Beep! Beep! Beep! I roll over and hit the alarm for the third time. It is Friday morning and my day off. I am looking forward to a day of home activities. In the darkness of early morning, I slide out of bed and throw the covers back over the bed. As I pull open the bedroom door, I am hit by a sudden overwhelming curtain of silence followed by wooziness. That was weird. As I take that first step down the hall, my right leg wobbles and I reach out for the wall. My right arm also seems somewhat uncoordinated and I need to think about where I place them as I traverse the morning route to the bathroom in the dark. I shake my head several times trying to clear the cobwebs from my brain. It is not unusual for me to experience vertigo at times, but it usually passes in thirty seconds or so. This does not want to go away. I peer at my face in the mirror. All facial movements seem symmetrical. I console myself that it is probably not a stroke. I conclude that this must be an escalation of my normal vestibular (ear) problem. Afterall, I have been sick for most of the last week with the common cold. Maybe it has moved to my ears.
“Are you OK?” It is the voice of my husband.
“No, I am not OK.” I stand there trying to clear my head. “I would go downstairs to the bathroom, but I don’t think I can make it that far.”
He offers me the commode as a seat, and I plunk down on it. I sense the watering in my mouth that precedes an upchuck. Oh dear!
“Do you need to throw up?” he asks.
“It’s coming. I don’t know what is wrong, but I think we need to go somewhere. I don’t know where to go at the clinic so maybe we should just go to the ER. Can you help me get dressed and then you should go plow first?”
Thursday had been a day of receiving three to four inches of snow followed by high winds and significantly subzero windchills. As I had driven home from work at the hospital at 7 p.m. the prior evening, I struggled to see the road in places. I would find myself on the wrong side of the road, disoriented, and with the need to get myself back where I belonged. As I finally drove up the drive, the wind-driven snow hit me smack in the front. The drifts were piling up in the yard and in the driveway. I didn’t know if we could get out without plowing.
I sit and contemplate my situation as Hubby makes his way downstairs and out the door. Because of the weather and the prediction of below zero temperatures, as well as an injured right arm from a fall on the ice on Wednesday, he has already decided to take the day off from work. If one has to be sick, I guess the timing could not be better. Hubby is home and neither of us are trying to get to work.
After attempting to throw up, the ever determined me decides to comb my hair. I have to look respectable. I plant my feet wide apart for stabilization at the sink and with a little thought into directing my arm, I am able to accomplish this task. Now to get downstairs. I grasp the rail as I put one foot ahead of the other. As long as I think about what my right foot is doing and grasp the rail to stabilize the spinning room, I do quite well. I collapse in the recliner in the living room. Uh Oh! Almost immediately, I can feel that premonition in my mouth. I am going to throw up again. There is no way I am going to make it to the bathroom. What am I going to do? I don’t really want to throw up on the carpet. I drop to the floor and crawl the six feet on my hands and knees to the laminated flooring just in time to heave over and over. Exhausted, I crawl back to the chair.
Bang! Hubby appears at the kitchen door. “I can’t get the plow truck to start but I think we can get out without plowing.”
“Let’s just go then.” I grab my basin.
The trees glisten with frost covered needles and branches. The sun shines brightly. It is flanked by the colored pillars of sundogs. The car thermometer displays 12 degrees below zero. On any other morning, this would be a beautiful scene to absorb and photograph. It is still a beautiful scene but not really enjoyable with one’s head in a barf bucket.
A lady with a wheelchair is waiting for us just outside the emergency room. I could not be more thankful as I don’t think I can walk anywhere at this point. We are whisked into a room and soon introduced to a medical student. I was expecting hours of waiting to be seen but when one is really in trouble, the most efficient means of obtaining medical care is the emergency room. I suppose it was that telling them that my right arm and leg didn’t work right. That triggers a different response than just throwing up or some such thing.
“Is this your partner?” asks the nurse who takes my vital signs.
“No, it’s the guy I picked up in the ditch along the way,” I intone.
“She hasn’t lost her humor.”
Soon, I am performing all kinds of neurological tests. “Squeeze both hands. Follow my finger with your eyes. Pick up your left leg. Pick up your right leg. Push down on the gas pedal. Pull back towards your nose.” I perform most of these with ease. I only stumble on two of them. “Touch your nose, then my finger with your right hand as fast as you can.” My finger has a hard time hitting my nose and it takes complete concentration to hit the doc’s finger. “Slide your right heel up and down your left shin.” To this command, I find my heel weaving down the shin bone. I just can’t make it go straight.
“We think you might have vestibular neuritis (a viral infection that affects the nerve of the ear) but because of difficulty with those two tests, we are going to send you for a CT scan.”
I grab my trusty barf basin and off we go. By this point, I am throwing up every fifteen to thirty minutes. If I keep my eyes open, the world has some semblance of stability. If I shut my eyes, the world goes around and around. When I sit up to transfer to the CT table, I sway back and forth like a branch in the wind. “I think we should just slide you over,” is the conclusion of the CT techs. Good decision!
I make it back to the ER just in time to throw up again. I have given up waiting for them to bring me the promised medicine for nausea. I hit the nurse call button. “Can I have some nausea medicine?”
“I don’t think there is anything ordered,” states the nurse who responds. Really? There have been two different doctors who have promised this. I am ready to collapse into a sobbing heap as I just keep heaving and heaving. I have lost track of the number of times now. Soon she is back with the treasured medication.
The med student squeezes her body though the slightly open door, “The CT shows a small cerebellar stroke, so we are going to put through a neurological consult.”
Shock would be my reaction. Why would I have a stroke? I don’t have high blood pressure. I don’t have diabetes. I am not particularly overweight. I have never had a blood clot. I do not have atrial fibrillation. I am only sixty-one years old, exercise regularly, and I take a full aspirin every day. All I can think of is my father who had a major stroke at eighty-two years of age from which he never recovered. He could not write or talk or communicate for the next seven years before he died. I would rather die than be like that.
Within a few minutes, the neurology resident appears, and we go through the same battery of neurology tests again. “I am going to send you for an MRI to evaluate the arteries in your head and then we are going to admit you to the hospital.”
By this time, I no longer care. I just want relief from the nausea. I want to sleep but every time I close my eyes, the world spins and renews my discomfort. By the time escort comes to take me to the MRI scan, I have received some Compazine for the nausea, but I still do not trust myself. The nauseous feeling lies just below the surface.
“What am I going to do if I have to throw up in the MRI scanner?” I clutch my emesis basin close to myself as if it were my security blanket as we set off again for another test. No one seems particularly concerned but me. I try to calm my rising panic as they strap me onto the MRI table and snap the head piece into place. I am somewhat claustrophobic anyway. So I talk to myself. Just take deep breaths and close your eyes. Then you can’t see how tight the tunnel is. I clutch my call ball and shut my eyes. At least the world has stopped spinning. The air blowing into the tunnel is cold and I shiver. By this point, all I want to do is sleep anyway so I doze off and on and soon the test is done. I am so glad the medicine is working.
I sway back and forth as I sit up after being transferred from the cart to my hospital bed. I close my eyes and go to sleep. This whole situation is beyond comprehension. My hubby settles down in the chair next to my bed. His face is lined with worry.
My assigned nurse comes by to introduce herself. She holds up the ridiculous yellow band that says, “Fall Risk.” They put them on everyone who admits to having a fall in the last year. Everyone in Minnesota in the winter is a fall risk and I have always told my colleagues if they ever put one of those things on me, I would cut it off. I stare at it and sigh. I guess I really am a fall risk. I soon discover when I try to sit up on the edge of the bed that a loud obnoxious noise also emits from the bed!
Sleep seems to be the only thing I am capable of doing without supervision. Before long, I am awakened again. A transport cart is parked by my bed. “You are going for a CT scan with contrast.” How many scans can I possibly go for? I just had a CT and an MRI and now we are going to do another CT – this time with contrast! So off we go again. I try to keep my eyes open to prevent the dizzying spinning.
Later that afternoon, the neurology resident comes by the room. “None of the scans show any evidence of vertebral artery tears, plague in the arteries, or a bleed. Since we do not find anything in your head, we need to look at your heart. I am scheduling a TEE (transesophageal echo) for tomorrow.” Gads! How many tests can they come up with? By this time, I am starting to feel significantly better and am returning to my normal personality. I ask to visit the bathroom and am trilled that I can ambulate fairly well. I still cannot pass a roadside DWI test but with the compensation of a wide-stance gait and a tightly clutched gait belt by the nurse, I can walk. Bored with being in bed, I sit up in the chair for a couple hours. I attempt to find and write down a few phone numbers for calling my supervisors, but my hand produces mostly an illegible scrawl. I can text if I take my time. After notifications to some family members of my state of affairs, I crawl into bed and sleep some more.
Steam rises from the chimneys of the city outside my window on Saturday morning. My immediate view is that of the hospital chapel, its door surrounded by frost. My life feels a little bit like it is surrounded by frost too. I was not planning to be here today. I have life to live.
Not being inclined to be an invalid, I situate myself in the chair. I just need to be careful about not doing any spins or dance moves. Reassured that I am fine and won’t do anything stupid, the nurses have turned off the bed alarm and I have reverted to being the patient+. This means I maneuver my own IV pole, my bedside table, and IV pump the best that I can. The lab gal comes to draw my blood and I ask her to use my left arm because the right antecubital area is all black and blue. “But someone has to come and turn off the IV,” she declares.
“No problem. I’ll take care of that.” And I do.
Soon there is a knock on the door and a lady from occupational therapy enters. “How are you doing? My job is to evaluate you from an occupational standpoint and determine if you need therapy. Can we go for a walk?”
I sign heavily. I am fine but I am happy to go for a walk in the hall. She slips on the dreaded gait belt and off we go. The IV pole provides all the stability that I need. I am convinced that if I stumbled or started falling, this lady would not be able to help me. She seems more unsteady and feebler than me. My being as good as I am, I reflect, has nothing to do with my own abilities but to the grace of God and his goodness in allowing me full return of my faculties. This facade of independence, competence, and strength that we all present to the world is just that, a façade that can be crashed at any moment.
I have not eaten any breakfast as I am not to eat in preparation for the planned TEE.
Imagine my surprise when the escort shows up with the transport cart around ten am. “I am here to take you to your MRI with contrast.”
“My MRI??” I question incredulously. “I thought I was going to have a TEE today?”
“The directions say we are going to an MRI,” repeats the escort gentleman.
I just love the communication around here. No one talks to me. They just change plans out of the blue. I guess we are going to an MRI. I think I will have met my medical deductible with two CTs and two MRIs. This time I am more prepared and feel physically better. I open my eyes in the MRI scanner and look around the best that I can while being in a head vise. Above me is a mirror that reflects the head frame back at me. It gives the illusion of more space than there really is. I can’t actually see the bore that surrounds me. That’s interesting. I wonder if they can see me from the control room.
Back in my room, I get up to the bathroom. My legs and my upper arms are covered with red spots intermingled with white splotches and they are starting to itch. Great! I must be allergic to the MRI contrast used. The MRI tech told me that no one is allergic to the MRI contrast. There is always a first. The only time I have ever seen this on me before was after several mosquito bites in the same area and that rash lasted for weeks. The only thing that was helpful was to grit my teeth and not scratch.
The resident comes by later in the afternoon to inform me that this MRI did not show anything abnormal either. “I thought I was to have a TEE today. How come we went for MRI instead?”
“We can’t do the TEE on the weekend unless it is an emergency, so we have to wait until Monday. We wanted to definitively confirm that nothing is going on in your head anyway, so we decided to do the MRI instead.” I am beginning to wonder if there is anything at all in my head. Maybe they are just trying to find a brain.
I sigh. I am already bored and feeling over tested. I have so many things I could do at home. “Can I go home today then?”
She gazes at me and smiles. “You do look quite well. I guess we could let you go home and come back for the other tests we want to do as an outpatient. I will order a 48-hour Holter monitor for you and once you have the device on, you can go home. We will order the TEE for Monday as an outpatient.”
“Versed and Fentanyl medications do not work for me so I would really like one of my colleagues to use propofol for me.”
“Just tell them when you get there,” she brushes my request off.
“That isn’t going to work,” I impress upon her, “If you do not order it as anesthesia, no one is going to honor my request. I know how this works around here.” I can tell by her face that she has no intention of following my request.
Taking a shower is the next item on the agenda if I am going to have stickies all over me for 48 hours. With meticulous care and deliberate moves, I gather all the supplies necessary and bask in the warm shower. I am still somewhat like a waving reed but if I take my time I can compensate for any remaining deficiencies. This could have been so much worse. How does one wake up one morning and five minutes later, the world has been turned upside down? It hits me that we are not prepared for something to happen to me. I have always planned that my hubby would go before me. After all, his parents died in their early seventies and mine were both 89 at their time of death. The urgency of remedying this situation floods over me.
Once my shower is done, the Holter Monitor tech comes to hook me up. The last order of business is to read the discharge instructions. I notice that they changed my cholesterol medication without telling me and that the resident has marked sedation instead of anesthesia on the TEE order. She comes back to see me one more time at my request and I point out to her that there is a box to check anesthesia. “Alright, I will see what I can do,” she finally concedes.
How am I going to know when the TEE is planned for on Monday is my question? The resident has given me the phone number for the floor at the clinic where they do these, but I do not have a time. I am told that they will probably call me to let me know but no one really knows.
Monday morning, I anxiously wait by the phone. I check the on-line portal for patients. It tells me that there is a TEE scheduled for “undetermined time.” That is helpful! Finally, after hearing nothing by 8:30 a.m., I make a phone call to the clinic. “You are scheduled at 2:30pm in the cath lab at the hospital,” she tells me, “We don’t usually do them there for outpatients.”
She transfers my call to the cath lab. They clarify that I am on their list, but the nurse then hesitates, “Are you on an anticoagulant now?”
“Nooo… not more than aspirin and Plavix. And I got three heparin shots in the hospital.”
“That’s all gone by now. So that’s not enough. You have to be fully anti-coagulated before we can do this. I need to make a phone call to the doctor and then I will call you back.”
I do not know what to say. I am confused. This seems rather excessive. But then, I don’t do TEEs every day, so I have to assume he knows what he is talking about. I wish they had thought of this on Saturday. Maybe I should just have stayed in the hospital.
Finally, around 10 a.m., he calls me back. “My mistake,” he says, “We should be good. I thought you were having a cardioversion. We don’t need full anti-coagulation for just the transesophageal echo.”
The light bulb goes on in my head. Now I know what has happened. I have totally messed up the system and confused everyone. In order to meet my request for anesthesia-controlled sedation instead of nurse sedation, they needed to schedule my procedure in a place where anesthesia is available. And in doing so, the nurse there assumed that I was having the procedure commonly done there. It always amazes me how confused the system can get by changing just one aspect of the standard practice.
But I am delighted to find that one of my colleagues, a Certified Registered Nurse Anesthetist, is there to administer that special drug, propofol, that I handle so adeptly every day. I drift off into a blissful sleep to wake up feeling comfortable and secure at the completion of the procedure. Finally, I am able to reap a benefit of my career.
In spite of all these tests, no clots, or artery tears, or cholesterol plagues are ever found to explain why this happened to me. It leaves me wondering. Is there another time bomb waiting to go off some day? Only time will tell. And I think I like being on the provider side much better than on the patient side.