SINGAPORE - A routine evening jog last May took a deadly turn for 60-year-old businessman Lee Man San.
With 2km to go before reaching his house at Telok Kurau, Mr Lee began to feel unwell. He coughed up blood, felt faint and sat on the grass. The dizzy spell passed after a few seconds, but he knew he needed to get medical help -- and fast.
Without a mobile phone and thinking it would be futile to call out to strangers, he chose to walk home, a journey which felt like an eternity to him, even though it took only about 15 minutes.
Mr Lee said he coughed up blood every few steps but, oddly, did not feel any chest discomfort.
At home, it was another challenge to get help.
It was his maid's day off and his wife and two sons, aged 29 and 30, were out.
Fortunately, his wife, Mrs Chris Lee, 61, who was at a movie, felt her phone vibrating in her handbag. She and their younger son rushed home in 15 minutes.
By then, Mr Lee was so weak that he had to be supported to the car for the three-minute drive to Parkway East Hospital.
There, his condition deteriorated rapidly, recalled Dr Su Jang Wen, a thoracic and cardiovascular surgeon at Gleneagles Medical Centre, who operated on him.
Mr Lee could not breathe on his own, his heart rate was barely discernible and his systolic blood pressure (the maximum pressure exerted by the blood on vessel walls) had plummeted to between 40 and 50 mmHg.
A person would usually faint if systolic blood pressure fell to below 70mmHg, said Dr Su.
Before he blacked out, Mr Lee recalled urging himself: "I cannot die yet. There are too many things I have not done."
A chest X-ray highlighted a big shadow in Mr Lee's chest.
Dr Hui Kok Pheng, a respiratory physician at Mount Elizabeth Medical Centre who had treated Mr Lee for pneumonia in 2010, felt it was more likely to be internal bleeding than the presence of a tumour.
Four doctors rushed to stabilise his vital signs. As soon as a chest tube was inserted, it drained four litres of blood which had built up in the space around his lungs.
Dr Hui said Mr Lee lost at least half of his blood volume within half an hour of being in the intensive care unit. He was losing blood faster than the rate at which blood was being transfused into him.
Things looked grim and Mr Lee's family members were told he had a less than 10 per cent chance of surviving.
The medical team had just about given up hope when Dr Su spotted Mr Lee's fingers in his right hand twitching - a sign that he was still alive. He decided then to go ahead with the operation.
Fortunately, a nurse activated by Dr Su had brought with her special surgical instruments required for cardiothoracic surgery, which were not available at Parkway East Hospital.
Doctors said Mr Lee was very unlikely to have survived the journey to another hospital for surgery.
In the operating theatre, the team raced to save him. Dr Su recalled: "When we opened up his chest, we could not see the source of the bleeding as blood was gushing out of his lungs."
Later, they found an abnormal air-filled sac in the lung tissue, called a lung cyst, measuring about 5cm in diameter - which was "quite big", said Dr Su.
For unknown reasons, one or several blood vessels in his right lung had burst and bled into this cyst. The resulting high pressure ruptured the cyst and led to a condition known as haemothorax.
Haemothorax is the accumulation of blood in the pleural cavity (the space between the lungs and the walls of the chest).
Dr Hui said Mr Lee's lung cyst might have been linked to his medical history of pneumonia.
A spontaneous rupture of a lung cyst, however, is "extremely rare", said Dr Su.
On the operating table, Mr Lee's lung tissues were so fragile that they could not even hold the sutures together to stem the bleeding.
Improvising, Dr Su "folded" the lower half of Mr Lee's lungs to cover the gaping hole and control the bleeding, a technique which was unheard of.
He then packed Mr Lee's chest with gauze and used that pressure to stem the bleeding.
Dr Su estimated that in all, Mr Lee required 42 units of blood products - which included platelets, plasma and blood cells - in the first 24 hours of his ordeal.
This came up to about 12 litres of donated blood. A person of Mr Lee's size would have a total of about six litres of blood in the body.
Miraculously, he survived the operation and was transferred the next day to Gleneagles Hospital.
The following day, he had another operation to remove the gauze packed in his chest and to seal the abnormal vessels which had grown into the lung cyst (embolisation).
He spent the next 10 days in intensive care before he was transferred to Singapore General Hospital at his family's request.
In all, he was hospitalised for almost three weeks. He recuperated at home for another month before returning to run his cake-shop business.
While resting at home, he penned down what he remembered of his ordeal: "Through conversations with my doctors during my hospital stay, I realised that many happy happenstances went my way on May 19 last year. The non-occurrence of any one of those would've killed me."
Mr Lee was referring to his wife picking up his distress call, doctors who sacrificed their dinner to rush to his aid, Dr Su detecting his sign of life and a quick-thinking nurse who brought with her more items than she was asked to.
The ordeal, he said, was "life-changing".
"I see things from a different perspective now and don't take everything so seriously. Money does not stress me out as much."
Mr Lee, who has high cholesterol and high blood pressure, is back to his thrice-weekly exercise regimen.
However, he has lowered the intensity by brisk walking 4 to 5km instead of jogging the same distance.
He figures that if he were a cat with nine lives, he would have already used up eight of these and would "treasure the remaining one".
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