a bunch of paperwork.

It was 12:30 p.m. I sat back down and waited. I called my dear friend Krupali, a radiation oncologist (and occasional hero, for feedback and advice. Cedars was said to be much better with billing and she knew many surgeons there. I said I’d consider relocating if it came to major surgery. A wheelchair came and took me to my room (incidentally, this seemed to be the only wheelchair at MDR Hospital with footrests). I changed into a hospital robe and laid down in the surprisingly comfortable bed. I felt no discomfort or pain laying on my back with my head slightly elevated. A nurse (finally) took my temperature and I was surprised to learn that I had a low-grade fever.

I texted my roommate and coworkers to let them know I had been admitted. My roommate was kind enough to rush over with the my necessities — tablet, charging devices and the New Yorker (thanks Free)! I called my parents and told them I was in the hospital. I gave them a quick recap and promised I’d keep them apprised.

I wasn’t convinced that this bowel obstruction intubation thing was necessary — if it doesn’t do the trick, surgery would be necessary. Why not rule out other diagnoses first? Fortunately, after a couple hours, I was visited by a surgeon. After I told him my symptoms — especially that I had a 1-2 year history of gallstone symptoms, he ordered more tests. Blood was drawn. A nurse unsuccessfully tried to insert an intravenous prick into my left arm and gave up.

As soon as the surgeon explained his rationale I was completely at ease. Whether I had appendicitis or a gallbladder issue, he performed these procedures multiple times weekly and specialized in laparoscopic surgery. Huge relief.

He gave me his card, I texted the details to my parents knowing they’d run it by my uncle, an endocrinologist for due diligence (more or less a Google search). Dr. Daniel R. Marcus was well-qualified. Most importantly I trusted him.

I was sent for a CT scan. The tech administered a sort of enema of dyes meant to illuminate my appendix and intestines for the scan. By this point, nothing really bothered me more than the discomfort and pain I felt from being turned on my side. I was wheeled back to my room and it wasn’t long before I could sense things being expedited. My white blood cell count came in at 27,000 per mcL (normal is between 5-10,000). An ultrasound confirmed the presence of gallstones as well as inflammation and necrosis of the gallbladder. I had a gallbladder infection and required emergency surgery. I returned to the room and a different nurse successfully found a vein for the IV through which fluids, antibiotics and anti-inflammatory medication entered my bloodstream.

Surgery

It was 3 p.m. I had a major health issue but the best treatment for a gallbladder infection is removal. As we learned in seventh grade science class, the gallbladder creates bile to help process fat as food travels from the liver to the intestine. But it’s not a vital organ and in fact, in my case, it seems to be completely unnecessary. Moreover, thanks to the magic of modern technology, laparoscopic surgery, which while common has only been typical since the early 90’s, requires just four micro-incisions, allowing for a quick recovery (recovery for open stomach surgery can last 4-6 weeks). I told my parents I’d be going into surgery. They said they wanted to fly out to be with me. I did not push back. “You need to have an advocate at your side,” my mom said and I knew she was right. I gave Dr. Marcus my mom’s mobile number and asked him to call when I was out of surgery.

I was wheeled into the pre-operating room and signed off on a cholecystectomy. It was 3:30. I was in a total zen state, knowing I had done everything I could and that — should the procedure go as planned — I’d immediately be better. An assistant asked whether I was supposed to get an NG tube as apparently was still indicated on my chart. “No. I believe that’s been updated,” I responded. I joked with the anesthesiologist about liking my cocktails strong. “Then you’ll enjoy,” he said as he administered some anti-nausea drug to the mix.

Warning: infected guts are gross but if you want to see two photos of my gallbladder and its surrounds during surgery click here.

It was 7 o’clock. The first thing I remember asking when I came to was whether or not the laparoscopic technique was successful. I knew enough from witnessing others’ recovers to know how dramatic a difference minimally-invasive surgery made on recovery time. I was relieved. Then, back in my room, I felt a sharp pain in my shoulder — I’d imagine it was a result of my positioning during surgery. They administered a small dose of dilaudid via IV and gave me a pillow to elevate my arm. That was the only pain I felt after surgery (I declined all subsequent intravenous painkillers as I had not gone to the bathroom since Saturday and did not want to further constipate the newly revamped plumbing).

It was a long but overall successful Monday.

Recovery

The nurses on duty checked on me every half hour or so. I slept pretty well between regular status checks (heart rate, temperature). My parents showed up at 10:30 p.m. I was still out of it from the anesthesia but I felt fine. The took the keys to my car and went to a nearby hotel.

At around 5 a.m. the nurse took me for my first walk since surgery. I walked like an old man for the first day or so… with my hands supporting my still distended gut (it had been pumped full of air for the surgery). It was a little uncomfortable using my abdominal muscles to pull myself up but otherwise it felt great to be on my feet, even if it was still difficult to stand up straight.

It was Election Day and for the first time in as long as I can remember I wouldn’t be voting. I ate some of what they called breakfast — it resembled small pancakes and eggs. It felt good to remember what hunger felt like. I was still receiving antibiotics and fluids via IV. I took a few more walks around the hospital wing throughout the day, each longer than the other. My walking was a little labored but not necessarily slowed, My gut felt a little tender and it felt as if my innards were jiggling. I eventually found a way to “sneak outside” and get fresh air via the cafeteria. The patio was meshed in as if it were a penitentiary but I am definitely one to break rules in the name of fresh air.

Another man was moved into my room. I was initially annoyed by this but was fascinated by his story. A commercial airline pilot, he was pulled from his flight from LAX to Mexico City to get his stomachache checked out and next thing he knew he was in my room recovering from an appendectomy. Dr. Marcus loved bragging about his most impactful appendectomy of the year — The L.A. Kings’ Brad Richardson had an emergency appendectomy before Round 1 of the 2012 Stanley Cup playoffs only to recover and return 6 days later and score a crucial goal in the decisive game against the Canucks.

My mind was blown by how incrementally fast my recovery was going. The incisions were so small that there was never any pain and while I was lacking for energy, I found that the walking was really helping me get my strength back.

I didn’t want to spend another night in the hospital but I couldn’t be released until it was certain that I was no longer infected. On Tuesday my white blood cell count had dropped by more than half to 13,000, it seemed I was healing and that the surgery had eradicated the gallbladder and the surrounding infected areas. My dear friend and business partner Kyra visited and it made my day. My parents stuck around as well, helping me get the nurses’ attention since the call button was broken and most of them seemed relatively uninterested to begin with. Dr. Marcus said I’d be discharged by noon the next day.

We watched the election results come in. I took one last walk around the ward with my parents (three laps this time!) and immediately after they left Ohio was called for Obama and another four years was sealed. I stayed up for a while catching up with email and some work but soon drifted off into sleep. It was much harder sleeping with someone else in the room — more nurse interruptions and occasional snoring. I woke up early and watched Obama’s acceptance speech on my Nexus 7 tablet. I texted my parents to enjoy themselves and take their time as the morning rolled on and I awaited a visit from the doctor. Nathan dropped by and visited with us, a definite high point of the week. Blood was drawn early but the doctor didn’t come around until 11 or so with the results and order to get me the hell outta there. My white blood cell count was at 6,000. My temperature was below normal. I felt great and looked forward to going home.

Home

My gut was still so sensitive on the ride home that it felt uncomfortable riding over speed bumps. I knew that this discomfort too would subside almost immediately as my innards settled in a newly aligned formation. It was 2 p.m. Wednesday, we picked up sandwiches and smoothies at Windward Farms and ate in my backyard.

My parents, heroes that they are, picked up groceries and bottled water for me before I got them a cab to the airport. Back in my bed, it almost felt as if I could *feel* my breath reach newly exposed parts of my gut as it would deepen. I napped hard for an hour and woke to take a walk around the neighborhood. I got some work done and went to bed early — I was ecstatic that not only was I feeling better but the issue — the organ! — was eradicated completely. I would never have that painful discomfort again.

Thursday I felt great. Worked from home without a nap and squeezed in a 2-mile walk around the canals. I’m a machine, I thought — it was hard to believe I felt 95 percent as good as new just 3 days after major surgery. Friday I returned to the office and broke up the day by participating on a panel at Silicon Beach Fest. That evening I had my first post-op beers and later saw The Afghan Whigs (thanks Mark)!

I’ve been extremely fired up and grateful since my surgery two weeks ago. I now consider myself back to 110% and can run and everything as I normally could. I’m looking forward to sharing Thanksgiving with my family in Chicago and stuffing my face just like every other year. As for you my friends and, really anyone crazy/bored enough to have read this far, let’s do lunch or drinks soon — on me!