(Ein wichtiger Hinweis: Ich bin medizinischer Laie. Ich habe nur lange mit meiner Krankheit gelebt. Ich kann alles medizinische hier falsch verstanden oder falsch wiedergegeben haben. Jede in diesem Text wiedergegebene Information ist potentiell aus dem Zusammenhang gerissen, falsch, unvollständig. Hört auf Euren Arzt! Fehler sind meine Fehler, nicht die meiner Ärzte.Meine Erfahrungen sind anekdotisch. Eure Erfahrungen können anders sein.)
In the last part I reported on my MRI experiences and on letters that change life. In the following I would like to explain why the prior history makes clear why “Presentation in surgery recommended” was such a significant message.
I would like to point out at this point that, even if in the text I use direct speech as a linguistic construct, that does not necessarily mean that the person said it exactly that way. I have summarised it, pointed it where appropriate, and otherwise it all depends on my memory anyway.
It was in the year 2018
Maybe I should tell this story from the beginning. Over many years I rather plundered myself. Didn’t take care of myself. Stress. Lived unhealthily. Exercise? What’s that? Stuffed myself with far too much. Because there was simply too much stress. Although: actually I am a stress and boredom eater. When I am distracted, or precisely not bored, then I sometimes eat nothing for very long stretches of time. That irritates some people a lot. I always had the associated health problems. Overweight. High blood pressure. And whatever else is connected with that.
At least I never smoked and, apart from the courtesy sip at some social occasions (okay, once or twice it may also have been the whole glass, but that was really a long time ago, also about 30 years), otherwise I regard the courtesy sip as the equivalent of baking with alcohol. Or comparable to overripe bananas, which have roughly the alcohol content of alcohol-free beer. Which, by the way, is not 0%, but only relatively low. About 0.6%. I never really drank.
That probably prevented further health problems. Nevertheless I recognised my limits, which were increasingly drawing closer. I remember a trip to the Lick Observatory on Mt. Hamilton in the Bay Area, on which I was quite short of breath. I put it down to the altitude. Possibly, though, it was already a sign of everything that was to come.
In the sense that I learned of manifest consequences, all of this caught up with me in November 2018. More precisely, on 26 November 2018. About a year later a pandemic was to throw everything into disarray. But on that day in 2018 only my personal catastrophe happened. If you look closely, the world is in disarray to this day. I experienced it on my own body. The time since 2018 therefore feels longer to me than it really was.
Even if one likes to associate a situation with a single point in time – precisely that day on which you get the diagnosis – much in the body is a long-lasting process. Even cancer is a process that begins with one cell that one day sets out to end people’s lives, or at least to change them. Long before you notice anything. Long before you know anything. And not only your own life changes; the life of the people you love is suddenly a different one too.
No matter which diagnosis it is: you associate everything with that day on which you are dealt the blow. And for me that was precisely 26 November 2018.
So my life had already caught up with me earlier. I just knew nothing of it. Because what was in me and which I no longer have after the operation does not arise from one moment to the next. Well, sometimes it does, but not to this extent. I had probably bred the problem in myself over years. It was the receipt for everything I had done before. But until that November I was wonderfully untainted by the knowledge that I had a problem. And that is how I lived too. Didn’t take much heed of my health. I was also only 45. I felt still too young.
I already wrote that I had a size problem, strictly speaking a diameter problem. I certainly already had a head start in all of this through genetic predisposition. I am quite tall. 1.92 m. And that in itself already means the potential for normal variants of organs that lie at the larger side of the norm. Unfortunately that also means somewhat less reserve to the limits that physics also imposes on the human innards. That cannot excuse the over-exploitation that nudged me to and over the limit. At this point it was my own fault. I couldn’t blame it on some unfortunate twist of fate. Bad luck. Or lousy karma.
Koblenz
The realisation that I had to change something, the awareness that it couldn’t go on like this, came with a hospital visit. Not in Lüneburg. But in Koblenz. A city that for me is inseparably connected with the situation that was to unfold over the next seven years. For me there was the time before Koblenz and after Koblenz. I am terribly sorry, dear residents of Koblenz, that I have no positive memory of your city. The memory of that night will probably keep coming up whenever I read “Koblenz” somewhere.
It was November 2018. I was on a business trip. I had an appointment roughly in the direction of Koblenz, so that it was expedient to stay in Koblenz. Also because I didn’t feel like staying in some romantic hotel on the Rhine again. That would perhaps be closer, but would then also have been a bit odd.
The whole day was strange. By my standards a high pulse. A little short of breath. I felt somehow keyed up. I normally have a pulse of about 55; if I am suddenly continuously over 80, that raises my eyebrows.
I already mentioned that I have a history of fear of flying. And to that I put down all the symptoms. Simply a case of fear of flying. Would have fit too. That happens to me sometimes. Just like that, without warning. And until that day I had, in 100% of all cases since I had the fear of flying under control, nevertheless boarded.
And following the maxim: don’t suspect a zebra when the hoofbeats can just as well be explained by horses, I assumed that it was simply a subliminal insecurity towards flying. I didn’t really worry much on that 25 November 2018.
A year and a half later I would probably have worried more. I would presumably have already imagined myself lying face down in a hospital. Yes, the images that were on the news back then scared me a lot. Like a lot of other people at that time, I think.
But in November 2018 I did not want to be kept from doing my job by a temporary episode of “scared of flying”. I actually wanted to fly. From Hamburg to Cologne. From there onwards by hire car to Koblenz. Nothing special. Something I have done so often. Flight from Hamburg to the nearest airport. Hire car to the destination.
So I drove to Fuhlsbüttel. Went through security. Queued at the gate. Was annoyed, as always, by the I-Am-Important crowd. Stepped through the gate. But before I reached the plane, it no longer worked. I didn’t feel well. Something told me I should not fly. Considered it an extremely lousy idea to board.
I got out of the plane again (strictly speaking out of the jet bridge; I did not enter the plane). And when I then sat in my car again in the car park in front of the airport, I felt totally stupid. Just like back then, the last time I didn’t board because of fear of flying. I already thought: “Noooo, please not again.” I was very proud that I had overcome my fear of flying, for all practical purposes, about ten years earlier.
I then had a fit of “But I damn well still have to quickly save the world” and “I promised I would take care of it”. It was Sunday, I was rested and did the obvious: I drove by car to the hotel in Koblenz. Directly from the airport in Hamburg to Koblenz.
Koblenz is a city that for some reason keeps cropping up in my life, beginning with a training course for an operating system that was very widespread back then, during precisely the above-mentioned Bundeswehr period. In barracks in Lahnstein. Lies basically right next to Koblenz. So far ending with the fact that last year or the year before I picked up a camper van there with my brother. Although “van” is a big word for this vehicle. It was a Piaggio Ape. Converted into a micro-camper. Here too I would not choose that prefix. Pico- or atto-camper seems more apt. My expensive racing bike also came from Koblenz. Koblenz again.
It was very late on this day – I can still remember the lights to the left and right of the Rhine – when I drove over a Rhine bridge near Koblenz. Street lamps, probably. Or the light from houses and flats, which bore witness to life in them.
It may sound totally daft, but when you look down at the lights of the villages and towns from a plane, or see them pass by from a car, you have more the feeling of being part of a whole. Light here means life. And the otherwise dead building fabric thereby seems alive. During the day the world is a bit boring as you drive past. At night fascinating. And you yourself add a light (well, strictly speaking two) with your own headlights.
When I arrived in Koblenz, it must have been somewhere between 10 p.m. and midnight. I arrived in the car park by my accommodation, checked in at the hotel. I had not flown, I was at the hotel. But my pulse was still high, I was still short of breath, I was still keyed up. Hmm. It can’t be fear of flying. I was standing on both feet in the hotel. Without a flight. A certain reassurance set in. “Phew, no fear of flying.” On the other hand, that worried me: “What the heck is it then?”
I undressed. I lay down in bed. I thought sleep would do me good after this day. It probably would have. But the sleep did not want to come. With my rolling-around-in-bed you could probably have driven a generator. On the contrary, it got worse and worse. Around 2 a.m. I gave up. The feeling that something was completely and utterly not in order became overpowering. I had to do something.
I went to a hospital that was near the hotel. Emergency department. And already the first measurement revealed the reason for the whole malaise: absurdly high blood pressure. A two right at the front of the systolic pressure. Big trouble. Not good at all. At first they called it a “hypertensive crisis”. In the doctor’s report it says “hypertensive emergency”.
Blood was taken from me. The analysis came back, however, with completely normal values. The junior doctor (in english nomenclature: intern) listened to my problem in the middle of the night. And, after a little research, also found out quite quickly the probable reason for this nocturnal visit and these blood pressure readings. The reason was so simple that it was almost a little embarrassing to me to go to hospital for it. But the high blood pressure was simply there and required treatment.
Despite the reason being found, they first persuaded me to stay in the hospital, at least for the night. But I first had to be convinced of the necessity. Because at night I saw it all differently at first. “But I have a customer appointment,” went through my head. I can’t stay here. “My suitcase is still at the hotel.” Plenty of excuses. I thought: “But the customer is waiting.” I am odd that way. I know that.
I am indebted to the two members of staff at the hospital who, that night, convinced me to stay in the hospital. Because precisely this staying was to change my life for the next few years and led to everything that has happened since, and especially in 2025.
How was I convinced? An older nurse told me that she had lost her husband to a similar piece of foolishness. Just wanting to quickly save the world can also end with the collapse or end of the world for oneself and others. In any case that took hold with me. I stayed in the hospital.
I would like to make one thing clear here: that I absolutely wanted to get to my appointment was nothing that the company demanded of me. That is such a Jörg thing. Probably inherited from my parents. They are like that too. Normally I find that a very good trait. Sometimes, though, it is really disruptive.
My boss would certainly have asked me back then whether I still had all my cups in the cupboard and all my slats in the fence (certainly considerably more politely, but it ought to convey the gist) if he had been aware of all that in the night and I had still said that I wanted to go to the customer. I assume, with a high degree of confidence in my assumption.
But he wasn’t, because it was in the middle of the night. Besides, I actually wanted to sleep and not phone people out of bed or write emails that would have been read only the next morning anyway.
It was only in the morning that I informed all those involved that I would be staying in the hospital and could not keep the appointment. Everyone also had full understanding for it. Customers, colleagues, managers. When in the morning I told my manager what was going on, there were no questions, but only a “We’ll take care of everything, and get well again”. In substance. And I felt pretty stupid (yes, again) that I had first had to be talked into staying in the hospital.
Perhaps a note here: if nurses want to convince you in the middle of the night that you should perhaps stay, then there is usually a good reason for it. They don’t suggest it to you without reason. They are not short of things to do in their job even without you. If there were no reason, they would surely point it out to you. They will have a very good reason. So forget your ego, forget your crude version of a sense of responsibility. And just stay. And let yourself be helped. A professor once said in a lecture: “Women go to the doctor. Men die.” And when I look in particular at the generation before mine, that is true too.
It wasn’t a completely normal hospital stay, though. After all, I arrived in the middle of the night. There were only a few hours until sunrise. It was not as if they had only been waiting for me. Given the choice of whether to spend the rest of the night in a room with an elderly patient groaning to himself, or in the corridor, I opted for the hospital corridor. So there I lay. The light was dimmed, but bright enough to keep me from sleeping. The nurses screened off the area as best they could. And I am very grateful to them for that. To this day. Even if they probably no longer remember that I lay there in the hospital corridor. But I can remember. And from this memory gratitude still arises. Thank you for talking me into staying. Thank you for the attempt to make the corner of the corridor as habitable as was possible.
The efforts didn’t really help, though. You simply can’t completely darken a hospital corridor. I slept maybe half an hour, an hour at most. Or I can no longer remember sleeping longer. I positively need anti-light to be able to fall asleep. Yes, okay, a light-tight blackout will also do. Otherwise I wake up with the sunrise. No matter when that is. What disturbs me even more when falling asleep are noises. Once I have fallen asleep, a marching band can walk past me, but to fall asleep I need quiet. So it was, so to speak, a decision for the presumed lesser evil.
The problem that led me to the hospital was very easy to solve. It was an intolerance to a medication that I had been prescribed for other reasons on the previous Friday. Yes. It was that simple. As I say: an embarrassingly simple reason.
I was also, in a way, foolish. I always say with performance analyses: what changed between “it ran usably” and “problem”? I should have done that with myself too: what changed? And that was, after all, the medication.
Medication no longer taken. A few days later the blood pressure was normal again even without medication. Different medication. No more problem. The side effect was even in the package insert. Which I of course had not taken with me to Koblenz. A bad mistake.
I probably wouldn’t even have really needed the suspected medication. There are, after all, illnesses that treated take two weeks and untreated 14 days. The situation in my case was slightly different, but not by much. I simply wanted to get fit again faster, or at least to have the feeling that I would get well faster. Because that week I had some private engagements that were very important to me. All of which I had to cancel after the situation in Koblenz, and also wanted to, because my thoughts were elsewhere. So in the end I had gained nothing.
Probably my karma simply wanted to take a run-up and kick me in the backside, and to point me to something that urgently needed my attention. And it needed this medication to create the stage for this kick. Maybe karma simply wanted to tell me: “Take care of it.”
And so the foot wound up, and the following morning was to answer the question of what I was supposed to take care of.
Incidental finding
For my karma did not mean my blood pressure. That, as I was to find out a few hours later, was not my biggest problem. The doctors in Koblenz gave me something else to take home with me. Right alongside the instruction: “But you will not take this medication for now. That is clear, isn’t it? Talk to your GP about it.”
The considerably bigger problem was an incidental finding. As, in fact, this diagnosis is almost always an incidental finding. Because it does not hurt. You are not restricted. You actually feel as you always do. If you don’t look for it, you usually don’t find it. And if something causes no complaints, then you don’t look for it.
There is no screening for this disease as there is, for example, for breast cancer. It mostly comes to light when you are scanning the heart anyway or, for some reason, having a CT or an X-ray of the chest done. Precisely by chance in the course of other diagnostics. There is a one-off screening for the disease when it takes place in the abdomen. From 65 you are entitled to that, and I really recommend having it checked. The place where I had my problem is, as a rule, not looked at.
Even worse: if you have issues, then you have a really big problem. Because then a process may be underway that can at some point, in the near future, kill you within three minutes. Just like that, out of the middle of life. At any damned point in time. Then it is usually a case of all hands on deck, of things going pear-shaped, and of something steaming away quite vigorously, not very pleasantly. After it has hit a fan.
It came to light because of a rule that applies in the hospital I went to: in that hospital in Koblenz it is – if I understood it correctly – stipulated that every patient who experiences such a hypertensive emergency receives a short ultrasound examination. They then look at whether everything is in order. Make sure that the high blood pressure has not broken something that requires immediate treatment.
“You ought to have one …”
To this day I remember this slightly dimmed room. I could nevertheless see through the window the wall of the house opposite. During the night I had not really been aware that the hospital lay so much in the city. Surrounded by houses on all sides. “Do you have a cardiologist?” asked the doctor.
I believe he didn’t actually want to know whether I was already connected to a cardiologist. Today I believe he wanted to know whether he was about to be the first to bring me a lousy piece of news. Or whether I possibly already knew what he was about to say, and would then just wave it off: “Yes, I know. It’s rubbish, but I know.”
Because another cardiologist would probably already have checked that beforehand and informed me of the problem. Although I may be wrong with the assumption; I read far too much into many things. Another side effect of the cork in the thought-vortex.
But my last cardiologist visit was, at that point, about 20 or 25 years ago. Probably that cardiologist is no longer even alive or is enjoying his well-deserved retirement.
With today’s knowledge of what he would tell me in the next moment, I later understood his facial expression. Although here too the same applies: presumably it was just his standard facial expression, and today I read too much into this situation. Because for me the day seemed pretty important, because it began pretty lousily, because the previous day had already been lousy and promised not to get any better either. To quote a really bad action film with Vin Diesel, which I nevertheless, to my shame, like to watch (I can recommend it, if you don’t expect intelligent entertainment): it boils down to the protagonist saying that there are bad days and that there are then also legendarily bad days. And this day was just becoming legendarily bad for me. For the doctor probably simply a Monday.
“No, I don’t,” I answered. “You ought to have one!” he countered, and pointed at the screen, showed me the diagnosis on the screen.
In the doctor’s letter that I was given, and whose primary content I will describe – along with the immediate consequences – in tomorrow’s part, it was to say: “First diagnosis of an aneurysm of the ascending aorta of approximately 48 mm”. Shit. Really big shit.
