They're Going to Cut Open My Belly and Rip Out My Guts
Faith, Trust, Humility and Medicine
Tomorrow, January 30, 2025, I’ll travel to the headquarters of a multibillion-dollar corporation and willingly let someone give me knock-out drugs so someone else can cut open my abdomen, slice out a piece of my colon, connect the severed ends to each other, then stitch the muscle and skin of my belly back together. This will have a remote but nonzero chance of killing me, yet I believe it will make my life better.
Assuming survival, I’ll be out of action here at Healing and Stealing for an unknown period of days, weeks or months, depending on: what my surgical team does while I’m unconscious; the skill, discipline and staffing level of the recovery nursing team; the strength of my immune system; my compliance with post-operative instructions, and; the need for pain medication. We’ll keep you informed of the progress as it happens.
A Potent Tug of War: Cutting out a piece of someone’s lower intestine is known as a partial bowel “resection.” Since 2016, I’ve had a series of episodes of diverticulitis, the clinical name for an inflamation and infection of part of my colon. Most people my age (63) develop diverticulosis, where the colon wall develops bulging sacs and thins out. Diverticulitis is when those sacs get inflamed and usually infected. A small portion of people who get diverticulitis get it over and over again.
That’s me.
In the past few years, I’ve gotten diverticulitis every 2-4 months. The infections are debilitating and have begun to steal weeks of my life each year. And as time goes by, diverticulitis patients face an increased risk of a severe, even life-threatening complication such as a bowel obstruction or a rupture of the intestinal wall that spills stool into your abdominal cavity. So after long consultations with various doctors, I’ve decided to have surgery.
For most people, major surgery presents a potent tug of war between fear and hope. The terror of the most intrusive imaginable violation of your body is balanced by the hope that a disease will be excised or an injury repaired, leading either to more life than otherwise might have happened, better life than what otherwise might be expected, or both.
For a health care writer, that emotional conflict is compounded by an additional conundrum: what do I say about it? Should I write anything at all? Saying nothing or sharing a one-sentence scheduling notice is definitely an option. Keep it professional. You’re not the story.
That kind of strained neutrality isn’t the point of Healing and Stealing. So if you come here only for fresh data and mordant commentary on the manipulations of the corporate executives and policymakers who control the U.S. health care system, feel free to stop reading. We publish a lot about the stealing in U.S. health care. What follows are some entirely personal reflections on the healing part - the sacred bond that lies at the heart of medicine, between people who are suffering and in need, and the people who heal and comfort them.
A Leap of Faith: Surgery is the ultimate medical miracle. Physicians, dentists, and other practitioners have been cutting open and rearranging or slicing out parts of the human anatomy for millenia, but the advances of the past 200 years defy belief. Today’s remarkable array of surgical techniques, supported by increasingly sophisticated imaging technology, are built on the foundation of two great 19th century advancements - the development of anesthesia and antiseptic measures to prevent infection.
As a 2012 New England Journal of Medicine review of the history of surgery noted wryly “[t]he first volume of the New England Journal of Medicine and Surgery, and the Collateral Branches of Science, published in 1812, gives a sense of the constraints faced by surgeons, and the mettle required of patients, in the era before anesthesia and antisepsis.”
Mettle? Indeed. The article describes harrowing procedures like cataract surgery that made me wince even when contemplated with modern anesthesia and without seem like the most ghoulish tortures.
My bowel resection essentially would have been impossible before publication of Henry Jacob Bigelow’s seminal 1846 article Insensibility during Surgical Operations Produced by Inhalation, describing the use of ether to render a patient safely unconcsious. Until that time, the New England Journal authors note, surgery “remained a limited profession. Pain and the always looming problem of infection restricted the extent of a surgeon's reach. Entering the abdomen, for instance, was regarded with reproach — attempts had proved almost uniformly fatal.”
The article reproduces a passage by 19th-century Professor George Wilson, written in response to claims from tough-minded Puritanical physicians that anesthetics were “needless luxuries.” Wilson recalled having his foot amputated:
The horror of great darkness, and the sense of desertion by God and man, bordering close on despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so. During the operation, in spite of the pain it occasioned, my senses were preternaturally acute, as I have been told they generally are in patients in such circumstances. I still recall with unwelcome vividness the spreading out of the instruments: the twisting of the tourniquet: the first incision: the fingering of the sawed bone: the sponge pressed on the flap: the tying of the blood-vessels: the stitching of the skin: the bloody dismembered limb lying on the floor.
I’m profoundly grateful to avoid Professor Wilson’s sense of “desertion by God and man,” in the face of unbearable pain, although nearly two centuries later his words hint at the essence of what I‘ll be doing upon entering the hospital.
Submitting to surgery is an act of faith.
I don’t believe in God, and certainly not in a conscious, invisible supernatural being that has a plan for each of us and occasionally makes random interventions in the material world. Many of the best people in my life do, or believe in a deity with a more amorphous set of powers. I’m honest enough to know that I don’t know who is right. For me, though, letting someone cut me open and rip my guts out is an act of profound faith in the very best of humanity.
I’m confident that the major advances that have made surgery a more common tool to heal injury and illness are real, arrived at through the exercise of intellect supported by leaps of intuition, even if imperfect, and not some long con contrived by a class of sadistic hustlers (although such people have plagued medicine for centuries). Despite the growing influence of financial conflicts of interest on medical publications, I believe that the scientific analyses of my condition published in medical journals, built on centuries of learning about human anatomy generally and digestion in particular, are accurate enough to warrant taking this risk.
Healing and Stealing readers know that my faith in medicine is contingent, hedged against the corrupt swamp of money that surrounds the practice of 21st century U.S. medicine. But that faith remains, as an acknowldgement that a simultaneous commitment to scientific rigor and and profound compassion are not only possible, but states of mind and feeling that a great many talented people in our society pursue with passion and dedication.
I had hoped write about my physicians and their staff by name, as I did Dr. Reznik and the Connecticut Orthopaedics team when I was forced to appeal my insurers’ denial of knee surgery last summer. Unfortunately, I haven’t had the time to finish a draft and show it to each of them to get their permission to do so, so they will remain behind at least a thin veil of anonymity. Perhaps later, I’ll edit it and identify them.
What it Takes to Trust Someone with Your Life: “Surgeons,” an anesthesiologist friend once told me, “are assassins.” He was talking about a moment where, having just witnessed a clear mistake that had killed a patient on the operating table, he watched a surgeon comfort the patient’s family as if the death were a random, inexplicable lightning strike.
Beyond a general faith in medicine, if you’re going to get surgery, you ultimately have to trust the specific people who take care of you. I’m not recalling my friend’s remark to question whether my surgeon would own up to a mistake if one happened, as they do with even the most skilled practitioners. Quite the opposite. I want him to have, and trust that he does have enough assassin in him to give me the best possible chance the operation will succeed.
I know people who faint at the sight of a drop of blood. To perform surgery well requires an entirely different response to the human body. I trust my surgeon to walk into the operating room and act with the cold-blooded, ruthless focus necessary to take my life into his hands, slice me open to perform a feat of astonishing skill and leave me better for it.
I trust him even though I don’t know him well. We met only once, with my wife Melissa present. He was thoughtful and open, listened and took care not to overstate what we know about my condition and the potential outcome of surgery. He’s an impressive guy, but that’s not why trust him. I think he gives me the best chance to survive and thrive because he was recommended by my gastroenterologist, who is one of a small group of doctors, therapists, physicians’ assistants and nurses who have made my life richer and more enjoyable than it might otherwise have been.
Humility - the Foundation of Medicine: For much of my life, I suffered from various digestive difficulties (I’ll try to tell the story quickly and without too many smelly details). Save for the diverticulitis, most of those symptoms are gone, thanks to two doctors who possess what I believe to be the most important characteristic of a good scientist or doctor: humility in the face of the body of scientific knowledge accumulated over many centuries and honesty in the face of what we don’t know.
Ten years ago, I came down with a case of Clostridium difficile, commonly known as “C-Diff”, a nasty digestive infection frequently associated with the use or overuse of antiobiotics. I’m pretty sure I caught it while taking a course of dental antibiotics that got exteneded when unexpected travel interrupted treatment for what eventually became a root canal. My primary care doctor listened carefully to my history, correctly deduced the source of my symptoms, and after a positive test, prescribed another long course of antibiotics to eliminate the infection.
It was a relief for a while, but after a few months, I started having similar problems - bloating, discomfort and then chronic, debilitating diarrhea. I was back to feeling exhausted and worrying about how close I was to the bathroom every second of the day.
My primary care doctor referred me to my gastroenterologist. Presented with my symptoms, he ordered every GI test in the book - celiac disease, lactose intolerance, another test for C-Diff, you name it. All negative.
After a few weeks of urinating and defecating in various containers, I met him at his office. After reviewing all the results, he said “look, we’re going to diagnose you with irritable bowel syndrome. What that means is that your digestion is messed up and we don’t know why. Some people have bad digestive symptoms like yours and we just don’t have a name for what’s going on with them or a way to treat them.”
Then he said something that changed my life. “One thing I can do is give you the latest research from Australia. A group of doctors has identified a set of carbohydrates that some people have trouble digesting. If you want, you can try their diet. What people do is take all of these foods out of their diet, see if things get better, then add the different groups back in and see if the symptoms come back.”
That was my introduction to FODMAPS - fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are classes of sugars that are difficult for some people’s stomach and intestines to break down. They sit in your digestive system and eventually ferment in the lower intestine, causing discomfort, bloating and sometimes severe, chronic diarrhea. I went home, took all of them out of my diet and my symptoms vanished in less than three weeks.
Done.
It wasn’t easy - the list of foods that do and don’t contain a large amount of these carbohydrates seems pretty random at first - eat strawberries but not raspberries? Sometimes it still isn’t easy to explain to wait staff why you need to know whether the home fries have onions in them. But now I can eat without feeling sick every day.
That’s probably more than enough excretory detail to last a while. What matters is my doctor’s ingrained intellectual humility. He had mastered his discipline’s existing science, yet was willing and able to discuss freely the limits of his own and his profession’s knowledge without embarrassment or defensiveness. He offered me the option to pursue a treatment course that, at the time, was still emerging in research in a leading medical school halfway around the world, with a clear explanation of what was known and what wasn’t.
I’ve had similar experiences with him at several other times. His dietary advice for diverticulitis has shifted as the research has gotten clearer, always without being defensive. “We used to think…” comes easily into our conversations. I trust him as much as I’ll ever trust anyone in that position. Humility in the face of the unknown breeds confidence in what is known.
So when diverticulitis landed me back in the ER this summer and he told me that, given the frequency of attacks and after this many years, surgery wasn’t immediately necessary but it might be time to consider that step, I thought long and hard and decided to do it. And when he referred me to the surgeon to whom he had referred family members, my trust and confidence transferred, lock, stock and barrel.
That bond, forged by honesty and clarity in the moment, but backed by years of learning and practice, is what medicine is supposed to be, can be, and should be. If you wonder about the source of the fury you may encounter here in articles about the stealing, now you know. The corruption and unnecessary disruption of the relationship between healer and patient should be unforgivable.
The Other Side: On the off chance that mortality cashes its longshot bet on me in the hospital tomorrow, I will go to the UConn medical school dissection table with only one major regret - spending too little time with and showing too little love to my wife Melissa, who still has the biggest, warmest heart I have ever encountered and who has bathed me in an astonishingly generous love for most of my life, and my sons Atticus and Aneurin, each of whom is a kinder, more decent person and better writer on his worst day than I could hope to be on my best.
But the odds are with me, and I have faith that I’ll see you on the other side and be better off for it.
Talk soon.