tl;dr Jim did not die. He reveals what happened during his recent health scare on the road, how when you least expect it, you should, and how that’s why you should prepare for the worst.

Mom always said, “prepare for the worst, and hope for the best.” So I’ve pretty much been preparing for the worst and hoping for the best ever since I first understood what she meant. Well, while I didn’t recently experience the absolute worst that could have happened to me, I came pretty damn close. It was probably the worst thing that has ever happened to me. At least yet. And at least we were prepared. Kinda. You’re never really prepared for major health surprises like Rene eluded to. Nor the nightmare our sick care system presents and the bills it brings when the shit hits your own fan. But I am still hoping for the best. Spoiler alert: I did not die.

Where Was I?

Meanwhile, back on the ranch, Jim wondered if maybe all of it had just been a dream. Everything since starting this whole Live Work Dream thing 18+ years ago – the full-time RVing adventures, that first year traveling to Maine, Florida, and Texas. From the Bayou to Rockies. The trips to Alaska, remote boondocking spots in the mountains and along the Mexican border. That close call on the Guadalupe, blowouts on the highway, the workamping jobs, three trailers, the Project M, and all those summers at Vickers Ranch. Plus so many more amazing memories. Maybe he was still in a coma from impaling himself on hay equipment years ago. Or maybe he was just lost in some moon age daydream, oh yeah…

No, this is the real deal. Nothing like a life threatening emergency to take you down memory lane and make you ruminate on the mysteries of life.

What Happened to Jim?

I’m not exactly sure where I was headed with that. But I had been thinking about writing something along those lines after our visit to see the Vickers. I was looking forward to camping out in the M on the upper ranch, reminiscing, fishing, stargazing, watching Nellie roam free. We were headed to Leadville to connect with the crazy musher friends after our stop in Lake City. And I was looking forward to reflecting on what an amazing strange trip this has all been indeed. But that trip probably would’ve killed me. As if I wasn’t doing a good enough job of doing myself in anyway.

Sit back. Let me explain.

I’ve been struggling through rehab for Achilles Insertional Tendinopathy ever since that crazy idea to run the Eugene Marathon in early May after that ultra-crazy ultra we ran in late March. That’s totally unrelated to my recent health scare, unfortunately. But it is directly connected to how I first felt it coming on. The foot was still hurting, but nothing like it was. I was back up to running a few miles without wincing in pain. And I had promised Rene we’d run the Dirt Circus, a fun trail run in Boulder for her birthday. I even got our friend Dave to join us while TC babysat Nellie. Yeah, I was slow. I was weak. But I didn’t hurt that bad. And I had no idea what was going on inside me.

When You Least Expect it, Breathe.

I took a break from training, and continued to feel weak. I just couldn’t get back into it. My rehab exercises for the foot were about all I could handle. And that was getting old. So I tried short jogs around the campground. That got old even faster. Most of those runs turned into a walk, with me arriving home short of breath. This was never a clutch my chest, “I’m coming for you Elizabeth!” shortness of breath. But I couldn’t even get through giving guests the spiel about our campground courtesies during check-in without losing wind.

I started thinking about Timmy. My nephew wasn’t even forty when he went into the hospital with a bad cough last year. He was dead within 48 hours. So I paid attention to my body. And Rene. With just a couple weeks left at our workamping job in Estes Park, I had a video consult with my doctor. He didn’t seem extremely concerned, but scheduled a barrage of blood tests. He did suggest I get them done soon, and see him in person as soon as possible. We went to Loveland for my lab draws the next morning. Yes, Rene had something to do with that decision.

Our summer commitment ended at Mary’s Lake campground and we relocated to Fort Collins. Then my doctor was gone for a week. So what do we do? Decide to go see Rocky Mountain National Park. Surely there will be less tourists now. Not. But we did enjoy a scenic drive to the Visitor’s Center, where I insisted we hike up the short trail with everyone else huffing along. Elevation: 12,000′

What was that about trying to kill myself? No, I did not die. But I sure felt it – must be the altitude this time! I scheduled the soonest doctor appointment, and continued to cope with my weakness. Just out of shape, that’s it! What’s another one mile jog around the lake? I arrived home winded and dizzy. This was more than just feeling out of shape. I’ve felt that plenty of times in my life. This was something else. Meanwhile, all my lab results were coming back normal. I needed answers.

After a thorough physical examination, my doc seemed almost as stumped as me. We talked about various possibilities for feeling the way I did. But I wasn’t getting my answer. He suggested it might possibly be a blood clot. “There’s one more test,” he suggested. “It could be clotting, but I doubt it.” He then continued to explain how a D-Dimer Test could help determine if further tests might be necessary. “It will tell us if you need a CT scan, but again, that would be pretty rare.” What’s one more blood draw?

I must be a pretty rare kinda guy. There’s apparently no “normal” range for D-Dimer results. But according to Kaiser, the healthy range is ≤ 499. My results: >4,000

When You Least Expect It…Prepare for the Worst

I woke up to text messages from Kaiser and a voicemail from my doctor. He suggested a visit to the emergency room. The concern in his voice was clear, he’d never seen numbers so high. “With results like this, we really need to get the CT scan done today.” My thought: How serious could it be? I mean I just ran a mile yesterday, kinda. (Or almost killed myself again, apparently.)

Rene’s concern: “Do you know how much an ER visit costs!?” Besides, we had our teeth-cleaning appointments. And we’d already rescheduled those once. So yeah, I sat through a thorough dental cleaning before heading to the hospital. We’d skip the Emergency entrance, and head to imaging. When I called that morning they said, “If your doctor has an order on file you can just walk in.”

“We don’t work that way,” I was told. “Might be able to see you tomorrow, maybe by the end of day.” That wouldn’t do. I kept hearing my doctor’s voice. My heart hurt for Tim. I was getting my CT scan. “I’ll wait,” I said. After all, the doctor had entered the order as STAT. He needed results soon. They called me back within a couple hours.

When I was told I might get results back in 24 hours, I scrambled to show the radiology tech my message with the doc’s STAT test request. My breath quickened, again, and she assured me results are usually reviewed pretty quickly. If you’ve never had that flush feeling of a CT with contrast injection, be glad. But the fun had just begun. The scan was quick, and the tech came to see me even more quickly. “Did you get good pictures?” I quipped with a smile.

“Yes. And you’re not leaving.”

Preparing for the Worst

I was prepared to get news about my current condition. I needed some sort of answer. But I didn’t expect my first ambulance ride. I called Rene waiting in the truck, and told her to come in. “I’m apparently not going anywhere,” I said… “WHAT!?”

That wasn’t quite true. I was going to another hospital. The CT tech walked me straight to the ER down the hall. There I was told an Interventional Radiologist was reviewing her scan. It showed a submassive saddle pulmonary embolism. Massive would mean the main artery to my heart was blocked. I was almost there. Saddle means the large embolus forming in my arteries for quite a while now had lodged at the bifurcation of the main pulmonary artery, blocking blood flow to both lungs. In short, I had one mother of a clot building up in my chest. This picture explains it much better.

My PE was apparently one for the record books. Or maybe next year’s textbooks. Google that shit next month and you’ll probably find this picture in Wikipedia. Remember the scene from alien? Looking back at this now, I picture it bursting out of my chest. Thank goodness they sucked it out. And though i did prepare for the worst, I didn’t die.

Thrombectowhat?

The next day I underwent my Thrombectomy. Just before wheeling me in, I met the IR surgeon. He informed my I’d be awake during the procedure. And here I was looking forward to a quick solid sleep, only to wake up and have it all done. Yeah, no. That’s not how it went.

They enter through a main artery in the hip. They feed the instrument up into the chest. “Okay, we’re going through the heart now,” the doc said. That came as a surprise. Watching my echocardiogram late the night before came to mind. And here he was pushing tubes through those valves. Then the sucking began. I could hear the vacuum pump engage every time he reached a sweet spot to extract some more clotting. The doc knew his stuff, he was certainly good at what he does. But the Penumbra rep is in the room to help guide the procedure. And prepare the pretty pics.

The ER doc tried explaining that’s how they, “get the cool pictures.” I now know what he meant. The rep isn’t just helping identify areas to go after more clots. He’s reassembling them to show off how effective their equipment is.

And I got to be an active participant. “Okay Jim, take a breath. Hold it.” Suck, suck, suck. “Let it out. Good job.” Repeat. I hung in their pretty good. Until I couldn’t. Did I mention my low blood pressure? Apparently it’s a pretty messy procedure. I must have lost a fair amount of blood. Because I began feeling pretty faint. But I wanted him to complete his job. To get every last bit of that muck out of me. Fainter I felt yet. The sweats, the tunnel vision. I was failing fast. “Just finish. Get it all,” I kept thinking to stay alert.

Down the Rabbit Hole

“How ya feelin’ there Jim?” The surgeon must have sensed me slipping away.

“Feelin kinda a faint here boss.” I was speaking to the guy they called the bartender. To the doc I said, “Don’t quit on my account. Get it all…” The last few words were a slur. And he reassured me, “We’re almost done here.” I held on to consciousness. Never so hard than ever before. I came so close to fainting, I wish I had. But it wasn’t for the last time that day.

The procedure left me in pain and extremely anxious. When I asked for something the bartender said, “We’ll let your nurses figure that out.” I’m sure he was happy I didn’t faint. Back in the room, I didn’t expect them to give me Oxy. And an Adavan. It was a dream…

Which quickly turned into a nightmare, when they woke me up a few hours later. My most excellent nurse was back. Saint Francis. He was an angel indeed. Much more attentive, knowledgeable, and kind than the day shift. But I was out of it. My blood pressure was already low when he removed my flow stasis. That’s the suture retention device they used to provide simple hemostasis after large-bore percutaneous venous procedures. Yeah, I had to consult the bot on that one.

Nothing quite like waking up from a dead sleep only to feel like you’re going to faint. Then finding seven nurses in your room with an attending physician standing in the doorway. And then there was that one woman with the extra large needle “ready to go”.

My blood pressure had dropped to 46 over something. All the beeping was getting fainter. And so was I. But I held on. And Francis held his shit together. Did he save my life? I don’t know. But it sure feels like it. Wheeling me off for a follow-up CT he told his colleague, “I’m taking our rapid down to imaging.”

“Why’d you call me your ‘rapid’,” I asked him through the fog. I now fully understand the meaning of Rapid Response. All too well.

Epilogue

Total, I spent about four days in the hospital. And three miserable nights. With two close calls I’d rather never relive. And one helluva photo to show for it. Rene is amazing for staying by my side the whole time. Aside from that first night. She might have been a bit more concerned about Nellie than me. She is the best case manager, but still refuses to give me a sponge bath.

I’m on blood thinners now, and may be for the rest of my life. “You could go off them someday,” said my doc. “But then you’ll only find out if they were working the hard way.” I’m never going through this again. I’m fine taking the pills. The first few days were by injection, but now it’s a pill. (Kaiser doesn’t cover the meds for an immediate switch from the IV Heparin.)

Apparently lots of people get clots. You may have some. They tend to start in the legs. And yeah, I’m now one of those folks with Deep Vein Thrombosis. Rene laughs when I do that impression. Ask next time I see you.

I named this one Thrombone Shorty.

So, how do I feel about large-bore percutaneous venous procedures?

I hope (and plan) to never go through anything like this again. But what can you do?

When you least expect it, prepare for the worst, and hope for the best. And, if you ever feel short of breath for a few days with no apparent reason: Ask your doctor about the D-Dimer test!