A Medical Economics Web Exclusive

What you learn when you almost die

A sudden illness nearly felled this rural FP. Here's how he regained his health and what he learned along the way.

By Bruce D. Greenberg, MD
Family Physician/King City, CA

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 "white-out" 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 call.

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.

• If you're not feeling well, seek early medical attention! We physicians should never feel we're so busy taking care of others that we don't have time to take care of ourselves. We need to follow the same advice we give our patients.

• If a colleague seems ill, approach him or her in a helpful manner. If one of my colleagues had said something to me earlier, I might have sought medical attention sooner. One physician friend of mine had co-workers convinced for months that his weight loss and excessive thirst were due to a strenuous jogging program. Of course, he turned out to have diabetes.

• I'm now much more aware of the upheaval a medical crisis causes—for both patients and their families. So I'm more aware of the help they require to meet their physical and emotional needs. We doctors often overlook such basic needs for family members as food, sleep, or transportation. This is especially true if the patient is hospitalized, as I was, at a distance from home.

• Patients regain a sense of security from being able to resume what they're used to doing. So while it's fine initially to tell recovering patients to rest, at some point, their goal must be to return to what's normal for them. We primary physicians can play a pivotal role in this process, although admittedly, it's difficult because the care of critically ill patients is taken over by a variety of specialists.

But we can certainly play a role when patients are having elective surgery and are having some of their follow-up visits with us. I try to motivate patients by getting them to plan out a post-illness or post-operative timetable so that I can check on their progress directly.

• More than ever, I encourage everyone—both patients and physicians—to remain physically fit. While this won't necessarily prevent you from becoming ill, I believe that I'm a living example of how it can definitely speed recovery time.

• When we're the ones who are seriously ill, we need to be keenly aware of the toll our illness takes on everyone around us. My wife, for instance, suffered from vague fatigue and malaise for several months following my surgery, even though her medical workup was completely negative. She "miraculously" recovered shortly after I was discharged from the hospital following the second surgery.

Likewise, I heard that many of my colleagues were dejected during my absence, and were questioning their own mortality. So as soon as I was well enough, I felt that I had to help in my colleagues' emotional rehabilitation. I did this by visiting them at the hospital and letting them know that I was going to be all right.

How about my own psychological rebuilding, considering that I had received so little help from the healthcare system? It's a process. On occasion, I feel an almost complete sense of denial, as though I had never actually been ill. At other times, I notice that my emotions are a little more labile. And sometimes, I look down at my wounds and want to shed a tear for all the suffering I've been through. But usually I quickly realize that I am just lucky to still be around to share quality time with family and friends.

Bruce Greenberg. What you learn when you almost die.

Medical Economics

Nov. 21, 2003;80.