It would have been a quiet and unremarkable death.
.
My doctor told me that although my body and skin had rebounded remarkably well from losing nearly 200 pounds since a September 2012 bariatric sleeve surgery, I undoubtedly qualified for the skin removal surgery and abdominoplasty, commonly referred to as a “tummy tuck.”
As I rapidly learned, referring to the procedure as an abdominoplasty elicited far more gravitas than calling it a tummy tuck.
All the walking, working out and smarter living during the past 18 months brought major changes, but the last vestiges of the old me still clung stubbornly in the shape of a spare tire of fat and loose skin that was as unsightly as it was uncomfortable. Prone to rashes and chafing, it was the one final reminder of my 400-pound life.
I scheduled the procedure for Feb. 24, approaching it with the confidence I’d earned through the success of the bariatric surgery.
I knew I had at least three major factors in my favor. I was in the best health of my adult life and physically fit for the surgery; I had worked especially carefully on toning my abdominal muscles, so the doctor said he would not need to cut and tighten the muscles themselves, as is common during a tummy tuck; and the surgery itself was performed by my University of Michigan surgeon as an outpatient procedure, not even requiring I stay the night. I would be in by 11 a.m. and home by 6 p.m., so how bad could it be?
I had been told it could be very bad indeed, by other weight-loss patients, by the doctors, by the testimonials I read on weight loss message boards. But I had also been told I would be out for a month after the sleeve surgery and would lose about 60 percent of my excess weight.
I bested that by two weeks and 30 percent, so I expected similar poster boy results from the tuck.
The commitment
The procedure went as planned and I was home less than 10 hours after I left.
So far, so good.
Except for the fact that I felt miserable. As I surveyed the extent of the procedure, all the warnings and cautions swirled in my head. The centerpiece was a 27-inch incision under my belt line from hip to hip, expertly stitched together but looking like I was Robert Shaw at the end of “Jaws,” perforated in a perfect semicircle by the maw of a great white shark. Even on whatever wonder drug was pleasantly swirling through my veins, I felt the soreness of the incision.
My abdomen was swollen to twice its pre-surgery size, yet also flat and sculpted in a way it hasn’t been since my high school football-playing days.
At the center of my new abdomen sat a brand-new bellybutton, created through an umbilicoplasty procedure as my old navel had been removed along with the excess skin and fat. That area was mostly numb and covered in gauze and surgical tape, so I had no idea what it looked like.
But the real aching misery lived, as it often does with men, in my groin. Two plastic tubes about 18 inches long sprouted from the area, leading to two hand grenade-shaped bulbs that were safety pinned in place, slowly filling with fluid that looked like blood. These were my two new pals, the Jackson-Pratt or “JP” vacuum drains that I would live with for at least two weeks.
They were the most visible sign of of tummy tucking, and they were tucking gross.
Keeping all this carnage in place was a flesh-tone “compression garment,” an ultra-tight single piece — well, girdle, really — designed to clinch the abdomen with force to keep the swelling in check.
The effect of all this was a degree of discomfort and pain I never came close to experiencing from the bariatric sleeve surgery. But I was just hours after the surgery and while my confidence was shaken, I was sure I would bounce back with quickness.
We had prepared for a week or two of my living on the first floor, sleeping upright in a recliner (no lying flat or stretching the incision) and I had everything from books to my phone charger to the TV remote at my side, arranged to fight the boredom of inactivity.
In sickness and in health
Those first 10 post-surgery days brought slow progress, not much moving around and unexpected —and unaccustomed and unwelcome — depression. I have long felt guilty about allowing myself to balloon to 400 pounds, and the untold damage that recklessness took on my family and life. Even though that life is in my rearview mirror, it lingers on that receding horizon like an angry and cheated sunset, coloring everything in purples and crimsons.
This newest incapacitation brought back that guilt, watching my young sons worry and my wife carry the load for all of us. Shannon was my nurse, company and taskmaster, providing comfort, love and attention — the pleasant aspects of recuperating. But she also served dutifully through the grossest duties: changing and washing compression garments and maintaining the JP Drains.
That entails a three-times-a-day procedure of unpinning the drains, using an alcohol-soaked cloth to pinch and strip the plastic tubing, forcing stringy blood clots and drainage debris through to the bulbs, then draining them, measuring the output and disposing of the bloody mess.
Choosing a Valentine’s Day card is one form of love; there is no Hallmark card for maintaining JP drains, but it became my habit to kiss my sweet wife’s head as she quietly went about the gross, gross task of clearing them.
As the days passed, the depression deepened. For one thing, I hurt. For another, I was blue because the daily exercise that had filled an hour or two of nearly every day of my life for the past 18 months had been reduced to three 10-minute slow walks around the first floor.
I could feel my hard work on my leg and arm muscles melting away with the inactivity. But I was also haunted by buyer’s remorse, uncertain that this surgery — unlike the bariatric sleeve surgery, which paid such great dividends — was worth the obstacle course of pains and problems. The swelling still distorted my abdomen, my new navel looked like a foreign element and the damned JP Drains freaked me out, protruding as they did from my body like Lovecraftian tentacles.
Worst of all, I hated being cooped up, largely confined to one room on one floor. I began to resent my cage and wished to be anywhere else.
’Til death do us part
I got my wish on the 11th day after the surgery. I woke up feeling fine but by 8 a.m. felt the unmistakable chills of a fever. There are a few danger signs of post-surgical complications and fever is a big red flag. I was at 102 degrees with no break from Tylenol when I called the clinic and spoke to a clinician who promised a nurse would call me back right away.
She did, 10 minutes later, with an urgent message for me to get to the clinic as soon as possible. Unfortunately, I passed out in my chair and missed the call. It was three hours later when I woke up, listened to the message and called my wife to tell her we needed to go.
At this point the fever was 103 and blinding in its intensity. At the clinic, the doctor inspected my incision and saw no outward sign of infection, but on the advice of my wife looked at the new colors of swirling debris in the JP drains and made immediate arrangements for me to be admitted to the University of Michigan Medical Center emergency room.
When I checked in, the fever was at 104.2 degrees and I have vague memories of feeling like I was swimming through hot Jell-O. The nurse took my blood pressure, frowned, checked it again, then wheeled over a manual unit and took it a third time.
All three measurements were the same: 74 over 48. In contrast, my heart was pounding, trying to compensate by working wildly at more than 120 beats per minute.
Sepsis is caused by the body’s immune response to infection. As the body fights to the point of septic shock, organs begin shutting down. The ER team was frantically working around me but I was only dimly aware of what was happening and had no sense of danger.
My wife, who works in health care, knew exactly what was going on and was holding my hand and talking to me softly as I drifted in and out of consciousness. I had been pumped with three IV bags but the fever held, my blood pressure continued to crash and I was unable to urinate despite being pumped full of liters of saline.
It would have been a quiet and unremarkable death, but I was blissfully, ignorantly unaware of the danger.
I did not experience any bright lights, visions of dead relatives or see my life pass before my eyes. Jesus apparently had more important visits to make and his face did not appear before my eyes. I kinda sorta remember the hum of the CT scan tunnel and the stream of white-coated visitors, but most of what I know comes from my wife’s reluctant descriptions.
The next thing I knew, it was a day later and I was in a hospital room, IV lines in both arms, legs encased in clot-fighting pressure cuffs and feeling a dreamy, foggy mindset courtesy of Norco, the new Vicodin.
I spent the first few waking hours absorbing the news and loudly complaining about being in a hospital bed. That first-floor living room suddenly seemed like a paradise to me.
My complaints were tempered when I heard why my roommate was hospitalized. Suffice it to say, his situation was a million times worse than mine. It’s not my place to share his story here, but his heroic determination in the face of medical disaster taught me great perspective and humility.
The doctors did not find the specific source of the infection and kept me hospitalized two more days to monitor my progress.
I believe that in six months, when all is healed and in place, the choice to have the abdominoplasty will be a good one for my health and future. I will soon be back to walking and in my normal routines. I won’t think of a tummy tuck infection as a near-death experience.
It would have been a quiet and unremarkable death, but I haven’t worked this hard to do anything but go kicking and screaming.
Michael S. Miller is editor in chief of Toledo Free Press. Contact him at mmiller@toledofreepress.com.
