I’m not certain of the date.  Might have to change it if this is not correct.  I”m going to say, March 9th, of this year.  2013.  I think that’s right.

I was in the yard of our country place,  puttering.  A neighbor drove by and commented on the yard, and the nice day.  I agreed.

Suddenly, there was a gnawing abdominal pain.  I climbed carefully up the hillside on our property, to the house.  The pain increased in intensity.

I wondered if it was indigestion.  It seemed worse, then I wondered if i was about to have diarrhea.  I headed to the bathroom.  Nothing.  The intensity continued to climb.  Now, it was a searing, all encompassing pain.

My partner was at Costco.  I texted him, I was in trouble.  I thought, differential diagnosis.  Location, abdomen.  Mainly left upper quadrant.  Rapid onset.  Debilitating pain.  I was thinking, possibly, heart attack – likely, inferior (lower heart) myocardial infarction (again, heart attack), or abdominal aneurism.  I needed him back home.  I wanted him to drive me to the ER for my health plan.  But I was also thinking, I might die.  Either diagnosis at the top of my differential can do that.

He didn’t answer.  Later, it turned out that his I-phone was in his car, and he was in the store.  I didn’t want him to come home and find me dead, just because I was trying to save the health plan money by not calling ambulance.  This was a true emergency.  I called 911.  This property is new for us.  I didn’t remember the address.  I asked if they can use gps on cellphone to locate me.  No.  I crawled to the other room, found some junk mail, gave them the address.

EMTs arrived.  They assessed me. They were also thinking the same differential diagnoses.  They administered morphine, oxygen.  I don’t remember if there was aspirin or nitro, maybe.  My partner arrived.  He was, I know, stunned by the developments.  But he rallied, corralled the dogs, got the neighbor kids out of the street, and followed the ambulance to the hospital.

I asked for the hospital for my health plan.  EMTs insisted on the closer hospital, a catholic hospital where I worked for a while, part time, maybe 6 years ago.  I did not want to go there, partly because they are terrible at communicating with my health plan, and I was concerned about discrimination.  But I did not have a choice.

At the hospital, I got the feeling the ER doctor thought I was faking it.  Maybe a drug seeker?  He asked what I thought was happening.  I had told him, I am an Internist, and gave my differential.  By this time, the morphine had helped with the intensity of pain, but my abdomen continued to be very tender.  He asked, what did I think he should do.  I responded, rule out MI (make sure this wasn’t a heart attack), and get a CT Scan of the abdomen to rule out dissecting aortic aneurysm (basically, a rapidly expanding explosion of the aorta that can quickly cause death).

That’s what they did.  I was not having an MI.  He came into the room after the CT, and told me he had bad news.  He proceeded to tell me, as an ER doctor, he often has to tell people bad news, so he is good at it.  After some more beating around the bush, he said, well, there actually is a reason for the abdominal pain.  There is a tumor in the stomach lining, about 10 cm diameter.  The center of the tumor was necrotic – basically, dead – and the pain caused by bleeding into the tumor.  Most likely, GIST.  GIST means, “gastro intestinal stromal tumor” – an uncommon type of cancer that most doctors never see, and I had never seen in a patient up until now.  He then asked me, what do I want to do about it.

I was thinking, this guy is a jerk, many of the nurses in this hospital were mean, the catholic management of the hospital will not respect my partnership and my partner, or my wishes if it goes really bad, and I don’t want to be in this hospital.  A tumor of that size, infarcted, hemorrhaging, but no aneurysm and my vitals were stable.  I stated, I wanted transfer to the hospital in my health plan.  My health plan is all for that, and I knew they would not only approve but, given the chance, demand it.  Ultimately, they took me by ambulance, 30 miles, across state lines, to the “mother ship” hospital of my health plan.

More assessment was to follow that day and the days to come.  This is my memory of Day Zero.