@Justin Xu,
This sounds like American vernacular (casual) (slang) speech. Explanation:
1. In US vernacular, a "two by four" or "2 x 4" or as in this case "2*4" is the name of a common size of cut wood used in construction etc and a length of such wood can be a crude weapon. It is a piece of wood whose cross section is two inches (~50mm) on one direction and four inches (~100mm) in the other.
2. In US rural vernacular, "about" is often abbreviated to "bout"
Thus the writer is talking about an expected or feared event (probably a sudden ALS progression) whose effect will be as serious and dramatic in his life as a "two by four" hitting him on the head.
Can you see the picture?