3cm of Complexity – Anna Vasof, 2024

This text seeks to express, as plainly and factually as possible, the almost uncanny connections that I have intuitively felt present over the past year between the microcosm of my body and the macrocosm of the world around me. 

So, my story begins in the summer of 2023 when I was filming a documentary about a hospice in Tirol. The idea was that I would live and sleep there for one week, together with the other patients, and record my discussions and observations there. But after the 4th day, I started feeling a big pressure in my chest. I was sure it was psychological because of the patients’ deaths I was witnessing. Even though I was mentally prepared to experience death, I didn’t imagine how physical this experience could be.

After finishing my work there, I decided to go to Greece to meet my family and have some vacation time to calm down the chest pressure. This was in August 2023.

But what happened there was that the whole country was on fire because of severe summer wildfires. These fires get worse and worse every year, burning forests, houses, animals, and even people

So instead of relaxing, I was watching the red sky, the black clouds, and smelling burned wood for two weeks, wishing that no fire would reach my village. My chest pains got worse, and I became convinced it was a side effect of the extreme stress or a combination of anxiety and hopelessness about the future. After returning to Vienna, even though I was still convinced that these chest pains were psychological, I decided to check my heart. After receiving perfect results, I was once again sure that everything was psychological, and I just needed to deal with my anxiety for the chest pressure to go away.

So, I started walking. I walked many kilometers every day, started observing details of everyday life, and slowly began to feel better. My breathing became less restricted, and the chest pressure started decreasing. Motivated by the positive results, I started also doing meditative sports, like Qigong and yoga.

This continued until March, when I faced multiple work disappointments (my hospice documentary was rejected everywhere, and at the same time, I had to deal with unnecessary “collegial” aggression and felt symptoms of burnout).

Somehow, these new frustrations caused me gastritis and then intense chest pressure. So I started again with medical tests. The medical system is very disappointing. Even though I have two public health insurances to avoid waiting months for basic tests, I had to pay for all tests at private clinics. The doctors charge insane fees for a five-minute checkup, treating patients arrogantly and telling you what you already know. These weeks were a nightmare. Many private doctors have this arrogance, treating patients as if they are little gods, being random or ironic about anything that is not obvious or an emergency.

Because of these doctors’ attitudes, I became convinced I was just a hypochondriac and that everything was in my head.

But at one point, a gastroscopy showed I had a 3 cm diaphragmatic hernia. A 3 cm diaphragmatic hernia is when the stomach moves into the diaphragm, and the opening there increases by 3 cm. It can also be bigger, mine was 3cm, a size for a diaphragmatic hernia which is not very big to be small and not too small to be big.

This was something I didn’t know how or when exactly happened. It is something common like many minor health issues that someone can face in life. Like all hernias, it can occur due to poor lifestyle and eating habits, or even from lifting something heavy, having an accident, or simply sneezing.

The most common symptom is heartburn, which I experienced as chest pressure. Upon observing closely, I realized that all my stomach issues, which I had been ignoring, were not just the result of stress, or overwork, but also from this hernia.

These heartburns resulted from gas coming from my stomach through this extended opening and pressing on my chest. Most of this gas is CO₂. I learned that every stomach, when digesting, produces minimal amounts of CO₂, which dissolves in the body or exits through the mouth. But with a hernia, the stomach produces even more CO₂, causing a constant feeling of pressure.

Even though it is a mechanical problem, fast and careless eating, along with stress, anxiety, and poor mental health, can increase the production of stomach gas.

Now that I had a tangible diagnosis, I needed to find a solution. After those nightmare weeks, it became clear to me that public healthcare wasn’t a viable option, as I didn’t have any personal connections with doctors, and they were all overloaded. A simple example: the average waiting time for a gastroscopy through public insurance is about four months. On the other hand, private healthcare often feels random, with most doctors more focused on quick, standard treatments and fast profits. I had to be cautious with my decisions, so I consulted three different doctors. Unfortunately, each had a different opinion.

The first put me through more painful and expensive tests, which I later learned were totally unnecessary. He told me he didn’t recommend surgery and had no particular advice—if it got worse, I should return.

The second made me do another gastroscopy because the first didn’t have enough photos for him. He also made me take three more tests to exclude other highly unlikely illnesses and told me that I had a 3 cm diaphragmatic hernia, which I already knew, and that surgery was the only solution. He warned that leaving it untreated could cause real trouble in a few years.

The third thankfully didn’t require more tests, just prescribed me tons of medicine, and told me to meditate, avoid stress, and preferably eat and live like a monastery monk.

So I decided to go with the third option. And indeed, I started getting better, but one random hot summer day, out of the blue and without any particular reason or deviation from my monk lifestyle, I entered a long period of chest pressure again.

I thought, “Let’s try some holidays again.”

I started traveling by car from Austria back to Greece, still hopeful that going south would help me. But the wildfires started again, first in Bosnia, then then worsened in Montenegro, and in Albania, I slept in a car full of smoke from a huge fire in the Valbona Valley. And, of course, in Greece, the situation was similar.

It felt as if all these wildfires were taking place in my stomach.

It was interesting to observe how people, including myself, try to adapt to these new conditions, continuing our holiday routines even while inhaling smoke under red skies.

On one of those sleepless July nights with chest pressure, I made a radical decision and wrote an email to the second doctor asking for an operation date.

The earliest appointment for surgery was two and a half months later, in mid-October.

During those two and a half months, I continued traveling, trying to stay in places where nature seemed calm. I worked with my hands, walked, avoided watching the news about the southern wildfires and the floods in middle Europe, and tried not to think about the planet’s future. My chest pain was present but less suffocating.

More or less, time passed like that, and by mid-October, I had my operation.

Before any surgery, you need to wear a robe that’s open at the back, and a muscular nurse pushes you on a wheeled bed to the operating room. There, I realized there was a traffic jam of these beds, one behind the other, with scared patients waiting for the same operation as me.

The surgeon spoke to me before the operation. To emphasize how routine the procedure was, he mentioned that I was his fourth surgery of the day, with one more scheduled after his.

Then they put a mask on my face, and the last thing I remember was seeing a yellow gas through it and coughing slightly before I fell asleep.

I woke up about three hours later in another room. A nurse told me everything had gone well.

The first thing I noticed was severe pain in my shoulders, which was strange since the operation was in my abdomen.

When they brought me back to my room, I asked every nurse why I had so much pain in my shoulders and not in my belly where the surgery took place.

They all said it was from the gas, and that it would pass.

In that sleepless night between painkillers and IV drips, I used my phone and asked ChatGPT what gas they were talking about and why I had shoulder pain.

It answered:

CO₂ (carbon dioxide) is used in a laparoscopic diaphragmatic hernia operation. In laparoscopic surgery, CO₂ is used to inflate the abdomen, a process known as pneumoperitoneum. This creates a working space for the surgeon by lifting the abdominal wall away from the internal organs, allowing them to see clearly and move instruments freely during the procedure. Here’s why CO₂ is specifically chosen:

• Non-flammable: Unlike other gases, CO₂ is non-flammable, which is crucial when using electrical surgical instruments.
• Readily absorbed and expelled: The body can easily absorb CO₂ and eliminate it through respiration, reducing the risk of gas embolism (air bubbles in the bloodstream) compared to other gases.
• Less risk of complications: CO₂ causes less irritation to the peritoneum (the lining of the abdominal cavity) than other gases, minimizing postoperative discomfort.

It’s a key element that enables minimally invasive surgeries like your diaphragmatic hernia surgery to be performed with smaller incisions and quicker recovery times.

The pain experienced after a diaphragmatic hernia operation using CO₂ is typically caused by the residual gas irritating the body, especially the diaphragm and surrounding nerves. Here’s why this happens:

• Irritation of the phrenic nerve: The CO₂ used to inflate the abdomen can irritate the phrenic nerve, which controls the diaphragm. This nerve irritation can cause referred pain in the shoulders, chest, and upper back—a phenomenon known as shoulder tip pain. This is common after laparoscopic surgery.
• Stretching and pressure: The CO₂ gas creates pressure on the diaphragm and surrounding tissues, and even after it’s released, a small amount can remain trapped. This can stretch the diaphragm and surrounding muscles, causing discomfort until the gas is fully absorbed.
• Absorption process: CO₂ is absorbed into the bloodstream and expelled through breathing, but this process can take time. While it’s happening, the remaining gas can cause bloating, cramping, and pain, particularly in the upper abdomen or shoulder area

While this pain usually resolves within a few days, walking and moving around can help speed up the absorption of the gas and alleviate the discomfort.

This is, at the very least, confusing: I treated the overproduction and accumulation of CO₂ in my body, which worsened as I thought about and experienced the environmental impact of CO₂ overproduction; yet I did this with an operation that inflated my belly with CO₂ gas.

Today, as I write this, it is the 7th day after the operation, and ChatGPT was right: my shoulder pains have decreased, and after several days, my body managed to absorb some of the CO₂ gas. However, my stomach and esophagus still feel full of gas.

According to ChatGPT:

The sensation of your belly being full of gas could be a result of digestive changes post-surgery, as your digestive system adjusts to the new anatomical structure. Slower digestion, or even air swallowing can contribute to this bloated feeling. The gas you’re feeling is likely either residual CO₂ or intestinal gas, both of which should gradually reduce over time as your body heals.

So, this is the story so far of my struggle to capture, reduce, and tame the gas that my stomach produces and to finally rid myself of heartburn. Over the past few months, I’ve encountered a degraded public health system and a profit-driven private one, full of conflicting interests and opinions, from professionals who saw no problem in a small leak to others who treated me with gadgets and drugs and others who threatened me with dire predictions about my future. In the end, I decided for a drastic solution—one that it’s still too early to know whether it was the right choice or just another unnecessary ordeal.

One thing is for sure: changing some habits has helped. But since the hole was there, it couldn’t close on its own—something the atmosphere is capable of doing by itself if humans change habits, systems and consider non- profit oriented solutions.

---

Anna Vasof is an architect, media, and time-based artist. She studied architecture at the University of Thessaly (2010) in Greece and Transmedia Art (2014) at the University of Applied Arts in Vienna. Since 2004 her videos and short movies have been presented in several festivals, some winning distinctions. In 2020, she finished her Ph.D. thesis about a cinematographic technique she developed titled “Non Stop Stop Motion”. She is now working on designing and building innovative mechanisms for producing critical videos, films, actions, and installations.

Click here for more information >