The Clot, Pt. 1

cw: medical, surgery, hospitals. 

Fourteen months ago, I experienced the biggest health scare of my life to date—a blood clot that transformed into nearly a fatal pulmonary embolism. It sent me to the hospital for a week and continues to haunt me, albeit while providing me a number of scary, bizarre, and funny (to me) anecdotes to tell at parties. In my personal history, there is now a "Before Clot" and an "After Clot" era, each replete with their own regrets, fears, and what-ifs. 

I've talked about The Clot with a sizable number of people, who helped me think through the frightened adrenaline rush of post-near-death-experience. I decided to share the story on this newsletter in the hopes that writing it down would be a (hopefully) entertaining exercise in figuring out an exact timeline of events, and also provide an interesting look at hospital practices in the magical world of hematology. 

This post will cover the diagnosis and emergency treatment; the next will cover the aftercare and cause (a more lengthy detective story than I expected).

On July 7th, 2024, I woke up dying. I was breathless just turning over in bed. When I stood up to use the bathroom, I instantly felt faint and woozy. There was something odd happening in my chest, too: it felt like my heart was fluttering against my ribs. I was also maybe experiencing minor oxygen deprivation, because my behavior for the next hour was fairly ridiculous. Sitting on my bed, struggling to breathe and feeling my heart pounding in my chest, I thought, maybe I need to eat something?

I stumbled to the kitchen and looked in the fridge. There was nothing there. I had been weak and listless for days, to the point I hadn't gone grocery shopping or watered the wilting plants on the windowsill. A jar of maple syrup, half-full, was balanced against the mustard in the fridge door. I opened it and drank a couple mouthfuls. After the third gulp of pure sugar I started to feel nauseated—I put it back. I had a mouthful of water from the sink to rinse the stickiness off my teeth. I still felt very, very strange. 

At this point I was also starting to experience the feeling. The feeling was crawling forward from the dark evolutionary recesses at the back of my brain, curling its fingers around my amygdala and starting to squeeze. The feeling was not urgent, and it wasn't certain, not yet. But some ancient lizard-impulse was starting to wake up and think, Hmm, something seems…wrong. 

I decided to take a shower. Maybe, I reasoned, the feeling was some form of really weird panic attack and I needed to stick my face under the water for a while. Of course, this was a terrible idea. The moment I got under the hot water, my over-burdened circulatory system promptly gave up. My vision started to white out, so I quickly got to my hands and knees. I lay there for a while in the tub, the water drumming on my back, my hair streaming toward the drain. The feeling was fully awake. It communicated, This is not a panic attack. You need to get out of the tub now. 

I thought, what if I stay here a while and gather my strength.  

The feeling communicated, Holy shit, you are dying. You are going to die in the bathtub, like Elvis. (I should note that the feeling was not very concerned with facts.) Rinse your hair and get the fuck out of the tub, idiot. 

I crawled out of the bathtub. I made the enormous journey of fifteen feet to my bedroom. I lay down on the bed to rest, and planned how to move around the room to get my clothes. I levered myself up and found my pants. I lay down on the bed to rest. I found a shirt. I lay down on the bed to rest. I thought, I should call an ambulance. I thought, I don't have the money for an ambulance. I got my phone and googled "emergency rooms in-network near me." I called a Lyft to take me to the emergency room. 

The hospital waiting room was mostly empty, just one or two people sitting and reading magazines. I aimed myself at the desk (I was having trouble moving and thinking at the same time) and said, haltingly, "Hello, sorry, I'm kind of…having trouble breathing?" 

The nurse got a look on her face I hadn't seen before in previous emergency room trips. I gave her my information, and as I did she put a green hospital bracelet around my wrist that said FALL RISK on it in black sharpie. I was processing this new status as I was put into a wheelchair and wheeled into the emergency room. I watched the waiting room disappear behind the big swinging doors. I was being seen immediately, it seemed. 

There was a hurried bustle of testing. I had an EKG test in a dim little room. I was put in a hospital bed and two or three nurses hooked me up to various sensors and cuffs and an IV drip as another took my blood. I had an X-ray, saw my heart beating on the grainy monitor like a bird’s wing suspended in darkness. A calm, pleasant medical student came in and introduced herself to me. I lay back and began, horribly, to feel better. 

I say "horribly" because I began to think I was just dehydrated or indeed, suffering a weird panic attack. I really was feeling better. Which meant that I was in the emergency room for nothing, which meant I was about to pay a big old emergency room bill for nothing. Which meant—I was interrupted by the medical student coming in. She was no longer calm. She said, "I am so glad you came in. Your D-dimer is really high. That means you probably have a blood clot." 

I thought, Uh oh. The feeling communicated, See? 

A doctor came in. She told me that they were putting me on heparin (AKA anticoagulants) immediately. She also said they were trying to get me into a CT scan as soon as they could, to check that the clot hadn't invaded my lungs. I was given a hospital gown, which blessedly covered my butt (albeit barely). I think I gave a urine sample and some more blood while we waited. The CT technician arrived to wheel me, bed and all, to the big, whirring room where the machine awaited. He gave me an injection of contrast that he informed me "might make it feel like you're peeing your pants" as it coursed through my bloodstream. He seemed mildly disappointed when I didn't feel anything—I got the feeling that watching people experience this was often quite funny. He went behind his little window and the CT scan roared to life.

It is at this point that I must reveal the Mayo Clinic webpage "Symptoms of a Blood Clot" had been open on my phone browser for several weeks. Around early June, I began feeling an aching pain in my left leg that did not disappear after a week of rest. While running for the bus one afternoon, I stepped on it hard and a shock of pure, white-hot pain shot up my calf. I went to an urgent care clinic in the Loop on June 14th, where they measured my calves and took my blood pressure. They assured me my legs were not swollen, my blood pressure was perfect, and my pain was most likely a calf strain…but hedged their bets a little and informed me I should go to the emergency room if I had more concerns. 

Not long after that, I started noticing other things. Going up the steps to the train, one hot mid-June day, my vision whited out and I had to sit and pant for a full five minutes before I could see properly again. The boxes my partner shipped to me in preparation for his moving in with me were overwhelmingly heavy for me, yet my friends could lift them with ease. Was I so incredibly out of shape? I took to Googling different combinations of the words "very tired out of breath no reason." Each time, that pernicious Mayo Clinic page popped up. I made a doctor's appointment to discuss my symptoms. For July 10th. 

Coming out of the CT scan on July 7th, I felt very tired and mildly out of breath. The technician put down the handrails on my hospital bed so I could scoot on to it from the scanner. He said, "Do you have a history of serious blood clots in your family?" I said no. He didn't say anything else. I knew. 

It did not take long for a doctor to enter my room, the medical student from before in tow. She informed me I had a massive pulmonary embolism, the kind called a "saddle clot" because of its wide, saddle-y shape. It was blocking the blood flow to my lungs. They were consulting with a pulmonary specialist about it.

They left. I opened my phone and pulled up every article I could find on blood clots.

A pulmonary embolism happens after blood cells somewhere else in the body clot together—most typically in the legs. If left untreated, the clot breaks free of its birthplace and floats merrily through the bloodstream until it reaches the lungs. Once unmoored, it receives a new name: no longer merely a clot, it is now an "embolus," literally meaning "plug." In the spongy flesh of the lungs, the embolus lodges in the arteries, the vessels that carry unoxygenated blood inside the lungs to receive precious oxygen. Passing blood cells stick to the embolus' mass, growing it larger and larger until the artery is entirely blocked. If, on its journey to the lungs, a large embolus breaks into multiple pieces, it can lodge in multiple arteries at once. Eventually, the major pulmonary arteries are a mass of hardened, sticky blood cells forming a solid wall. 

Faced with catastrophic failure, the circulatory system shunts blood through smaller arteries and veins—keeping the body alive, but starving it of the oxygen that keeps the brain and muscles functioning normally. Eventually, there is no way for the body to sustain itself on this thin pittance of oxygen. It begins to fail. The estimated occurrence of death in untreated pulmonary embolism patients is one in three. 

Two cardiovascular surgeons appeared at my bedside. They told me that given the size and shape of the clot, they could perform a surgery called an embolectomy. Confusingly, they did not say they recommended the procedure—instead, they presented it as a choice: get the surgery, or remain on anticoagulants to see if the clot would dissolve on its own.

I lay under the thin blanket and tried to think. As my phone warned me its battery was nearly exhausted, I skimmed abstracts from the American Journal of Cardiology. I was determined to know what I was getting into. The more I read, the more nauseated I felt. The complications rate for the surgery was in the single digits, but it was several numbers away from "one" or "zero." There were potential side effects, of course, and possible complications. But more than anything, as I struggled to draw deep breaths and my heart pulsed weakly in my chest, I was afraid of the cost. I had recently started nannying for a family and there was a little more cash in my bank account than had been there for several months. But I knew it would be a drip in the bucket of medical debt if my insurance only covered part of the procedure; or worse, decided it wasn't necessary. 

I was texting constantly throughout all this. My partner, my parents, my friends. My mother was adamant I should get the surgery. She invoked a family friend, an emergency room nurse. "W says you need to get the clot out," she said. "She says it'll help you heal faster." I trust W a great deal. The cardiologists came back. I said I would get the surgery.

In the operating room, I met my anesthesiologist. She wore a beaded lanyard, and she had very gentle hands. I'd started to cry a little earlier, and I was trying to put on a brave face over obvious tears. I felt angry at myself that I couldn't be businesslike, calm and collected in the face of unexpected emergency surgery. I mustered some nodding and a few "yeses" in response to the anesthesiologist's questions. 

She said, "We're going to put you in something called a twilight state—you're not quite awake, not quite asleep. But you won't feel any pain." 

A man I'd not met was readying something by the side of the surgical bed. "Nope," he said, loudly, "General anesthetic." 

The anesthesiologist looked back at me. "Never mind," she said soothingly, "You'll be completely under." 

Several people helped me transfer from the hospital bed (soft, warm, wide) to the operating table (narrow, hard, chilly). The surgeons introduced themselves to me rapidly—I don't remember their names. There was a tremendous amount of bustle around me, many hands in blue gloves adjusting lights and arranging monitors around the table.

"We're going to start anesthetic now," the anesthesiologist said, "I'm going to put this mask over your face. Just breathe normally, and I'll count backward from thirty."

"Does this have an amnesiac in it?" I asked as the mask came down over my face.

"Yes, it does!" she said. 

"Good," I said.

As I lay unconscious on the surgical table, the surgeon made a small incision, maybe smaller than two inches, in the soft join where my thigh and my groin meet. One of the largest arteries in the body, the femoral artery, runs through the thick muscles of the thigh (the largest muscles of the body, therefore requiring some of the largest arteries and veins). At the crease of the groin, the femoral’s various outcroppings lie closer to the surface of the skin than anywhere else. Through the incision, my surgeons wove a flexible catheter into the artery, like rowing into a river from one of its smaller tributaries.

Arteries are favored in most surgeries of this type because they are much more muscular than their frailer brothers, veins. Sticking a catheter inside a vein is certainly possible, but a journey of any length risks tearing the vein walls or scarring their interior. Meanwhile, arterial walls are thicker, stretchier; much preferable for avoiding surgical accidents. 

The process of embolectomy is not simply sedate-and-cut. It's a surgery that involves the heart and lungs, and by proxy every other organ in the body. The surgeons need to remove as much of the clot as possible without small pieces breaking off and floating away to cause havoc elsewhere. Unfortunately, rapidly rushing blood through the arteries can easily sweep away such small pieces. To compensate, it has become common to induce the unconscious patient into a state of deep hypothermia. Chilly liquid is pumped into the patient through an IV, pulling their body temperature down, down, until the heartbeat slows and blood flow is a sludgy trickle. Little pieces of clot drift slowly, rather than racing away.  

The catheter slides through the circulatory system, guided by a camera, until it reaches the lungs. There, it either rotates a flexible wire inside its length like a tiny propeller, or shoots pressurized jets of saline; either way, it breaks up the embolus into smaller pieces. Suction within the catheter vacuums up the pieces, sucking them out of the body. Freed of the dam blocking the lungs, the blood can again exit and enter the organs as usual when the patient wakes.

It may seem cold and clinical to relate all of this as happening to "the patient," rather than "to me," but my knowledge of the surgical practice and my experience of it are strangers to each other. I was breathing in the anesthesiologist's mask; I was looking at the tear-blurred tiled ceiling of the operating room; I was closing my eyes to block out the bright lights. Then darkness, and the vague knowledge that time had passed—although how much time, I could not say. 

I woke slowly. I was being moved. My eyes were closed. I was cold, terribly cold, the coldest I'd ever been. I could not focus on anything but the cold. My teeth chattered frantically. I couldn't move; my muscles were locked in ice. I vaguely remember people exclaiming around me, and then, slowly, warmth radiating all around my body. When I could finally open my eyes, I saw I was wrapped in what looked like a huge sheet of white plastic bubble wrap. It was blissfully warm. The nurse appeared, perhaps sensing my stirring. She was cheerful, friendly, deeply sympathetic. "You were so cold when you came in, it freaked me out!" she said. The bubble wrap, she told me, was something called a Bair Hugger, and it was on its highest setting, cocooning me in tropical temperatures. I loved the Bair Hugger. I was still so cold. 

I blearily looked at the clock: it was 10 at night. I'd been in surgery for seven hours. I called my partner, my parents; updated my friends that I was alive and awake. And (it took another hour), I finally got some food—the first food I'd eaten since my glugs of maple syrup in the morning. An Activia sugar-free strawberry yogurt. I can honestly say it was one of the best meals of my life. I took a deep breath and realized that, for the first time in months, I could breathe. 

The feeling slithered back into its cave.

NEXT TIME: Why did this happen? And How do I stop it from happening again?

The Blatant Self-Promotion

• A spiritualism-inspired adventure for Trail of Cthulhu I wrote for Pelgrane Press.

• I wrote a goodly chunk of Renegade’s most recent Vampire: the Masquerade book, Tattered Facade. My favorite bit of mine is the hunting-in-the-city minigame in Chapter One.

Linx

• Animals getting CT scans

• Hogs with blue flesh (there’s a picture, jsyk)

• Here is a poem that I like

• The Biggest Croissant in Malaysia (and tumblr mirror)