Dale Low

The making of a poop-hole I walked into the ER at St Luke's hospital in San Francisco on Sunday March 27, 2011 under my own steam (with my wife/kids in tow). My stomach was really hurting – I'd figured (for some reason) that it was my gallbladder. I remember someone on the admitting staff asking me "is that a self-diagnosis?" Everything got fuzzy after that. Flashing neon The next thing that I remember is being in a pitch dark place with bright, continuously changing neon signs flashing right in my face – the signs represented restaurants and bad TV shows from the 70s and 80s. It seemed to last for hours. I tried desperately to escape multiple times by tightly closing my eyes to no avail. Shortly after I arrived at the ER around 3 PM, the staff at the hospital ran some blood tests and determined that I had some sort of overwhelming infection and would need to be admitted. I was moved to the ICU around midnight, diagnosed with sepsis and toxic shock by 6 AM on Monday, and put on a ventilator by noon. The left side of my lower abdomen turned reddish around 3 PM and black patches started to appear by 5 PM. By 6 PM, they had tentatively diagnosed Necrotizing Fasciitis (NF) and started exploratory surgery an hour later. The first surgery lasted 8½ hours and confirmed the presence of rapidly spreading NF – as a result, my colon and lower intestine had liquefied. During the operation, they removed as much of the "black mush" as possible, which resulted in a permanent colostomy. My spleen was also a casualty of the first surgery as it had swollen to three times its normal size; subsequent analysis revealed it to be filled with cancerous cells due to Hairy Cell Leukemia. Apparently, the leukemia had significantly weakened my immune system – allowing the NF to attack with such ease. On Tuesday around 1 PM, I was transferred to CPMC Pacific where Northern California's NF expert resided. It took two ambulances to transfer all of the stuff. At some point, I found out that I'd only been given about a 3% chance of surviving my second or third operation – which was two or three days after I was admitted into the ER at St Luke's – due to the severe stress that the NF had unleashed on my heart, kidneys and other internal organs (resulting in a "resting" heart rate of 160 and blood pressure of 20/40). I understand now that this was probably around the same time when I experienced "neon hell". Apparently, death begins in Las Vegas. Underwater computing farm In my dreams, I became aware that I was at a hospital – as a result of my employer testing out some newfangled underwater computing technology. Several of us, including myself, were trying out this new technology. The only downside was that you had to carefully exit the "computing pool" to prevent decompression or other problems. Exit, which was via a special hatch, had to be arranged in advance. I had made arrangements to go out for dinner one night, but had a problem getting my heart rate down enough to be allowed to exit. Somehow I was able to leave and was walking the streets somewhere (not SF) – and was fine for two days in the "real world" before somehow getting sick and having to go to the hospital. After the first surgery at St. Lukes, the next three at CPMC (on Tuesday, Thursday and Friday) were to stop the NF from spreading. The surgeons worked valiantly to stay ahead of the NF – removing random already-killed-by-NF body parts (including my scrotum). On several occasions, the NF came close to cutting off the main artery to my left leg, but, luckily, the surgeon won that particular battle. On Friday, my condition was upgraded from critical to stable. The food bank "hospital" The hospital in my dreams turned out to be the SF food bank. For some reason, they had hospital beds there - and the combined weight and kinetic energy of sleeping patients and their movements was used to grind up donated food for distribution to schools. Each bed functioned as a component of a giant blender, which would take any type of food and turn it into a special smoothie. Each patient was loaded up with all kinds of food in their bed, which would be ground up by their legs as they slept and contributed to the giant drink. My legs were exhausted after many nights of "sleeping" and grinding! To make things more interesting, one could watch the outline of things that were queued for grinding though opaque curtains via open closet doors at the end of the bed. In my dream, it was also election time, and several candidates were touring the food bank. To emphasize their joint medical/food services, food bank employees put a stack of rutabagas and other vegetables on my bed for photo ops. I couldn't move my legs at all. No doubt this impression was due to the physical restraints that now adorned my legs (to prevent me from ruining the surgeon's fine-but-incomplete handiwork between surgeries) at the "real" hospital. Hanging out When I wasn't at the food bank, I spent a lot of time hanging out - in the living rooms of 70s/80s TV shows, on the top of dusty restaurant awnings, and on the tops of ladders. My parents and sister were usually there. To them, hanging out on the tops of ladders was perfectly normal. While hanging out on ladder tops, my fingers were electrical wire nuts and my Mom would scold me whenever I tried to remove them (apparently I had repeatedly tried, even when heavily sedated, to rip the various tubes out of my nose and mouth). Oddly, my Mom had the same type of connectors for her nose. I had three more surgeries (on April 6, 13, and 20) for reconstruction that resulted in a new scrotum, lots of skin grafts from my right leg to various parts of my lower abdomen and buttocks, and a repurposed "unused" muscle (also from my right leg) to help hold the reconstructed bits together. Test flight One morning, I woke up in the cabin of an airplane. I thought I was in Japan (probably due to recent tsunami coverage). The flight attendant kept alternating between changing my dressings and finishing a painting. Eventually I asked why I was in Japan, and they told me that no, I was just in a flight simulator behind the hospital – they just used it to determine if people were well enough to fly (and thus, somehow, be eligible go home). After I coughed a few times and failed the test, they took me back inside – but the hospital was too crowded so I spent the next few nights out in the hall by the elevator. My wife thinks that this particular dream resulted from the nurses' repeated attempts to get me to cough (while semi-conscious) after the vent had been removed. The "real" hospital When I first woke up in the "real" hospital's ICU (on April 6th after the vent was removed), I had a wonderful case of amnesia. I could understand English, but knew nothing of who I was or how I got there. I felt like a child: I even had to relearn object permanence. For the next little while, my body seemed very fragile - every time I learned a new piece of information that could not be reconciled with previous knowledge, my body would "reset". To me, the reset was an extremely painful sequence that began with my pulse increasing uncontrollably, followed by my entire body shaking, resulting in unconsciousness. I screamed silently for people not to discuss things that I knew nothing about when I was within earshot – though I could not actually speak since I'd been recently disconnected from the ventilator. Recovery When I wasn't in the OR, I was receiving dialysis (as my kidneys had shut down for a while) or in recovery – drifting in and out of consciousness. After the last reconstructive surgery, my days were simple – regular (and often painful) dressing changes, eating hospital food while lying on my back, visiting with family and friends, and re-watching every episode of Star Trek: Next Generation on a friend's iPod. On May 4, I got the go ahead from the surgeon to try standing – except that I still wasn't allowed to sit or bend at the waist – and hadn't been vertical in 5½ weeks. Turns out that the PT department at CPMC is creative and enthusiastic about restoring mobility, and by noon on May 5 had me strapped to on a tilt table – with some adaptations to work around the wounds and skin grafts. I made it to about 50 degrees before my blood pressure and heart rate started to approach dangerous territory. My last trip to the OR (on May 11) was to get rid of the 125+ staples that came with all of the reconstructive work. The next day I finally got to sit up and pivot to sit in a wheelchair for up to 30 minutes at a time. It was a great feeling to finally be mostly upright and away from the bed – if only for a short period of time. The next day, I stood up momentarily, with the aid of a walker. On May 14, I got my first taste of the great outdoors – my wife and a friend got permission to wheel me outside to the hospital's courtyard. The fog & drizzle were a welcome relief after 48 days of re-circulated hospital air! The next week consisted of regular PT to reawaken my dormant leg muscles – mostly shuffling down the halls of the hospital with the aid of a walker and doing exercises in the hospital's gym under the watchful eye of a physical therapist. On May 21, I tackled stairs and was finally discharged on May 25. I was in the ICU for 17 days, and spent a total of 2 months in the hospital. The total surgery count was 8. I am very grateful for the fine work done by the skilled surgeons at St. Luke's and CPMC who saved my life – and my leg. And I'm sure that my recovery was aided by the many friends and family who visited (some from far away). Since my release, I've been able to return to work and even resume mountain biking with the aid of a special air-filled seat (since a lot of the skin grafts ended up on my buttocks). I feel lucky that my only long-term complication from the NF is the colostomy – as well as the still-tender skin graft (donor and recipient) sites. I've since undergone a round of chemotherapy (in the hospital) for the leukemia – but, compared to my hospitalization for NF, it was a walk in the park.