Feb 11th I had my tonsils out, Feb 15th I had to go to the ER for emergency surgery to stop bleeding out of an artery in my throat. In hindsight there were many points on the decision tree that could have left me dead. This is me unpacking that experience, so is long, rambling, and without spell check:

I had my tonsils out as a 37 year old adult. It is very different recovery procedure vs a kids or young adults. Tonsils are generally useful things and in the modern world apparently better to be left in than taken out.

However after a series of terrible infections in October I learned from an ENT that even healthy, my tonsils are fucking huge. As a ‘big guy’ I also have a small jaw and a deviated septum, combining to make sleep when I have healthy tonsils miserable without a the aid of a cpap machine, and when sick, nearly impossible.

Fast forward to February, when travel, work, life align for me to have the procedure, which is decided to both remove the tonsils and fix the deviated septum (the first week of recovery is so miserable, they suggested i do both since I’d not really notice the difference with a broken nose - this is in fact true).

February comes around, my fiancé is able to be here with me since this will be the first time in my life I’ll have undergone a surgerical procedure, let alone general anesthestia. Her being 8 hours time difference away while I recover solo seemed like a terrible idea. Parents scheduled a vacation to visit as well to be on hand. Both of these were great ideas.

Fast forward: Procedure happens, nothing strange, easy recovery for the first 4.5 days. I mean it sucks. It’s painful, as adults we probably all clench our teeth more than kids, so after your jaws have been forced open for them to operate on, the same muscles that are near where your tonsils formerly were feel like they’ve been hit with a cricket bat. The worlds worst TMJ. And your fucking ears hurt cause those muscles wrap around the ear tube bits.

The thing about tonsils is the doctors can’t use stitches to hold the wound closed after they are removed. They cauterize the incisions. This is where being an adult without the wolverine healing powers of youth makes this suck. The only thing that is keeping those wounds from opening up and you bleeding out are blot clots and scabs. Around 5-7 days or so, they can start falling off - for kids at this point the underlying tissue has probably fully healed and complications are rare - for adults theres a 4% chance you start bleeding again with the only way to stop it is to cauterize it. Which is in essence doing all the terrible bits about a tonsilectomy over. In this case on the saturday night after Valetines day.

Friday I have my first post-op visit, see the ENT, get the stents from the septioplasmy out. Get reminded again to be wary of spitting up clots and scabs, to chug / gargle ice cold water if one starts bleeding, to call the emergency contact number if it doesnt stop after 10 minutes. But otherwise I’m healing fine, I can add some solid food besides apple sauce and jello to my diet, and go on with my recovery. Atleast my nose felt a ton better.

Saturday afternoon the first clots come out - seem to be more from my nose than throat (still a problem, but not as big, if I don’t stop it), manage to get things under control, but still feeling unsure about it, I call the emergency line. Oncall doc gets back to me, figure out the at the ER/Hospital that I’m familiar with (and takes my insurance) is one they have admit rights to (since this procedure was done via my physicians clinic, not said hospital). Pretty much the “ok, what should I do next if this shit happens again?” - because I understand there isn’t just going to be one of these. Other things to do: gargle fresh water, swish and spit three times, then see if you’re still seeing blood or was it just bloody mucus. Keep it cold to slow down circulation so scab / clot can take hold (so look like a cartoon character with a toothache).

Finally decided I didn’t feel comfortable sitting around not knowing if this is really ok. It seemed ok but I was nervous, my fiancé was nervous, I didn’t want her to worry also I told myself. I should just go to the ER and have someone look at me, it’s expensive ease of mind I tell myself but I’m lucky enough to afford it. This is the point where I feel like I could have made a dumber decision and dismiss that as an uncessary worry.

So we go to the ER, grabbing a lyft, carrying an emesis bag which are the list of items you never knew you needed in your bathroom cabinet until you’ve had to use one, and then they are a godsend. Get seen by the ER ENT specialist, they get in touch with my clinics oncall ENT specialist, everyone knows whats up, he takes a look in my throat - sees that I had been bleeding, looked like it was from my nose, should be ok, but come back if it happens again.

We go home, have some food, and an hour later I get the senstation of something stuck in my throat. I start coughing a lot and now in hindsight it wasn’t food. It was a scab. A big one.

I end up spitting it up in the sink, and it’s ugly. I feel more blood coming, I start doing all the tricks, it slows down a bit, but I keep coughing and it gets worse. It generally subsides but never really stops, so we decide its time to go back to the ER. This time holding the lovely emesis bag under my chin and spitting the blood into it every minute or so along the ride. The lyft driver was a champ (also Lyft this time because I was 1- mobile and 2- knew that if I got back to the same ER as before I’d probably have a good chance just getting triaged immediately).

Walk back in, different front desk people, but within two minutes the same ER nurse comes back out and whisks me back to the same ENT room as before - it was a slow night apparently and early (another reason why I wanted to come to the ER the first time around 5pm when it could be slow and my little quibble could be addressed easily). They move me to a gurney when they see that i’ve got a bag of blood that I’m slowly filling up. I remember seeing lots of colors and saying that, them sticking me with fluids and getting my blood pressure backup - my 20 year old wilderness first responder training made me remember some things like to speak up about shit like that. I keep spitting up blood. So much fucking blood. And then a clot and then an even bigger clot which is when shit got scary. Spitting up a clot feels like giving oral birth to flying spaghettis monsters young - it’s a hardish ball covered in long hair like fibers soaked in mucus and blood (touched by his noodly appendage indeed). With the second one the blood was bright, almost foamy. I recalled enough of both highschool biology and pig butchery to know that’s wasn’t from a vein, but an artery.

Saturday night in the ER, spitting up blood from a hole in neck artery. This’ll be fine. At this point the Oncall Doc was there, they were already prepping for surgery - it was slow to get started because the night staff had gone home with a 30 minute return to station requirement - so technically everyone around me said it was going to be fine. No one acted like they were losing their shit. I felt like I was walking a tightrope, that shit could go sideways but just keeping my breathing and focusing on anything they told me to do to help stay on track was my best bet. The moment that sunk in for my fiancé of it going from ‘this is fine’ to ‘this might not be fine’ was when they brought in the tracheostomy tube acknowledgement form. When they put you under for the procedure, they try to do intubation (its what they did previously for me), but given the emergency circumstance there was a chance they’d have to resort to a trach to keep be breathing instead. That’s when she said she almost fainted.

Luckily my parents arrived at that point to provide a needed distraction and then began the awkward waiting as they connect a second bigger IV to me to keep me full of fluids. Blood results come back from the sample they took when I arrived and I was already borderline low, and that was before Clot and Big Clot arrived on the scene. I just get to sit there and spit up blood, try to make small talk with the ER nurse, and pretty much hope I don’t die and try not to think about that too much since can’t really do anything about it except what I was already doing.

Luckily I wasn’t loosing time, I was able to talk, my blood pressure was back to normal (all things considered), so just more waiting. When I was finally wheeled to the operating room, it was through a maze of hallways and elevators, the experience of being pushed around on a gurney when you’re a few pints low is surreal and sets the ground for a weird dissosociative experience. Get into the operating room, they have me move to the operating table, before I lay down the Oncall Doc comes in to say they want to put some marks on the neck now just in case. Oh yeah, for the trach I say. Yeah.

They bring over the O2 mask and say they are going to start to put me out, to which I remember replying with something like “fucking hit me, lets get it over with” which I then immediately recall thinking “ah they’re not going to take me serious now” before I start inhaling as deeply as possible so i can just get out.

I woke up later, everything was fine, I hurt a whole fucking lot, but got to spend the evening in the hospital (wrapped up around 1am i think?) and was slowly reinflated through my IV and having the sweatiest evening as the DVT bands around my legs that kept pumping them also made me always too warm.

The next day the Doc confirmed some things:

  • I have a small jaw
  • I have a big tongue (also swollen from prior surgery)
  • that made it one of their more difficult complications
  • they had to put a stitch through my tongue to pull it out of the to find the artery i was bleeding from (‘found the pumper - at the base of the tongue where it meets the throat and where the tonsil was attached’)

As I write this it’s been six days since it has happened. The first part of this week sucked as I couldn’t figure out sleep or really how to eat. My fiancé was amazing and kept me hydrated and put up with my terrible sleeping and getting up in the middle of the night. By wednesday I had my parents bring over Nong’s Broth (which you can get for $5/quart if you ask - protip for any hungover portlandite since you can order on caviar and add coconut water to it as well) and that started to get me enough calories to start feeling human. Temporary suspension of plant based eating is in effect until I’m not worrying about spontaneous arterial bleeding.

Followup from todays post-op ( part 2) is that I only have one scab left, the one that they had to cauterize last saturday night, so I’m not technically out of the woods yet. But my docotor was able to visually inspect it, and confirmed what I felt like a weird lump in my throat was the scab, so when that lump is gone, the scab is gone. It has healed great now it’s just waiting another two or three days before I introduce anything harder than soup or ice cream to my diet.

So that little fucking scab is still there, like loose weak stitch in the sail (or Oogie Boogie) that if tugged on can open everything up again, and restart the clock on my return to having a functional mouth hole again.

Other random thoughts:

  • I watched a shit ton of gourmet makes during the second recovery, having watched a lot of grand designs during the first recovery and currently unable to bring myself to watching that until I know I’m out of the woods since it was the show we paused before our second ER visit, weird I know
  • Nongs is fucking amazing
  • Our world of medical insurance is terrible and the number of possible points where financial burdens could have turned me away from getting the right care in the right timeline make it so really only the well off can afford to be healthy
  • Fun fact under the effects of scurvey the lesions that form aren’t new wounds, but old healeds wounds whose reparative tissue breaks down. So in the desert island situation, I’ll probably die of blood lose through my throat lesions now instead of the usual brain hemorraging (moana_youre_welcome.gif)