Stroke Me, Stroke Me

December 16, 2008

ORIGINALLY published July 18, and August 11, 2006

“You have an egg sized mass bleeding on the left anterior side of your brain.”

HEARING these words was not really a shock. I knew that there was something wrong because I had lost the ability to read the night before – which was the reason I was in the St Claire hospital ED; coupled with the throbbing pain in my head.

The attending doctors demeanor and abruptness in exiting my triage room lead me to assume the worst. I resigned my self to the fact that I was going to die. I stayed with this belief for about two hours while we awaited the transfer to UPMC Presbyterian in Oakland. I was at peace with this reality. Really, what else can you do when you get ‘news’ like this? Cry? Freak out? Fuck it. I was just going to slip under the waves and call it a day. The unnamed pain killer that I was on probably helped. My resignation was easy, in part because of the hospital staffs lack of communication and even eye contact. I was really sad at the prospect that I wouldn’t see my kids again but was glade that my wife was with me so I would not die alone.

I asked the paramedic that was reviewing my case what he thought.

“You are still talking; you have not lost any motor skills and your still awake – in my experience, that is a really good sign.”

Upon arriving at Presby, I was put into a triage room and visited by multiple sets of doctors; the stroke team; the neurosurgery team and attending ED physicians. Each team made me run through a battery of neurological tests – pushing with my right and left feet; squeezing their hands; interpreting these little cartons, as well as dozens of medical history questions. Finally, after what seemed to be hours, one of the attending doctors finally discussed their thoughts with me.

I had had a bleeding event in my brain and it was either a stroke or an aneurysm. They were not sure if it was still bleeding because the persistent headache was a symptom of the bleed and could also be an indication that the bleeding was still occurring. Stroke Me by Billy Squire reverberated through my head for several days from this point.

I was admitted and sent to a step down unit for trauma patients. This entailed constant monitoring. I was woke up every two hours and had two go through ten minutes of neurological testing. I was also plugged into four different machines that constantly monitored my vitals as well as getting three different catheters inserted into my arms for the administering of drugs. The last stay that I had in the hospital was when my tonsils were removed as a kid and it was nothing like this. The step down unit is crazy – everyone is hocked up to multiple machines and this creates a really weird soundtrack. The rhythm would change every two hours that I would wake up – I guess with the constant moving of patients to the ICU and down to regular units. And then there are the screamers who are no doubt brain damaged.
“HELP ME!”
“I’m DYING!”
“AHHHA”
They scream all night.

OF all the procedures, the CT scans are the easiest. They basically stick you in a tight pipe and x-ray you for half an hour. I had three of these during my stay. The angiogram – now that was a different story. Everything about this procedure was surreal. They wheeled me into the room for the procedure and it looks like something straight out of an alien abduction. To my left was a huge wall of monitors. Music was playing (Eric Clapton – I fucking hate Eric Clapton) and the nurse keeps talking about what she is going to do over the weekend. They rip my drawers off and start to shave the area between my wang and leg. This is where they will punch through my femoral artery and guide a catheter up to the edge of my brain and inject ‘illumination’ as they call it. I don’t remember any anesthetic as they made their way in – it felt like any of the needle sticks that I received during the week. I could not feel the catheter snaking its way up through my brain, but when they shot in the stuff to illuminate the x ray image, it was quite painful. An intense heat radiating through the different parts of the left side of my head. The extraction of the catheter hurt like hell. The performer pushing as hard as he could into the artery while pulling it out. This lasted for ten minutes and I had to keep my leg completely immobile for six hours.

MY final night of my five day stay was possibly the worst. I had gone through three days of the two hour tests with the addition of blood draws. The staff had been great (albeit completely disorganized) but this final night would be the exception. It started to go down hill in the afternoon when a gram of Dilantin was mainlined into my arm. I have never felt such an excruciating pain in my life – my arm is still sore and swollen tonight. This is an anti-seizure medication given as a precaution. I could feel this shit creeping through my bloodstream and it is best described as a burn, a constant second degree burn that builds with intensity to the point that I was nauseous and felt like I was going to pass out. This was the initial load to be followed with 100 Mg boosts every 6 hours. The nurse that administered it claimed that this was normal but would not provide an oral dose instead. And this shit made me high as a kite – higher than I had ever been. I started to nod out and my ears started to ring. As I slogged through this stupor, they put a guy in my room that had been fucked up severely on Grant Street in a fist fight. He was sort of delirious and had the TV on as loud as could be. When I would manage to fall asleep, the staff was in with this guy chatting. Keep in mind that I was not allowed to receive anything for pain (the site where the angiogram had been performed hurt worse with every following day and the burning from the Dilantin made my arm impossible to even move) because of the potential to mask new bleeding pain and that the days of two hour sleep disruptions was starting to take a serious mental toll.

What really pissed me off was that they injected more Dilantin and gave the fucking guy Morphine so he would dose off with the fucking Girls Gone Wild Infomercial in a constant loop. Then a new screamer started that from time to time would wake my roommate out of his Morphine stupor.

FRIDAY arrives, and the neurology team has yet to meet with me. I had been waiting for three days to learn more about the three possible procedures and recommended course of action that will be required to correct what is now diagnosed as a dural AV fistula. A friend gets involved and actually has the chairman of the Department of Neurological Surgery at the University of Pittsburgh School of Medicine visit me to discuss the non-invasive option. We set a date for the Gamma Knife procedure. The only other option was to surgically enter my head and there are too many possible complications, like double vision and the lose of cognitive ability and logic. For someone whose job is the analysis of data and development of strategies based on said analysis, this is a risk I cannot take. The drawback to the Gamma Knife which uses focused radiation to embolize the vein and it can take up to four years to correct the malformation.

SIX AM, AUGUST 8, 2006: Strolling into the Gamma Knife Suite you immediately notice the smell. I’m not sure if it is a cancer smell (Gamma Knife is used for inoperable brain tumors as well) or what. Sort of like a burnt hair odor

ABOUT the procedure: Basically they screw a frame into your head that enables a grid to be calculated so that the gamma rays can be focused at the precise spot that is a problem. The attachment of the frame is crazy, they screw these pins into your head. You are numbed with a cream as well as injected with a ton of Novocaine at the sites in the front of your head and the back of your head where the pins pierce flesh and muscle and anchor into your skull. I was also given a nice dose of Ativan to calm the nerves. The injection of the Novocaine and the tightening of the pins is a very strange sensation – similar to piercing fibrous meat with a skewer, but it is your meat. It is especially thick in the back of your skull as there is a lot of muscle that they have to go through.

Before the procedure, the focal point of the treatment had to be determined. This was done via CAT scan and Angiogram. Now, if you read my last blog, you know that the angiogram was the worst thing ever. Interestingly enough, it was not bad at all this time. I did have to remain still for 6 hours but there was no pain in the area of the femoral artery where they entered and the beds in the Gamma Knife Suite are covered with two inch thick padding.

ON to the Gamma Knife procedure. I am moved into the lead walled room. I am really blasted on my second dose of Fentanyl and cannot really keep track of time. I did bring a couple of CDs which they played during the prep and through the procedure. I started with the new Don Cab and ended with BlueNote Breakbeats volume 1.

THERE really is not much more to this story. I basically have to wait for three years to see if the embolization takes so I float through life until that time with the potential of it popping again. I actually have a 5% risk that it will (a bit higher than the initial percentage that I was originally told) of it happening again and even if it takes I could experience another bleed.

IN the past month I have learned a lot. I don’t take every day for granted and I try not to get stressed out by stupid shit. I finally feel normal again. And I suppose you can’t ask for much more.

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