Ep. 70 | It Comes Back

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On a warm afternoon in Rhode Island in the summer of 2003, a 50-year-old man flipped burgers on the grill while sipping a beer.

He had moved to the area for a job a few years ago, but he still felt like the new guy at work.

And so a midsummer barbecue was a perfect perfect excuse to get the whole team together for some extracurricular bonding.

As the sun set and the backyard full of people turned dark, he crouched down to plug in some lights strung along the deck.

But as he bent over, he felt a sudden surge from his gut.

He lurched to the edge of the lawn, fell to his knees, and heaved as stomach acid and half-digested food flowed up into his throat and spilled out of his mouth.

The man's co-workers rushed over with napkins and water and helped prop him up against the railing.

Once he was upright, his stomach gradually settled, and after the man got over his embarrassment, the party returned to normal.

But the experience confused and disturbed him.

He wasn't drunk.

He hadn't been nauseous.

It hadn't really even felt like he was vomiting exactly.

It was like the contents of his stomach had just decided to exit his body, and he was powerless to stop it.

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From Balin Studios and Wondry, I'm Mr.

Balin, and this is Mr.

Balin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape: our own bodies.

So, if you like today's story, please invite the follow button to a quiet study session in the library, and just as they begin to focus, start rhythmically tapping your pencil on the desk non-stop, humming off-key versions of popular songs.

This episode is called It Comes Back.

In the summer of 1982, a corporate sales director named Roger Donovan walked up the steps of a suburban house in Detroit, Michigan and knocked on the door.

It was his 29th birthday, and one of his coworkers had insisted on throwing him a party.

When the door swung open, nearly half his office was clustered inside, and they all shouted happy birthday and blew noisemakers.

Roger had only been at the job for about a year, so he really appreciated the warm welcome.

Especially since lately, lately, he'd been feeling strange and kind of lousy.

He developed a nasty wet cough, despite not being congested or sick.

Some nights it got so bad he couldn't get to sleep, which left him feeling wrecked in the morning.

He hoped it was just some weird seasonal allergy thing, and so he was just trying to tough it out.

So for now, this party was a pleasant distraction.

Roger had some drinks and snacks and caught up with a few co-workers he rarely got a chance to chat with.

But towards the end, he found himself in the back patio near a group of people who were smoking.

Although Roger himself had never been a smoker, being around smokers didn't usually bother him.

But tonight, the smoke triggered his cough, and once it started, Roger couldn't stop.

It got so intense that he felt embarrassed and decided to leave.

But on the drive home, the cough stirred up this churning in his stomach.

He could feel liquids sloshing around inside of him and it made him feel queasy.

Roger thought back to what he'd eaten at the party, but there was nothing out of the ordinary, except for maybe a slice of birthday cake, which he didn't eat very often.

And so he couldn't figure out why he was having so much gastric distress.

Back at his house, where Roger lived alone, he turned on the TV and laid on the couch.

He hoped being sedentary would help calm his stomach down.

But only minutes after laying down, Roger began coughing heavily again and then felt a surge of nausea that immediately forced him to sit up straight.

And as he was sitting there, he began sipping some water and eventually he sort of calmed down and caught his breath.

But he still felt rattled by what his body was doing.

Crawling into his bed later that night, Roger wondered if maybe he had developed some new allergy to something, or if the coughing indicated a respiratory problem like bronchitis.

Either way, it worried him because it was new and because he had no idea what could be causing it.

Clutching a pillow to his still churning stomach, he realized it was probably time to see a doctor.

A few days later, Roger sat on the examination table in the office of a local pulmonologist, which is a doctor who specializes in the respiratory system.

The doctor held a stethoscope to Roger's chest and asked him to take in a few deep breaths.

After a minute of doing this, the doctor nodded, removed the stethoscope from his ears, and told Roger that his breathing sounded like he had asthma.

Roger was surprised because he'd always lived a very active life and never had any breathing issues before.

The doctor shrugged and explained that asthma can start at any age and can range from very mild to severe.

He thought Roger most likely had what's called late-onset asthma, which is actually very common in adults.

He prescribed Roger an inhaler and told him that using it frequently would make a big difference in his cough and breathing.

He also advised Roger to see a gastroenterologist for any of his digestion issues.

Roger took his advice and a few days later visited with a recommended local gastroenterologist named Dr.

Ostrander.

And after listening to Roger's organs and asking some questions about Roger's medical history, Dr.

Ostrander concluded that Roger probably had acid reflux.

This would explain Roger's nausea, his digestive pain, and his coughing.

At first, Roger was skeptical of this diagnosis.

He had never had digestion issues before.

and he found it especially odd that it would set in at the same time as his late onset asthma.

Why would all of this just start now out of the blue?

Dr.

Ostrander wasn't a lung specialist, so he wasn't really sure about if and how the asthma played a role in the acid reflux.

But he said it's not usually connected to something like acid reflux.

He explained that for most people, acid reflux is not something a person has their whole life.

It comes and goes depending on a variety of factors.

Sometimes it's triggered by eating unusually rich foods, or lying down too soon after a big meal, or stress, or smoking cigarettes, or even certain medications can cause it.

Dr.

Ostrander explained that when food travels down the esophagus to the stomach, sometimes the sphincter muscle at the bottom of the esophagus relaxes at the wrong time, or it relaxes too much.

That allows stomach acid to flow back up into the esophagus, which can cause heartburn, nausea, or stomach pain.

And if the stomach acid sloshes high enough, it spills into the lungs, and that can block the airway.

And so the doctor speculated that this could be the source of Roger's cough.

Dr.

Ostrander prescribed Roger some medication to help reduce his stomach acid production.

But otherwise, he told Roger not to worry too much and just be aware of his diet in case there might be a particular food triggering all of his symptoms.

A few months later, on a rainy autumn evening, Roger sat inside on his couch feeling defeated.

He had been using his inhaler diligently for months, but he hadn't noticed a difference.

His cough was the same.

And the meds had done nothing for his acid reflux.

Even on nights when Roger went out of his way to eat an extra bland, simple dinner to avoid irritating his stomach, he'd still feel a surge of nausea as soon as he laid down.

The Michigan weather didn't help either.

Once summer ended and the temperature started to plummet, the chill of the air would sting Roger's lungs, particularly on early mornings before work.

By the time full-on winter hit, Roger knew he'd basically have to stay indoors because outside, he'd struggle to breathe.

Being cooped up inside so much only darkened Roger's already dark mood.

But he hoped that eventually, somehow, his body would acclimate to whatever was going on and he'd come out on the other side.

In the meantime, he took another puff on his inhaler and laid back down on the couch.

About 10 years later, Roger walked alone down a dark and silent suburban street late at night.

The only sound was his footsteps echoing on the concrete and the occasional huff of his inhaler.

Walks like these had become routine for Roger.

Over the past decade, his cough and digestion problems had steadily worsened.

Roger relocated to Augusta, Georgia for a new job last year, but that hadn't helped.

It was a welcome change from breathing the frigid air of Midwestern winters, but even in the warmer southern climate, he often woke up with liquid in his lungs, causing him to cough until he vomited.

These fits left him feeling delirious and nauseous, so he began taking late-night walks around the neighborhood just to settle his stomach.

As Roger slowly shuffled along the empty streets, he felt depressed and disoriented.

He'd recently turned 40, which he worried might be a health tipping point.

What if his stomach issues and coughing only got worse with age?

Roger took another puff on his inhaler and sighed.

He didn't understand why all the doctors he had visited over the years had accomplished so little.

At this point, Roger had been taking acid reflux medication and using his inhaler for a decade straight, yet his symptoms really had not improved in the slightest.

And the lack of sleep as a result of these symptoms that were just not being curbed was really taking a toll on him and beginning to affect his performance at work.

As Roger looped back towards home, letting his thoughts wander, he suddenly noticed an odd sensation in his chest, an unfamiliar pressure he'd never felt before.

He stopped under a streetlight and ran a finger over his chest, trying to sense where this pressure was located.

Roger took a slow, deep breath and abruptly stopped.

There was again.

The moment air filled his lungs, he could sense it.

There was the soft pressure at the base of his lungs.

It was almost like there was an invisible hand inside of his abdomen literally holding his lungs up.

Roger shook his head, totally confused.

I mean, who could actually feel their lungs?

That's not a sensation you get.

And so, now, in addition to all these terrible symptoms he had had for years, Roger wondered if he was also starting to lose his mind.

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Another decade later, on a cold morning in the fall of 2003, Roger sat at the edge of an indoor swimming pool in suburban Rhode Island.

His brain still felt blurry from yet another bad night's sleep, but he hoped a good swim would set him straight.

After eight years in Georgia and countless doctor's visits that led nowhere, Roger decided he needed a major change.

He was approaching 50 years old and felt like he was in a bit of a rut, so he applied for and landed a job near Providence, Rhode Island as the vice president of a technology company.

Roger was coming up on three years at this new job and had grown to love the team there, but unfortunately, his health problems had come with him.

His cough had steadily worsened over the years, lasting longer and cutting deeper.

The acid in his stomach sloshed around and went up into his esophagus anytime he wasn't actively standing upright.

As a result, he had taken to sleeping on a mound of pillows to try to keep his body somewhat propped upright.

It was not comfortable, but otherwise he'd be woken up by a sudden surge of vomit.

In an effort to strengthen his breathing, Roger had found a local health club with an indoor pool and started swimming most mornings before work.

It was the only activity Roger had discovered where his body could be horizontal and not trigger his symptoms.

He didn't understand why, but he embraced it.

Swimming had become by far the best part of his day.

Once he was ready, Roger took a deep breath, dove into the water, and swam all the way to the other side.

After a couple of warm-up laps, he tried testing how far he could swim while holding his breath underwater, surprising himself by making it two whole lengths of the pool.

As he climbed out and toweled off, Roger felt energized.

He also felt confident that whatever his health issues were, he did not have asthma.

There is no way he'd be able to hold his breath so long and swim so vigorously if he did.

It would also explain why the inhaler had never made a difference in 20 years.

Roger was tempted to just throw the inhaler away.

A couple weeks later, Roger hosted a barbecue party and suffered the worst flare-up of symptoms he'd ever had in over 20 years.

While he was grilling burgers for his coworkers, Roger at some point had casually bent over to plug something in, and a torrent of half-digested food surged out of his mouth.

There was so much stomach acid leaving his body that Roger fell to his knees, unable to breathe and feeling this terrible burning sensation all along his esophagus.

The experience was a wake-up call.

Roger had to face the truth.

His condition was not something he could just keep ignoring.

It was only intensifying over time, and his body was starting to lose the fight against it.

A week after the barbecue, Roger's colleagues stopped him in the hallways to ask how he was feeling.

By now, word had spread.

Everyone knew something was seriously wrong with Roger's health.

But as much as he tried to act like it was no big deal, Privately, Roger was starting to panic.

He knew his life could not go on like this forever.

He had been battered by the same digestive and respiratory symptoms for decades, and clearly they were not going anywhere.

The thought of fighting this battle for decades more to come felt unbearable.

But Roger did bear it, without relief, for 20 more years.

And he did that by distracting himself by focusing on his career.

After leaving Rhode Island in 2008, Roger had hopped around to a few different places before finally landing the biggest opportunity of his life in 2014.

He was named the chief marketing officer for a fabric manufacturer in Cleveland.

On a spring morning in 2023, Roger strolled through the company's massive industrial warehouse to inspect a new delivery of fabrics all neatly stacked on pallets.

Although he'd recently turned 70, Roger had no intentions of retiring anytime soon.

However, the harsh chemicals used to clean the knitting machinery wreaked havoc on his lungs.

Even before COVID hit, Roger had taken to wearing a mask in the warehouse to avoid exposing others to his coughing.

Even so, his coughing fits only continued to get worse.

Many days, Roger would be forced to make an excuse in order to hurry to his office, lock the door, and hack until he vomited into a trash can.

Then he would wait until the entire office emptied out to dispose of the vomit in a toilet.

And the nights after work were very lonely because his condition made it impossible to socialize.

Roger's digestive system was too fragile.

He dreaded going to bed, knowing that his cough would inevitably wake him in a fit.

The lack of sleep continued to add up, and he was older now and really felt his age, and so it wasn't as easy to bounce back in the mornings.

Then came the breaking point.

Later that week, in the middle of the night, Roger woke with his usual cough and stumbled to the refrigerator to fill a glass of cold water, but he couldn't make it.

A sharp pang in his chest made his knees wobble, and he slumped onto the couch.

Roger tried to take slow, deep breaths, but his lungs felt shrunken.

The shortness of breath made him so dizzy, he worried he was about to pass out.

Lying there motionless, waiting for his body to stabilize, it hit Roger with total clarity.

It could not go on like this.

It was no longer bearable.

When his alarm went off later that morning, Roger called his primary care physician and booked the next available appointment.

A couple days later, in the middle of the weekly staff meeting, Roger's cell phone vibrated with a voicemail from his doctor.

Roger had been on edge, waiting to hear back about the results of a CT scan.

At his appointment a few days ago, Roger's doctor had theorized that Roger might have chronic bronchitis.

That would explain the wet, nagging cough.

He proposed a CT scan to look for inflammation in the tubes connecting the windpipe to the lungs, which Roger agreed to.

But the last 48 hours after the scan had dragged by as Roger's head swirled with worries, he hoped whatever news he got would finally put the years of uncertainty to rest.

Apologizing for the interruption, Roger stepped into the hallway to return the call.

And as soon as he heard his doctor's voice, he could tell something was very serious.

The doctor spoke calmly and urged Roger not to worry until they knew more, but his CT scan had come back showing dark spots across his lungs.

These could be one of many things, but among the possibilities, unfortunately, was cancer.

Roger's heart sank.

A part of him had always dreaded that his condition might be something truly terrible.

Slipping the phone back into his pocket, Roger returned to the meeting.

His coworkers carried on with business as usual, but Roger's mind was elsewhere, reeling at how everything in his life could have led to this.

Dr.

Gregory Crane had heard plenty of unusual medical histories over his many years as a pulmonologist in Cleveland, But the 70-year-old man sitting in his office was a rare case.

Roger's story spanned so many different jobs and cities and major life changes, yet throughout them all, his symptoms had never improved.

And then when Roger explained how he could actually feel his lungs like there was a phantom hand inside of his body, Dr.

Crane was riveted.

Roger had been referred to Dr.

Crane after receiving his CT scan results.

Although it took multiple tests to prove it, Roger's doctor eventually determined that those dark spots on his scan were not cancerous.

But despite this good news, Dr.

Crane could plainly see that Roger was not a healthy man.

His eyes were sunken and his skin looked gray from fatigue and the exhaustion of constant coughing.

Ruling out cancer was a relief, but it didn't solve the much bigger question of what was causing Roger's condition.

Dr.

Crane's first thought was that Roger must have some unusual type of asthma.

But Roger was quick to explain how previous doctors had diagnosed him similarly, yet four decades of using an inhaler had not helped at all.

And so after running some additional tests, Dr.

Crane told Roger something that no doctor had told him in 40 years.

Roger's hunch was right.

He definitely was not asthmatic.

All those huffs on the inhaler had been for nothing.

Roger sighed, shook his head, and then pulled out his inhaler and chucked it at the small trash can in the corner of the room.

But he missed and it hit the floor.

When Roger stood up to pick up the inhaler, he suddenly began coughing violently.

He quickly stood back upright and the cough died down.

But the sight of Roger bent over gave Dr.

Crane an idea.

He told Roger there was one more test he wanted to run.

One morning the following week, Roger dragged himself out of bed after another ragged sleepless night.

His head felt tingly and hollow from being awoken every couple of hours in a fit of of coughing.

No matter how simply he streamlined his diet or what angle he propped himself at to go to bed, his stomach still churned and his lungs still felt blocked.

As an increasingly elderly man, Roger worried he would not be able to keep fighting this off much longer.

Today, however, he felt more optimistic than usual.

He had a special procedure planned with Dr.

Crane that he actually had high hopes for.

Roger showered, but then skipped coffee and breakfast because he was told not to eat or drink anything for four hours before this this operation.

At the hospital, Roger was led to a room where a technician was preparing a computer monitoring system.

Roger felt a bit nervous, but more than that, he felt desperate.

His body was beaten down by fatigue.

This procedure seemed like his last chance.

There was a knock at the door and Dr.

Crane entered, followed by a nurse carrying a kit of medical equipment.

Dr.

Crane told Roger to lay on the hospital bed and try to relax.

Roger did his best, but flinched when Dr.

Crane moved close, holding a thin, flexible catheter.

Dr.

Crane had warned Roger that this procedure would be uncomfortable, but even though Roger knew that, now that it was happening, it was hard not to be anxious.

The first thing Dr.

Crane did was he sprayed a numbing medication up Roger's nostrils and into the back of his throat.

After that, he guided the tube up Roger's nose while the nurse handed Roger a cup of water to drink.

With each swallow, Dr.

Crane slid the catheter further and further down Roger's esophagus until it reached the entrance of his stomach.

Roger almost gagged many times, but managed not to break into a coughing fit.

Once the catheter was secure, Dr.

Crane looped it over Roger's ear and connected it to a small computer about the size of a smartphone.

Then he attached the computer to a belt, which Roger was to wear for the next 24 hours.

Roger could eat and drink like normal, but he would need to keep a diary of his meals, activities, and symptoms.

Meanwhile, the tip of the catheter inside of Roger would be recording the levels of acid in Roger's esophagus and transmitting them to the computer.

The rest of Roger's day was bizarre.

Doing anything with the catheter up your nose and down your throat was awkward.

He had told his boss he was taking that day off for medical reasons, so he had plenty of time to kill.

Roger went for a long walk in a nearby park, then bought some groceries and made dinner for himself while watching TV.

Nighttime felt long, strange, and uncomfortable.

Roger's stomach was irritated by the tubing, and his breathing was as bad as ever.

Lying in bed, staring up at the ceiling with a bulky belt around his waist strapped to a computer, Roger felt a little ridiculous, but he had run out of options in his life.

And so at this point, even the smallest sliver of a chance that this procedure could help him was worth taking.

And the next day, he found out it was definitely worth the risk.

Dr.

Crane had downloaded and studied the data from the computer, and the results were conclusive and shocking.

The test that Dr.

Crane had administered was called a 24-hour pH impedance test.

By tracking the fluctuations in acid levels in Roger's esophagus across an entire day and night, he discovered something that no other doctor in 40 years ever had.

Roger's esophagus was defective.

He was missing a sphincter at the bottom of it.

That meant there was no barrier between his esophagus and stomach like most people have.

So there was nothing to stop the contents of his stomach from coming back up if his body was positioned at the wrong angle.

And so night after night in bed, Roger's stomach fluids flowed up into his lungs.

That's why he coughed so much at night and why walking around upright helped settle his stomach.

Dr.

Crane could not determine whether Roger was simply born without a sphincter in his esophagus or whether his sphincter had been damaged or destroyed over the years somehow.

But regardless, the effect was the same.

Roger's rare condition actually had a name.

It was called non-erosive reflux disease.

Roger was shocked as Dr.

Crane explained his findings.

All these years, he had imagined so many different outcomes, but this was never one of them.

Dr.

Crane referred Roger to a gastric surgeon colleague of his named Dr.

Amanda Davenport to confirm his findings.

But she soon discovered that a missing sphincter was not Roger's only medical curiosity.

It would turn out the reason Roger could feel his lungs as if there was a phantom hand putting pressure at the bottom of his lungs was because his stomach had broken through the layer of muscle at the bottom of his lungs called the diaphragm and was actually pushed up against them.

That meant the fluid in his stomach was directly next to his lungs.

That pressure Roger felt came from the stomach fluids sloshing around because there was no sphincter to contain them.

And so that was what he was feeling.

Dr.

Davenport was able to move Roger's stomach down, mend his diaphragm, and create a sphincter in his esophagus by using extra tissue from his stomach lining.

And the operation was successful.

And ever since, Roger's cough has vanished, and he can now bend and stoop and sleep in any position he wants without worrying.

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Bollin's Medical Mysteries on the Wondery app, Amazon Music, or wherever you get your podcasts.

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Ballin.

A quick note about our stories.

They are all inspired by true events, but we do sometimes use pseudonyms to protect the people involved, and also some details are fictionalized for dramatic purposes.

And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

This episode was written by Britt Brown.

Our editor is Heather Dundas.

Sound design is by Matthew Cilelli.

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and our coordinating producer is Taylor Sniffin.

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