Tag: health

An Essay by Eric Picard

In 2017, I was living in San Francisco and working in Oakland, CA, at Pandora — the music software company, not the jewelry company. I was commuting back to Seattle on weekends to see the kids, but my wife also took a job in San Francisco, so we at least got to travel together.

On July 1st, 2017, Erynn and I got married in Newport, RI at the Colony House, the former seat of the Colonial Legislature before the country was a country. It was amazing, a wonderful wedding that was a long time coming; we’d been together for ten years. The story of our wedding is fantastic, but I’m not telling that story today. Instead, I’m telling you about what happened when I went back to work a few weeks later.

On July 18th, 2017, I was at work, in a boring meeting that I don’t even remember. And all of a sudden, my testicles started to ache. And I mean really ache. For the men reading this, the pain was sort of like two minutes after you take a big hit to the boys. That dull aching feeling deep inside.

After a few minutes of this increasing, I excused myself to go to the restroom. I stood up, and the pain moved to my lower abdomen, mostly in the lower back. It was excruciating.

I went to the restroom and checked on the boys, and everything seemed okay, but the lower back pain was terrible. And it’s hard to describe — everything just felt wrong. I was in a cold sweat. I felt panicky.

I went to my desk, and my group assistant took one look at me, said that I was green, and told me to go to the hospital immediately.

So, I went to a nearby urgent care. While standing in line, the nurse behind the counter looked at me and said, “Sir, you need to step out of line and go directly to the Emergency Room.”

I took an Uber to the closest Emergency Room, at Alta Bates Berkeley Hospital, and I could barely walk when I got out of the car. The attending ER doctor was kind of rude, and she seemed skeptical of my story, as if she didn’t quite believe me. But they gave me morphine, and I’ll tell you, this was a revelation for me. Morphine makes almost anything tolerable, apparently.

They did a bunch of tests, including an ultrasound of my boys. I had so much empathy for the poor woman who had to do that job. She looked almost as uncomfortable as I felt.

They also did a CT scan of my lower abdomen — without contrast. After about six hours, they sent me home. The attending in the ER basically accused me of “morphine seeking.” I was pissed. I told her I’ve never felt pain like this and asked what I was supposed to do. She said, “It’s my job to make sure you’re not going to die. And you’re obviously not dying. You should follow up with your primary care physician or maybe go see a GI doctor.”

Thus began weeks of pain, questions, and exhaustion. I could barely walk without being completely wiped out. And we lived in SOMA, about a mile from the BART Subway system. So, I was walking to the subway to go to work. Usually, this was a 10–15 minute walk. It was taking me 45 minutes to walk to the subway.

I saw a GI doctor who ordered another CT scan of my abdomen with contrast. That was scheduled for two weeks later. In the meantime, I was flying back to Seattle, WA, on the weekends, to see my kids. And I was exhausted. Everything took a long time. I couldn’t eat solid food, reinforcing the idea that maybe it was a gastrointestinal problem. I lost about 15 lbs in the first week, and would lose 30 before this was all over.

On August 8th, at 7:00 AM, I had my follow-up CT scan back at Alta Bates in Berkeley, this time with contrast, which was supposed to be looking at my GI tract. So, I went back to my apartment in San Francisco.

At 9:30 in the morning, I got a phone call from my GI doctor. Now, I don’t know about you, but that’s the one and only time an actual doctor has called me directly. I’ve had calls from doctor’s offices. But no doctor has ever called me directly.

She said, “Mr. Picard, where are you right now?”

“I’m at home on the sofa in San Francisco.”

“Is anyone there with you?”

Now I’m getting worried.

“No, I’m by myself.”

“OK, well… I’d like you to immediately go to UCSF Emergency room. I’m going to call ahead, and they’re going to be expecting you. You just skip the line and tell them your name, and they’re going to take you right back.”

Uhm… “That sounds like you found something bad. What’s going on?”

“Well, we discovered something on your CT scan that was unexpected. It turns out that you’ve had an abdominal aortic dissection.”

Gulp. “Okay. I know what all those words mean. But I don’t know what they mean when you group them that way. It doesn’t sound good.”

“No, it’s very serious. I recommend that you get in an Uber or taxi — that you absolutely don’t drive yourself — and once you’re in the car, you should call your wife to come meet you at the hospital.”

So, I get in the Uber and go to UCSF Medical. I knew it was serious, and I was really scared.

I get to the ER, and I walk in and go to the front desk, and I said, “I’m Eric Picard, my doctor said she called…”

And the nurse grabbed me physically by the wrist and dragged me back into the ER. “Right this way, Mr. Picard.”

Now, it’s important to say something I learned about emergency rooms that day — that I never knew before. ERs are set up in descending order of priority. Room 1 is the scary room — the one with all the crazy equipment in it. The machine that goes, Bing! If you go to the ER, and they put you in Room 9 or Room 14, you should feel okay about things.

As we walked into the back area, where all the doctors are, the attending physician looked up and saw the intake nurse dragging me back with her. She said, “This is Mr. Picard, he’s had an abdominal aortic dissection. I was going to put him in Room 2.”

He said, “No, let’s bring him right into Room 1.” This would have scared me more if I knew about the room order thing.

About an hour later, the doctors walked in and all were very grave. My wife had just arrived, and the doctor said:

“I have some very serious things to discuss with you both. I know this will be distressing, but I want to get your expectations set the right way. Your life as you know it is over. We’re going to run a bunch more tests on you, we’re going to redo the CT scan that they did over at Alta Bates, and we’re going to do a lot of work here. But the end outcome is going to be that you’re going to spend at least the next two weeks in the ICU on massive doses of blood pressure-reducing drugs. You’re probably not going to be able to work anymore. You’re not going to be able to lift anything. You’ll basically be laying in bed or on a sofa for the rest of your life.”

He left and we immediately started surfing the Internet to learn more. It wasn’t contradicting anything we’d heard. I found out that I was in good company. Aortic dissections killed Albert Einstein, Lucille Ball, John Ritter and Alan Thicke among many others. People with aortic dissections basically die. 30% die on the way to the hospital. 80% die within two years of their dissection. Not the most heartening news.

So, what is an aortic dissection? It’s basically a tear on the inside of your aorta that drives a small channel of blood in between the two layers of the blood vessel. Almost like a balloon animal opening up a new path along the inside of your aorta.

If you’re lucky, the bottom of this new balloon animal path tears back into the aorta, which leaves you with two paths through the one artery. If you’re unlucky, the outside of the aorta tears, and you die.

I also learned that normally a person with an aortic dissection is in their 80s, has super high blood pressure, is a heavy smoker, and is generally unhealthy. Which was weird, since none of those things were true for me.

Most of the time you hear about aortic dissections in the upper aorta, the part above the heart. In my case, this was the lower aorta, or abdominal aorta. The part that goes down from your heart towards your legs. Mine starts just below the branch off towards your kidneys, and goes just into my right leg.

So, the day went on, and I had all the same tests this time as the first ER visit. But this time I also met with the vascular surgeons, these are the doctors who specialize in things like arterial dissections, aneurysms, etc. Several medical students came in and looked at my aortic dissection on ultrasound so they could learn how to diagnose them better. I really wish that Alta-Bates’ doctors had that experience.

So, it was a great surprise when the attending physician and the on-call vascular surgeon came back in the afternoon and were smiling.

“Mr. Picard, I know we said some scary things earlier. But we’re going to send you home. You’re in a very small group of people who get a dissection but are overall healthy. And you’re young. So, we’re going to send you home. You should not fly, and you should just lay on the sofa and not pick anything heavy up. You can walk to the bathroom, you can eat, you can watch television. And we want you to come into the office to meet with our head of vascular surgery on Monday. We don’t want you to spend the next few days doing internet searches for your condition. Just take a few days and then come see us Monday, and we’ll think things through with you.”

Needless to say, it was a huge relief, but I did spend the next few days laying on the sofa, constantly surfing the internet, and reading every research paper on aortic dissections. The statistics are horrifying.

Monday morning arrives, and Erynn and I go to the UCSF vascular clinic to meet with the guy. Now, this is the guy who is the number one guy in the world. When I tell other vascular surgeons that I was seen by Dr. Charles Eichler, they audibly gasp or their eyebrows disappear into their hairlines. And my research and personal connections were all telling me — thank goodness you’re seeing Dr. Eichler.

So, we go into the office, and the ER Vascular Surgeon from the previous week comes in, Eichler being her boss, and she sits with us and chats while we wait for him. We wait, we chat, we wait.

Along comes Dr. Eichler — he’s gruff, barely acknowledges us, walks right past me, and sits at the computer to look at the scans. He reads through them and grunts, mutters to himself, grunts again. And he says, over his shoulder:

“You’re fine. Go home and come back to see me in a year.”

Erynn lets out a gasp. I’m confused.

“Uhm… I’m sorry, what? I can hardly walk. I can’t eat solid food. I’ve lost 30 lbs in less than a month. And they told me my life was over.”

Dr. Eichler realizes this is one of those moments he’s been clearly coached on. A ‘bedside manner’ moment. He rotates his chair and looks at a point somewhere above my left shoulder.

“All right, I understand. You’ve had something really scary happen, and it was traumatic. But you’re going to be fine. There’s nothing to do, you should just take an aspirin every day for the next month, and take it easy. You’re young, healthy and you’re going to be fine.”

“Well, that’s… good news? So I can start training for the Marathon tomorrow?”

“Sure, that’s fine,” he says.

“No, you don’t understand. I can’t eat or walk. Do I need to do anything? Is there something to fix?”

“Oh. You were joking. I see, well you’re in a tiny population. There aren’t many people like you. We don’t have any statistical data on people like you. Our best bet is to let your tear scar over and let you heal. In a few weeks you’ll feel better, and in a few months you’ll be totally back to normal.”

And he was right, for the most part. Two months later I was back to normal.

This does bring us to one major thing I learned. Healthcare in this country is NOT equal. Even among major hospitals, it’s not equal — the care I got at Alta Bates versus UCSF was completely different. UCSF was much better.

And also, the billing was totally different. My out-of-pocket bill for literally the same exact tests in two different hospitals was radically different. The total out of pocket bill for Alta Bates was almost $8,000. The total out of pocket bill for UCSF was about $2,500. Same insurance, same care, same tests. In fact at UCSF I saw more doctors, and more specialists.

What was the main difference? Alta Bates outsources their ER and all the specialists and testing. You’re in one hospital, but you’re engaging with a dozen or more individual businesses. Each of them bills individually. Some of them sent me bills more than a year later. At UCSF I saw doctors who are on staff, and I got one bill at the end of my treatment.

So, my advice to everyone is — shop your doctors and your medical care in advance. It doesn’t cost more to go to a world-class hospital rather than a closer hospital. And it doesn’t cost more to see the best doctor in the world, as long as your insurance covers it. Find a hospital that is a teaching hospital. Find doctors who are on staff, and who aren’t paid by the procedure.

My unexpected adventure with my aorta taught me a lot about the disparities in healthcare, the importance of seeking second opinions, and the amazing resilience of the human body. And oh, morphine was a revelation.

So, if you ever find yourself in a situation where your testicles start to ache inexplicably, remember my story. It might just save your life — or at the very least, get you a direct call from your doctor.