Acclaimed journalist Sebastian Junger and interventional radiologist Dr. Indravadan Patel join us to explore Junger’s harrowing brush with death, chronicled in his memoir In My Time of Dying. What begins as a mysterious abdominal pain spirals into a life-threatening medical emergency, revealing the miraculous precision of interventional radiology and the fragile line between life and death. We delve into the mysteries of consciousness, the power of modern medicine, and the profound questions that arise when one stares into the abyss.
Acclaimed journalist Sebastian Junger and interventional radiologist Dr. Indravadan Patel join us to explore Junger’s harrowing brush with death, chronicled in his memoir In My Time of Dying. What begins as a mysterious abdominal pain spirals into a life-threatening medical emergency, revealing the miraculous precision of interventional radiology and the fragile line between life and death. We delve into the mysteries of consciousness, the power of modern medicine, and the profound questions that arise when one stares into the abyss.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine:
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic today is leaking aneurysms and treatment with interventional radiology. Our book is “In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife” by Sebastian Junger.I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine. I am so excited about my guests today.
Sebastian Junger is an award-winning American journalist, author, and filmmaker, with much of his work focused on war, survival and the human condition, he's the winner of a Peabody Award and the National Magazine Award for reporting. His memoir “In My Time of Dying,” is his latest book. Sebastian, welcome to the show.
Sebastian Junger:
Thank you for having me.
Dr. Denise Millstine:
Dr. Indravadan Patel is an assistant professor of radiology and a board certified interventional and diagnostic radiologist. He's the chair of Vascular and Interventional radiology at Mayo Clinic in Arizona. His clinical focus includes expertise in management and treatment of vascular malformations. Dan, welcome to “Read. Talk. Grow.”
Dr. Indravadan Patel:
Thank you. Excited to be here.
Dr. Denise Millstine:
“In My Time of Dying” is a medical and contemplative memoir of the author's brush with death after experiencing abdominal pain at his remote home in New England, that brought him closer to death than he could have expected from a ruptured, leaking aneurysm that the author was unaware was present.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll talk about aneurysms and also coming close to death.
Sebastian, I kept hearing about your book. Even had an old friend from college tell me she was anticipating reading it and thought it would be perfect for “Read. Talk. Grow.” And then I saw you at the Tucson Festival of Books, and I knew she and all the others were right. So thank you again for being here. We know this is memoir, so your inspiration for the story is known, but tell us how you knew you had to write this memoir, this time.
Sebastian Junger:
Yeah. I mean, I've been a journalist and a war reporter for much of my life. That's now in my past. But I'm used to not focusing on myself. I'm the vehicle for information. I'm not the point of the story. And this was the first time in my life where I was the story. I'd been almost killed a number of times overseas in war zones, but really, the closest I ever came to dying, I think, was almost certainly, you know, in my own driveway and in the hours that followed in the rush to get to the E.R..
So what I recovered, I think I surprised the doctors by surviving. Read the tea leaves here. You know, I got the sense that they were prepared for me to not make it. So that was very traumatic for me, way more traumatic than combat. And it took some months, even a couple of years, psychologically to recover. The physical recovery was easy and but psychologically, it took a couple of years. And eventually I thought, you know, I write about everything that's compelling and interesting to me. And this suddenly became very compelling and interesting, not just what happened to me medically and the sort of miracle of technology and expertise that saved my life. But the sort of weird enigma of like, do we really know what happens after we die?
I'm an atheist. I'm a rationalist. I'm, you know, all that stuff, right? And I just. Yeah. Lights go out. You're done. Like. Good night. My mind was open to the possibility that maybe there's something else. I don't mean something religious or Christian. I mean something that we fundamentally don't understand about quantum reality and about consciousness and life and death.
Dr. Denise Millstine:
Yeah, these are big questions that have been asked throughout time and probably will be asked throughout time. And we're so glad that you captured your experience and considered this in this book. So thank you for bringing it to us. Dan, tell us your reaction to the book and also what it's like to be an interventional radiologist.
Dr. Indravadan Patel:
Like you, Dr. Millstine, I also heard about the book and read the book, just, you know, it was a page turner. The medical part was, you know, super interesting and just you're coming to the realization that you actually are dying, even though, as you mentioned in the past, you know, your books vividly paints many different pictures of your quote unquote, brushes with death and whether war time, weather surfing, whether being alone in the middle of a cold winter in Spain, in the middle of nowhere.
But this one moment really captures the true essence of what it means to maybe be alive, or to maybe know what death is. I found that very interesting. And then beyond that, like you mentioned, sort of that metaphysical stuff, I found that super interesting. I'm a nerd and a geek when it comes to that type of stuff. And you definitely made it very palatable and easy to read and digest for laypeople and even people that just, you know, have an interest in it. Very, very great read.
Sebastian Junger:
Thank you. Yeah, sometimes I would get comments from people who say, oh, I loved your work, but I they'd almost apologize if I don't understand quantum physics. I'm like, look, you're in good company. Neither did Schrodinger, right? Like, neither do quantum physicist. They know that there is something very puzzling happening at the quantum level, but they have no idea how or what. And so if you don't understand quantum physics, you're in very good company. It is the in some ways, the ultimate mystery.
Dr. Indravadan Patel:
And I love how you sort of tackle that and go back and forth between some of your personal experiences, some of your familial life. And, you know, for me, reading the book, I sort of hung on to a lot of the medical jargon and medical terms. And, you know, as an interventional radiologist that came natural and easy for some of the listeners or people interested in the book, you know, an intervention radiologist. We do lots of interesting, amazing things that in the quantum physics world is just bewildering to many. And, you know, we use these techniques and these technologies to minimally guide catheters or wires into places within the body that you didn't know you could get to, to treat. In your case, an aneurysm, to open up a blocked artery to get rid of blood clot. If you have, you know, something in the lungs. It's just a great, fascinating field which just keeps evolving. I found your relationship between a lot of those different aspects very fascinating.
Sebastian Junger:
Yeah, and I'm eternally grateful because my understanding is that in these sort of old days before interventional radiology, the solution to something like what I had would be to cut the person's abdomen open, open them up, and try to find the bleed. I had an aneurysm that had ruptured and I was gushing blood into my own abdomen. And, you know, you'd have to sort of operate on them in the O.R. and try to find the bleed and cauterize it, or seal it before the person bled out. And the outcomes weren't great for that procedure.
You can imagine someone was already compromised. I'd lost half my blood by the time I finally got to the hospital, an hour and a half later, I probably lost half my blood. And you sent me into the O.R. That's an uphill fight for me, for my body at that point. So interventional radiology, I mean, I never heard of it before this, right? But afterwards, like, oh, my God, it's basically magic. Like, you could enter someone's vascular system in their groin. And then where do you want to go? You want to go in their brain. You can go in the brain. You want to go to their heart. You wanted to go, you know, where do you want to go? I was like the interstate system to get on I-90 in Boston, San Diego, San Diego, Seattle. You pick it right there and you can do that without cutting someone open and fix the problem. And that's just, I mean, it's just mind blowing. And it saved my life. My little daughter's, who are now eight and five, they were three years old and six months old at the time. They will have a father. And because of what you guys do, it's totally extraordinary.
Dr. Indravadan Patel:
Appreciate that. And it's to highlight some things that you said. You mentioned, the interstate. Whenever I talk to patients or people about what interventional radiology does, I liken it to, you know, all roads lead to Rome, the Anglo-Saxon version. Right? I could also say, all roads lead to Istanbul or something else. I think in your book you had mentioned they tried one approach.
You mentioned the femoral artery, but, in fact, they actually had to go through your radial artery, which is in your wrist, to actually get the quote, unquote, job done just because of how challenging and varied your anatomy was and different from, you know, some other patients. Every human being is unique and, you know, your story is definitely unique.
Dr. Denise Millstine:
I want to just make sure readers understand what that looks like. Dan. So many of us will think of a radiologist. My husband is a radiologist. As somebody who sits in a dark room and looks at pictures all day. It's more complicated than that when my husband listens to this. I'm not saying that's all he does, but that's, I think, what we imagine a radiologist ought to do.
And they're a physician who many patients never see. They might see the name on a report, but they don't see them face to face almost all the time, where an interventional radiologist actually does see the patient face to face. And you're someone who gets called in for a procedures, and in this case, maybe we'll focus on this situation for emergencies.
So you carry a pager, an old school pager, and it goes off when somebody like Sebastian is coming into the hospital with what is suspected to be a bleeding aneurysm. What are others situations where you might get that page? And, you know, I got to get there and be ready to go.
Dr. Indravadan Patel:
Call can be taxing. Call can be brutal. But call is also very rewarding. You are there in times of patient's needs, in times of family member’s needs, in time of your fellow colleagues, you're referring, physicians, providers, nurses. So it can be very, very satisfying to help patients in need in their time of need. Situations that are commonplace, do tend to be things like, bleeding, aneurysms, blockages in the arteries where you may have to go in to the vascular system and open up an arterial system to allow blood perfusion to get to a critical structure like an organ or a limb. Other situations include removing clot, whether that is in your lungs like a pulmonary embolism, or in your brain like in a stroke.
Certain situations call for different techniques, whether you're coiling, plugging, stenting, ballooning these are all different types of instruments to, get the job done. Sometimes the procedures are fairly straightforward and can take ten, 15, 20 minutes. And then sometimes it can be challenging and complex and can take three, 4 or 5 hours.
It is very fascinating, complex and varied, which makes the job, and I hate to use the word job, but it makes what I do very fascinating and rewarding and interesting. Seeing the patient on the other end of it, or the family member on the other end of it, really keeps it going and call isn't as burdensome or isn't as taxing when you get those types of situations.
Sebastian Junger:
I was at a convention of interventional radiologists in Nashville a couple months ago, the yearly gathering, and one young man came up to me and he said, thank you so much for writing your book. I'm going to give it to my mother. She still thinks I'm the guy who pushes the clacker in the X-ray room like that. So he was appreciative that I was going to clear that up.
You know, it makes me wonder, like, can you have a glass of wine at dinner? I mean, I mean, if you're always prepared to rush in and save someone's life if you're driving there, presumably like that must really constrain your life. I mean, that must be tough.
Dr. Indravadan Patel:
Yeah. No. Great question. So, yes, there are, strict rules and policies. I work at Mayo Clinic. We follow, you know, certain rules, just like many hospital systems do. But correct, you do have to be within half an hour or so of the hospital facility, and you do have to be sort of cognizant and aware that at any moment you could be called and you have to review, you know, imaging, talk to referring teams, see a patient, see a family member, talk through what is happening and why a certain procedure is or isn't needed.
Sometimes, we intervene by recommending against a procedure or recommending against doing something because that isn't always the best solution. So yeah, it can be, you know, deeply rewarding. But without question, there are the other facets of being on call and being available.
Sebastian Junger:
You know, it's interesting for the patient. You know, unlike surgery, I was awake the whole time. I mean, I was watching the doctors work on me. My vital signs were too low to be fully sedated. I didn't get a little fentanyl in me, but I was completely conversant and aware. And so I got to sort of watch this drama, which was good and bad.
It took a long time for me to realize that I might die. And I finally realized that on the fluoroscope, listening to the doctors talk about what to do and how this didn't work and that didn't work, and like, what are we going to do now? And it dawned on me.
Dr. Denise Millstine:
Let's hit the pause, because I do want to talk about the book and how you got to that point, because for listeners who haven't read the book yet, what I wanted to say to you, Dan, is that that list of things that you do in the context of your professional life made me think. All listeners are thinking right now, I hope to never have to meet this type of doctor, but I am so glad that they exist in case I should need them. So really gratitude for what you do.
But Sebastian, can you go to that day so you live in a remote area of Cape Cod. This is 2020, so you are really in a situation where you are pretty far from medical care and had had these lingering symptoms, but that day it became clear that you knew something was terribly wrong.
I liked this quote from your book, “I was young and had no idea the world killed people so casually.” Will you just bring our listeners to that day and what happened that led you to the hospital.
Sebastian Junger:
Yeah. So the property is in the end of a dead end dirt road in the woods. There's no cell phone service. The landline is old so when it rains the line short out. It's basically paradise in a lot of ways, unless you have a ruptured aneurysm. And when we're an hour drive from the nearest hospital, which is a small regional hospital.
Right. And so I'd been I'd had pain intermittently in my abdomen for about six months. And, you know, it wasn't terrible pain, but it got my attention. And, you know, I should have gone to get it checked out. But I, you know, just whatever. I didn't get there. And then one night, right before dawn, I had a terrifying dream that I had died, that I was already dead, that I was a spirit.
I was watching my family grieve, and I was trying to reach out to them. And they couldn't hear me. They couldn't see me. I was made to understand that it was too late. I was dead, and I woke up in a terrible fright. I never I didn't know such a dream was possible. And 36 hours later I was dying.
And I, you know, I don't know how that works. Does the unconscious mind understand bodily processes? Was that, you know, I don't know what that meant, but it was a singular experience. So the way I knew something was very wrong, like in mid-sentence, I was talking to my wife and we had a little bit of babysitting, and we were in a cabin that was even more remote, that I'd built deeper into the woods, and we were there for a little, you know, like checkout time.
And this is during Covid and in mid-sentence in mid-sentence. I felt this pain shoot through my abdomen. And it wasn't unbearable. But it was bizarre, right? It's kind of searing pain, and I couldn't get rid of it. And I stood up to sort of try to work it out, walk it out. And, and I almost fell over and my blood pressure was plummeting.
I didn't know this, but blood pressure was plummeting. I sat back down. I said to my wife, you know, I'm going to need help, and I'm fit. I'm a lifelong athlete. I'm not a walking heart attack. You know, I use the same belt loop that I did in college on my belt, you know, whatever. Like, and I didn't understand, and I couldn't stand up.
And my wife sort of dragged me out of the woods and we. And called 911. And it took quite a while for them to get there. And, you know, by that time I was going blind, but hemoglobin levels were so low that it was producing sort of blindness and I was syncope. I was in and out of consciousness and, I didn't know that I was in and out of consciousness, but my wife was watching me go in and out and she realized, oh, he might go out and not come back. I mean, she knew she was maybe watching me die.
Thank God I did not know that the ambulance crew showed up. And by then I got into compensatory shock and I sort of revitalized I. I was clear minded. I could see again. I had still had pain in my abdomen, considerable pain, but I but I was clear to me I was only I was me again.
And I almost was like, you know, I don't need to go to the hospital. I'm good. And my wife said, no, no, no, you're taking him to the hospital. And I remember thinking at that moment, this is why they say married men live longer. This is the reason for that statistic, right? I'm living it right now. Like I just watched it happen in real time. So they put me in the ambulance. And, you know, I don't think those guys thought I needed to go to the hospital either, right? I mean, they were sort of on my side, like, yeah, you're probably all right.
And an hour later I needed ten units of blood. My blood pressure was 60 over 40 by the time they got me to the trauma bay, I was still conscious, but I've probably lost something like half my blood, which is right at the dividing line where they can bring you back or not. Like I'm right on the cusp.
They started putting a, they rushed me into the trauma bay and started and put a large gauge, cordis line into my neck, a needle through my neck, into my jugular to transfuse me. So I'm lying there, and I'm an atheist. I'm a rationalist. My father was an atheist and a physicist, which is like atheist squared. Right? So that's who's lying in the trauma bay. That's me, I'm like, I don't believe in anything, anything you can't measure or test, as my father would say.
So I'm lying there, and suddenly this black pit opens up underneath me and I'm getting pulled into it. It's like the universe is cracked open. And I am getting pulled into this sort of infinite void. And I'm terrified of it. I have no idea I'm dying, like absolutely none, right. But I'm terrified of this blackness. And as I panic, suddenly my dead father appears above me, to my left and above me. And basically he's there in this sort of energy form, this sort of essence, and he communicates with me by some manner. It’s not speech, right? I don't know, but communicates to me, basically, it's okay. You don't have to fight it. You can come with me. I know how to do this. I'll take care of you.
I was absolutely horrified. I was like, you're dead, I'm alive. The party's over here. Like, why would I? Why would I go with you? Right? You got this all wrong. I'm just in for belly pain. Like you're misunderstanding this situation. We'll talk a lot later, but that's not what's happening right now. And of course, that is what was happening while my father is there petitioning me to go with him, I said to the doctor, you got to hurry. I'm going. I'm going away like I'm leaving. They transfuse me, and after I'd stabilized, they got me into the interventional radiology suite and then the real work began of seeing if they could save my life.
Dr. Denise Millstine:
So incredible that you, by a matter of moments, were able to get care. Dan, what are your thoughts about those paramedics? I mean, it's easy in retrospect to say clearly there was an emergency. But when you have a young fit person with abdominal pain on a hot summer day who sort of comes back to themselves and is like dismissive, that would have been a really easy situation for those paramedics to say, drink some fluids and call us back if you had any problems. And that would have been life ending. Do you agree?
Dr. Indravadan Patel:
Oh yeah. Without question. You know, there are many parts to life which are mysterious and fascinating and how just one little shift in your thinking had your wife not said, no take him. Had the paramedic not agreed to to come in on time. Had you been stuck in traffic. I've been to Cape Cod. I know how traffic can be very, very brutal on certain days. There's really only one way in, one way out.
Had an interventional radiologist not been at that hospital, even though there are, let's say 1200 of us, you know, around the country, certain areas you may have to go six hours before you get to an interventional radiologist. So there are many, many little parts to your story where it was life and death.
But luckily or by the grace of XYZ, by whatever you want to say or believe in, you know you made your way to the interventional radiology suite. Again, after getting stabilized by the paramedic, by the ED physicians, by the jugular line that you mentioned, the cordis getting you blood transfusions. Eventually made it to interventional radiology suite and again, complex anatomy, finding the bleed and eventually stopping that bleed from persisting and continuing, so that way you can pretty much, come back to.
Dr. Denise Millstine:
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine:
I feel like there's another healthcare professional who's really important at this point in the story, which is the E.R. physician. You describe them as sitting towards the ambulance bay so that they are have eyes on patients as they're coming in. And, Dan, I felt like there was this just gut reaction. Sick. Not sick. Can you tell listeners about that. And is that a real thing and is that really important?
Dr. Indravadan Patel:
Oh, yeah. Without question, Denise, as you know, having been in medicine for 12 plus years, almost 15 years, right, if you count training and everything. You can tell, just like the ED physicians, just like seasoned nurses, they are eyes and ears when, a patient is kind of going downhill or doesn't look good. You can kind of tell there are certain looks, certain sounds, certain skin changes, sweating, sometimes not sweating.
There's many little interesting, intricate facets to the human body and spirit, when they're kind of teetering between life and death. So yeah, it's without question fascinating and live many ED physician providers sort of, are situated in that manner to see who's really sick and who needs assistance right away.
Sebastian Junger:
And, you know, just to note, the patient themselves might be, is a very unreliable witness here, right. Like, not only is your brain compromised by whatever's going on, I wasn't thinking clearly. I was thinking like a drunk or something. You know what I mean? I was, like, very sort of confused. But also, I had no reason to think I was dying.
Right? Like we think of dying is this is big, catastrophic experience. I just had belly pain. Right. And I remember it's like what? I mean, I thought at the very worst I'm like, I might wake up tomorrow morning after an operation to find out that I have a tumor in my abdomen and I got three months to live. And this might be really, really miserable. Right?
But I had no idea this was going down right now. Why would I think that? So the patient themselves, I think, often has no idea what the stakes are. When the doctor asked permission to put the cordis line into my jugular, you know, it didn't sound very pleasant. And I was like, you got to represent yourself with the doctor, you know, you got to whatever. So I was like, I was like, you mean in case there's an emergency? That was my question to him. And he was like, sir, this is the emergency right now. Well, that was news to me. I had absolutely no idea that this was an emergency. I basically was like, well, if you say so, you know, do what you got to do. But, you know, we'll see. Like, that was that was my attitude about it.
And in some ways, thank God. I mean, the whole thing would have been so much more terrifying had I thought I might be dying right now. I may never see my family again. I mean unbearable thought, right? I mean, they would have reproduced the dream that I had absolutely anguishing thought. And I'm so glad that I was spared that.
Dr. Indravadan Patel:
The story that you paint. It was compelling to read because it gives the patient perspective of the medical side of things. You know, you sort of pointed out just a little while ago. You know, you're kind of in and out of consciousness. You're in compensatory shock. You don't feel great. And then all of a sudden you're back into and with it, you, you know, question whether or not this is a real emergency. You're like, oh, it's just belly pain. Maybe it's an ulcer. It could be a tumor. But you know, I've lived a good life. I still got some time. There are many things that are going on through your head.
And just like on the patient side, on the medical side, we also are going through these not necessarily checklists, but things that we think you and your symptoms and body presentation may represent. So it's interesting dichotomy and dance that the patient and medical team kind of go through it.
Sebastian Junger:
Another interesting thing here is that, I mean, I was 58 years old at the time. I read young. I'm an athlete. I'm healthy person. Right. So the guys in the ambulance sort of misdiagnosed me because. Cause apparently, what happens if you're experiencing blood loss? Your heart rate goes up to compensate for the loss of blood pressure that you're experiencing through blood loss.
And so suddenly you're up 30 beats a minute or whatever to sort of pressurize the system. Right? Well, I was a 58-year-old with, with a pulse of 58 or whatever. Like, I mean, I have a really low pulse because I'm a lifelong athlete. So when they read my pulse at, you know, what was I probably in the 80s, I'm sure they were like, oh, well, that's normal, right?
So the sort of combination that I was presenting with, they didn't realize was the classic outlines of abdominal hemorrhage because, you know, having a pulse of 80 and in your late 50s, isn't that abnormal. And so, I mean, one important thing, probably for those guys, the sort of first responders to say, what's your ordinary pulse? Because if they'd known I was up 30 points, they might have suddenly thought, oh my God, this is an emergency. Like he's he's bleeding out.
Dr. Denise Millstine:
Yeah. That's such a good point. And we often will in medicine say treat the patient, not the numbers. So even though 80 is normal, 80 might not be normal for you. And that takes somebody stepping back and looking at the whole picture.
Dan, there are very few things that take down a young, middle aged, healthy man in this way. So it feels like as Sebastian arrives, there's this thought something it's bleeding. And a nurse, paraphrasing here whispers to you, Sebastian, you didn't hear it from me, but it's not your aorta, which you didn't know was, you know, good news to hear it. She thought she was giving you, like, a piece of relief. But can you just talk about that Dan, how that would have been a very different situation and also a much more common situation, and then maybe this is a good time to talk about what actually was found to be bleeding and why.
Dr. Indravadan Patel:
The aorta is the biggest artery that comes directly off of your heart, and it provides the blood flow to basically the rest of your body. There's the upper thoracic aorta, which gives rise to arteries that feed and perfused your brain, your head and neck, your upper extremities. And then as it works its way down to the diaphragm and below in your abdomen, it gives arteries and supply to your abdominal organs like your liver, your spleen, pancreas, kidneys and bowel.And then it further goes down to go to your lower extremities.
The aorta. If that had a rupture or an aneurysm or a dissection and it with blood loss and leakage extrapolation, it would be a much different story because as you put it in your book, Sebastian, it sounds like you did a lot of research, which we'll talk about in a minute. Without question, most patients would die in the field at home of a good number of patients. If they even make it to, the paramedic might die there. They may also die in the hospital. Very, very few patients actually make it out of the hospital when they have, injury to their aorta where it's ruptured and frankly, bleeding.
What you were found to have was a smaller aneurysm, which is just an outpouring or weakening of the wall, one of the smaller arteries surrounding the pancreas. You had an interesting condition, though, because you mentioned, you know, being young, being athletic pretty much your whole life, your ligaments that sort of support your diaphragm, your median arcuate ligament, it became strong and robust.
And this easily happens in younger patients. Because of that strong robustness of that median arcuate, it caused compression and narrowing on your celiac artery, which is the first artery that comes off of your abdominal aorta, that celiac arteries gets supplied to your upper abdominal organs like your liver, your pancreas and your spleen. Typically, we'd want to get into the celiac artery with our little catheter and wire, using X-ray to guide to that little aneurysm that you had in your pancreatic duodenal arcade or your gastro duodenal arcade.
Sorry for all the long medical jargon. But basically one of the little arteries that are supplying your pancreas. Because that area was blocked, we had to find us circumvent and try to find, a different path to get there and then to coil or block the arteries, coils as you can imagine, just like mattress spring coils, but very, very micro and scale, you know, millimeters in scale.
Dr. Denise Millstine:
So you've got this long tubing, you've got this guidewire that's making the tubing stiff so that you can, going back to the highway analogy, drive from the entry point in the body up to where the artery is bleeding. But you talk in the book, Sebastian, about how there was this decision point, whether they were going to have to take you to the O.R., the operating room, because they just couldn't get there. And it was really the creativity of the experienced physicians at the bedside to say, let's take one more approach and try to come from a different part of the highway to get there. And indeed, that is what they were able to do. And that is where they saved your life.
Sebastian Junger:
Yeah. So I was on a fluoroscope, which gives my understanding, is it gives sort of an X-ray video of what's going on in your body and sort of in real time so they can guide their wires and tubes. And I was in incredible pain, sort of kidney stone level pain. And there's one nurse was so wonderful, you know, they couldn't sedate me.
But the power of human touch is so extraordinary. And it's almost beyond measuring. Like she. She held my head and she said, breathe with me. This happened a couple of times during this long, long night. And she calmed me down. Did the pain subsided like the effect of that was I mean, I feel like I take that over fentanyl, right? I mean, it really, really worked. And you mustn't forget that component of it because the patient is a very, very alone. And that connection is vital probably to their survival.
So at any rate, you know, this went on for hours. And then finally, my memories that the doctors, the vascular surgeon and interventional radiologist, they were sort of working as a team and I think had this not worked, the vascular surgeon would have taken me downstairs to the O.R. and done his best on me, and they would have called my wife to sort of say goodbye if that was what happened, because the outcomes might have been really bad.
So but my memory was the interventional radiologist, Dr. Dombrowski is extremely experienced and innovative and amazing, and he straight up saved my life. He basically was like, well, we've done everything. You know, it's not working. We done everything we can. And the other doctor sort of nodded and I couldn't believe it. I was like, what do you mean not working?
Like I'm just in for belly pain. Just fix this so I can go home. I couldn't believe it, right. Then Dr. Dombrowski, my memory is he said or maybe we can try going through his left wrist. And then the other doctor. My memory is, he said, I like the way you think. And then they started working on my wrist and that worked.
It was such an extraordinary thing to hear. The doctors deliberating, like, patients don't usually get to hear that. And doctors might even forget that. You know, it's like the children are listening, like, careful what you say around the children. Like, yeah, I'm all ears. I'm very invested in the outcome here.
The other thing I would say, just as a sort of advice, is that, you know, to save my life, I was on the fluoroscope for hours and I got radiation burns. It was like a light sunburn on my back. And I knew it was unnatural because it was a perfect square, right? I showed it to my wife and she was radiation burns, and she was pretty upset about it. And I tried to joke about it. I was like, well, listen, we can call it square Nobel, right?
And that joke did not work at all. So my first piece of advice is. don't do that with your spouse. You won't humor them out of an alarming situation.
But the other serious point is that, of course, later I was very, very traumatized. I almost died. For a year or two, I was way more anxious and sort of agoraphobic and paranoid than I ever was coming back from combat, which I've done many times in my life. I suddenly seized on this idea that in saving my life, they might have exposed me to so much radiation that now I'm going to die of cancer.
And then I did some research and I found out it actually exposure totally manageable. It doesn't really change the numbers. Like, you're good, you're fine. Right? People who have almost died are going to be extremely anxious and paranoid about their bodies, and about doctors and health and everything. And the more you can tell them you got this much radiation and these are the numbers. You have to have that conversation, because otherwise you could live for years with this sort of terrible paranoia that the universe missed you once, but it's going to track you down and get you again, you know. And it's magical thinking. But humans are very prone to magical thinking, and it's extremely troubling.
Dr. Indravadan Patel:
Yeah, no, that's a very great point that you put. I think on the medical side of things, we do have a difficulty sometimes with communicating with patients about everything that they're sort of experiencing and going through, and also what we're experiencing and going through. But without question, there should be avenues and areas to talk and bounce ideas off of. And how patients, you know in their time of need, not just acutely, but also sort of long term and chronically to help manage those types of thoughts and in situations without question.
Dr. Denise Millstine:
And I think this is why we have these conversations on “Read. Talk. Grow.” Because maybe somebody, you know would say to you, oh, how lucky that you survived. And they wouldn't have a concept of really how difficult it is on the tail end of it. As you're then walking in the woods in your remote property and thinking, what if something comes up and now I am again isolated. And so we have to understand the story to understand how that can be a big challenge as well.
There's another set of heroes in this story that I want to make sure we mention. While you are losing blood, they call a code Crimson, which means everybody in the hospital needs to help mobilize blood to get it to you. But they you wouldn't be able to receive that blood if that blood hadn't been donated. So I just wanted to make sure that during this episode, I don't know if one of you would comment on the importance of people donating blood and having stores of blood in case emergencies occur.
Sebastian Junger:
Yeah, I would love to, if I may, because it's a very important point for me. I survived because of great medical care and ten people donated a pint of blood. Ten people, ten people I'll never meet, saved my life, allowed my daughters to have a father, my wife to have a husband. I never thought about blood donation before that.
After this, like, oh my God, we all must. We must donate blood. Because eventually you're going to be on the gurney; your daughter, your spouse, your friend. Like we're all going to be that person needing blood. You must donate. And I and I thought of it in even broader terms, like, we live in this big, wealthy, amazing country, right? 325 million people. Like, what could any one of us do to help, to do anything for this country. The country doesn't need me right? It's one of the demoralizing things about living in a mass society. Right?
And actually, that's not true. We cannot manufacture blood like we need you to donate blood or people will die. Children will die. And while I'm on a roll, we need you to serve in jury duty. I can't do that for you. You need to serve a jury. Do you ever be accused of a crime? You deserve to have a jury of your peers. And you will get one no matter what. But you don't deserve one if you don't serve on jury duty and finally vote.
Those three things are easy to do. And taken together, they make you feel like you're part of something and part of something grand, something great. Which is this country. When I donate blood, I donate blood every 3 or 4 months. And I honestly like it's such a good feeling. They treat you like a hero. You get Oreo cookies and a juice drink and you go home. You go home feeling like a good person. Like that's a straight up win. And like in every regard, you know? So like, please, please do it.
Dr. Indravadan Patel:
Yeah, I would definitely echo that. I gave blood yesterday actually. And, I got a, you know, some chocolate little covered coconut macaroons. So if not for the altruistic reason that Sebastian says, do it for the Oreos and the chocolate.
Dr. Denise Millstine:
You heard it here first.
A lot of the book is about the near-death experience. In fact, much of the book that we've talked about happens very early in the book where we look at the medical aspects. And I wanted that to be the focus of the conversation. But before we wrap up, I'm hoping you both will make some comments about this coming close to death or near-death experience. What we don't know. What's happening in the body, and then we'll wrap up.
Sebastian Junger:
I woke up in the ICU and the nurse told me you almost died last night. In fact, it's kind of a miracle that you made it. The first thing that went through my mind, I remembered seeing my dead father like, oh my God, I saw my dead father in the pit. Like I had no idea I'd almost died. Right? I woke up to this terrible news.
So when I got home, I started researching it because I was very unnerved by what I'd seen on the threshold and by the dream that I'd had prior that I had died. And I started researching it. And come to find out, like, it's a very, very common experience and not just in, you know, crisis moments like I was in, but people in hospice care or older people and they're in their 80s who are dying.
The hospice nurses will tell you that it's very, very common in the last days and hours for the dying person to be actively in communication with the dead, right? Like I was with my father, like they're in the room, right? No one else can see them. You know, there's lots of neurological explanations for the white light and the tunnel and, you know, floating above your but the out-of-body experience. There's all kinds of things that happen in near-death experiences that are, you know, sort of explainable through neurochemistry, neurology of the distressed and dying brain.
And I'm a rationalist, and I bought all of that. The only thing that I didn't quite understand how it would work was the uniformity of the vision of seeing the dead. Even with people that don't know they're dying, don't understand they're dying. And for me, that with that opens up is it's not for me, a gateway to Christianity.
I'm still an atheist, but it's a gateway to that sort of acknowledgment that as amazing as our scientists are, as brilliant as they are, physicists. We just may not understand anything or manage very little about the physical nature of the universe, and of consciousness, and of life, and of death. We just might not have the beginning of a clue of what that reality is at the quantum level, which of course is the ultimate level of all things.
So the book sort of explores those possibilities and there possibilities not espoused by mystics and saints, right? These are possibilities espoused by physicists themselves. Or like, you know, consciousness is a strange thing and affects everything at the quantum level. And the universe might be one massive consciousness that we all participate in in minute amounts as our individual selves. It's a totally plausible theory. And those are the kinds of things I play around with towards the end of the book, trying to understand this incredibly bizarre and ultimately, for me at least, terrifying vision that I'd had.
Dr. Indravadan Patel:
Yeah, I think the latter part of your book is, you know, super fascinating because it tries to tie in, you know, to your point, the metaphysical, the spiritual, the rationalization. You know, you mentioned throughout the book your father being a physicist. Yeah. You mentioned, you know, you're a rational atheist. I had to consider myself along those lines.
So I read it with great fascination. And, it really is telling how people are always looking for, quote unquote, the God particle. Right? The essence of being this consciousness. I think you do a fantastic job of trying to, in your own personal way, trying to decipher what meaning is, what consciousness is, and you do it in such an interesting way, tying in sort of personal stories. You just do a fascinating, fascinating job without question, a great read.
Sebastian Junger:
Thank you. Thank you.
Dr. Denise Millstine:
I'll just briefly comment that, unlike the two of you, I do come from a religious and a spiritual background and, do believe in a higher power. And I find the exploration to just be that, an exploration and a questioning. So for our listeners who are in all camps, essentially, I think this is a very approachable way to look at this question of what you just said, Sebastian, that we just may not understand anything when it comes to consciousness, life and death.
I want to thank you both so much for being here with me today to talk about “In My Time of Dying.” I hope listeners will go out and read the book. Thank you.
Sebastian Junger:
Thank you so much.
Dr. Indravadan Patel:
Thank you. Appreciate it.
Dr. Denise Millstine: “Read. Talk. Grow.”is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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