Voyage into Volvulus

Click on most photos to enlarge. If you dare!

Pro tip: If you look like anything at all like this when you reach the apex of your vacation, you are definitely doing it wrong.

Unfortunately though, that is indeed a photo of me taken on Wednesday, May 22nd, 2013, when I was actually much much better than I had been. My wife refrained from taking any pictures at the nadir of this story. All of which is why I, writing this up in retrospect,  think I’ve just returned from the Apollo 13 of vacations. Or maybe the Fantastic Voyage of vacations, considering that a miniaturized camera and high-tech equipment were sent deep into the nether regions where the Sun. Does. Not. Shine.

But we’re getting ahead of ourselves. Even before things began hitting the fan, so to speak, in a way, my timing in getting away on vacation was ill-fated: the week that the Obama administration was very visibly melting down, with scandals on all fronts, my wife and I skipped town for a 9-day long cruise through the Caribbean followed by 3 days visiting friends and family in New York, or at least that was Plan A. Still though, unlike El Rushbo, who always claims to think that bad “Progressive” news happens when he’s away, I don’t think my rep is quite that big enough to say that the Obama-ites deliberately picked this week to implode.

The flight out from San Francisco Airport on Wednesday, May 15th was remarkably uneventful, though the in-flight magazines provided by American Airlines were a hoot. There’s the base magazine distributed throughout the airplane cabin, and “Celebrated Living,” American Airlines’ “Premium” magazine, which can be found in their Admirals Clubs, and onboard their planes, in the first and business class cabins. Nothing tells your executive passengers that they’re part of a swank, exclusive First Class One Percent Livin’ Large elite group like a last-page magazine profile of the drummer from a heavy metal group, with a toothpick dangling from his unshaven mug:

Paging David Brooks — your idea of “bourgeois bohemians” has officially exhausted itself, along with the rest of the American limousine left. And paging heavy metal: the idea that there’s any sort of “rebellion” involved is done as well. Why it’s as if Keith Richards had himself photographed endorsing Louis Vuitton luggage. (Oh wait…)

The following day, Nina and I, and three thousand or so other passengers, clambered onboard the Royal Caribbean Cruise Lines’ Explorer of the Seas, departing from Bayonne, New Jersey, which always reminds me of the opening line grunted by Dan Aykroyd in an earlier, funnier 1979 edition of Saturday Night Live:

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This was the first cruise Nina and I have taken in a while that didn’t involve communing with the writers and readers of National Review. This time around, we were surrounded by lots of New Yorkers and northern New Jerseyites, which doesn’t surprise me, since driving to Bayonne to hop on a cruise ship for many east coasters is much more relaxing than dealing with the TSA and the purgatorial hell of sitting on an airplane (with or without having to read fawning profiles of the travel preferences of heavy metal drummers). Since I grew up in South Jersey, and Nina in Manhattan, the Nooo Yaawwwwwk accents certainly seemed familiar, although the amount of leg and shoulder tattoos didn’t — apparently you must have this much ink to ride this ride:

Potemkin village people: Yes, those are stereo Communist hammer and sickle tattoos on this oceangoing “gentleman’s” back.

Easy Rider Meets the Love Boat

Like Las Vegas, the typical American cruise ship maintains a certain level of ambient swank, but at least on Royal Caribbean, any sense of Old World hauteur is toned down sufficiently to make it accessible to all. Although getting onboard the first day and walking down the Explorer of the Seas’ Vegas-like promenade full of shops and restaurants while being assaulted by thuggish rap music makes my ears feel like they’ve been raped.  This is the first impression the cruise line wants to make to its largely middle-aged and older passengers? (I can’t imagine what someone in his 70s or older thinks of this aural assault.) Even the ship’s “Connoisseur Club,” its cigar and high-end hooch room, was playing Van Morrison tunes. Although I guess compared to the pneumatic jackhammer-like unmelodic gangsta rap, Van’s certainly a step up.

Friday the 17th was a sea day, and for the most part, I think I felt fine. On Saturday, we arrived in Bermuda, and Nina had reserved a private car and excellent tour guide, whose accent was a bit like a Caribbean Burl Ives, to give us a tour of the island. What’s astonishing is how clean Bermuda is. I think I only saw one patch of graffiti during the length of our excursion. But it’s a slightly Patrick McGoohan Prisoner-esque Portmeirion-like atmosphere: at first glance, the houses appear to be painted the same uniform three or four pastel colors, but can’t be painted the same color as a neighboring house, unless owed by the same person, and all of the roofs are identical in finishing, in an effort to collect rainwater for reuse. Apparently Ross Perot and Michael Bloomberg are frequent vacationers here. And Bloomberg must love the controlled tropical socialist tone.

On the other hand, though, there are pockets of hedonism and fun: onboard our cruise ship was a group of motorcycle enthusiasts, who had brought their bikes onboard, and were meeting up with their fellow riders on each island. Whatever racism was apparent amongst the motorcycle gangs of the Hunter Thompson/Gimme Shelter era wasn’t visible here — the American and Bermudian bikers happily roared off together in search of tropic thunder.

When the Plumbing Stops…

Sunday the 19th was another sea day, and it was at the Hillary-esque time of 3:00 AM in the morning that I began to notice that my internal…plumbing…was…not…working. Meals — and the food in general onboard the Explorer of the Seas was surprisingly good and plentiful — were going in, but they were Not. Coming Out.

This was not good.

Nina and I took the elevator down from our cabin on the tenth floor to the infirmary on deck one of the ship. Longest elevator ride of my life. They gave me Maalox and pills that would, in theory, rotor my rooter.

No luck — back in my room, I simply threw up the pills.

So back into the High Anxiety glass elevator, ten stories down to sickbay once again — where the staff gave me an X-ray, and the ship’s doctor announced that I was distended. Very distended. I thought she mentioned that John Hurt would be an excellent choice to star in the movie adaptation of what I was currently going through, but I may have misunderstood.

I was in agony.

I had an IV needle inserted into my left hand, whose visible hardware looked a bit like a Borg implant, to pump me full of saline solution and ringer’s lactate, both to keep me hydrated and because after decades of M*A*S*H and Emergency! reruns, it’s apparently the law that these be employed in any medical crisis situation.

But the next item pushed things even more to an Alien-like atmosphere, when a polypropylene tube was inserted into my stomach via my nose. (That’s it in the photo atop this post.) It was designed to drain whatever was left in my stomach out, and to reduce the chances of vomiting (though I was doing a fair amount of that at first as well). It was connected to a thick Baggie that eventually filled up with a dark greenish liquid. (I think a technician named Ash checked to see if this had a potential for use in the Weyland-Yutani weapons division, but again, I may have been hallucinating from the pain by then .)

My wife thankfully spent the night with me in the infirmary, sleeping in an adjacent bed (and I use the term loosely; it might also have been a gurney); the gray spartan linoleum-covered floors and walls made for quite a contrast with our swank cabin ten stories up. Little did I know that this was just the first of a pair of transitions further into the Heart of Darkness.

On Monday morning our ship arrived at its next scheduled port of call, Philipsburg in St. Maarten, Netherland Antilles, an island with a total population of about 77,000. I was rolled off the ship on a stretcher, and was then placed, along with Nina, in the back of an ambulance. Sirens blaring, the ambulance departed the dock, with two of Bob Marley’s ex-roadies onboard (OK, I’m not sure of that last detail) as driver and attendant, loving every minute of tear-assing through their island’s narrow, mostly one-way streets, on our way to the St. Maarten Medical Center.

The hospital, which was built in the early 1990s, is a largely concrete two-story affair built around a pair of central open courtyards. I was wheeled into a small room, which looked like a Hollywood production designer’s attempt at creating the stereotypical third-world 1950s examination room. Except smaller, because there was no room here for the lights and 35mm Panavision film camera, especially once Nina, my carcass writhing about on a stretcher, a large suitcase, and a pair of laptop bags were crammed into the tiny room.

A young female local doctor introduced a tall plaid short-sleeve shirt and blue jeans clad dark-haired male doctor. We didn’t catch his name, but think of a vaguely Teutonic Robert Mitchum. He ordered an X-ray and left. I was wheeled into the X-ray room, which took way less time than it would have in 99 percent of U.S. hospitals. Returned to our stereotypical third-world examination room, once we paid the lab fee (via credit card; it was apparently separate from the main hospital fee), Mitchum the Teuton (to borrow from a memorable Fred Siegel article on Mencken) eventually returned and announced that I had to be admitted, and watched. And watched. And watched until they could find the source of my blockage.

My gurney was wheeled down the hall, past one of the open-air courtyards. (The main corridor has plastic accordion-style walls, which were open the whole time we were there, to let the sunlight and warmth and humidity and mosquitoes in — and give the staff and patients a stunning view of the verdant green mountain behind the hospital):

The Password is: Volvulus

I was assigned a room with three men of the island, each of whom looked to be somewhere between middle-aged and Methuselah. In retrospect, the facilities were relatively modern and pleasant, but given the agony I was in — and the existential fear I was drenched in — I felt exactly like I was in one of those clichéd scenes in the Warner Brothers gangster movies of the 1930s, when Edward G. Robinson or James Cagney is first thrown into the Big House. How long am I going to be here? How do I bust out?

But busting out, in a sense was the whole problem. Eventually, the diagnosis came back that my colon had developed a volvulus, which basically means it was so badly twisted, it was completely blocked. And if the massive amount of waste and gas inside it ruptured, the high likelihood of infection would leave me in very bad shape, possibly even being fatal. But sadly it was only after a night in the hospital, another set of X-rays, and a day of agony that this condition was discovered on the last set of X-rays.

Not only didn’t we know what was wrong, but we didn’t know whether I could be sent on a Med-evac flight to the U.S., and all I knew was that the pain was staggeringly intense. If I balanced myself just right, sitting Indian cross-legged style on the hospital bed, it would subside by a slight amount. But otherwise, I was wrecked.

The attending doctor eventually recommended a colonoscopy, but not just a regular one; this was a special one with a balloon and vacuum cleaner added to the camera. Actually he didn’t recommend anything; he gave me a choice of having the procedure or waiting in extreme pain for my colon to rupture so I could have major surgery. The theory is, the probe is twisted and turned through the volvulus, the balloon is blown up — whoopee! — and then withdrawn, hopefully untangling the torsion. All the while, the vacuum cleaner is tidying up the interior, if you get my drift.

That was the plan, at least, which the doctor performed on Tuesday late afternoon. Immediately before he began, I was given a sedative through my Borg IV input, but it had not fully kicked in by the time the probe had docked, IYKWIMAITYD. Between the pain of the initial entry and my cramps, which by then were at their worst, I believe I was making the appropriate amount of blood-curdling screams. (See also: John Hurt in Alien, once again.) However, the doctor’s response was something along the lines of “Cut that out! Don’t be such a baby!” I think he was kidding around, employing a little tough love, but geez, it’s not every day the Proteus capsule is sent out on a new mission.

Fortunately, the sedative began to kick in, and things began flowing, and the doctor was able to rotate the twisted portion of my colon back into position.

Back in my cell ward I felt like a new man. That night, I never slept more soundly in my life. I was alive! Plumbing was working! I’m getting out of the Hanoi Hilton! Life is Good!

The following day was a long series of examinations and transitions. Plumbing still working? Check! No need for the plastic throat tube? Check! Although the nasal tube had been left in for quite a while after I was feeling better so that if everything wasn’t “flowing freely” they wouldn’t have to re-insert it. It was during this stage that my wife took the picture at the top of this story.

Payment? Cash.

In order to avoid the administrative fee the hospital charges, the operating doctor asked to be paid directly. My wife didn’t have any checks with her, and wasn’t sure what the whole procedure would be.  She also, she says, wasn’t about to trust my release from the hospital to a credit card terminal attached to a 56k modem.  (Plus, there’s just something remarkably comforting about American schmundo, as Jonah would say.)

So while I was inside the Hanoi Hilton, my wife was living out an episode of Miami Vice, withdrawing a rather healthy flashwad of cash from the local bank. She then proceeded to lock herself in the restroom and divide the cash into envelopes for the doctors, and another for anything else requiring immediate cash payment. Later the doctor rolled the privacy curtain around my bed, to count out the money Nina had for him.

Twice.

Coincidentally or not, while I hadn’t been plugged into an IV since early that morning, I still had the needle in my hand. It was only after the privacy curtain episode that he authorized a nurse to remove the Borg-like IV intake valve from my left hand. As she removed it, and put a cotton ball and bandage on the vein, she mumbled something about, “put a little pressure on that.”

What’s “a little pressure”? My volvulus and I had been under a lot of pressure for 3 days.  So I held the cotton ball, for a couple of a seconds, then forgot. By the time I looked down, the floor was splattered with a huge puddle of blood. We had been in a Miami Vice episode; we might as well have had plenty of  red, red vino on tap from Al Pacino’s Scarface as well.

In any case, fortunately, the vein was repatched, appropriate pressure reapplied, and it quickly closed. I packed up my Android tablet (my lifeline to the world, thanks to the hospital’s so-so WiFi) and escaped.

(Incidentally, at some point in this article, along with Dave Barry, I need to mention the importance, if you’re a middle-aged guy like me, of having your inners diagnosed to prevent this sort of thing. This is as good a place as any, so let my hell be your forewarning.)

The entrance to the Pasanggrahan Royal Guesthouse Hotel.

Yoda Guy. You Do Not Seek Yoda Guy…

The transition from our swank cabin, to the Spartan medical center on deck one of the ship, to the Hanoi Hilton was strange enough; suddenly, after a shuttle bus supplied by the port agent arrived to take me and Nina  back to the hotel she had been staying at while I was in the hospital, I was back at the hotel as well.

The Pasanggrahan  Royal Guest House Hotel in Philipsburg, St. Maarten is over a century old, and looks like a setting for a Ralph Lauren photo shoot. The following day, sitting out on the beach, overlooking the Great Bay of St. Maarten, everything began to feel surreal, not the least of which was the intense euphoria of being alive again still running strong. The day before I was wearing a grubby hospital gown. The next day after Nina broke me out of the Big House, I was wearing seersucker shorts, my trusty Rough Creek Lodge baseball cap, a Brooks Brothers tennis shirt with Quadrophenia-esque styling, and a pair of Carrera sunglasses. (With prescription lenses to offset my nearsightedness, of course.) I was never more proud of my wife, who was an absolute organizational genius while I was flopping around in the hospital.

Dennis Hopper’s Blue Velvet character could not be reached for comment.

Judging by the quantity of signage on the boardwalk behind the hotel, St. Maarten is a sort of Rollerball Island: it seems co-owned by De Beers Diamonds and Heineken. I felt bad not helping stimulate the latter half of the equation after all they’ve sunk into the local economy, but bubbly alcohol was contraindicated after my recent hospital stay. Though come to think of it, I’m mildly surprised they didn’t serve Heineken to us in the hospital. The only slightly ominous note was that the island’s birds seem to incessantly coo the “whoo whoo!” chant from the Stones’ “Sympathy for the Devil” as they patrol the beach. (Perhaps Keith hooked them up with a Louis Vuitton sponsorship.)

That’s more like it!

Forget Tom Selleck’s AT&T ad from the start of the 1990s which promised the wonders of sending and receiving faxes from the beach; I downloaded Theodore Dalrymple’s Our Culture, What’s Left Of It onto my wife’s Kindle, and was reading it on the beach while she swam deep into the bay.

But then, cultural downfall wasn’t merely a theoretical concept; it was literally right next door. Just outside the perimeter of our 1930s tropical fantasy, immediately adjacent to our hotel, our jewel-like little Ralph Lauren photo shoot backdrop, is the storefront for Yoda Guy.

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In the 1970s, Yoda Guy was an assistant to Stuart Freeborn, the veteran British makeup artist who designed Yoda, Chewbacca, and many of the other creatures in the original Star Wars trilogy, along with the makeup for countless other films, including Peter Sellers’ three characters in Kubrick’s Dr. Strangelove, and the ape-like hominids in 2001. Yoda Guy now makes a living shilling for tourists to visit his small exhibition to his days in the rebel cinematic alliance, a long time ago, in a makeup room far, far away.

Did I mention that we stayed on the third floor of our hotel and it has no elevator? There’s a Big Bang Theory episode just begging to be written here, if Sheldon can be talked into getting onto an airplane or cruise ship.

But I just couldn’t accept the premise. If there really is a Yoda Guy, it’s George Lucas, or Lawrence Kasdan, who contributed to Empire’s script, or Freeburn, who helped design him. Or heck, Frank Oz, who brought him to life and supplied the little green curmudgeon’s Grover-like syntax-mangling voice. Plus after the infantilizing feeling of the hospital, I wanted to put away childish things.

I just couldn’t go in. But I did get to hear the Star Wars theme and a posh British woman’s voice on a loop, inviting other tourists to visit the wonders of Yoda Guy!  Sitting in the hotel’s front patio, on their lovely overstuffed rattan chairs, I heard it again and again and again and again. Oh how the hotel staff must love being next door to Yoda Guy.

Unfortunately, there are only a couple of flights a day out of St. Maarten back to the U.S. So on Friday at 5:00 AM, we woke up, took a shuttle to the airport, and, like Victor and Ilsa in Casablanca, had our letters of transit stamped, and escaped to the U.S.

Once over the U.S., the in-flight movie was Ang Lee’s Life of Pi. An existential story of survival in the endless watery nether-regions of the Third World. The tidal waves in the film seemed perfectly choreographed, bump for bump, to the endless turbulence of our airplane.

Worst. Flight. Ever.

And also the best. We were alive, we were headed home to America.

Related: If you’d like to read about the above incidents from my wife’s perspective, “What Happens and What Royal Carribean Cruise Line Does When [You’re] Taken Off Ship to a Hospital” is a lengthy post she contributed to the popular Cruise Critics message board. And here’s her original thread on the cruise, with a some additional photos (including a cool shot Nina took from our ship as it ducked under the Verrazano-Narrows bridge with 16 feet or of headroom to spare), before things hit the fan. Or stopped hitting the fan, as it were.

Update (4/7/14): Two quick follow-up notes to this post: I had two volvulus incidents in short succession a few months after the above post was written, and went for surgery — in a nice, safe American hospital — very shortly afterwards, in August of last year. I’m very happy to report that as of today’s date, I’ve been symptom-free, and now that I’ve been shorn of two and a half feet of big floppy excess colon, the plumbing is working — knock wood — rather nicely, thank you very much.

And speaking of thanks, I recently got to thank Dave Barry personally for his 2008 article on colonoscopies during the course of my interview with him. As I told him, his article helped me to get through four colonoscopies last year: three emergency repair jobs (the one in St. Maarten and two in States), and the examination which led to my surgery. Dave’s apparently gotten used to complete strangers thanking him for writing about this topic and mentioning their incidents to him, so he was a very good sport about my mentioning my own gory details to him.

All of which is yet another reminder to get your own plumbing checked ASAP, so that you don’t have live out the above horror stories — or worse.