Orange Juice, Laxatives, and Near Death Experiences
So here's the story in full on my heart attack. You'd better hunker down. It's going to take a while.
Book Tour: Outcast
On March 24, I began the first leg of a seven-city booksigning tour in support of Outcast, which had just been released. Each day, I'd be visiting a new city (Lexington, Chicago, Kansas City, Seattle, Sacramento, and Phoenix, then a break of a few days, and finally Austin). In a typical day, I'd arrive at the airport, be swept up by a media wrangler working with my publisher (Del Rey), check into my hotel, do a whirlwind tour of local bookstores (anywhere from two to eight stores, where I'd be signing stock - that is, signing copies for the booksellers, but not for readers standing in line), attended the main signing (this one with autograph lines and costumed fans such as the 501st, Rebel Legion, and Fan Force in attendance), often would go out to dinner with local-area friends or fans or both, and then would return to my hotel late in the evening. Each day would follow that pattern: Lather, rinse, repeat. It's a tiring schedule, but I've done it before without consequence.
But this time there were some new factors in play, and to understand them we briefly have to visit September 1993, July 2008, and September 2008.
Set the Way-Back Machine
July 1993 was when I was first diagnosed as a diabetic (Type 2). At that time, I was placed on a program of diet and exercise that kept my blood sugar largely in control. The problem was, well, I didn't exactly follow up with regular doctor appointments and reevaluations. Emotional factors such as denial of the problem, an unwillingness to 'fess up when situations began to grow out of my control, and so on led to several diabetes-related consequences over the years, including the loss of some eyesight to diabetic retinopathy and glaucoma in 2006. (I haven't been able to drive since that time.) So by 2008 I was a diabetic whose condition was doubtlessly worsening while I remain unaware of and unwilling to confront it.
Then, July 2008. I attended a convention where I did a lot more walking than I expected to or was in shape for, despite the fact that walking was my preferred form of exercise. I wore three huge blisters on my feet (right foot forward at the pad of the foot, right foot at the heel, and left foot on the right side of the heel). Then I continued walking too much, causing the blisters to rupture. In the weeks that followed, they healed at varying rates.
Which brings us to September 2008. On September 6, I celebrated my 25h anniversary as a freelance writer. But some of my housemates were less concerned about that anniversary than by the fact that two of my July blisters still hadn't healed (one was oddly drippy, in fact) and now my right lower leg was developing a rash that looked suspiciously like cellulitis. They ganged up, and I agreed to go to the doctor.
When I did visit my general physician, he immediately diagnosed the drippy blister on my right heel as a foot ulcer, which is bad news for a diabetic (or anybody). Don't research foot ulcers while you're eating, by the way. Not a good idea. The podiatrist immediately sent me off to physical therapy, a several-times-a-week regimen of applying medicines to and rebandaging the foot ulcer. Since some of the podiatrist's first words indicated that I was in some danger of losing the foot to amputation, I went into full-bore panicky focus-on-the-problem mode.
All of which, I suspect, contributed to my heart attack, and here's why.
In focussing fully on the foot ulcer, I basically ignored the diabetes completely. In addition, my usual form of exercise had been walking, and suddenly I was doing none of that as treatments progressed for the foot ulcer. I thought about substituting other forms of exercise for walking, but I never managed to do that, never substituted one exercise habit for another. Plus, there was a substantial stress factor at work. So: Diabetic, no treatment for same, no exercise, high stress. (And I haven't even mentioned the fact that heart disease runs strong in my mother's side of the family.)
By late March, after months of regular bandaging and 55 days on a Wound VAC (Vacuum Assisted Closure) device, the foot ulcer was almost healed and I was ready to face my book tour. Or so I thought...
Book Tour and Heart Attack
I embarked on the book tour and completed my signings in Lexington and Chicago without incident. Then, in Kansas City, things began to go wrong. I had a marvelous lunch of pad Thai with my media wrangler there, but the meal sat in an oddly heavy way in my stomach. During the signing itself, I felt tired and weak, and ultimately chose just to have dinner afterward with friends who were in town from Des Moines and Topeka rather than with the 501st and Rebel Legion folk who were arranging a dinner expedition (sorry, guys - next time, no heart attack). At that dinner with my friends, I ordered only a bowl of soup and could eat no more than about a fifth of it.
Once I was back in my hotel room, nausea set in, and I thought I had the problem figured out - it had to be a severe case of constipation, such as one I'd had a year or so earlier. In that earlier illness, constipation had caused everything I ate to come back up again, which continued until the stomach was empty and laxatives could work their magic on the problem. Content that the problem was not a serious one, I settled in for an entertaining night of throwing up.
Of course, I was actually having a heart attack. A minimum of five chest arteries were now mostly or totally blocked, and the physical demands of the trip had finally made the problem a critical one. But I was experiencing no chest pains, no tingling or shooting pains down one arm; I didn't know that heart attacks come with a greater variety of symptoms than the ones we've all heard about.
By morning, my stomach was empty but the "constipation" hadn't relented, and I was weaker than ever. I called to cancel the Seattle leg of my trip and to arrange to stay on in Kansas City for another day recuperate. Before they headed home, I asked my friends from Des Moines for some laxatives and a carton of orange juice (hence the title of this blog entry), in case I could keep the OJ down for nutrition. Then I settled in for another day of throwing up and waiting for the laxatives to work.
Now, bear in mind, I was also not very rational at this point. I thought I knew what the problem was and was determined to wait it out. Anyone who had been suddenly plunged into my physical state - nauseated, weak, not thinking straight - would have known that something was profoundly wrong, but I'd gotten there gradually and didn't know. (Subsequently I set myself a simple test i don't have to be rational to complete successfully. You can use it, too. Ask yourself the question: "Am I helpless?" If the answer is "Yes," then go to the hospital. It's that simple - but only if you arrange it before you lose your powers of reason.)
So after the next night I was in no better shape. I canceled my Sacramento signing and went back to bed, back to throwing up, back to laxatives. I even had a very tasty burger from room service. And threw it up.
By the wee hours of the 29th, I was determined not to lose the rest of the tour. I packed - it took me two hours - and managed to get to the airport for a replacement flight to Phoenix. At the airport, I was too weak to walk through Security, so they brought up a wheelchair for me and to get me on the plane. And we took off for Arizona, with a layover at Dallas/Fort Worth airport.
Odd Coincidences In My Favor By the time we landed in Dallas, reality had set in. I realized I was not suffering from just constipation and that I'd never be able to walk off this plane. After the main cabin emptied of passengers, I asked a flight attendant to call 911 for me.
The paramedics who arrived were brisk and upbeat. They gave me an aspirin to chew, told me that I was in the midst of a heart attack, and told me that my blood sugar was 600 (a god n umber to be at is 100, and even in the worst of times I'd never seen my own above about 370, which happened once a couple of years previously). I began to have a sense of just how much trouble I was in.
They took me to Baylor Hospital in Grapevine, admitted me, began to determine the seriousness of my problems. And while there was no question that those problems were serious, I suddenly had some significant factors working in my favor.
It was only coincidence that my layover had been in Dallas, but it was an extraordinarily helpful coincidence. Baylor Hospital has a very capable cardiac unit and a motivated nursing crew. My home is in the Austin area, only about three hours away by car. My mother lives in Denton, TX, even closer, and works in Lewisville. A good friend of mine, who by (here's that word again) coincidence is a cardiac rehabilitation trainer, lives in the DFW metroplex. Suddenly all these factors were conspiring to benefit me.
Diagnosis, Treatment, Hallucinations, and Dying
As it turned out, I needed a stint in one artery just to keep me going long enough to receive full diagnosis and surgery, and then I needed a quadruple bypass Things were just that clogged up.
I was in and out of lucidity in the days between my admission (March 29) and surgery (April 2). When conscious, I knew what was happening, but my total waking memory for those four days amounts to maybe five hours of waking time... and I'm pretty sure I was awake longer than that.
I was also spending a lot of time asleep/unconscious and experiencing a series of intense, interconnected hallucinations, in which I had reached a malevolent afterlife in which I was tested and often tortured. These events played out in a series of semi-independent scenarios. When awake, I knew I had been hallucinating, but when hallucinating, I had no ability to distinguish between what I was experiencing and reality. It was, to say the least, a grim few days.
I coded - that is, my heart stopped, causing the medics to revive me with defib paddles - something like three times between the morning of my surgery and the following day. The last time, though my heart activity was restored, I evidenced very little neurological activity, and the medics scheduled me for an electroencephalogram to determine whether I had anything going on upstairs. Though the medical staff was not yet telling my family and loved ones to prepare themselves for the worst, some of the nurses and doctors were beginning to exchange little shakes of the head.
Writers: They Just Won't Shut Up An Intensive Care Unit nurse told me this story about the day after my surgery, when all the head-shaking was going on. She'd just come on duty, assigned to me, and had been let in on the not-that-hopeful prognosis.
So it kind of surprised her a couple of hours later when she looked through the window of my door and saw me sitting up, vague but awake, waving her in. She charged into my room and I began waving at her, as if holding a pen - all I could do to communicate, since I was still on the respirator.
"A pen?" she asked. "Do you want to write something?"
I nodded, and she brought me a pen and a pad of paper.
Carefully, laboriously, I spelled out my message to her:
H - A - L - L - L - L - U - L... At which point I lay down and fell asleep.
I guess that the urge to write is stronger in me even than the idea of what it is I need to write.
But that was the end of the crisis. After that, I began to recover. I had no more hallucinations (though for a day or so I did still believe the hallucinations had been reality, and insisted that I speak with a representative of my Captors to let them off the hook of having to set up a new scenario for each punishment or torture session - they no longer needed the pretense; fortunately, even those last lingering delusions faded soon).
Recuperation
Heart surgery of the sort I experienced has some interesting consequences. I had to relearn how to stand up, how to walk. I had to regain lost hand-eye coordination. Today, a month and a day after my surgery, I'm still suffering weakness that I hope will eventually fade. My eyesight in my good eye worsened after my operation, though it has been improving in little bits and fits since then.
But some good things resulted from my hospital stay (in addition to my not dying, that is):
Paying the Piper
Of course, there's a considerable down side - several, actually &mdsah; and in my case the worst of them is the deluge of bills that has resulted.
Like one in six Americans, I have no health insurance, and now I'm committed to pay for major surgery and a three-week hospital stay.
I will. I'll be working harder and better. I'll be applying for grants and dispensations with every agency that will listen. And friends have set up the Aaron Allston Donation Fund, which has already begun receiving donations that will help with my medical-related bills, past and future. (An aside to those of you who have donated or plan to do so in the future: Thank you so much. I'm flabbergasted every time a donation comes in, and hope to be able to do as much good for other people in the future.)
Final Thoughts
The chief thing that I hope some readers of this blog get out of my story is that the need to fully control one's own circumstances can and will worsen your situation and potentially kill you, as it nearly did me. In my case, the need to remain so firmly fixed in control stems, I think, from an irrational fear of being a nuisance to others. But I found that an extraordinary number of people, including a large number of folk who've never met me but simply appreciate my writing work, are happy for me to be an occasional nuisance - so long as it's not deliberate, and against the alternative of having me go away forever. Your own family and friends feel the same way about you; so bite down that false pride, ask for help, and keep yourself healthy. Be smarter than I was.
So, anyway, that's my story.
I hope you'll continue to visit this LJ, my community LJ, and my web site, where I'll try to keep you up-to-date on the events of my life and writing career.
I just hope that they turn out to be a bit less interesting for a while.
Thanks, everybody.
Book Tour: Outcast
On March 24, I began the first leg of a seven-city booksigning tour in support of Outcast, which had just been released. Each day, I'd be visiting a new city (Lexington, Chicago, Kansas City, Seattle, Sacramento, and Phoenix, then a break of a few days, and finally Austin). In a typical day, I'd arrive at the airport, be swept up by a media wrangler working with my publisher (Del Rey), check into my hotel, do a whirlwind tour of local bookstores (anywhere from two to eight stores, where I'd be signing stock - that is, signing copies for the booksellers, but not for readers standing in line), attended the main signing (this one with autograph lines and costumed fans such as the 501st, Rebel Legion, and Fan Force in attendance), often would go out to dinner with local-area friends or fans or both, and then would return to my hotel late in the evening. Each day would follow that pattern: Lather, rinse, repeat. It's a tiring schedule, but I've done it before without consequence.
But this time there were some new factors in play, and to understand them we briefly have to visit September 1993, July 2008, and September 2008.
Set the Way-Back Machine
July 1993 was when I was first diagnosed as a diabetic (Type 2). At that time, I was placed on a program of diet and exercise that kept my blood sugar largely in control. The problem was, well, I didn't exactly follow up with regular doctor appointments and reevaluations. Emotional factors such as denial of the problem, an unwillingness to 'fess up when situations began to grow out of my control, and so on led to several diabetes-related consequences over the years, including the loss of some eyesight to diabetic retinopathy and glaucoma in 2006. (I haven't been able to drive since that time.) So by 2008 I was a diabetic whose condition was doubtlessly worsening while I remain unaware of and unwilling to confront it.
Then, July 2008. I attended a convention where I did a lot more walking than I expected to or was in shape for, despite the fact that walking was my preferred form of exercise. I wore three huge blisters on my feet (right foot forward at the pad of the foot, right foot at the heel, and left foot on the right side of the heel). Then I continued walking too much, causing the blisters to rupture. In the weeks that followed, they healed at varying rates.
Which brings us to September 2008. On September 6, I celebrated my 25h anniversary as a freelance writer. But some of my housemates were less concerned about that anniversary than by the fact that two of my July blisters still hadn't healed (one was oddly drippy, in fact) and now my right lower leg was developing a rash that looked suspiciously like cellulitis. They ganged up, and I agreed to go to the doctor.
When I did visit my general physician, he immediately diagnosed the drippy blister on my right heel as a foot ulcer, which is bad news for a diabetic (or anybody). Don't research foot ulcers while you're eating, by the way. Not a good idea. The podiatrist immediately sent me off to physical therapy, a several-times-a-week regimen of applying medicines to and rebandaging the foot ulcer. Since some of the podiatrist's first words indicated that I was in some danger of losing the foot to amputation, I went into full-bore panicky focus-on-the-problem mode.
All of which, I suspect, contributed to my heart attack, and here's why.
In focussing fully on the foot ulcer, I basically ignored the diabetes completely. In addition, my usual form of exercise had been walking, and suddenly I was doing none of that as treatments progressed for the foot ulcer. I thought about substituting other forms of exercise for walking, but I never managed to do that, never substituted one exercise habit for another. Plus, there was a substantial stress factor at work. So: Diabetic, no treatment for same, no exercise, high stress. (And I haven't even mentioned the fact that heart disease runs strong in my mother's side of the family.)
By late March, after months of regular bandaging and 55 days on a Wound VAC (Vacuum Assisted Closure) device, the foot ulcer was almost healed and I was ready to face my book tour. Or so I thought...
Book Tour and Heart Attack
I embarked on the book tour and completed my signings in Lexington and Chicago without incident. Then, in Kansas City, things began to go wrong. I had a marvelous lunch of pad Thai with my media wrangler there, but the meal sat in an oddly heavy way in my stomach. During the signing itself, I felt tired and weak, and ultimately chose just to have dinner afterward with friends who were in town from Des Moines and Topeka rather than with the 501st and Rebel Legion folk who were arranging a dinner expedition (sorry, guys - next time, no heart attack). At that dinner with my friends, I ordered only a bowl of soup and could eat no more than about a fifth of it.
Once I was back in my hotel room, nausea set in, and I thought I had the problem figured out - it had to be a severe case of constipation, such as one I'd had a year or so earlier. In that earlier illness, constipation had caused everything I ate to come back up again, which continued until the stomach was empty and laxatives could work their magic on the problem. Content that the problem was not a serious one, I settled in for an entertaining night of throwing up.
Of course, I was actually having a heart attack. A minimum of five chest arteries were now mostly or totally blocked, and the physical demands of the trip had finally made the problem a critical one. But I was experiencing no chest pains, no tingling or shooting pains down one arm; I didn't know that heart attacks come with a greater variety of symptoms than the ones we've all heard about.
By morning, my stomach was empty but the "constipation" hadn't relented, and I was weaker than ever. I called to cancel the Seattle leg of my trip and to arrange to stay on in Kansas City for another day recuperate. Before they headed home, I asked my friends from Des Moines for some laxatives and a carton of orange juice (hence the title of this blog entry), in case I could keep the OJ down for nutrition. Then I settled in for another day of throwing up and waiting for the laxatives to work.
Now, bear in mind, I was also not very rational at this point. I thought I knew what the problem was and was determined to wait it out. Anyone who had been suddenly plunged into my physical state - nauseated, weak, not thinking straight - would have known that something was profoundly wrong, but I'd gotten there gradually and didn't know. (Subsequently I set myself a simple test i don't have to be rational to complete successfully. You can use it, too. Ask yourself the question: "Am I helpless?" If the answer is "Yes," then go to the hospital. It's that simple - but only if you arrange it before you lose your powers of reason.)
So after the next night I was in no better shape. I canceled my Sacramento signing and went back to bed, back to throwing up, back to laxatives. I even had a very tasty burger from room service. And threw it up.
By the wee hours of the 29th, I was determined not to lose the rest of the tour. I packed - it took me two hours - and managed to get to the airport for a replacement flight to Phoenix. At the airport, I was too weak to walk through Security, so they brought up a wheelchair for me and to get me on the plane. And we took off for Arizona, with a layover at Dallas/Fort Worth airport.
Odd Coincidences In My Favor By the time we landed in Dallas, reality had set in. I realized I was not suffering from just constipation and that I'd never be able to walk off this plane. After the main cabin emptied of passengers, I asked a flight attendant to call 911 for me.
The paramedics who arrived were brisk and upbeat. They gave me an aspirin to chew, told me that I was in the midst of a heart attack, and told me that my blood sugar was 600 (a god n umber to be at is 100, and even in the worst of times I'd never seen my own above about 370, which happened once a couple of years previously). I began to have a sense of just how much trouble I was in.
They took me to Baylor Hospital in Grapevine, admitted me, began to determine the seriousness of my problems. And while there was no question that those problems were serious, I suddenly had some significant factors working in my favor.
It was only coincidence that my layover had been in Dallas, but it was an extraordinarily helpful coincidence. Baylor Hospital has a very capable cardiac unit and a motivated nursing crew. My home is in the Austin area, only about three hours away by car. My mother lives in Denton, TX, even closer, and works in Lewisville. A good friend of mine, who by (here's that word again) coincidence is a cardiac rehabilitation trainer, lives in the DFW metroplex. Suddenly all these factors were conspiring to benefit me.
Diagnosis, Treatment, Hallucinations, and Dying
As it turned out, I needed a stint in one artery just to keep me going long enough to receive full diagnosis and surgery, and then I needed a quadruple bypass Things were just that clogged up.
I was in and out of lucidity in the days between my admission (March 29) and surgery (April 2). When conscious, I knew what was happening, but my total waking memory for those four days amounts to maybe five hours of waking time... and I'm pretty sure I was awake longer than that.
I was also spending a lot of time asleep/unconscious and experiencing a series of intense, interconnected hallucinations, in which I had reached a malevolent afterlife in which I was tested and often tortured. These events played out in a series of semi-independent scenarios. When awake, I knew I had been hallucinating, but when hallucinating, I had no ability to distinguish between what I was experiencing and reality. It was, to say the least, a grim few days.
I coded - that is, my heart stopped, causing the medics to revive me with defib paddles - something like three times between the morning of my surgery and the following day. The last time, though my heart activity was restored, I evidenced very little neurological activity, and the medics scheduled me for an electroencephalogram to determine whether I had anything going on upstairs. Though the medical staff was not yet telling my family and loved ones to prepare themselves for the worst, some of the nurses and doctors were beginning to exchange little shakes of the head.
Writers: They Just Won't Shut Up An Intensive Care Unit nurse told me this story about the day after my surgery, when all the head-shaking was going on. She'd just come on duty, assigned to me, and had been let in on the not-that-hopeful prognosis.
So it kind of surprised her a couple of hours later when she looked through the window of my door and saw me sitting up, vague but awake, waving her in. She charged into my room and I began waving at her, as if holding a pen - all I could do to communicate, since I was still on the respirator.
"A pen?" she asked. "Do you want to write something?"
I nodded, and she brought me a pen and a pad of paper.
Carefully, laboriously, I spelled out my message to her:
H - A - L - L - L - L - U - L... At which point I lay down and fell asleep.
I guess that the urge to write is stronger in me even than the idea of what it is I need to write.
But that was the end of the crisis. After that, I began to recover. I had no more hallucinations (though for a day or so I did still believe the hallucinations had been reality, and insisted that I speak with a representative of my Captors to let them off the hook of having to set up a new scenario for each punishment or torture session - they no longer needed the pretense; fortunately, even those last lingering delusions faded soon).
Recuperation
Heart surgery of the sort I experienced has some interesting consequences. I had to relearn how to stand up, how to walk. I had to regain lost hand-eye coordination. Today, a month and a day after my surgery, I'm still suffering weakness that I hope will eventually fade. My eyesight in my good eye worsened after my operation, though it has been improving in little bits and fits since then.
But some good things resulted from my hospital stay (in addition to my not dying, that is):
- I became closer to family members I hadn't seen much in the last several years.
- Likewise, long-ago classmates and friends have gotten in touch, some of whom I actually want to reconnect with.
- All the hallucinations and delving around in my subconscious threw a lot of thoughts, emotions, even plot ideas and characters up out of my subconscious, like a bad storm churning up a sea-bed; among other things, I went into the hospital with only one chapter of Five For Frankenstein done and came out with about 80% of the novel outlined.
- I suddenly liked coffee after a lifetime of disliking the stuff.
- A certain lassitude that has affected my work for years seems to have vanished. Now, every day, I want to leap up and rattle away at the keyboard, when previously there had been several days of any week in which I just felt too tired, in a creative sense, to be effective.
- Perhaps most important of all, in the time I had available t think about my situation, I came to an important realization. All through my adult life, I've been kind of a control freak &mash; though I had no interest in extending control over other people, I always had to be in control of my own situations. The upshot of this was that whenever I was in control of a situation - such as having enough income to handle medidal needs - things woulkd be just fine, but whenever i lost control (for instance, due to income variations), I'd sweep the situation under the rug, ignoring it until such time as I could reestablish control over it. Often, before I could reestablish control, I'd be altogether out of the habit of dealing with the problem, which is one of the major reasons my diabetes was only occasionally managed. What I learned, the important thing, was how to ask for and accept help, how to give up the illusion of being in control of an out-of-control situation. And this wearing away of a counterproductive bit of false pride means, I believe, that I'll be able to manage the disease, and other problems, in the future.
Paying the Piper
Of course, there's a considerable down side - several, actually &mdsah; and in my case the worst of them is the deluge of bills that has resulted.
Like one in six Americans, I have no health insurance, and now I'm committed to pay for major surgery and a three-week hospital stay.
I will. I'll be working harder and better. I'll be applying for grants and dispensations with every agency that will listen. And friends have set up the Aaron Allston Donation Fund, which has already begun receiving donations that will help with my medical-related bills, past and future. (An aside to those of you who have donated or plan to do so in the future: Thank you so much. I'm flabbergasted every time a donation comes in, and hope to be able to do as much good for other people in the future.)
Final Thoughts
The chief thing that I hope some readers of this blog get out of my story is that the need to fully control one's own circumstances can and will worsen your situation and potentially kill you, as it nearly did me. In my case, the need to remain so firmly fixed in control stems, I think, from an irrational fear of being a nuisance to others. But I found that an extraordinary number of people, including a large number of folk who've never met me but simply appreciate my writing work, are happy for me to be an occasional nuisance - so long as it's not deliberate, and against the alternative of having me go away forever. Your own family and friends feel the same way about you; so bite down that false pride, ask for help, and keep yourself healthy. Be smarter than I was.
So, anyway, that's my story.
I hope you'll continue to visit this LJ, my community LJ, and my web site, where I'll try to keep you up-to-date on the events of my life and writing career.
I just hope that they turn out to be a bit less interesting for a while.
Thanks, everybody.