Robert Ferrari cannot remember what actually did it -- a hard cough maybe, or straining up the stairs -- but somehow the 72-year-old retiree blew a small hole in his esophagus during a trip to Italy last year.
Ferrari, of Center Moriches on New York's Long Island, showed up at a doctor's office in Italy with the common symptom of chest pain. For days, he walked around with a misdiagnosis of acute gastritis while the undetected hole in his esophagus was feeding a ticking time bomb -- but an appeal to the ABCNews.com Web site may have helped him get the care that he needed.
"These are people who literally die within hours," said Dr. Timothy Nostrant, a professor of medicine in the division of gastroenterology at the University of Michigan, in Ann Arbor. "It can vary from days to hours, but literally something has to be done."
The small hole in Ferrari's esophagus leaked whatever was in his throat -- air, water, bacteria-laden saliva -- into his chest cavity, Nostrant said. Without medical intervention, his chest cavity either would fill with enough liquid to crush a lung or it would develop an infection that could kill.
"People get very, very sick, often very quick," said Dr. Sudish Murthy, a staff surgeon in the department of thoracic and cardiovascular surgery at the Cleveland Clinic in Ohio.
"Regardless of who you are, it is a life threatening condition at any age," he said.
Ferrari got sick and was rushed to an emergency room in La Spezia on the Northwestern coast of Italy, then transferred to the San Martino University Hospital in Genoa. Doctors there manage to keep him alive and finally discovered the esophageal rupture that was filling his chest with infected fluid.
But that was June 2009, and the journey through traveler's insurance, medical evacuation and one of the biggest struggles -- getting a doctor in the U.S. on the phone -- had only just begun.
"We were desperately hoping that his condition would stabilize and that we would be able transport him home, but in order to do that we had to have a surgeon here who was able to treat him," said Ferrari's sister, Barbara Ferrari Shannon.
Thanks to his family's clever dealings and a little help from ABC News, Ferrari received what doctors hope will be his final operation this Tuesday in New York.
Through it all, the Ferraris have learned some lessons about wading through a medical emergency nightmare in a foreign country.
"My brother is on Medicare, he is 72 years old and he was in excellent health before he left," said Shannon. "What I think most tourists are unaware of is that Medicare pays nothing if you're out of the country. Our coverage was minimal, but at least we had it."
The family had purchased basic medical coverage from Access America, which was picking up the medical bills while the family was in Italy. At that point, Ferrari already had gone through costly surgeries in his throat to remove dead tissue left from the infection and spent more than a week in an intensive care unit.
But to get him back to the United States for more medical care would require a medical evacuation flight, which Shannon said costs $67,000 and which Access America first tried to decline to cover because he was receiving care in Italy.