I just had another brush with the uncertainty of life.

There was the time at sea on midshipman training when I fell overboard from a YP on the midwatch: miles from shore, pounding along at eight knots, seas of six feet. I was in a hurry, I let go of a ladder at the wrong second, and the small patrol craft bucked me off. I went over the rail and (as I was going down) I inadvertently stuck my foot through a closed chock. The torque (and the sudden deceleration) slammed my head into the hull and gave my ankle a heck of a sprain.  I was dangling upside-down by my toes, and my head went underwater. But I piked my torso back up to the chock, pulled up to the rail, and climbed back on board. I didn’t tell anyone. The lieutenant in charge was a real jerk, so I kept my mouth shut and finished my watch on adrenaline… and I duct-taped my ankle for the rest of the trip.

In June 1991, I was our submarine’s inport duty officer in the legendary port of Subic Bay, Philippines.  Instead of epic Olongapo liberty we had front-row seats to the explosive volcanic eruption of Mount Pinatubo, amplified by a typhoon and even a minor earthquake.  We did an emergency nuclear reactor startup in mere minutes (colloquially known by reactor operators as “latch ’em & snatch ’em”) and it still wasn’t enough to maintain lights and ventilation.  Several FEET of volcanic ash was deposited on our submarine and in the engineroom’s seawater suctions (and in every orifice).  Worst 36 hours of our lives, but we survived.

There was that 25-foot outside set at Chun’s Reef where I ended up in the toilet bowl, tumbling and spinning underwater and running out of air. My surfboard leash finally tugged at my ankle and I figured out which way was up. After a quick gasp of air (and three more waves) I got out of the churn.

There was the time at a Blue Öyster Cult concert when I drank so much Southern Comfort that I… well, I’m sure many of you have done that too.

The point is that I got into situations where I was no longer able to affect my fate. Initially, it seemed like a good idea, and then I lost control of the consequences. Each crisis was followed by the epiphany that I probably wasn’t invulnerable, let alone immortal. But eventually, I learned from all of those lessons, right?

And then a couple of months ago I had an emergency appendectomy.

You can’t control emergencies

Click on the image for more info…

The humiliating part is that I know about appendicitis! It’s the bane of the submarine force because it’s unpredictable and deadly. You have to be in agony to admit the severe abdominal pain to the corpsman: he’s going to take your temperature and “manipulate” your abdomen (like a Thai masseuse “manipulates” your shoulder muscles) and then stab you for a blood sample. If you’re running a fever and your white blood cell count is high, then he’s not even going to discuss your options. He’s going to call the CO about driving the boat to the MEDEVAC point, and within 30 minutes everybody knows why we’ve changed course & speed. “Pack your seabag, shipmate, the deployment’s over for you.”

Even with my sea-duty experience, I was surprised by the speed of my acute appendicitis. I felt a little discomfort after a big lunch, and I thought it was gluttony indigestion. At bedtime, the pain was worse, but I still went to sleep. By 11 PM I was awake and hurting, and I actually tried to walk it off.  At 3 AM (thanks to MayoClinic.org) I was pretty sure it wasn’t gas, a kidney stone, or diverticulitis. Even then I took some acetaminophen and finally got two hours of sleep.

The next morning my spouse and I wasted 30 minutes at our neighborhood medical clinic. (I figured Tripler’s emergency room would just pat me on the head and park my butt in the waiting room for six hours.) But the clinic didn’t have any open appointments, so we arrived at Tripler at 9 AM. By now the pain was much worse.

It turns out that showing up in an emergency room with severe abdominal pain and a fever gets you head-of-the-line privileges. You’re probably not going to die, but the faster they can operate then the fewer problems they’ll have to fix. They had a white blood cell count by 10 AM and confirmed their suspicions with a CT scan by 11 AM. After that the surgeons were standing around treating me to morphine shots waiting for an operating room to open up. Our table was ready at 4 PM, and the medical students were gathering around.

A minute after the propofol injection, I stopped remembering.  Two hours later I was in the recovery room, wondering when they were going to start the surgery.  My spouse re-oriented me, I made the mistake of trying to sit up, and then we decided that a little more morphine would be yummy.

No, I won’t be sharing photos or videos. (I’m a writer.) You can find plenty of appendectomy gore on YouTube.

You can’t change your mind in the operating room

By the time the surgeons decided to operate, I’d abdicated my vote on that debate and chosen a large bolus of morphine. I doubt that I could have reasserted control of the process; the surgeons knew my appendix wasn’t going to heal itself with antibiotics.

If the appendix has not ruptured, a laparoscopy makes a couple of very small holes and your appendix is “extracted” through the navel incision. (Ouch.) If your appendix has ruptured and spewed its purulent gangrenous contents all over your abdominal cavity, then the surgeons set aside the laparoscopes and reach for the scalpels. They slash & mop and then stuff you with antibiotics, drains, catheters, staples(!), and other “support” gear.

The surgeons got in there before my appendix ruptured. Everything came out all right (so to speak), but it was ready to blow. The soreness and swelling around my navel (and subsequent comments from a few of the medical students) reminded me of the scene from the first “Alien” movie.

After the surgery, I was woozy from the anesthetics (and lack of sleep). I hadn’t eaten in 30 hours, and general anesthesia sort of shuts down your digestive system. However, the staff on the surgical ward wake you up every two hours to check your vital signs and to encourage you to use the bathroom. I’ll spare you the details of that night.

“You can check out any time you like”…

By the next morning, big surprise, I was ready to go home for some real rest (and bathroom privacy). Big surprise, they wanted my white blood cell count to be lower. We negotiated as only a military retiree can chat with a colonel. He broke off the talks with “Well, we’ll see how your next blood sample comes out” and I never saw him again. But by lunch the nurse and I agreed that they’d stuff me with more antibiotics, I’d sign the “against medical advice” waiver, and I’d take more antibiotics over the next two weeks before returning for a final white blood cell count. We all understood the rules, but the staff was legally conservative.

Tripler Army Medical Center has annoyed me mightily many times over the last 25 years, but they made up for it on this trip. Mahalo nui loa to Tripler’s emergency room staff, the surgeons, and all of the 6B1 Guardians. I was unconscious when I met some of you, but I sincerely appreciate everything you did to save my life.

But wait, there’s more!

About 18 hours after surgery, my spouse dropped by to help with my release.  A few minutes after she arrived, our daughter called to announce her engagement. (It’s all good!) We had a great talk, and we’ll spend more time together in the coming months. There’s no rush. Her fiancé is on active duty too, so they’re going to synchronize their tours and probably have the big wedding party in 2017. As you dual-military couples know, the actual marriage license may have to happen sooner.

Happily, when she called I was awake, ambulatory, and unmedicated.

That’s when this appendicitis crisis really hit home: I was fortunate to not have a ruptured appendix or, even worse, be stuck in a diagnosis wait-and-see. I’m very glad that I didn’t have to ask my family to call back after the morphine wore off.

Lessons learned

Yeah, I know, but I’m a submariner. Every incident is followed by a critique.

Financial independence. I’m very glad to be financially independent and (mostly) in control of my time. I can’t imagine dealing with appendicitis if I was working a full-time job. I would’ve gone into the office that morning “just to check on a few things before I see the doctor” and ended up getting a free ambulance ride.

Stay in shape. I was warned that I’d need four weeks of recovery time. Yet three days after coming home, the pain was gone. By two weeks the incisions had healed and I was ready to paddle back out into a most excellent 4-6-foot swell. Two decades of military PT (and, in retirement, another 13 years of workouts) paid off when I really needed it.

Lose the weight. Speaking of exercise and a healthy diet, my appendix was easily accessible because I’m not fat. The anesthetist was happy with my cardiovascular health and he had an easier time with the drugs. I bounced back quickly because they had a smooth operation with less physical trauma.

Live near a major medical center. Oahu crams a million residents around the nation’s 12^th-largest city with its second-worst traffic. My spouse and I have talked many times about moving to upcountry Maui or north Kauai. But when I needed fast medical help, a highly proficient crew was only 30 minutes away. If I ever need chronic care, I’m close enough to tolerate the commute.

Buy health insurance. This has been an issue among a few people in their early 20s and late 50s. I’m sure my appendectomy cost more than my annual pension. Yet once the ER staff saw my military ID, nobody asked about insurance. Three weeks after the surgery I hadn’t even seen a benefits statement, let alone an invoice.

Get your stuff together. I was asked six times (between the ER and the OR) whether I had a medical directive. (Yes, I do!) This would’ve been a terrible morphine time to chat with my family about how to let me die if the surgery went wrong. Imagine trying to find a notary for a power of attorney, too.

Carpe diem. I had somehow decided that I was “too old” for appendicitis. Just like paddling into the wrong wave, my life simply smacked me upside the head to remind me about my mortality.

Postscript… two weeks later.

I drafted this post a couple of days after the appendectomy, and then I learned another lesson.

At the surgeon’s two-week follow-up, the pathologist’s report said my appendix had a “well-differentiated neuroendocrine tumor”, also known as a carcinoid tumor. “Well defined” means that the tumor cells looked “not very abnormal” (which seems oxymoronic) and yet not cancerous. The tumor is considered benign because it’s smaller than the minimum size for cancerous ones.

The surgeon thinks that the tumor was unrelated to the appendicitis. It’s just a data point.

I’ll accept his opinion for now, but I’m going to show up on time next spring for my second five-year colonoscopy.

And until then, carpe diem.  As you read this my spouse and I are visiting our daughter in Spain, roaming Andalusia for the second time this year and snorkeling through more incredible cuisine.  I’m already living the life I want to live, and there are certainly a few more life-affirming events to look forward to.

Related articles:
Fast Personal Growth Through Slow Travel
“Do I Really Need Servicemembers Group Life Insurance?”
Eight Reasons Not To Worry About Military Retirement
Book review: “The Longevity Project”
Exercise with a purpose
During Retirement: Healthy Lifestyle (excerpt from the book)