A few weeks ago, I wrote about the meandering approach of death as one grows older. In that essay, I mentioned early on how Death is an unwelcome visitor, and that I did not fear him, but only felt his presence as a challenge.
Well, the grim reaper apparently took exception to my comment and decided I needed a bitch-slap or two. So, a week after publishing that story, I awoke in the morning, and shortly after rising, began to feel distinctly dizzy. Dizzy isn’t something I normally do, so that in and of itself was interesting, particularly as it began to get so bad that I couldn’t stagger from table to door without grabbing onto something. The doctor part of my brain started clicking. Allergy? Don’t have any. Vestibular dysfunction? I wasn’t sure.
Then the fun started. I noticed a creeping numbness on my left cheek. I went to the mirror. I couldn’t smile with the left side of the mouth. That was my “oh, shit” moment. I hate “oh shit” moments.
I staggered upstairs, shouted Daughter #1 out of bed, and told her I needed to go to the hospital. Now.
I had a lot of difficulty staying awake for the ride, but Daughter #1 was very good at annoying me sufficiently to keep me alert. Actually, she’s had a lifetime of practice at it, so it was virtually second nature to her.
I had her let me off in front of the ER. I staggered to the entrance, bounced my way through the frames of both doors, and managed to get to the front desk without falling. “I’ve got a problem,” was about all I could manage to get out, and then there was a wheelchair underneath me and my daughter beside me to give them the specifics. (And my health insurance card. This is America, after all). I’m pretty sure up until that point, they were figuring they were dealing with a guy who’s main problem was being good friends with Jimmy Beam and his partner Jack Daniels. That would have been my first guess.
ER was on the ball, and had me in radiology for a CT scan in no time at all. But it was a strikeout. No clot, no hemorrhage. My heart checked out just fine as well. So they did another CT with contrast, to see what they had missed. Before I went for the second one, they began preparations to send me to Danbury, which has a hairy muscular Stroke Unit. Phone calls were being made, spare IV needles were inserted in case one bounced out on the way.
I was injected with the contrast medium, which frankly felt like someone had lit me on fire from the inside, at least for the whole 6 minutes I managed to stay in the machine before puking my guts out all over radiology. I’m pretty sure that wasn’t their first party, because they had a tray under me and a horsefeed bag over my mouth before my second inning started and nobody was even swearing.
Back at ER, the news was good, if weird. Still, no clot, no hemorrhage. ER doc says we must have missed something, so let’s do an MRI.
So I got wheeled down to radiology for one last pitch. Most people don’t enjoy getting an MRI all that much. You’re confined to a torpedo tube, have a plastic cage over your head, and several dwarves are trying to pound their way into your brain with rocks and pickaxes. It’s noisy. Being an experienced meditator helps, though. I declined the offer of music in the headphones, and once in the tube, focused on my breath and in joining with the sound of the dwarves. Twenty-five minutes goes by in a snap like that, and then they were pulling me back out, and wheeling me back to ER. That time in the tube, though, that was when I began to realize I was going to be ok. If I could meditate, I could think, and if I can think, I can generally figure out what to do next.
Good news! Still nothing. Bad news! We don’t know what this is. By that time, however, my symptoms were dissipating, and like a good ER doc, my guy passed me along to be admitted for overnight observation, secure in the knowledge that, even if he didn’t know what the game was, his patient hadn’t died, and that’s really the entirety of the ER doctor’s job. They skipped the whole trip to Danbury, as I didn’t really fit the bill. What’s a mini-stroke without cardiovascular problems? Not worth a trip to Hairy Muscular Stroke Unit, that’s for damn sure.
Fine by me. I didn’t really want to go to Danbury, as it was further away, and lunch where I was had been pretty tasty. I figured if I had to spend the night in the hospital, I’d rather do it at one with good food.
Dinner was worth sticking around for. Roast beef, rare, thinly sliced, a twice-baked potato and minestrone soup. About 7:30, the hospitalist came wandering in and introduced himself. We spent a good half hour chatting. He had familiarized himself well with my case, and after we talked, he suggested that the prior diagnosis was not correct. He had an entirely different diagnosis in mind.
It was a real departure from what I had been experiencing earlier that day, because aside from my symptoms, there was no evidence to support the idea that I had a cardiovascular disorder. The problem with that was, first of all: No clot, no hemorrhage. Second, my heart functions like a champ; I have none of the risk factors for cardiovascular problems except for being mildly overweight. People who train 3–4 days a week in a martial art like aikido and who ride their bicycle instead of taking a car everywhere, rarely have cardiovascular disease.
But that morning, after my 2nd CT scan had come up goose eggs, the ER doc had been fairly insistent that I take a “clot-buster” drug. Its called a tPA, and has to be administered fairly shortly after the onset of a stroke to be effective. When it is needed, it is a lifesaver. However, it has significant downsides, including causing fatal bleeding in the brain and elsewhere.
“We’re almost out of time here,” the ER doc said, tapping his finger on his clipboard.
“I’m gonna pass,” I said. “I’m a less is more kind of guy.”
“OK,” he said. “But I’m going to rush you into the MRI. If it’s positive, I think you should take it.”
As we know, that wasn’t the case. No clot, no hemorrhage.
Still, late that afternoon, the nurse came around with her cart, and an aspirin and a Lipitor.
“Here’s your medication,” she said.
I asked her what it was, and she told me.
“I’ll take the aspirin,” I said, “but I’m gonna give the Lipitor a pass.” I had a bit of a headache anyway, leftover from that damned dye and the fact that I’d had very little to drink that day.
But the thing of it was, that despite the fact that there was no evidence of vascular pathology, they were treating me as if there was. Because that’s protocol. That’s what you do from an evidence-based perspective.
To her credit, the nurse took my refusal in stride, gave me the aspirin and moved on.
In the course of our conversation, the hospitalist told me it was a good thing I turned down the clot-buster. It was the right move, he said, because clearly a clot wasn’t the problem. My problem, he said, was severe sleep apnea. That is what had caused the lack of oxygen to my brain, resulting in stroke-like symptoms. We went over the labs and my history, and the diagnosis really did have wheels. I was pleased. Here was another doctor, an MD no less, who thought like me, who looked beyond the surface and the presumed mechanism, and pursued the facts to where they led him, no matter how odd.
I was relieved, because here was an answer which actually fit the entire scenario. I was no longer trying to fit a square peg in a round hole. I went to sleep at ease that night. Well, as much at ease as a guy wired up to an EKG and with IV needles in both hands could muster.
The next morning, another nurse stopped by with her cart and my medications.
I’ll take the aspirin, I said, but keep the Lipitor.
The nurse in this instance was not quite so accommodating to a change in the regimen. She went on a bit of a rant about it, but in the end, left the pill in the cup, and moved on down the hall. A bit later, just to make sure, they did an ultrasound of my carotid arteries. About an hour after that, the hospitalist stopped by, shook my hand, and cut me loose. The carotids were completely clear, he said.
It took another three hours for the paperwork to pass through the system, but by 4 p.m., I was at my car door. It was parked where Daughter #1 had said she left it. The sky was gray and overcast, and the cold November wind cut through my sweatshirt. I smiled. That was a swing and a miss, I said to nobody in particular. But I know he was listening.