Friday, September 12, 2014

The Longest Night

It was a Tuesday morning, and I was just about to leave for work, when my husband became suddenly ill.  He was nauseated, vomiting, and with a killer headache.  He said when he stood up, the room started spinning, and he vomited immediately; feeling the room swim around him, the nausea unavoidable.

I called my office to say I would not be on time.  “My husband is suddenly violently ill,” I said. “I’ll be about 20 minutes late.” My supervisor laughed at me.  “Take your time; take care of your husband.”  Later, when I logged in to our computerized system EXACTLY on time, she and I laughed together about the exchange.  My husband is grown, he can take care of himself, but he did deserve a few minutes’ TLC.

After calling work, I returned to him, lying on the bed.  His head hurt, he couldn’t keep down the Advil I gave him, and he was miserable.  We ran through the possibilities—ear infection, vertigo, migraine.  I asked him if he was afraid it was something more serious, and he said no, he was just upset about feeling so bad and knowing he needed to be at work.  We were both very wrong.

His vertigo, nausea, and headache did not relent.  That night he was able to have a little soup, as long as he didn’t move his head too much.  He fought to keep it down, along with some Advil.

When he awoke the next morning, still miserable, we called his doctor.  We made a same-day appointment.  This time I really was going to be late for work.

The doctor assessed him—his blood pressure was fine, his blood sugar was fine, he did not have the neck stiffness associated with meningitis, and although he was still dizzy, he could walk and function.  She checked his eyes, and could tell his brain was not pushing against his eye balls.  She verbalized her own thinking of the differential diagnosis, landed on virus, and sent him home.  She encouraged us to call back Friday if he wasn’t completely better.  He ate a small dinner, struggling bite by bite to keep it down.

The next morning was Thursday, and because of our schedules, I was already at work when he awoke, and right away called to tell me not only was he not feeling better, but he felt much worse.  The room was still spinning violently, nothing was helping the headache which was now unbearable, and he couldn’t keep anything down.  He called his doctor for advice.  She suggested the ER for imaging.

I left work early, although honestly, we debated the need for this.  We know, though, how long these things take, and figured the earlier we got started, the earlier we would get home.

We walked through the emergency room door of Duke Regional Hospital at 5:30 and were triaged almost immediately.  The triage nurse also went with vertigo, apologetically warned us that the wait time was nearly three hours, and sent us back to the waiting room.  Bill lay down and slept.  I read Cuckoo’s Calling by JK Rowling on my iPad. 

About three hours later we were shown a room in the ER, and at 9:01, the team came in for the assessment.  There were questions about the symptoms, we said we were there for imaging, but we were concerned about the cost.  The nurse very appropriately, with just a touch of firmness but not overbearing, said, “No, we’re going to do a CT scan.  With symptoms like this, you really need it.  In the end, it’s probably a virus, but we don’t want to take a chance.”  She strung up an IV fluid bag.  The sign on the wall said the wait for a head CT is about 90 minutes.

We could hear other patients with headache and nausea, some with vertigo, getting fluids, getting scans, feeling better, going home.  We expressed gratitude for our health insurance and resigned ourselves to the CT scan.  Nursing staff with various credentials came in to offer pain meds, some oral, some through the IV.  They started the contrast.

Bill went for the scan about 90 minutes later, came back, and at a few minutes after 11, Jill-the-nurse came in to report that Bill had had a stroke.  There was a “sizeable” infarct – or section of his brain that was dead and would never recover.  While speaking to us, she interrupted herself with, “That’s the neurosurgeon on the phone.  Let me talk to him and I’ll come right back.”


The nurse was going to speak to the neurosurgeon about my husband.  I stared at the door where she had just disappeared.  Alarm bells sounded dimly in the way-back part of my world.  There had been a stroke.  There was an infarct.  There will be a neurosurgeon.

Bill, it turns out, was feeling waves of relief.  He had a diagnosis.  They would know what they’re treating.  The pain would stop soon.  He lay his head on the pillow and chatted pleasantly with me.

I did what NO ONE should ever do.  I knew, even as I did it, that it was a mistake.  I know better.  I opened up my iPad and googled cerebral infarct.  Within seconds I had this sentence forever in my brain:  Cerebral infarctions vary in their severity with one third of the cases resulting in death.

Bill was talking pleasantly next to me.  I have no idea what he was saying, but I was sure my face betrayed my fear.  The next few minutes passed in a fog, and at some point Bill looked at me, and said, “Is this bad?”

“Honey, it’s bad.”

His demeanor didn’t really falter.  “It’s gonna be ok,” he said, and I started to re-orient myself.  The stroke had happened; the infarct was there.  My husband was not dead.  He was also not different.  He was his usual self; he could talk and joke, and was not at all diminished.  He just couldn’t walk without getting dizzy and sick.  But in fact, there were times when he could walk fine, as long as he held his head steady.  The room continued to swim in and out of focus, but I started to feel less like I was floating over a huge chasm.

At some point the nurse came in, said the doctor would be in to see us soon, that Bill would be admitted to the hospital, and I think she probably started some new medication.  She expressed her own surprise that Bill was doing so well, saying “What’s remarkable is that he has no deficits.  It’s incredible, really.” 

In this period, I started texting some of my closest friends with the news.  It was about 11:30.  I found out later, each in turn had done the same as I, had seen the “one third of the cases resulting in death” sentence, and responded tactfully. 

I went back to Nurse Jill and asked her as straightforwardly as I could, “I understand the event has happened.  He will heal from here.  He will get better, as much as the brain can, which can vary.  But he is not going to get worse.  The situation is done, and it’s all better from here.  Am I right?”

She confirmed that, yes, this was as bad as it would get, and it would, indeed, get MUCH better. 

I could breathe again. 

I started texting those friends that things were ok, and were only going to get better.

“My husband had a stroke,” kept coming in to my head.  I couldn’t stop it.  Such a daunting phrase.

The doctor came in the room.  He was amazing.  He explained to Bill that he had had a stroke, and now there was permanent cell death to a spot near the back of his head.  He explained that the stroke happened in the part of the brain that affects balance.  It was all starting to make sense.

He explained that this type of stroke is most often caused by an injury to the neck, where the artery clots while trying to heal; the clot travels into the brain and gets stuck, blocking off blood and oxygen to the neighboring cells.  He said we can never really know with things as complicated as the brain, but that he had plenty of reasons to assume Bill would make a full recovery. 

He was drawing a picture of the brain that looked an awful lot like Q-bert.  I said that out loud just as the realization hit me that he was too young to know what Q-bert was.  Sigh…

He explained that it was important to verify its cause, and not assume, in order to effectively prevent another.  We agreed totally.  He said there would be another CT scan, this time of his neck, to assess the damage to the artery.  The two large arteries in the back of the neck that feed the brain are called vertebral arteries, and damage to these arteries is called a dissection.  He was writing with a magic marker, and wrote next to Q-bert, “cerebellar stroke,” saying “This is what we know.”  Then he wrote next to his little drawing of a heart and its big arteries, “vertebral dissection,” and said, “This is what we want to confirm.” 

Some part of my brain marveled at his bedside manner.  I felt informed, comforted, respected, and hopeful.  He even said, after mulling it over for a few minutes while he spoke, “Q-bert was the one that jumped, right?” 

I started to believe it when Bill had said, “It’s going to be all right.”

A nurse came in to do a simple chest x-ray.  Although they explained why at the time, I don’t remember now, but I think because they wanted to rule out gross abnormalities of Bill’s heart, and to identify any other risks that might be slinking around in his chest and abdomen.  The nurse pointed me in the direction of glass doors so I could get enough signal to use the phone, and I called my mom.  As I dialed, I fought back a wave of tears.  The urge left me, and it never returned.  I couldn’t help feeling like we had come incredibly close to disaster, but I also felt incredibly grateful.  It had already turned out ok.   

My worries waved back over me throughout the night.  Even though I knew with my thinking self that the worst was over, I still had a visceral reaction to the dangerousness.  “… with one third of the cases resulting in death.”  I remember a moment around 2 when I had the Kindle app open in front of me, and I was staring at the last few pages of Cuckoo’s Calling.  I had a surreal feeling of being in a dream.  I was sure I would wake up any second.  I would be in my room, Eddie next to me, snoring his little dog snores, and Bill there.  I would look around the room and feel the relief that this was just a dream.  I checked in to my senses and my intuition.  Could it be a dream?  I wasn’t waking.  I knew it was real.  From now on, there would never be a day when this hadn’t happened.  I wasn’t going to wake up.

At 3:30 we were still waiting on the neck CT scan, our animals had not had dinner, and Bill said he really just wanted to nap.  He suggested I go home, and I agreed, asking him to call me when the result from the CT came back.

An observing part of my brain was surrealistically aware I was driving out of a hospital parking lot at 3:30 in the morning.  When was the last time I was even on the road at this hour?  What was I doing driving in the pitch black, in this strange car, at this end of town?  How did this happen?

I plugged in my phone and blared Spiral Rhythm, going straight to “The Faith Inside.”  I was grateful that this is my daily choice of music; the familiarity was soothing beyond the message, “There ain’t nothing in this world that faith can’t get you through.”  The surreal observer asked the atheist what, exactly, she had faith in.  The doctors?  The science?  Bill?  I shoved those thoughts aside and basked in the soothing music; I thought about the thank-you note I would write to Spiral Rhythm; I wondered again what the hell I was doing following my headlights down Duke Street in the middle of the night.

At home I rounded up the animals I could.  Tolliver was out on his nightly prowl and would not return before 6, but everyone else was there, wondering why the dinner service was so late.  I fed them with little ado, and told Eddie aloud, “Daddy won’t be home for a few days.”  He didn’t seem to appreciate the gravity of the news as he nuzzled my knee.

I stared around the house.  I tried to imagine myself going to bed and falling asleep.  Alone.  In my house.   “… with one third of the cases resulting in death.”  I wandered over to the computer.  I texted Bill to see if he was ready for me to send out an email to our friends.  He agreed, it was time.  I sat down and drafted the most incredible email of my life.  I filled in the address list to about 75 people.  I realized there were more on Facebook and messaged a few people there.  It’s an embarrassment of riches to email nearly 100 people, none of them from our jobs, when something important happens.  I again felt grateful for my Village, for living in the City of Medicine, for my husband being well.

I went to bed with Murder She Wrote on Netflix.  It’s just enough of a distraction to allow me to sleep.  I was out before the first notes of the charming and cheerful theme song played.  Bill woke me briefly to say the CT scan had come back positive—the cause was a vertebral dissection.  The mysteries were all solved, and recovery would continue.  I slept.

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