A Fair Warning
The following is an account of my appendectomy which was performed in Kyrgyzstan. Due to the medical and at times gruesome nature of this story, I have chosen to omit a few details and spare the public of some photography. That said, there may still be a few details here not suitable for queazy stomachs. You’ve been warned. Read on at your own risk.
Today I woke up around 5am with some mild abdominal pain. I didn’t think too much of it but by 7am the pain was a bit more alarming. I contacted the Peace Corps Medical Officer (PCMO), who told me he would come immediately.
I, like most people, enjoy hot showers. Though as my closest friends know, it might be more correctly described as a fetish. So to help make me feel better until the doctor arrived I stood in the shower, but by the time he got there just 20 minutes later, I was barley able to stand at all.
When the doctor arrived he gave me a quick examination and decided to take me to the Peace Corps office to the Medical Unit for additional examination. We have a 0-10 scale for pain. We were not at the office for long until my pain moved from a 3/4 to a solid 6. We left immediately to a nearby specialty diagnosis center. On the way to the clinic the pain sharpened; fluctuating between a 6 and a 9. (I never give anything a “perfect” or maximum score, but this could have qualified for a 10, especially on the bumpy roads)
At the diagnostics center I had two exams: some sort of electronic scan, not an MRI or CAT Scan, but something else, and an EKG.
With results in-hand, the doctor and I went to the National Surgical Center (hospital) where he had a team of surgeons already on standby for our arrival. The PCMO had worked at this hospital for several years and knew all the surgeons and administrators very well.
The surgeons quickly chaperoned me in to an exam room and prodded around on my abdomen Flipped me one way, then the other. Kept poking. “Does that hurt?” “YES!”
The diagnosis was made: Appendicitis. Absolute textbook, classic appendicitis. And an appendectomy was recommended to be made immediately.
Now I should take a moment to explain that as a Peace Corps Volunteer I have access to some of the best healthcare that I will ever have access to unless I become President or a Congressman. The Peace Corps medical team, their procedures, resources and truly global network of facilities they can send me to on a moment’s notice are all remarkable. In the case of Kyrgyzstan volunteers, when we need medical attention that a local facility can not accommodate (or does not meet the Peace Corps’ stringent requirements), then volunteers are medivaced to Thailand. This is the holy grail for PCVs. All of us secretly hope to get sick enough to get a trip to Thailand but not sick enough to remove us from service.
Unfortunately, an appendix teetering on the edge of bursting does not wait for the flight to Thailand, so headquarters sent word for me to have the procedure done locally. Bummer.
AN IMPORTANT NOTE: What follows in the following days’ posts might come off as critical. In fact, much of it is. I outline some shortcomings of my care and the facilities, but I don’t want this to be misconstrued as statements that I believe Kyrgyz doctors to be incompetent. Rather, I hope to show that the medical staff’s skills are quite good, considering their access to resources. It is the resources and facilities which are lacking. Not the surgical skill of the team who worked on me. OK, you’ve been warned (again). Keep reading.
Here is a photo gallery of my surgical prep experience. I was not able to take pictures inside the surgical ward but the conditions were much cleaner. Still, the facilities were very lacking. See how the room used for surgery prep more closely resembles a rundown janitor’s closet? The shelves of buckets are full of cleaning chemicals and also store the highly rusted razors that the doctors wanted to shave my stomach with. Horrifying. Upon seeing the razors, however, the PCMO left to buy new razors and shaving cream. This is only one example of why having the PCMO service is so critical. He knew he could get a better resource and went to get it. But being left alone in this janitor’s closet was one of the most terrifying moments of the ordeal as I contemplated what was about to happen to me…
I was led to the surgical area but the PCMO was not allowed to enter the surgery room. After coming inside, the surgeons starting to ask me all these really important questions like if I had any allergies to medicine. if I had allergies to any of these specific medicines, what is my weight and height (I don’t even know in metric!) and on and on. These were things that I believe they needed to know but to which I had no answers. This begins the terrifying period of my being truly alone in this hospital. Here I am about to undergo what is already a scary event in one’s life, and I am all alone, counting on my foreign language skills and in a room that Western horror movies would love to gain access to for any climatic scene.
Nothing has been updated since Soviet times, I think. Even the large, maneuverable light above the operating table which should offer crystal-clear light for the surgeons had 4 burnt-out bulbs (from 12) and the remaining 8 were not exactly blinding. That’s the last thing I saw before I woke up choking on a plastic tube.
Day 1. Part 2.
I start to come out of my drug-induced coma with 2 very uncomfortable realizations: 1) my hands are strapped down; 2) my throat has a intubation tube down it.
Certainly I have no criticism of being intubated. That’s part of it. But it was somehow a surprise. I just wasn’t told before what to expect coming out of surgery and this was a new experience. In part of my shock I bit down, and then released the tube, which is in 2 parts. One part goes all the way in, the other part just comes within the teeth. When I released my bite, the short part fell down to the back of my throat and sat on my tonsils. This freaked me out and gave the sensation of suffocating, though I imagine the other tube would have prevented that, medically speaking. But this was very very uncomfortable and made me think, “is this what water-boarding feels like?”
The nurses realized I was coming-to fairly quickly and came to me… but not to my aid. With my hands strapped I couldn’t signal anything and as I tried to use my hands to signal something about pain and not being able to breath, they just tightened me down. My left hand went numb it was so tight.
The 2-5 minutes it took to un-incubate me and free my hands did of course seem like forever. But once I could breath on my own again I really didn’t have any complaints. The pain killers still had hold of me.
After some time, maybe a long time, maybe not a long time, I really don’t know, the PCMO, came to my side. He immediately checked that I was responsive and told me the good news that the operation had been successful. He informed me that I was in the ICU and would stay here overnight. He would not be permitted to stay here and asked if I needed anything. I only needed my phone and to know the time.
The time was 830pm.
All of my personal items had been taken back to the Peace Corps office so I couldn’t have them at that time but he would bring them in the morning. This is a bummer because now I had no way to contact friends, family, or to send the pre-drafted email to a very important appointment I had at that very moment and had the foresight to write an email explaining the circumstances in the case I would not be up to making the conference call, but without my phone, I couldn’t send the message. I despise no-show no-calls and now I was one. I know this should seem like a mild reason for distress considering the circumstances, but it was all I could think about: powerless in the ICU, unable to communicate to the person next to me or a person half a world away, and being undependable at the same time. All huge stressors.
Of course with time, the folks wondering why I didn’t show up did forgive me, I just wish the doctors had given me more reasonable expectations that I would be knocked out for 8 hours instead of just “a few” hours.
I don’t have photos of the ICU but it was a fairly large room with 6 beds and a nurses desk. The decor and condition is the same as all the other hospital photos so it shouldn’t take too much imagination.
The best story I can tell from the ICU is that I requested a container to urinate in, which they gave me, but after 30 minutes of trying it was a no-go. The nurse took it from me and gave the same container to the guy in the next bed right after it had been between my legs. Not exactly a best-practice for sanitation.
Sleep was a welcome distraction to the pain which started to creep in, but these nurses have a talent for loudness. All night I heard laughter, sounds of breaking glass or other objects hitting the floor, Beyoncé ring tones and car horns from the open window right above my bed.
Around the time I was finally resting in the ICU I was abruptly interrupted by two nurses poking at my stitches. I didn’t really feel it, the drugs were still in my system, but it was enough to wake me. Then they pulled up a gurney next to my bed and instructed me to brace for impact, this was going to hurt. And boy did it hurt when I moved to the other bed. That was more awakening than a Starbucks redshot and gave me an appreciation for how Harry Whittington must have felt when Dick Cheney shot him in the face with a shotgun.
Once nestled into my wheeled platform, I had no choice but to watch the ceiling lights zoom by, or at least the light fixtures, as many of them didn’t actually have bulbs in them. After a few turns down not very lengthy hallways we entered a room. My room. My “lux” room.
The room is painted mint green. Glossy. White floors. Windows at one end, the door at the other. There is a bathroom and a sink. Next to the bed were 2 small tables and a chair for a guest. The bed was pretty comfortable but the blanket they covered me with was excessively heavy and I could not bear the weight on my stomach.
There is no TV. No radio. No internet. No telephone. And no nurse call button. Once they closed that door, I was isolated and happy to be alone to finally rest in silence….
… I wake up. Seems like it’s time for bathroom attempt: round 2. But I can’t get out of bed myself. I still don’t have my phone. There is no nurse call button. So I improvise by using all my strength to bang on the concrete wall and clap my hands. I still don’t have any voice. Every movement hurts, but nothing hurts as much as trying to speak; the pressure of my diaphragm on the operated area is too much to bare.
This continues for an honest half hour or more before another patient’s family member walk by my room and hears me. She opens the door, I implore her to get a nurse and one does come right away. I tell her what I need, and off we go.
Here is some humor for you: the surgical team retained my hospital gown and as I had no other clothes, I’m just naked for the rest of the day. Everyone kept yelling at me as I lay in bed, naked, asking me where my clothes are and why am I not wearing them. The only answer I had for them was, “I don’t know!”
Somewhere in here I was visited by the PCMO, but as he had left my personal belongings in the Peace Corps office after my operation, and he had come directly from home this morning, he did not have my clothes or phone at this time. I was told I would have to wait for him to return in the evening. This means yet another 8 hours of waiting to call my friends and family to let them know that I am ok.
The rest of the day was a series of doctor visits to poke me and me trying different clapping methods to get the attention of nurses. Eventually my voice started to come back and I could just scream. Still it hurt like hell but it yielded the desired results faster than clapping seemed to. At every visit and every assisted trip to the bathroom, there I was, in my birthday suit as I had come into the world. The nurses were more embarrassed about it than I was; I don’t get too shy around medical professionals. Still, I would have preferred some clothing.
In the late afternoon I was astonished by a visit from my girlfriend, Naziia! After not hearing from me for 24-hours she was worried sick and came to the hospital herself. After dealing for hours with hospital administrators, security and nurses, she finally found where I was. It wasn’t a problem of her being restricted access to me, it was a problem of no one in the hospital knowing who I was or that I was even there. She ended up going door to door throughout the hospital until she found me. It took her about 3 hours!
Naziia is amazing. From this moment, she didn’t leave my side for the next 3 days. She even slept on the cold floor of the hospital and helped me with everything. She only left me to get nurses or food. She was my ambassador during my time of greatest need and I will always be in her debt for it.
Not long after Naziia found me, the PCMO came back and he brought me my personal items. I immediately switched on my phone and called my parents. Their professional background is in the medical environment so they never had too much concern about me as an appendectomy has been a “basic surgery” for a very long time. But still, it was surgery and they were worried since more than 30-hours had passed and no one had contacted them. I put a positive light on everything and told them everything is perfect, there were no problems, I just hadn’t been able to get a call out. They appreciated the update and let me get back to rest.
I want to say right now that this whole experience was uncomfortable, but hey, surgery is. But the time, the better part of 24 hours when I was alone, without an advocate, without my phone, without a translator, was TERRIFYING. Not having the strength to take care of myself and not having full confidence in my understanding of what people were telling me was just awful. If there is a real complaint to make here, it is this point. To be left alone in these conditions with no way to call for help and also for my family to have not been contacted and updated on my status, is totally unacceptable.
The PCMO also brought me some food stuffs. He brought bottled water, yogurt, crackers and juice. Not much but it was something. At this point it was enough. I haven’t eaten anything at all in over 48-hours.
Resting efforts came and went. Around 19:30 a woman burst into the room to mop the floors. That wasn’t awesome. But after she left the only other interruption I had was a nurse to stick me in the butt with something that would help me sleep. And it sure was good at that.
Day 3 and Beyond
The rest of my days in the hospital were pretty similar. Every day I had a little more mobility and little less pain than the day before. The schedule in this place runs pretty smoothly:
0600 - Wake up 0715 - Morning IV drip of antibiotics 0745 - Morning mopping of room 0800 - Surgical doctors make their rounds (poke me) 0830 - Breakfast 1000 - Bandages changed 1300 - Lunch 1400 − 1600 - No visitors in hospital. Door are locked. 1800 - Dinner 1930 - Evening mopping of room 2000 - Evening IV drip of antibiotics 2100 - Shot in the butt to help me sleep 2200 - Sleep
On Day 3 I didn’t do anything else. I just stayed in bed as much as possible and read news articles and listened to music on my iPhone. The iPhone 5 that Naziia bought me a week earlier. Have I mentioned yet how awesome she is? And this device is so nifty in situations like sitting in the hospital. It even tracked my location with pinpoint accuracy. The photo shows my room’s location in the hospital
I was called out of my room in the morning and told to chase after this nurse. I could barely lift my head while walking. Chasing just wasn’t in me. She led me to the worst place imaginable: the stairs!
“Ok. It’s Day 4. I can do this!” And of course I did do it. I was wobbly but I did the stairs and it wasn’t so bad. Slow, but the pain was minimal. She took me to join a large group of waiting people outside of a room labeled “УЗИ” which means “ultrasound.”
She waited with me a few minutes and then urgently took off. She told me to wait here and she would be back in 10 minutes. I stood and stood and I hurt and hurt. This was getting a bit much and after more than an hour of waiting and seeing no sign of her or any additional progress in the line I gave up and went back to my room.
I collapsed on my bed but was almost immediately called for again by a doctor. “Great, I have to go back down there now,” I thought, but it wasn’t true. I only had to go across the hall to an exam room. I was laid out on the table and the sharp and shiny type of instruments appeared. I told them, “you know I didn’t get the ultrasound, right?!” And they said, “oh, no? It’s ok, we can do this without that.” I still don’t know what they did but I know I didn’t appreciate the either unnecessary ultrasound or the impatience of the doctors to just ignore whatever information the ultrasound was meant to reveal.
I went back to my room but after a bit I got up the courage to try the stairs again. Mostly because I was out of units on my phone and I heard rumors I could add units on the first floor. Which was true. There was also the hospital cafeteria where I ate my first “real food.” It was chicken samsa and oromo, typical Kyrgyz food and the only thing available in the hospital cafeteria other than fried bread.
Naziia went to my house and brought me some books, my laptop and my hard drive with my movie collection. Also on this day Peace Corps catered lunch to my room. It was the first flavorful food I have had since the surgery. My country director, Seth Fearey, also visited me this day. In his 3 years in Kyrgyzstan I am only the 2nd in-country surgery.
Usually everyone is flown off to Thailand and so he doesn’t get to visit sick volunteers. His visit was truly meaningful to me. I have always held him in the highest respect (his life story is incredible) and he is a genuine and good man. We have always gotten along and he has always been there for me. Delivering food in the hospital, and oh yea, some really interesting books I requested as well, just adds to the pile of reasons why I think Seth is amazing and I will always appreciate him.
My colleagues from Kloop also visited me today and brought me oranges. My closest colleague, Aikol, was the only one allowed into the hospital because actually her dad is a surgeon here. She found my room and then we walked together to the emergency room lobby where my colleagues awaited me.
They also came because they needed to get my apartment keys. We were to receive a distinguished international guest the next morning, a radio journalism trainer from Deutsche Welle, and he was staying at my apartment. It needed to be cleaned and of course I was in no condition to do it my self! See? Even from a hospital bed I am taking care of business and receiving foreign guests! I am a very productive and efficient person!
Everything started as usual and then I had a morning visitor! Nadezhda, my new neighbor but long-time friend paid me a visit. And she brought me a cool stuffed-animal of my appendix’s soul. Halarious.
Peace Corps brought me lunch again. Again typical Kyrgyz food, but it’s from the best Kyrgyz restaurant in the country. And I love that place. But I am really getting tired of the lack of variety. Just the same, the food was awesome, and Peace Corps is awesome.
The rest of the day was spent just meandering the halls of the hospital. I took photos of everything that seemed interesting. Here check out these digs. And for those of you in the West, the next time you complain about the price of healthcare, know that this is what happens with the money, investment and regulation isn’t around.
I finally am checking out of this place! Woo hoo! I can not express how happy I am to be on my way. The PCMO told me yesterday he would come around 11am. I sent him a SMS asking if we can stop at Sierra coffee on the way home. It is on the way to my house. He only responded with, “I come at 1315.” Sad face. But what’s a few more hours then?
I pack my things and am ready to go well in advance and spend the time reading. The sun is out for the first time this whole week and it looks like a beautiful day. I can’t wait to go outside. It will be the first time for me to be outside for a whole week.
Like clockwork, the PCMO walks through my door at 1315 with the Peace Corps driver. He instructs the driver to help carry my things and instructs me to follow the driver out to the car. The PCMO worked here for 5 years so he just needs to say hello to a few people. I fully appreciate the politics and the importance of keeping relationships up. This whole thing started and finished with the hospital’s best offerings of VIP service and I am certain that the PCMO’s personal connection with the hospital had an influence on that.
Waiting at the car with the driver was awful. Not because of the driver, but because of the pain. The driver is great, I like him a lot. Walking out of the hospital was a long and downward slopping driveway and then a good distance more to the car and now I hurt a little. Standing hurt, sitting in the car also hurt. Getting in and out of the car was the worst. We waited for more than half an hour before the PCMO came. Maybe closer to one hour.
I asked again if we could go to Sierra. After all, it was well after lunch and I have not eaten today. I was told there had been time, but now there was no time and they just had to take me home. We drove right past Sierra, it was so depressing.
Arriving home to no food in the house and being left alone I decided that the best thing to do was to order pizza, which I did. And it was amazing. I never order pizza. In 2 years living in Kyrgyzstan this is maybe only the 3rd time I have ordered pizza. So after the week I have had, this is the treat I give to myself. A bargain at 10-times the price. I ate it until I fell into a food coma, which was the perfect way to welcome myself home after a week of terrifying misery.
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