Box Hill Hospital, Victoria

I will return at some point to my last post from Vietnam, still unpublished. But now we take a detour from fun travel to not-so-fun travel.

Safely home from Vietnam, we had a lovely Sunday out at Whittlesea Agricultural Show. Whittlesea is a small country town about 50 km from Melbourne. There were baby farm animals, musicians, horse jumping, lawnmower racing, a circus, homecrafts, lots to eat and drink — everything you'd expect from an agricultural show.

Ken was recovering from his hip replacement surgery, and on crutches; one of our friends hasn't been well and needed a wheelchair — but we had four fit and healthy people in our party of six (including our friends' 30+ y.o. son and partner). A fun day out in the country!

I was the driver for the day, as Ken wasn't yet able to drive. We arrived home at about 5 pm. I felt a bit tired, and then a bit nauseous, and about two hours later starting vomiting. Ooops, shouldn't have eaten that pita gyros! Or that mango ice-cream! But the vomiting went on and on, and then I was vomiting enormous, gassy, painful bubbles. Then the abdominal pain started. (I definitely shouldn't have eaten that gyros, I thought.) I struggled through the night, drove to the GP early on Monday who said, 'Let's stop the vomiting and see how you feel.' Hmmm.

By 2 pm that Monday afternoon, I thought I would explode with abdominal pain. On a pain scale of 1 to 10? 10. Appendicitis pain is at the same level as labour pain, but it doesn't come in waves. It just obliterates. Ken wanted to take me to hospital but I wanted drugs. Immediately. He called an ambulance. The two paramedics inserted a cannula and started pumping fentanyl into me. I'll come back to fentanyl later in this post, but I will just say that for a drug that is 100 times more potent than morphine, and 50 times more potent than heroin, my pain was winning by a knock-out. Pain 1, fentanyl 0.

As we have private health insurance, the ambos asked if I wanted to go to a private hospital or public hospital (Box Hill Hospital). I was positive that I wanted the public hospital because (a) it's very close by, (b) it's an acute hospital with an excellent Emergency Department, (c) we had a good experience in this hospital 20 years ago when Luke had a ruptured appendix, and (d) we like to support training hospitals. But mainly (a).

'Okay then,' said the ambo cheerfully. 'Bockers it is.'

I wish I could have enjoyed my first and only ambulance trip more ... but c'est la vie. The next few hours blur but I do remember having a CT scan, being told that they had to remove the appendix and possibly part of the bowel, and that it may be something similar to Crohn's disease. I had to sign a consent form authorising a diagnostic laparoscopy, surgical laparoscopies, resectioning of small and/or large bowel, attachment of a stoma bag. Frankly, I would have agreed to anything just to stop the pain.

By this time Ken had driven himself (yes, driven!) to the hospital, the family was on the phone and our daughter-in-law (an Emergency doctor) was on hand to chat to the Emergency Department doctor treating me and translate the medigobbledygook. Everyone seemed cheered by my excellent 'bloods' except me. All very nice, but what about the pain?

I was in surgery on Tuesday morning at 8.30 am, first cab off the rank. I remember being pushed on my bed to the operating theatre, rolling out of the lift and bumping over the rim of the lift door. Those bumps were like being hurled from the top of Everest onto glass rocks far, far below.

Hello, lovely two surgeons (Hello, I'm Matt and this is Ravi), anaesthetist and theatre nurses. Goodbye, pain.

One of the surgeons phoned Ken after the surgery. Ken's notes say that 'the surgeons found a very bad appendicitis situation — removed it, and had to drain and wash pus away. Have left a drain in for now. No holes in bowel, and no fluid detected from bowel, which is great news. Need to monitor her carefully now to prevent an abscess (a collection of pus) developing.'

Good afternoon, Melbourne! It's Tuesday 5 November, Melbourne Cup Day, a public holiday for the biggest Australian horse race. It's also US election day, about which I feel zero interest. This may be the best thing about having appendicitis.

I wake up with seven attachments: (1) nasogastric drain down my nose into colon, 56 cm long, draining into a bag; (2) gastric drain through tummy, stitched into place, also very long and draining into bag; (3) urinary catheter and bag; (4) oxygen via nasal cannula; (5) cannula from paramedics in left hand; (6) cannula in right hand (antibiotics, liquids) and (7) the most fun one, air compression socks attached to a machine that massaged each leg alternately. In my blur, these felt like I had my little dog Elsie lying next to my legs in bed.

Pain level? About 5. Sheer bliss. And that was mainly when I moved.

So, just to clear things up, that pita gyros and mango ice-cream had nothing to do with my appendicitis. I shall happily return to eating them again. Appendicitis is one of those random events that can affect anyone at any time, at any age. It affects 10% of the population. If it hasn't already, it can happen to you!

If you're interested, these are two good explanations.

• I like this five-minute video. It includes poop rocks and a very debonair pinworm: https://www.osmosis.org/learn/Appendicitis

• This NHS article is clear and simple, and has a nice little video at the end (scroll to the bottom): https://www.nhs.uk/conditions/appendicitis/

My understanding is that appendicitis can range from mild to infernal. If an appendix is just having a bad hair day, and is removed, you can be out of hospital in 24 hours. But the grumpier the appendix gets, the worse the outcome and the longer the recovery period.

Like pregnancy, appendicitis brings out the horror stories. Ken's physiotherapist, originally from Scotland, told us about the 21 year old daughter of a friend. A few months ago, the young woman was fit and athletic, studying exercise physiology at uni in Scotland, when she experienced abdominal pain. Went to the hospital, was examined and sent home (just like Luke!) and then had her appendix rupture. (Just like Luke!) She developed sepsis, had to have a tracheotomy to breathe, and spent one month in ICU. So, you know, I am grateful.

A fun fact: gastric fluid is green. Not olive green. Bright leafy green. The colour and state of my gastric fluids became my focus for the next 9 days.

The post-operative ward was well designed with a window the length of the wall next to my bed, so it was bright and airy, and had a view east towards the hills. At night I could see the lights of Ringwood, an outer-metropolitan hub about 15 km away.

Hospitals are noisy places. Those constantly beeping machines!

I shared Ward 7.2 (abdominal post-operative ward — or, as I call it, the Farts and Burps Ward) with an 80+ year old woman who was as sharp as a pin. Far sharper than me on many of my earlier days! My fellow patient, whom we shall call Nellie, had been in hospital for one month and had had four surgeries: diagnostic laparoscopy, removal of tumours in the bowel, removal of a gangrenous gall bladder and stapling the remnants together with a million staples, and removal of an infected staple or ten. Nellie had various stomas and various drainage bags, and I admired her fortitude. Having said that, we would not have been friends in real life but she entertained me enormously, and I am grateful for that.

It's also a very good thing to have a ward-mate to stop one feeling too sorry for oneself. Everything's relative, right?

Nellie and her husband had been government officials who had travelled extensively and lived in other countries. She had plenty of visitors, and had strong views on How the World Should Work.

• On American politics: 'They [the candidates] are both awful. Now they've got the least awful.' (Me: But have they? Have they really?)

• On Australian politics: 'We have to get rid of Adam Bandt [the Greens leader]. He's a traitor.' She really disliked Kevin Rudd, too.

• One of her friends was heading to Malta. 'It's a dear little place. Fortified, of course. We popped across there for weekends when we were living in Libya.'

• On being given chicken broth: 'I don't like chickens.'

• And my favourite. The nurse wanted to get her out of bed to sit in a chair. Nurse: I'll get you a towel to sit on. Nellie: A what? Nurse: A towel. Nellie: Oh, I thought you said a snail. For some reason this continues to tickle me no end.

Nellie was there when I arrived pre-surgery, and she was still there when I left nine days later. I wish her well.

I can't speak highly enough of the nursing and support staff. The surgeons and doctors waft in and out on celestial chariots, but it is the nurses who are the angels who translate the doctors' instructions and carry them out with grace and competence. They are so busy! Why do we not pay them more? I think that good nurses demonstrate the perfect harmony of left and right brain skills. I overheard an older nurse telling a colleague that she had no plans yet for retirement. 'My body hates it, but my mind loves it,' she said.

We're blessed, too, having trained, skilled, often young/youngish people from other countries who choose to work in our health system. While many of the nurses had Australian accents, there were plenty of foreign accents too: Japanese, Ukrainian, Irish, Chinese, Filipino, Canadian, South-east Asian.

One of my nurses was a 27 year old dude hailing originally from the Philippines. He'd bounce into the ward singing under his breath. Let's call him Nathan. One morning while he was helping me with, um, bathroom activities, he asked me if I'd been born in Australia. (The accent, I think.)

Me: Nope, South Africa.

Nathan: Ah, so you're American.

Me: No, wrong continent. South Africa is not America.

Nathan: My geometry isn't very good.

Me: Neither is your geography.

I said, 'We've met so many lovely Filipino people —' and before I could say, 'working on cruise ships', he said, 'working as nurses'. No, I haven't been in hospital enough to meet many nurses, but cruise ships on the other hand ... He told me that nursing was a very popular career choice for Filipino people. 'We're disrupting the white dominance in hospitals,' he said cheerfully. I applauded. Our chat moved on to Filipino food, which we love. 'Ah,' said Nathan sadly, 'I am 27 and already have gout.' It's the curse of a particular gene common to Filipino people — he can't eat those epitomes of Filipino cuisine: barbecued meat and seafood.

Apart from these fun convos, Nathan was also a genius at inserting cannulas.

Now, before you think that my nine days was pure entertainment, the low point came about four days after surgery when the potassium level in my blood crashed. This appears to be not a good thing as it affects the kidneys and the heart. 'We're going to give you two bags of potassium intravenously,' said one of the nurses. 'It might sting a bit.'

'It might sting a bit' is the understatement of the century. Potassium chloride irritates the nerve endings in the veins as it flows into them — producing severe acute pain, actually. So I had some painkillers, and some ice at the site, and endured the horror for a few hours. This is what potassium chloride feels like as it drips into the bloodstream.

I think I cried when the two bags were finished. Or I might just have been crying the whole time. I recovered over the next 24 hours. The nurses returned. 'That doesn't appear to have worked,' they said. 'We need to give you more.' How many more? Another SEVEN bags.

'Right,' I said, screaming internally (maybe externally as well, I can't remember). 'I need drugs. Proper drugs.'

And so began what I call my OxyK weekend. I was soothed by regular doses of endone (oxycodone) that almost knocked me out completely while the 14 hours of potassium, antibiotics, glucose, whatever, dripped into me, via two cannulas, one in each hand. I can highly recommend opioid medication for this purpose.

I defy anyone (in Western culture) to spend time in hospital and not think of Florence Nightingale. At these moments of pain and vulnerability, the thought of having to endure cholera, typhoid and dysentery as well as amputated limbs or shredded flesh is just horrific. And what about developing appendicitis in the midst of all that? For all the Victorian schmaltz that persists, I reckon she and her nurses must have been tough old bats to clean up the mess. I say that with enormous admiration.

It's a sad thing, isn't it, that she worked in the Crimea — the same region where another bloody war is being fought as we speak. Progress? I think too of getting acute appendicitis in Gaza, or Lebanon, or the Sudan, where it's unlikely you'd be able to choose your preferred hospital. In fact, it's unlikely you'd survive.

I can tick off going in an ambulance on my bucket list, as I can taking fentanyl and oxycodone. (Actually, none of these were ever on my bucket list.) The strongest opioid, fentanyl, was a bit of a bust for me as the acute appendicitis won that contest hands down, but the oxycodone was jolly good. Addictive? Very. I read Patrick Radden Keefe's really good book, Empire of Pain: The Secret History of the Sackler Dynasty, about oxycodone/Oxycontin a few years ago, and it's powerful stuff. The book and the drug.

On about Day 7, feeling immeasurably proud of being able to trundle on my A-frame alone to the bathroom, drainage bags draped over the frame, I sought validation from one of the nurses. 'How am I doing?' I asked. 'So far, so good,' was all she'd say.

I tracked my progress in hospital by sending photos of food to the family. For the first two days, it was nil per mouth, and then tiny sips of iced water. Then I progressed to apple juice and unrestricted water. Bliss! A major step forward was clear liquids only: this meant water, black tea, apple juice, jelly and chicken broth. The best chicken broth I have ever tasted in my life! The next advance was ice-cream, yoghurt and pea soup. A breakfast delight of oatmeal and pureed apple and pear. Finally, the day before I was discharged, I had slow-cooked beef, carrots and mashed potato. I loved every mouthful. I awarded 3 Michelin stars to the food.

Home after nine days in hospital, and very tired ... but now making slow and steady progress, like the tortoise. So far, so good.

'You'll be fine,' said one of my neighbours. 'You're a tough lady. Industrial grade.' I'm immensely flattered, and immensely grateful.

PS There are some interesting stories about fentanyl if you feel like going down that rabbit hole, which I did, including the argy-bargy between the US and Mexico about fentanyl and gun trafficking across the border. The US blames Mexico for pushing fentanyl northwards; Mexico blames the US for pushing guns southwards. The lack of gun control in the US, says Mexico, has directly contributed to the US opiod overdose crisis. Mexico also points to the 'social decay' in the US and the breakdown of family values. 'There is a lot of disintegration of families, there is a lot of individualism, there is a lack of love, of brotherhood, of hugs and embraces,' Mexico's president said in 2023. Here's to love, brotherhood, hugs and embraces, but let's not hold our breath for these being high on the new administration's agenda.