A SUDDEN ILLNESS NEARLY FELLED THIS RURAL FAMILY PRACTITIONER . HERE'S HOW HE REGAINED HIS HEALTH
AND WHAT HE LEARNED ALONG THE WAY
By Bruce D. Greenberg, M.D. — Nov. 7, 2003
In April 2002, I was cruising along in my busy, rural practice. At 53, I was in excellent physical
shape, working out on a treadmill and exercise bike, and training with weights.
One day, I developed some nausea, a slight fever, and lower abdominal pain. Assuming it was prostatitis,
I started myself on antibiotics, but continued to work my full schedule for the next several days. People
later told me that they noticed I was having trouble walking and sitting. But nobody said anything to
me at the time, except for a nurse who remarked that I looked a little pale.
By the weekend, I felt even worse. So after rounding on my patients, I went to the emergency department.
They took one look at me and rushed me into a room, where they started an IV and drew labs. Someone pressed
on my abdomen and immediately ordered a CT scan. A short while later the report came back that I had "free
air."
By this time, I must have been on the verge of septic shock. An out-of-town surgeon (we didn't have a
local one at the time) did an exploratory lap, which revealed a perforated diverticulum. So the surgeon
did a bowel resection and temporary colostomy.
Unfortunately, I had aspirated during the intubation, and the surgeon had been unable to extubate me
without my oxygen saturations falling drastically. A chest X-ray showed almost a complete "whiteout"
on one side. Since I couldn't be managed adequately at our rural hospital, I was transported by helicopter
to a larger medical center an hour north.
I woke up a couple of days later in the ICU so weak I could hardly move. I looked up to find multiple
IV bottles, including several "big gun" antibiotics (I later needed antifungal meds, too), dopamine,
and several types of TPN. I had also received a blood transfusion, and had on board a radial artery line,
a PIC line, a Foley cath, and an orogastric tube. I could feel a bandage on my neck where a jugular line
had been. Although I had a fever of 103, my entire body was icy cold. I was under the care of a surgeon,
a critical care pulmonologist, and an infectious disease specialist.
I made progress, though, and after several days, I was moved to a step-down unit. It was then that the
reality hit of how close I'd come to dying. I'd suffered a near death experience, too, and thought at
the least, I should have a visit from a psychiatrist. I almost had to order this myself, since nobody
had raised the issue. But my entire exposure to professional mental health therapy consisted of this:
The psychiatrist spoke to me for about five minutes, with questions like "this must have been really
scary for you, huh?" He made a second brief visit a few days later asking if I was depressed, to
which I replied, "No, I just want to get well and get going again." That was it.
After several days of physical therapy (I was NPO for 11 days and had lost about 15 pounds-mostly muscle
from my arms and legs), I was able to walk on my own. I was then transferred to a med-surg floor and was
allowed to eat. In total, I spent 16 days in the hospital.
How I exercised my way back to health
When I finally returned home, I was so weak that I had difficulty just walking from room to room, and
I experienced frequent dizzy spells and near syncopal episodes. After the slightest exertion, I had to
lie down and nap for an hour. But I was determined to rehabilitate myself through exercise, beginning
with two-pound hand weights, and walks around the neighborhood.
Most people told me to rest until I got stronger, as if inactivity would make me better. Meanwhile, no
healthcare provider ever gave me any specific advice on exercise. I had only one follow-up visit with
the pulmonologist who simply told me that my lungs would be fine and that I didn't need to see him any
more. The surgeon saw me weekly, but was mostly concerned with my incision, which he had been forced to
leave open because of the degree of infection.
Estimates of my return to work ranged from three months to four, but I knew I could do better. As soon
as my incision was less tender, I got back on my exercise bike, and soon I was walking about three miles
a day. I did as many exercises as possible with weights, so long as they didn't put too much stress on
my abdomen. Five weeks after surgery and a ventilator, I was proudly back at my office seeing patients,
and only 10 days after that, was back at the hospital doing deliveries and taking calls.
The ordeal wasn't quite over, though. Six months later, I had to return to the hospital for the surgeon
to reanastomose my colon. I knew that I had to prepare myself adequately for the upcoming procedure, so
I embarked on a rigorous training program that included running on the treadmill 15 to 20 miles a week.
This time, without the complications of infection and shock, everything went great, and I was an inpatient
for only three days. After seeing the surgeon the following week for staple removal, I demanded to be
released, and I happily returned to an almost full schedule immediately.
What this ordeal taught me
This terrible experience taught me some valuable lessons.
Bruce Greenberg, e-mail: kgreen2017@yahoo.com
What you learn when you almost die.
Medical Economics Nov. 7, 2003;80.
Copyright (c) 2003 Advanstar Communications Inc.
Reprinted by permission from Medical Economics magazine.
Medical Economics Healthcare Communications at
Montvale, NJ 07645-1742. All rights reserved.
