Foreword by Steerpike
It was 2008 – around this time of year, actually – that I sent an email to Jen, and asked in oh-so-casual a tone what it cost to maintain Four Fat Chicks, the beloved gaming site she had run tirelessly for nine years before announcing her retirement.
She told me. “Are you thinking about taking it over?” (absolutely not, I thought, I wouldn’t have the first idea how. I’m just curious).
And then: “You should talk to Brad. That’s MrLipid. He asked me the same thing.”
Well heavens, I thought. Maybe we could do it in partnership. That would make it a lot easier. He’d do the work, I’d take the credit, everyone would win. So I got Brad’s phone number from Jen and gave him a call.
More Foreword by Steerpike
Brad and I have now been talking pretty regularly over Skype for four years. That reedy, disembodied baritone belongs to someone who’s become one of my dearest friends. We’ve talked games and movies, websites, business startups, fecal transplants, Republican inexplicability, high school reunions, human centipedes; even one lengthy discussion about the giant bronze warrior Talos from the Ray Harryhausen classic Jason and the Argonauts. We’ve endured technical nightmares, hackers, DDOS attacks, name change, host migration, and me breaking the place more times than either of us can count. We’ve been friends for a long time now. Like so many people associated with this site, I have never shaken his hand, but that doesn’t make him any less precious to me.
Not long ago Brad went through something that almost took him from us. This is that story.
When I read the first draft I called and asked if he was sure about this. It is, after all, a personal and terrifying experience. To my shame I admit I’d been the one to suggest he write about it, callously not realizing until the instant after the words left my thoughtless lips that maybe he didn’t want to put his most harrowing moments, his brush with Hell, up on a game site. To be honest I felt more than a little guilty. I’d only suggested it, but I was kind of feeling I might have made him feel obligated.
“Everyone hears these stories, but they’re about people they’re not connected to,” Brad replied. “But the people on Tap are part of our lives. If they hear the story from me, it might become more real.”
There are morals to the story, and messages. But mostly it’s an honest and frank narrative, written in that classically dry, wry, only-him MrLipid style. Be warned that it is also as scary a thing as I, at least, have ever read; because it happened to someone close to me.
One of the most wonderful things about the time in which we live is how it’s brought us all together in unimaginable ways. That opens us up, naturally, to more loss as well as more gain. That I’d never have known any of you existed were it not for Four Fat Chicks and Tap, and that such a thing would have irredeemably diminished me, is what I learned as I read this. “More loss” is a risk I’m willing to take. But it is nonetheless something we have a responsibility to appreciate, and remember.
Game (almost) Over!
Being the tale of my nonfatal myocardial infarction (NFMI aka nonfatal heart attack), subsequent back-to-back GI (gastrointestinal) bleeds, and struggle to sort out all the hospital bills.
Oh, and finally, a fair amount of medical lingo (with plain English definitions) to give the whole experience a veneer of verisimilitude.
My First NFMI
My story begins with a modest chest pain after a speaking engagement in late October 2011. Modest, in this case, means a perceptible but hardly crippling tightness behind my sternum. Went to bed with the pain, noticed it, slept. Woke up, noticed it was still present, thought about what my wife had said about digging me up and killing me again if I left her by dying from something like an untreated heart attack. Decided to do something about it.
Showered, shaved, drove to the emergency room, and stated I thought I was having a heart attack. That got people’s attention. Saw a physician’s assistant and his assistant, got an EKG (electrocardiogram – traces the electrical activity in the heart), got a ride in an ambulance. Seems I really was having a heart attack. Got to the hospital, was told that there was triponin (an enzyme found only in the heart) in my blood, which indicated a heart attack since triponin only leaks out into the blood stream when there is damage to the heart. Given my low level of pain, I preferred to think of what was happening as an “enzyme leak.”
Got wheeled on a gurney to a private room where I was put on a heparin IV (intravenous) drip. A drip involves one of those hanging bags that dispenses a measured amount of liquid through a tube and then through a needle into a vein in one’s arm. (Little did I know how many needles I would be poked with in the coming month). Heparin is a powerful anticoagulant (blood thinner) that heart patients are given to prevent or break up clots that might form in the blood and create problems somewhere else in the body. Unlike warfarin, which is an anticoagulant usually given in pill form, must gradually build up to therapeutic strength, and was first used as rat poison, heparin is an anticoagulant that works almost instantly, making it ideal for emergency situations. Which, apparently, I was now in.
My wife arrived, having been called from work. I put on my chipper face and said my discomfort didn’t even rise to the I-shouldn’t-have-eaten-that-last-burrito level. I was definitely glad to have her presence in this strange new world. I had managed to last sixty years without spending any time in a hospital.
An internist and a cardiologist dropped by to talk about what I might expect in terms of treatment. I might need a stent — a fine metal mesh tube inserted into a narrowed artery to keep it open. Or I might need my coronary arteries reopened through the insertion, inflation and withdrawal of a small balloon. There was an intense discussion of the pros and cons of bare-metal stents or drug-eluting stents. (A drug-eluting stent has been coated with medication which is slowly released, or eluted, as blood flows over it.) Show of hands from anyone who has ever run into the word “eluted” before.
Got another trip, again on a gurney (I never walked anywhere as a patient), to another part of the hospital where they perform an angiogram. A thin tube was inserted in my femoral artery (they cut a small hole in my crotch next to my junk and feed the tube up to my heart), and the doctors took a look at the condition of my coronary arteries. Some blockage, but nothing worth an operation. No stent required, drug-eluting or not, and no balloon.
Back to my room. The cardiologist, having heard I didn’t require his healing skills, had vanished and only the internist remained. I was told what to expect from the drugs he was recommending. He recommended a beta blocker and a statin in addition to the ACE inhibitor and low dose (81mg) enteric coated aspirin I was already taking.
Let’s go to the drug store…
Time to sort through this pile of pills. ACE (angiotensin-converting-enzyme) inhibitors, originally synthesized from compounds found in pit viper venom, lower blood pressure by reducing the ability of blood vessels to contract. Beta blockers lower blood pressure by causing the blood vessels to enlarge. Statins reduce the amount of cholesterol in the blood stream. The theory behind the therapeutic value of statins is that cholesterol can build up on artery walls and cause a disruption of blood flow in someplace vital like, say, the heart. (I say “theory” because there is a fair amount of debate within the medical community about the value of statins.)
And finally, the lowly low dose (81mg) enteric coated aspirin. It’s called low dose because a single standard aspirin weighs in at 325mg. The enteric coating keeps the aspirin from dissolving before it reaches the small intestine. Aspirin is an acid (acetylsalicylic acid) and it can cause mischief if, for example, it dissolves and disperses in the stomach.
I was told that the beta blocker tended to produce fatigue and I should be ready for that. (Brace for fatigue!) It was suggested that I take it at night and use its side effects as a sleep aid. I was not told, and only learned later, that a possible rare side effect of beta blockers is spontaneous bleeding.
I suggested it might be an idea not to start multiple drugs at the same time since it would be difficult to sort out any side effects. We settled on my starting with the beta blocker.
I was taken off the heparin drip and told I would be discharged in the morning.
A nurse showed up in the middle of the night like Banquo’s ghost and asked if I wanted to take my first statin. I explained that I had already had this conversation with the internist and had decided to start with the beta blocker.
Went back to sleep and awoke eager to leave. Midmorning a nurse came in and presented me with a small cup containing the daily drugs I was to take from this point on. There was the ACE inhibitor, the beta blocker, and a single low dose aspirin.
There was also a small brown bottle, about 2/3rds the height – and a bit more in the girth – of an AA battery. It contained 25 nitroglycerin tablets. Like the tablets Clifton Webb is reaching for in Laura when he collapses. I was told I was always to keep them on my person, and always to keep them in my right pocket. In the event of severe chest pain, I was to sit down, place one tablet under my tongue, and let it dissolve. (They fizz if they’re fresh.) If the pain had not gone away after taking three tablets, I was to call 911 (emergency medical services). The sitting down part was important because there was a possibility of falling down after taking the pill. Nitroglycerin, in addition to being a great way to blow things up, is also a rapid-acting vasodilator — it opens up the vascular system and allows blood to flow more freely. If it were to flow rapidly out of my head, I might not be able to remain upright.
I put the tiny bottle in my right pocket and took my other pills with a glass of tepid water. Instructions upon discharge included seeing my primary care physician within ten days. Per hospital regulations, I was taken by wheelchair to the discharge area while my wife fetched our car, picked me up, and drove me home.
I thought my exposure to modern medicine was pretty much over. I was wrong.
Well, I did not notice this box but the one down below so I posted a response down there and goodness knows where it went. I am a dufus.
In summary, amazing story Mrlipid. I’ve not been at this site lately but I have time on my hands of late so thought I’d poke around and your story caught me off guard.
Sounds like you have a wonderful woman at your side! I was amazed at the amount of blood you lost. In game turns I am giving you +20 end, +15 str and I am tossing in +5 spell power for your consumption of a twilight drug. 🙂
Hope you continue to do well.
Gah!!!!!!!!!!!!!!!!!!!!!!! That was scary but infectious reading!! Glad it has a happy end but really, every time I get reminded about the health insurance American-style I get shivers.
Amazing experience, Mr. Lipid and one that, hopefully, being as challenging as it was, really made the taste of living ON for you better.
@Auditrix: I do have a wonderful woman at my side. Thanks for the good wishes.
@Meho: Every day’s a win. And everything tastes great.
Jesus, Mary and Joseph! Your whole story just reinforces my thought that “modern” doctors are simply casting chicken bones and hoping for the best.
So glad you lived to tell the tale, MrLipid.
@Toger: Thanks. I’m grateful I’ve got a place to tell it. And long-time friends who are willing to listen.
I felt a bit jelly-like reading chunks of that, absolutely terrifying but wonderfully written. I’m so glad you’re feeling well now mrlipid and I hope it continues, I don’t think you can go wrong with daily scrambled eggs for breakfast though. Eggs benediction indeed!
I’ll echo Meho’s thoughts on American healthcare. 100,000/60,000USD is just a staggering amount, and let me get this straight: the insurance company pays that? How much does healthcare/insurance usually cost from month to month then?
And thanks for the How Doctors Die link, that was a real eye-opener.
@Gregg B: Thanks.
Here’s a breakdown on the costs. The total bill for the heart attack and two GI bleeds came to $ 100,000. The bill for the heart attack care came to about $ 35,000 and the bill for the bleeds about $ 65,000.
I pay roughly $ 625/month for insurance with a $ 2000 deductible. I’m on the hook for the deductible plus a percentage of total bill after that. Which means the out-of-pocket cost to me was about $ 3000 and the insurance picked up $ 97,000.
If at all possible, I plan to die like a doctor.
Lipid also pointed me to the How Doctors Die link. Eye-opening is right. It’s something that’ll always be in my mind from now on when there are medical emergencies.
We could have a long, long talk about American healthcare, but it wouldn’t make anyone happy. My mother was in the hospital a couple weeks ago – one week, $55,000. The battles with Medicare are as epic as the battles with private insurance, which will actively look through your entire health history for a reason to refuse you when possible. “You were hospitalized with a minor stroke? Well I see here that you were treated for a concussion 35 years ago. Preexisting condition. No coverage, sorry (we’re not sorry).” What’s most baffling is why so many Americans vehemently oppose reform.
I’ve given MrLipid very strict instructions (a) not to have another heart attack and (b) not to go through any of that again. Assuming he follows my orders he”ll be with us for a good long time! 🙂
One of the advantages of being in a high risk pool is that the high risk pool, by definition, assumes preexisting conditions…and has no choice other than to ignore them. It’s the insurer of last resort and can’t be fussy about old concussions. Or hang nails.
I pay tax of around £600 per month and earn around £1,500 after tax. The tax I pay covers all my health care and local services such as council tax and the amenities they provide, bin collection, police, fire services; basically everything that’s public sector my taxes go towards.
I would consider £500 a month for all this (considering 99% of services I don’t use) rather a lot of money, but I’m incredibly grateful for the NHS. I’ve been nothing but ill all year and have had dozens of trips to the doctors. I also dread to think how much removing my tonsils would have cost privately.
Lipid, I shall finish reading your article (tonight, promise)
As trivia, Lewis, I did some Googling and in the States an uninsured tonsillectomy would set you back about $6000 for the procedure. There’d be added costs for any blood or lab work, anaesthesiologists, and of course if you have to stay in the hospital overnight that’d be a large addition. I’d say it could be managed for around $8500 all-in.
What’s so maddening about MrLipid’s experience, beyond just the scare, is that 75% of it was caused by doctors. Well-meaning doctors, sure, but aside from the initial issue it was, as he put it, a “disease caused by treatment.”
I made the shocking mistake to read this when I was hungry and a little tired. TWICE. Both times I wound up feeling a bit dizzy. It reminded me of my own (nowhere near lethal!) agonising visits to the hospital a couple of years ago, all bottoms and colonoscopy. I hate that feeling of being so vulnerable and fragile, that there are things inside of us that might just go pop and bust; and that’s what MrLipid’s incredibly matter-of-fact monologue brought home. Even though it was the treatment that was life-threatening that the original problem.
Glad you made it through MrLipid, despite the better efforts of your doctors =)
@Harbour Master: Thanks. Glad to be here.
I take it as a huge compliment that you read it TWICE.
Ah, I wish I could say I read the whole thing twice! I just got queasy and had to stop until I had got some food inside of me. But I did read the passages about your first bout of “diarrhoea” twice, once to make just to work myself into queasiness, second time to prove I was good to continue.
@Harbour Master: Then I take it as a huge compliment that you got through it. 😉
That was extremely brave bit of writing mrlipid. I commend and thank you deeply for it. Admitting vulnerability and owning it like that is against the big book of macho rules (and more manly than not crying or remaining stoically silent).
Having had my share of brushes with the American medical miasma, I could really relate to much of the what you revealed. Your use of wit and humour through the piece helped soften the ugly truths spilling out of the experience. Out of compassion, and simply to relieve a bit of misanthropic disdain for industrialized health “care”, I took a Rango break about half way through. If the writing was of less quality I surely would not have returned; but, you have a gift for storytelling.
Here’s to hoping that you find more beauty in your future than in your past, and more joy in your present than in paths not taken!
@Brown Fang: Wow. I’m humbled. Thanks.
De nada. 😉
I apologize for all the typos in my post (wrote quick without editing).
Bloody hell, mrlipid. Bloody hell. Glad you are still with us. I’m 61 and so far haven’t had the pleasure of any long hospital stays. You always think you’ll be different, that the docs and tubes and machines won’t get to you but it always does. And yes, first rule, ALWAYS be nice to the nurses.
Wow mrlipid, I don’t even know what to say. Horrendous experience, fantastic bit of writing. Glad you are still with us and hopefully you will never have to go through that again.
Thank you for sharing your experience with us. It was eye opening and has given me plenty to think about and be thankful for. You tend to forget how quickly your life can be turned upside down and what we take for granted on an everyday basis.
Much health to you my friend and to all fellow Tappers.
@Scout: Bloody hell, indeed, Scout. Bloody hell, indeed.
For what it’s worth, I’m 61, too.
@tanis38: Thanks. Life is fleeting. Don’t miss it.
Mr Lipid, that was very scary to read but so marvelously written. In the beginning, it sounded like what I experienced about a year ago when my husband had a quadruple bypass. He had been suffering pain while playing tennis for quite a while and never told me. Finally he went to the doctor. We were lucky that he came through it with flying colors, thanks to a wonderful cardiac surgeon. But your story quickly descends into horror. It makes me angry that the medical profession didn’t do better by you. I am so glad that you survived your ordeal. Take care of yourself and enjoy your eggs.
MrLipid, first let me say I’m happy to hear that you FINALLY got through that horrible ordeal. I also admit I had to cut your story up in separate parts to read, because I get queasy and faint easy when it comes to blood and needles and the ilk. I can’t imagine confronting one’s mortality to that extent. The worst I went through was having my appendix removed (which wasn’t great). Health is very fragile, thinking of how complex our bodies are and what all can go wrong. It’s also scary how much we still have to learn about how to properly diagnose and treat various ills. Depending on our medical system to be the knower of all is … well … probably a tad misguided. Still, it is amazing the talents that the doctors and nurses and specialized surgeons all possess and the benefit to humanity that they bring. It also brings to mind how much faith the world puts in all these prescriptions. While true that many are life savers, it’s scary to realize how dangerous side effects they can bring when combined with others. All in all, we just put our faith in the system I guess and keep our fingers crossed. My personal mentality is to not take drugs unless I absolutely have to. Other than a daily vitamin, that’s about it.
I wish you well and hope you now have many healthy years in front of you to focus 100% of your energies on Tap Repeatedly again. 🙂
@Pokey: Thanks. Glad to hear your hubby is doing fine. As for the medical profession not doing better by me, I think they did their best. The nurses were great. As far as my ordeal, I’ll paraphrase the pilot’s line about landings: any hospital visit you can walk away from is a good one.
@lakerz1: Thanks. Didn’t realize I was writing a serial. 😉 I tend to forget that it’s a big advantage to have no issues with blood or needles. If you want to read a book that may tell you more than you want to know, read Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch. Yipes! And now, your kind wishes in hand, back to the games!