My big left toe

One day in early August, my big left toe started swelling up and became a red balloon that I couldn't fit a shoe over.  It wasn't painful, just big and very red.  A friend diagnosed it as Gout, a disease I'd read about in nineteenth century novels but was otherwise unfamiliar with.  Gout is known as the "disease of kings" since it results from overindulgence in rich, fatty foods.  My friend, a wonderful French cook, knew perfectly well that the only royal meals I consume are at his table, but he couldn't resist the opportunity to suggest that my health problems were the result of my diet.  A quick Google search told me that Gout is an extremely painful condition, so he was wrong and it wasn't the cause of my problem.  But—what was it?

Another friend, Dimitry, a physician's assistant at Maimonides Hospital, urged me to get my big left toe checked out, but I'm one of the people who thinks it's better to avoid the medical profession whenever possible, so I did nothing, and just hoped the inflammation would subside on its own.  For me there are two major problems with doctors:

1. Medicine is Ivan Illich's prime example of a disabling profession.  In his view, our reliance on doctors as experts tends to reduce our ability to look after our own health, so the more healthcare we consume, the less healthy we become, an important point with which I fundamentally agree.


2. Doctors always find more problems and tend to suggest drastic solutions.  They're like hammers in search of nails.  The joke is that if you tell a surgeon you have a headache, he'll recommend a brain transplant.

Unfortunately, the inflammation of my big left toe persisted, and then I discovered a large red and blue mark on the left side of my torso, an angry lesion that seemed to grow and diminish in sync with the swelling of my big left toe.  Sometimes it appeared as an amorphous red area, like one of those red-state/ blue-state maps of Alaska or South Carolina.  Other times it shape-shifted into perfectly concentric oval rings, which should have clued me to suspect a deer-tick bite, but there are no deer anywhere in Brooklyn, so Lyme disease just didn't occur to me as the culprit.  Nor did I remember that I'd recently spent several days working on the exterior of my mother's house, which is located in a leafy zone up north where deer are common enough to be regarded as pests.  Looking back, I don't know how I could have been so clueless.

But I was clueless, though I did finally gave in to Dimitry's insistent prompting and presented myself to the Bellevue ER, where the doctors were amused to discover Lyme disease in their midst, an oddity in the city that none of them had seen before.  Bellevue is a large city teaching hospital, and the main Emergency Room teaching doctor kept bringing groups of young acolytes over to stare at the prominent target-shaped lesion on the leeward surface of my body, so much so that the old Cuban stevedore in the bed nextdoor to mine suggested I start charging admission.  I was given a three-week course of amoxicyllin and sent home, but I had to return to the ambulatory clinic for several more tests to make sure the Lyme spirochettes were eliminated.

Meanwhile, my big left toe gradually normalized, but my General Practitioner had trouble figuring out whether it had been caused by the Lyme infestation, so he ordered other tests that included an EKG, and that's when they discovered I had a significant heart murmur—or rather confirmed it since the GP had heard it through his deathoscope.  He told me the EKG didn't look good, and ordered another round of tests, including an echocardiogram, CAT scan and catheterization.  The echo machines are in great demand at Bellevue so it took several weeks to get in there.  Now those weeks are behind me, the echo-gram is done, and the cardiologist has informed me that my aortal valve, the valve that meters blood from the left ventricle into the arterial tree, needs to be replaced with stainless steel or pig tissue, so I'm on the launching pad for open heart surgery.  (Like... whoop--dee--shit.)

If I decide to get the surgery, I will probably survive, since the statistics for this particular procedure are pretty good and they do it at Bellevue all the time, though there could be complications, but after it's done I won't actually feel better.  They tell me that I will notice no perceptible change in my overall health.  Of course I also have to find a way to pay for it, and since I am now completely asymptomatic, it is pretty difficult to wax enthusiastic about heart surgery.

Let's review, shall we?  Starting with a stupid little inflamed toe, I moved on to being diagnosed with Lyme disease, which is somewhat serious, but fortunately the doctors cured me of that.  Unfortunately, they found a potentially fatal problem I hadn't been aware of that, had they not found it, might not actually be harmful and I might be perfectly fine and would not now be facing major surgery.  If I don't do the surgery, chances are pretty good that I'll continue living for a long while, though there's also a chance I might not.  (The cardio-guy I went to for a second opinion said that I could have it done next year, "but why wait?"  He also told me I could drop dead at any moment.)

Am I fortunate that they found this problem, or not?  And is it really so important to live a little longer than I would if I don't get my aortal root and heart valve replaced with tissue from a pig?  (What kind of pig?  A nice friendly pig with a curly tail that has to die for this?)  I'm really not sure, but what bugs me even more than imagining what they have to do to temporarily disconnect my aorta without killing me is that I still have no idea what caused the inflammation of my big left toe.