So, yeah, I woke up in the hospital…

My first thought upon waking up and being capable of coherence was, I’m glad my insurance has kicked in, because this room is costing Blue Cross Blue Shield a fuckton of money. My second was, goddamn, I’m thirsty, how long have I been out?

The answer was, of course, “three days” and that information was kindly provided to me when one of the ward nurses came in to check on me. I also learned that I was at the Penn Comprehensive Neuroscience Center at the Hospital of the University of Pennsylvania and that I should probably hold off on food and water until the doctor could talk to me.

Dr. Angstadt, the doctor in question, gave me six kinds of kindly professional Hell because the hospital had had to query my medical records from California, as I’d not yet gotten around to actually visiting the primary care physician I’d picked out. (Ooops. You know what they say about doctors being the worst patients? Broadly true.) He also let me know in that same kindly professional Hell-giving way that he had been in contact with my parents vis a vis treatment directives, as I’d been unconscious and nonresponsive and did not have an advance medical directives document filed anywhere that could be found. (Yeah.) He let me have some water, because I wasn’t nauseous, and then started in on the evaluation. Standard questions first: when was my last migraine, what interdiction meds was I taking, what OTC painkillers I used most frequently, if I’d been experiencing unusual instances of blurred vision, asymmetrical numbness or weakness in my face or limbs, dizziness, more sudden and severe headaches than usual, any recent blunt head trauma. Then the physical examination and, by the time he started listening for carotid atherosclerosis sounds, it finally dawned on me that they thought I had had a stroke. In fact, I said out loud, “Wait — you think I had a stroke?” Which occasioned the application of another six kinds of gently professional Hell, which included a rather pointed reminder that mid-thirties is not, in fact, too young for a stroke especially given my personal medical history of life-long moderate-to-severe migraines plus the stroke-risk inherent in my triptan-based pain control meds and, by the way, hadn’t I graduated from medical school in the last ten years? (Yeah, it was that kind of morning. Afternoon. Day.) They’d already drawn blood and my labs had come back with a normative clotting profile for my age, no significant chemical imbalances, sugar and cholesterol levels good. No blood clots or cholesterol crystallization in the retinal blood vessels. Blood pressure was a little elevated, but we both attributed that to finding myself laying in the stroke unit of a major university hospital with no memory of the last three days to be found. Then he called the nurses in to remove the IVs and get me some real food, because he wanted to continue lecturing me during a time when I wasn’t cranky from hunger.

Food was brought. I asked if I could get out of bed (answer: no) and if I could have a phone (answer: yes), and so I started making calls. Dr. Weller had, unsurprisingly, already been informed where I was and had a broad understanding that my condition was considered “of serious concern” and said she’d have some papers for a temporary medical LOA brought over that day. Then I girded up my loins, did the time zone calculations, and called my Dad.

….There are some conversations you don’t ever want to have with your parents. I finally managed to convince him that it’d be a waste of time and money to fly out right now — I’d probably be out of the hospital before he could even get all the plane tickets lined up. Yes, I was fine — just a bad migraine. He could stop worrying. I’d call again as soon as I was out of the hospital. Give Rin and Mom a hug for me.

He did not sound particularly like he was going to stop worrying.

I’m really not sure I can blame him. I was dozing a bit, because there’s nothing in the universe more boring than a hospital room with no television, when Dr. Angstadt and the rest of the neuro team assigned to my case came back in, with nurses, a ward cart, and a mountain of paperwork. One of the nice things about being a doctor in the hospital is that other doctors will not, in general, treat you like a layperson when it comes to the details and severity of your condition. Dr. Martine Tucker, the doctor who’d been on duty when I was brought in and who did my initial evaluations and treatment, did not even pretend that the situation wasn’t worth my new journal tag. I had been brought to the U of Penn Hospital in the early morning hours of 1/11 by ambulance — my building manager had used her emergency access keys to obtain entry to my apartment after someone had banged on her door complaining of a loud noise coming from inside and promptly called 911 when she found me unconscious and nonresponsive, in mid-seizure, on the floor. The seizure stopped before the EMTs arrived but I remained nonresponsive in the ambulance. The EMTs performed a physical evaluation that included an EKG that displayed the sinus tachycardia and rising-falling T-U waves that characterizes a stroke’s effect on the brain’s sympathetic and parasympathetic control of heart function. That, combined with the medical ID migraine dogtag I wear, led to the decision that subsequently routed me to U of Penn’s neuro center, where I was admitted as acute, possible stroke, and diagnosis and mitigation protocols were immediately enacted. Because severe enough migraines can actually mimic the symptoms of stroke, Dr. Tucker ordered an immediate diffusion weighted image MRI — pretty much the fastest method of identifying areas of abnormal brain function that most hospitals can access.

This is where the superlative form of what the fuck comes into play.

The DWI returned the information that my entire brain was in a state of profound abnormal function. In fact, it was in the process of shutting down. In fact, Dr. Tucker informed me that all electrochemical function in my brain ceased at a little after 0400 hours. I did not, however, code. My heart continued to beat, albeit arrhythmically, spontaneous respiration continued, my autonomic reflexes continued to respond, and, about twenty minutes later, my brain function resumed in a completely normal fashion.

Everyone was, shall we say, pretty surprised. I did not, however, wake up until this morning, which caused quite a bit more surprise and excitement. I’d been under basically continuous monitoring the entire time I was in the hospital and during that time my brain continued to bop along as brains are wont to do, despite having just suffered some sort of trauma sufficient to cause it to shut the fuck down completely, the only sign of any oddity the fact that I wasn’t awake and couldn’t be woken up for love or money. Until, that is, I woke up on my own crabby and in want of coffee.

Yeah. The superlative of what the fuck.

Naturally, the neurology center wanted to do some tests. And by “some” I mean “all the tests ever conceived in the mind of any neurologist anywhere on Earth in the entire history of time.” Given the circumstances — and I would like to emphasize for emphasis that the circumstances were “my brain had shut the fuck down and restarted itself and  nobody had one damn clue how or why” — I was completely okay with this. I spent the rest of the afternoon filling out a vast quantity of paperwork, waivers and informed consent forms and insurance crap and my temporary medical leave request. I called McDreamy and asked him if he could stop by my place and bring some things to the hospital for me, and called my building manager so she would let him in, and shortly thereafter the hospital had copies of my migraine diary, my Do Not Resuscitate Order, my organ donor card, and my Advance Medical Directives. And over the next five days I did, in fact, have every goddamned test under the sun. CT scans. MRIs. Six different kinds of tomography. Just plain angiography. Ultrasounds of probably every major artery in my body. EKGs twice a day. Blood tests for everything up to and including meningitis and encephalitis. The results?

Inconclusive. No signs of aneurysm or arteriovenous malformation. No signs of stenosis in the carotid arteries. No brain tumors, abscesses or bleeds. No infections or inflammations of the brain or meninges. No electrolyte imbalances or hormonal abnormalities. It is not lupus — it is never lupus. For that matter, no signs that my brain had actually suffered any damage from, y’know, completely shutting down. Yes, I’m a little hung up on that. I’ve lived my entire life thus far with a neurological disorder  whose cause is substantially debatable, whose triggers are many and occasionally twitchy, and which can only be managed, not really cured. I have become accustomed to it occasionally punishing my fondness for Pepsi, salted mango lassi, and vegetable curry with blinding agony. Some things you just learn to deal with, because a life without salted mango lassi is a life not worth living. Unexplained total neurological shut down? Not really in the same category of manageable condition. My doctors concurred with this assessment but also couldn’t really give me any answers because, again, inconclusive test results are inconclusive. They finally discharged me with a request that I not drive while they continued trying to figure out what had caused my brain to turn on and off like a light switch and a stern admonishment to actually see my doctor and think about changing to another kind of interdiction medication since what I’m on might be might not be cutting it any longer and the triptan painkillers couldn’t be ruled out as a possible cause of my…episode, and a fuckton of follow-up appointments with an assortment of specialists. Also a request that I make myself available for certain clinical trials and the suggestion that I either get a roommate or develop an action plan with a trusted neighbor to help me monitor my condition at home. My discharge instructions were a half-inch thick but I was cleared to return to work on light duty.

McDreamy, in his continued role as the best human on Earth, picked me up at the hospital and took me home. Or, to be more precise, his home. Admittedly, that was my fault. I complained out loud about the whole ‘get a roommate!’ thing being a perfectly wonderful option if you weren’t sitting on a year-long lease on a one-bedroom apartment with six months remaining. Later that evening we went back to my place and put everything I couldn’t live another minute without in the back of his car. I have since been ensconced in one of his guest rooms where I am residing “until medically cleared.” The building manager and rental company agreed to this arrangement, and to let my car stay in the building lot, on the grounds that I’ll continue paying the stipulated rent until the end of my current lease, at which point I might be able to negotiate a two-bedroom apartment and actually get a roommate. According to McDreamy, I’m paying rent to him in the form of Indian food once a week, intellectual stimulation, gas money for the car pooling we’re going to be doing for the foreseeable future, and exercise partnership. Also teaching him how to play World of Warcraft. It is, I will admit, extremely comfortable being here, not alone.

Less comfortable? While I was in the hospital, the detective that I’d met at John Q’s house in October was killed. Died. The official determination was suicide — threw himself in front of a SEPTA train on the morning of 1/14.

Even less comfortable? The detective in charge of the Christmas day investigation called me. She’d seen his autopsy photos. He had the same parallel-four scratch marks on his arms as the male Christmas day victim.

Rin — you may absolutely not talk about any of this with Dad or Mom.


~ by Dr. Nate Harada on January 26, 2012.

3 Responses to “So, yeah, I woke up in the hospital…”

  1. So let me get this straight.

    Your brain bluescreened and then *rebooted*?

    If this is what 1/11 does to you, watch your ass on 4/04, is all I can say…

    • …Actually, you know? Blue Screen of Death and hard reboot actually does pretty accurately describe what happened. I’d find this a good bit more fascinating if it weren’t for the fact that a) it happened to me b) some of the best neurologists in the country cannot actually explain why it happened to me c) they also can’t explain how to keep it from happening again and d) did I mention that it’s not actually possible to physically survive the cessation of all brain function?

      And thank you so, so much for the 4/04 thing. And it’s not like 12 isn’t also a multiple of four.

      ….Man, now I’m freaking myself out again.

      • Well. Not that I’m not enjoying watching your paranoia blossom, but just because you’re a doctor and rational and all…*has* the hospital investigated the possibility that its brain-wave equipment just fucked up?

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