Offshore Medical Emergency: Dealing with Appendicitis 90 Miles Out

Andy getting wheeled from the ambulance into the ER at Newport Hospital at 0500 Tuesday July 5.

About 48 hours has passed since my appendectomy. I’m sitting at my cousin Dan’s kitchen table in North Andover, about 20 miles from Boston, writing this while I spend a few days here recovering. Isbjorn is back at sea, having departed Newport yesterday morning around 0800, about the same time I jumped in the car to drive the two hours north to here.

I’m stiff. I’m sore. I haven’t had a good poop since Sunday morning. I’m bored. I’ve watched more TV than I have in years. On the plus side, Wimbledon and the Tour de France is on in the mornings, and Germany is about to play France this afternoon in the Euro football championships to see who gets to play Portugal in the Finals. This whole thing feels surreal.

Recovering with my cousin's son Jack and their dogs Meg & Molly!

The thing is, I never get sick. Ever. At least not the kind of sick that requires a visit to the doctor, let alone to the hospital. In an ambulance!  The occasional cold, sure. The flu? I had it once in the past ten years. I was due for this, in a pessimistic way I guess. And almost fitting that it happened not only on the boat, but also while we were offshore at sea, and with paying crew to boot! And to me! Anyway. Here’s what happened.

We left Annapolis on a beautifully clear Saturday morning, July 2, a brisk north-westerly blowing cooler, drier air down behind a strong cold front that had passed over the night before, bringing heavy rain and thunderstorms and the first-ever lightning strike to the Capitol building in Annapolis that Ben Franklin himself designed. 

Isbjorn sailed all the way north on the Chesapeake to the entrance of the C&D canal on one tack. The wind was very shifty, oscillating between west and north, heading us then lifting us as our crew of Bruce, Lance, Jim, Mike, Liz, Mia and I constantly trimmed sails to keep us off the shoal waters north of Rock Hall. It was July 4th weekend to boot, so somebody was constantly on watch on the leeward rail, keeping an eye out under the big genoa for traffic. Unlike last year, we had no drama on the way north, and more wind (and less heat!).

Mia & Liz modeling the new #isbjornsailing beanies prior to departure in Annapolis!

By dawn Sunday morning we were offshore of Cape May, and in hindsight, this was the start of my ailment. It had been a motorboat ride down the Delaware, but with a little bit of rain on Sunday morning came just enough wind to sail once offshore. When the rain stopped, we hoisted the spinnaker and continued like this for the rest of the day and indeed into the dark night. We’d have no moon on this trip north. With an overcast sky, the night was dark. Paul Exner taught me the trick of turning on the steaming light on these dark nights to illuminate the spinnaker for the helmsman and trimmer, which is precisely what we did. Works great.

Back up a bit. Mia served up some broccoli pasta for dinner on Sunday evening, which I ate reluctantly. I hadn’t really been hungry much of the day, and had noticed a bit of a stomach ache earlier in the afternoon, after lunch. I put it down to the hot sauce I’d eaten the two previous nights, hot sauce we’d bought in Antigua way back in February. Nobody else in the crew had had any, and otherwise we’d been eating the same, so that must have been it, I thought.

Even further back, in November, during the lead-up to the Caribbean 1500 start in Portsmouth, I had a similar stomach ache during the screening of Yves Gelinas’ iconic sailing film ‘Around the World with Jean du Sud.’ The showing was held at the Commodore Theatre on High Street, an old art-deco theatre from the 1940s that’s been lovingly restored to it’s original character, yet with modern projection and audio. The audience is seated at small round tables, each with their own wam lamp and rotary phone. You place you order for food, beer, wine and popcorn on the phone and it’s served momentarily thereafter by the waitstaff. A classy place. Yves was even on-hand in person to introduce his film with an inspiring speech about ocean sailing and his career as a sailor, inventor and philosopher. Gelinas, firmly in his 70s, would join the rally on the original Jean du Sud, his beloved Alberg 30, sailing offshore for perhaps the last time. He and his mate Kevin spent the winter in the Caribbean before returning to Quebec this past spring. His film was a highlight of the rally pre-departure program.

It was midway through the film screening that I had to get up and leave. My stomach turned and ached and I walked, briskly, back to the B&B where we were staying and spent the rest of the afternoon either laying in bed or sitting on the toilet (unsuccessfully, I might add, save for some serious belching). Two days later, and I was back to normal. Hmm, I thought. And that was that.

Bruce and the crew fixing the mainsail outhaul shackle in the C&D Canal.

Fast forward to Sunday night’s pasta dinner. Despite my lack of appetite and slight stomach ache, I ate it anyway. To be quite frank, I really felt like I just needed to poop. It was the same feeling as November, and that went away, so this should too, I told myself. So I made some coffee, which typically does the trick. No dice. I went to bed a while later, still feeling bloated and not myself. I’d taken myself out of the watch rotation for this trip right from the start so I could remain in a traditional captain’s role of constantly being on-call and ‘floating.’ Liz, Bruce and Mike were the ‘A’ watch, Mia solo on the ‘B’ watch, and Jim and Lance together on the ‘C’ watch. 

I was woken up shortly before midnight when I felt the boat lurch. Isbjorn had rolled, and by no fault of Jim or Lance, the spinnaker collapsed and managed to wrap itself around the headstay pretty good. I put on my PFD and my glasses, rousted Bruce and together we went to the foredeck to work out the mess. The wind was still only about ten knots, so ten minutes or so of wrangling got the sail untangled. We doused it and set the pole in the dark, winging out the genoa instead and sailing on through the rest of the night in a slightly more stable sail configuration. I went back to bed, begrudgingly acknowledging that my stomach ache seemed to have gotten worse…

By Monday morning, the feeling in my stomach had gotten worse still. I had a fitful night’s sleep, partially because I’d been getting so much so far on the trip - it was calm, and not being the watch rotation afforded me a lot of time off. (Moitessier, by the way, has a great line about the captain’s responsibilities that goes something like, ‘when it’s calm, the captain can stay in his bed as long as he likes. But when it’s blowing, the captain must remain on the helm, for days at a time if necessary, to see the boat and crew through the worst.’ I liked that). But my night’s sleep was also fitful because of my stomach. I still felt like I just needed a really big burp or needed to poop or something. By then I’d lost the taste for coffee. 

I ate a few spoonfuls of yogurt, thinking that because of the bad hot sauce, maybe my natural, ‘good’ gut bacteria had taken a hit and I was having trouble digesting food. Yogurt, with it’s natural cultures, couldn’t hurt, right? That was about 1000 on Monday morning, July 4. 

Meanwhile, we were having the best sailing of the trip so far. The wind had built through the morning and we were still wing-on-wing with the new carbon spin pole that I’d gotten from Larry, the owner of another Swan 48 called ‘So Far’ (and ironically the same boat Paul Exner sailed to victory in the Trans-Pac race many years back). We were making 6-7 knots bang on course, the new Watt & Sea that was only installed the day before the crew arrived last week was finally putting out positive amperage on the battery monitor, the sun was out and it was ocean sailing at it’s best.

But my stomach was again noticeably worse.

“There was a lot of weird noises coming out of the head!” Bruce remarked in hindsight the other day after my surgery. I had been in and out all night and most of the morning in a failed attempt at dislodging whatever was causing my malady from my bowels, whether it was out one end or up the other. I even went outside when Mia was on watch and everyone else was asleep to try and throw-up. I stuck my finger down my throat three times, but only got some yellowish colored yogurt from my meagre breakfast.

To make matters more ‘real’, so to speak, that same week last November a woman in the fleet actually did have appendicitis but realized it before they left and never got on the boat. And in Portsmouth just two weeks ago during the DelMarVa stopover, another crew member got violently ill in the men’s bathroom. My dad actually had to let him cut the line in front of him.

“He was green,” my dad said, “and looked really bad.”

He went to the hospital later that day and didn’t come out for a week - they had to remove 8 inches of his intestine that had become necrotic (ie ‘dead’) after a blockage caused by who knows what. He nearly died.

So I knew the consequences, and they were well on my mind on Monday about midday. But I also had the business to think about. We’ve had so many setbacks this year with the boat, what would this do? Would all the crew jump ship in Newport and we’d have to refund them? Would we be able to get the boat up to Lunenburg in time for the next three trips, which were all stacked on top of one another? If I assumed that the rest of this Canadian trip was going to be canceled, which was a pretty good assumption just then, we were looking at the potential of refunding something like $30,000 in crew fees that had already been paid to us. If you listened to the ‘On the Brink’ podcast, you’ll know we simply don’t have that in the bank without going into debt.

And then there was the issue of health insurance. Mia and I had Obamacare through 2015, but in January purchased a special plan underwritten by Lloyd’s of London through a company called Seven Corners that provides international health insurance. You can get a cheaper rate if you live in the US but travel outside the US for more than six months per year. The plan came with a high deductible - I think ours is something like $3,000, and I haven’t yet found out how much we’ll actually owe from my treatment - but we’d never had to use it before. So that was on my mind too.

But ultimately it came down simply to this - was I just being a big sissy, or was I really sick? I told myself that if any of the crew had exhibited similar symptoms it’d have been an easy decision. I wouldn’t want to be responsible for the health of a crew member like that offshore. You always play it safe. But with myself it felt different. I’m used to pushing through pain, mentally and physically. I’ve run six marathon’s, one 31-mile ultra-marathon, completed two half-Ironman triathlons, cycled 100 miles twice, cross-country skied 90 kilometers in one day, done a whole bunch of crazy physical feats that require that you ignore the pain to successfully get to the finish line.

In the end, my pain, actual or imagined, won out. I had to finally admit that something wasn’t ‘right,’ and that I was, progressively faster, getting worse. Mia and I, in the privacy of the morning watch outside, started discussing contingency plans. We got out the ship’s medical guide and went through the list of stomach pain prognoses. None were very good, and almost all recommended getting to the nearest examination facility, and stat. 

When we had decided that action was unavoidable, we also wanted to make a good example of it for the crew. How could we make this a ‘teachable moment?’ After all, medical emergencies are all part of the ocean sailing game, and at some point you’ve got to face up to these things. So we wanted to do it ‘right.’ Mia got the sat phone out - by then, about 1330 in the afternoon, I was in the fetal position on the cockpit seat, weak, tired and in pain, not wanting to stand, sit or even speak. She was in charge now. She called my dad first to tell him we were diverting towards Newport and could he get in touch with a doctor we could talk to in the meantime. We’d call back in ten minutes.

The crew was briefed. The guys came up, we gybed the genoa off the pole and altered course about 30º to port to come up onto a broach-reach and aimed the bow towards Newport, about 90 miles to the ENE. I think our new COG was 007º if I remember correctly.

Mia next called Miles Poor, the former fleet surgeon for the Caribbean 1500 under Steve Black and a sort of mentor to Mia and I. Miles still performs doctor duties in Mexico, treating kids with cleft palates, but not longer actively practices in the US (he talks about this in fact in episode #111 of the podcast). Miles advice was obvious - get him to the nearest hospital and don’t be afraid to call for a helicopter!

Then Mia called my dad back again, who’d by then had some info for us. None of his local family doctors would agree to give advice over the phone, so he finally called the Coast Guard, who put him in touch with a doctor who they keep on call for precisely these kinds of scenarios. Mia thanked my dad, then rang up the good old USCG, who patched her through to the doctor (by the way, if you haven’t realized it yet, a sat phone is ABSOLUTELY indispensable on an offshore voyage of any duration, for precisely this reason). The doctor informed Mia that she was to take my temperature regularly, keep me hydrated, give me Tylenol (to ward of possible fever) and monitor my progress as we continued on towards Newport. The Coast Guard took our information, including our whereabouts, who was aboard, etc etc. They wanted Mia to call back hourly to update them on my progress and the boat’s towards Newport.

By 1500 I was back in my bunk, now permanently. Mia assumed the role of captain, taking herself out of the watch rotation to navigate, communicate with the Coast Guard and take care of me. Bruce, the most experienced crew member onboard, took over as sort of watch leader, and the rest of the crew continued on their normal routine. The wind was up even more, and ironically this was the best sailing of the whole trip - Isbjorn was blasting along on a broad reach doing over 8 knots at times. Sleep for me down below became less and less possible as the pain and discomfort in my stomach increased.

By midnight it had started raining again. Isbjorn was approaching Block Island. I kept dozing off and waking up with a spike of pain in my stomach, which by then had started to migrate to my right side, a classic sign of appendicitis. Mia kept encouraging me to take small sips of water. My mouth was dry as cotton but I had little interest, not feeling like doing anything. She’d continually called the Coasties, who I learned later had followed up and called my dad back each time to keep him informed, which was pretty nice of them. I kept asking myself if I was ‘scared’ by then, and honestly I don’t think I was. I knew for sure that something was off, that was beyond a doubt by then. But I never felt like it would end badly. I was just really in a hurry to get to the hospital. I kept asking Mia to see if the Coast Guard could send a boat out or something as we got closer, and by then we were motor-sailing Isbjorn at close to 3,000 RPMs to make speed. I just wanted to get off the damn boat. The best the Coast Guard could do, short of us actually requesting a helicopter (which, though cool, didn’t feel like it was necessary by then, despite my pain), was to arrange a berth for us in Newport and for the local ambulance to be there waiting for me on our arrival.

Finally I woke again one last time when the engine RPMs decreased as we entered the harbor. It was about 0400 on Tuesday. I struggled out of bed and into my sweatpants, t-shirt and jacket, wool socks and shoes. I had a fever running by then too, so was shivering badly. The rain and dark night didn’t help. I stayed down below so had no real sense of space as we came in, only knowing we were coming alongside when I heard Bruce working the throttle back and forth to swing Isbjorn’s 36,000 lbs of displacement around in the small turning basin. Mia let him take the helm as we came into the dock. He did so perfectly, only later admitting it was the largest boat he’s ever docked! Good on you Bruce.

Lines secured, I was ready to bolt. Mia had packed a bag for both of us - she’d come along to the hospital while Bruce and the crew would take care of the boat. At that point I didn’t give a damn about anything at all - the boat could have sank in the harbor so long as I got some relief at the hospital.

The ambulance arrived as promised just a few minutes later, and for the first time in my life I climbed in the back. I was at least proud enough to walk up the dock and into the thing myself! I was downright freezing by then given my fever, which I later learned had gotten up to 102º in the hospital. They wrapped me in blankets, took my vitals and by 0500 were lifting me in the gurney into the ER of Newport Hospital. By 0530 I’d had my first shot of morphine and the world was right again for the first time since Sunday.

Thankfully for me, the ER was practically deserted that morning. It was July 5. I’d asked if they had had any fireworks injuries over the weekend.

“Mostly just drunk people hurting themselves,” said one of the nurses. “But since last night was a work night, it’s been really slow in here this morning,” he added. Good for me.

I got asked the typical physical questions and medical history, of which I have practically none (other than being formerly obese in high school - when I was 18 I weighed 255 pounds. I weighed in at 169 at the hospital that morning). I had shoulder surgery when I was twelve on a benign tumor I said, and my mom died from brain cancer. But beyond that, I’m fine.

The first doctor who saw me acknowledged that I had the classic signs and symptoms of appendicitis - pain starting in the middle belly, then migrating to the lower right side, difficultly taking a deep breath, comfort when in the fetal position, etc. So that was the prognosis, but I needed a CT scan first, and that confirmed it.

By 0900 I’d met the surgeon, Julia Tannesari, who told me what was up. They had an opening around 1030 in the OR, and would be doing a laparoscopic procedure to remove the appendix. Three incisions would be cut in my belly - one for the camera, one for the light and the other for the tool that would remove it (through my belly button!). The appendix, thankfully, hadn’t appeared ‘frankly ruptured,’ as the surgeon put it, on the CT scan, but she wouldn’t know for sure until she got in there. In the meantime I’d be moved to a proper bed upstairs and have as much morphine as I needed.

Even before we met the surgeon I had already been on the phone with my dad, who’d offered to immediately come up to Newport to either take care of me or take the boat for us. I wanted to keep the crew informed so they didn’t automatically assume the trip was scuttled. I called Bruce back around 0730 to tell him my dad was on the way as relief captain, and regardless of my situation, the boat would leave again as early as that evening, or as late as the next morning, and that the crew should plan accordingly. Mia emailed the gang for the next leg that was to meet us in Lunenburg to say we’d be a day or two behind schedule but that everything was still a ‘go’ as planned, more or less, with my participation the only real question mark. Only Mike in the end had to leave from Newport to get back to work on time, but everybody else stayed on. And Mike promised he'd be back!

By 1130 they were rolling me into the OR. I wasn’t nervous at all - somehow I expected that this was exactly what was going to happen, and I was excited at the prospect of getting relief from the pain. It’s the second time in my life I’ve been put under general anesthesia; the first, when I was only 12, I remember quite vividly. One moment you’re chatting with the nurses and surgeon, the next you’re awake in the recovery room saying silly things as if you were drunk. It was pretty much the same story this time too. One of the assistants was a Cowboy’s fan and gave me a hard time about being from Philly. The anesthesiologist was a sailor himself who owned a C&C 33 in the harbor and actually took one of our business cards for Isbjorn!

I only vaguely remember coming out of it in the recovery room this time, speaking with the surgeon. She told me the appendix was in fact ‘necrotic’, but indeed hadn’t ruptured. The infection was caused in the first place by what she called a ‘stool stone,’ which showed up clear as day on the CT scan as a sort of dime-sized obstruction where the appendix attaches to the intestine. That in-turn blocked the blood flow, the surgeon explained, allowing the bacteria that lives in your gut to attack the appendix, which, with no blood flow, had no defenses, and hence the infection. She continued to say that if I could eat, walk and pee by the end of the day, and didn’t have a fever, I could go home that same day. New goal, I thought. I’m outta here!

Doped up on painkillers post-op.

I went back upstairs where Mia was waiting for me. I was groggy, of course, but feeling fine (doped up on drugs to be fair!) and in high spirits. My fever had already disappeared and I ordered a fruit salad from the kitchen staff, the first food I’d eaten since Sunday night. By 1630 I was up and had peed, and by 1700 we were standing on the sidewalk outside the hospital getting ready to head back to the boat. I was only in the hospital for twelve hours.

By then the crew had moved Isbjorn out to a mooring, the rain had stopped and it was a beautiful day in Newport. We took the Old Port Marine launch-ferry out to the boat, where an unsuspecting crew were astonished to see me return from the dead. Mia went back ashore to fill my prescription for pain medications and buy some groceries for dinner. About an hour later, she returned, this time with my dad who’d just driven up, and all eight of us enjoyed a dinner in the cockpit as I gingerly tried to find a comfortable spot. That night on the boat was tough, just trying to get into my bunk, but all-in-all I was thrilled.

A shaved belly and some bruised incisions.

I learned from the surgeon that what I had experienced back in November was probably indeed a mild flare-up of appendicitis that my body was able to heal by itself. The symptoms were identical, at least initially. The fact that I recovered so quickly from that instance was what kept us offshore longer than I might have otherwise. Those last 18 hours, from the time we decided to divert until I got into that ambulance were brutal. My only regret is not diverting sooner, considering how quickly my condition deteriorated.

I also wonder what might have happened had we been on the way across the Atlantic? A sat phone would have been a godsend, of course, being able to consult with a doctor. And next time we’ll carry some high-test antibiotics on board, which can slow the onset of appendicitis once the signs start showing up. By in that scenario, far from shore, you’re looking at a minimum few days until primary care - perhaps a transfer to a commercial or military ship and a helicopter ride, probably to a foreign country, once in range (which is only about 300 miles, by the way). A daunting thought, but a real thing to plan and be prepared for when doing this kind of thing.

In the end, Isbjorn would only lose 24 hours due to the stop - thanks hugely to Mia and the entire crew for stepping up to get the boat safely into Newport and coordinating with the authorities, and to my dad for filling in as my relief captain and driving up to Newport, basically on zero notice - and I’d get some R&R at my cousin Dan’s up in Boston. My surgeon informed me that the first 5-7 days were crucial in the healing process - if I kept a fever off, and kept infection away, I’d be good to go back on the boat, albeit in a minimized role, in time for the next trip. I can’t lift anything more than 20 pounds for the next 4-6 weeks, as I have a high risk for hernia since they sliced open my abdominal muscles, so no actual ‘sailing’ for me. But I can still be captain! 

So that’s where it stands now. I’m two days in, and despite some to-be-expected pain from the surgery, I think I’m doing pretty darn good. No fever, no infection. I tried going off the pain meds this morning (I’ve only been taking 600 mg of Ibuprofen anyway, scared of the side effects of the Percocet that they also gave me), but that didn’t exactly work to plan. I think I’ll stick to the high-test Advil for at least a few more days. 

Isbjorn is rounding Georges Bank as I type this and should make landfall in Lunenburg sometime on Saturday. I’ll fly up to Halifax on Saturday or Sunday, July 9 or 10, to rendezvous with Mia and the boat, the next crew will arrive on Monday and by Tuesday July 12 - one week after my surgery, and in fact the day this will come out as a podcast - I’ll be offshore again, bound for St. John’s, Newfoundland on Leg 7.

Minus one appendix of course!