Wednesday, August 13, 2014

A Hole In The Head. Literally.

In late June, a few seconds after finding myself face down and bleeding on the dark sidewalk a few yards downstream from the Green Street bus stop in Central Square I suddenly thought of the line from Malcolm Lowry's Under the Volcano,   But suddenly the Calle Nicaragua rose up to meet him. 

But unlike the drunken Consul,  I was stone cold sober , and had no memory whatsoever of the split second between strolling in the dark killing time before the arrival of the 10:35 bus and the rising up of the Calle Verde and its infliction of head laceration, nosebleed, fat lip, elbow wrench and smashed glasses. No Oh, shit, I'm falling, no oops I've tripped -- just the post-lapsarian state of having fallen. Lord have mercy.

A  kindly young man came to my aid; he ushered me across the street to the bathroom of the parking garage where he worked and where I did a rudimentary self exam and toilet-paper-based blood stanching, concluding I was not ER material and that if my fellow bus passengers objected to my ghastly visage, well, they could simply keep their eyes glued to their devices and ignore me.

I'd been to my husband's big band concert at the Cambridge YMCA and had opted, as I often do, to take the bus home rather than wait until the clean-up activities to be finished. Nonetheless, when I arrived home, he was in the driveway and was understandably aghast at my smashed face. All would be well, I reassured him. I'd go to urgent care in the morning.

All was, more or less,well: the fat lip receded, the elbow xray only showed a small chip at the site of the ulnar collateral ligament (am I they only person on the planet who has not heard of "Tommy Johns surgery" ?) and the head CT was fine. Two days later a sanguine orthopedic PA issued me a David Cronenbergesque  (cf. Dead Ringers)  hinged elbow brace that I was to wear 24/7 for a month --
and, by God, I got through that, too.

I had no time for the trivial headaches that I eventually realized had been waxing and waning for 2 weeks and for which I was eating untoward amounts of ibuprofen-- my neck, I thought. Caffeine withdrawal. Wearing glasses so old I could not remember how many prescriptions ago I got them.

Then, suddenly, ten days ago, a Sunday, as I descended the stairs, my left leg gave way and shook for a few seconds, a strange little event that saw fit to happen 4-5 times that day; I went to urgent care again and everything seemed normal. Neurology consultation could be arranged on Monday. On Monday I had 60 seconds of complete left foot drop and by Tuesday night I was in the MRI tube having had time to conclude that I probably had a chronic subdural hematoma, a slow accumulation of blood under the brain covering that can happen weeks after trauma. As I returned to the waiting room I glanced at the screen where an image of the top of my brain was displayed -- my God, I thought, I'm right. 

And when the MRI tech instructed us to have a seat, that the radiologist would be in to speak with us momentarily, I knew something was up: I was right -- chronic subdurals on both sides, with my brain shoved 5 mm to the left which is, let's just say Not A Good Thing.

Giddy, I turned to my husband and announced -- I was right ! I am a genius ! Now I'm going to swagger about !

We were directed down the street to the ER at Beth Israel, where, still puffed up with my diagnostic brilliance, I smiled like a madwoman at the intake clerk and announced:

Hi  ! -- I have bilateral chronic subdurals with 5 mm of midline shift !

So, long story longer -- I had more scans, got admitted, got my head cut open last Thursday by a kind neurosurgeon (who meticulously preserved the hairdo, such as it is) -- I wish I could report it was a trephination, which is such a cool and historical procedure -- but it was a more humdrum "minicraniotomy"-- and the whole thing was (he told DK) "textbook." (And, boy, did I ever get great care at the BI !) Came home Saturday.

So here I am, forbidden to drive for 4-6 weeks, indulging a strange craving for strawberry jam, devouring Nordic police procedurals insatiably (comforted by the fact that I am in good company) and cared for by my doting husband and son.

And oh yeah -- my Green Street Nose Dive is the proverbial gift that keeps on giving: the contrast CT showed an incidental "tiny" AVM (tangle of blood vessels I've likely had since birth) for which I'll have an angiogram next Tuesday.

Then what ? That remains to be seen.

Here's a more cheerful Dive (Lake Street Dive) by way of apology for such a self-indulgent tale !


christopher said...

Wow. Getting on in years is not for the faint of heart. My mortality is in development too. I have grown to care about you over the years of dipping in and I have long welcomed the images and thoughts you share. I do not consider this self indulgent because I want to know. I feel it a privilege to be here. I believe most people who follow you feel like me.

Lucy said...

Oh my goodness, poor Paula! So glad you're home and recovering. Take lots of loving care of yourself and eat as much strawberry jam as you want, though how you can bear to after seeing inside all the crucial squishy bits so up close and personal I can't imagine...


Paula said...

Christopher, thanks for your kind words. I'm not always as interactive with or appreciative of people who read my stuff as I should be -- it's a real blessing. And as for the mortality thing -- indeed.

Lucy -- thanks for the well-wishes ! I'm just glad I didn't have to see my own crucial squishy brain bits. I've found that years of practicing medicine have given me an oddly abstract map of my innards -- organs a few cm away from the surface seem deep and remote and mysteriously occulted --

Dale said...

Oh, so glad you got all fixed up! Isn't it odd how one does aspire to the dignity of trephination? Kind of like it was so cool to finally have a REAL broken limb, with a cast and everything, when I was a kid. Ain't nobody can say it ain't real, when you got that cast!

But anyway, for your friends, a minicraniotomy is quite enough, and we're very happy to have to you stop there. xoxo. Rest up and get all well!

tristan said...

wonderfully alive and kicking ... attagirl !

Paula said...

Thanks for the well-wishes, Dale -- I'm glad someone else appreciates the finer aspects of vintage surgeries !

And yes, Tristan, fully alive and fully kicking !

Leslee said...

Wow! Glad you're okay! Heal well. As a medical writer, I only write about squishy bits, but never have to actually see them, at least not in the flesh (nasty pics of, say, skin infections bad enough). But it has given me an appreciation and fascination with medicine.

Speaking of vintage surgeries, we watched the pilot of Steven Soderbergh's The Knick TV series last weekend - be thankful your fall didn't happen in 1900, Clive Owen notwithstanding.

forsythia said...

WOW! Take care of yourself!

Ronnie said...

Yes, take care.

Paula said...

Thanks, Leslee. I have a new appreciation for what the brain can do at cross-purposes with what I usually call "me." Yeah, 2014 is probably a better time to have a subdural than 1900.

Forsythia and Ronnie, thanks - I am being an utter layabout using up my (thank God) vast stores of sick time.

Anonymous said...

We're always standing on the edge...


We are reading your thoughts, and looking at your amazing pictures. Don't stop now!

Be well.