Poetic License

Mondays are hard no matter how you look at it. You are more likely to have a heart attack between 4:00 and 10:00 on a Monday morning, but the opposite is true for car accidents, which are most likely to occur during the Friday evening rush hour. But strokes can occur any old day of the week. They are more likely to happen during the early morning, with 6:30 being the median time. My stroke hit around 9:45 in the morning, just after my first work meeting of the day.

I had an uneventful morning, as my days go, with all my usual meetings before 1:00 p.m. According to my calendar, the afternoon looked to be a rather easy one, with my last meeting scheduled to end around 5:00 p.m. Mind you, I wasn’t thrilled about the beginning of another work week. I had dragged through getting the day started, gulping down my coffee before a shower, eventually making a couple of eggs and a piece of toast before sitting down to the computer. I gave the dogs a couple of nibbles from my plate when I was finished. I went through the usual round-up on that first call.

I needed to review some documents between calls, but I decided to take the dogs out before getting started with that. My eyes felt blurry. I reasoned that I just needed a quick break. After the dogs went out the back door, my left arm went completely numb. Dead. I tried to shake it loose, to wake it up, but all that happened was my hand twitched. It must be my shoulder, I thought. My shoulder has been bothering me a lot, and I’ve been seeing a specialist. But then, by the time I got the dogs inside and sat back down in my chair, my left leg felt numb and distant as well. I tried to type a message to someone I’d been communicating with on Slack, but my left hand would not cooperate. It did not obey my brain. I ended up typing right-handed only.

I sent a message to my son, again typing one-handed on the phone.

“I think I need to go to the hospital.”

He called me immediately. He asked what was going on. He said it would take him half an hour to get to me, and then time to get me to the hospital.

“Call an ambulance,” he advised.

Before the ambulance arrived, I managed to wrangle my dogs into my room and shut the door. I unlocked the door and sat in my recliner, waiting. The sirens approached. The EMTs came in and assessed me. Things happened quickly. I heard them saying my left pupil was sluggish. My face drooped. They were taking me to the hospital.

A lot of things happened in a short period of time. Most every provider I talked to was “on wheels,” meaning they were connected through a web meeting and were rolled from room to room on a cart on wheels. It is a very odd thing to be completely assessed by a person who is not in the room. Sometimes a proxy nurse or PA worked in the room with me at the direction of the doctor. This is not your mother’s healthcare.

By the time I was sent upstairs, because of course I was admitted “for observation,” I was told I had had a stroke at some point in the last year, between my last head CT and the one they had just done. The stroke was “age indeterminate” but was not the current one. That stroke took place in the left frontal lobe. This one would have shown up in the right hemisphere of my brain. They planned to do an MRI and an echocardiogram later. One provider said it could be a transient ischemic attack (TIA), which would not leave the signature of a stroke on my brain.

All of it was exhausting. Even yesterday, when I met with my primary care physician, I was still trying to figure it all out. Why do they have me on magnesium? What was my diagnosis? What about this medication? I was sent home with four new medications that I have to remember. Several times over the last week, I have become confused about what they prescribed and why. I still struggle to remember. Typing is exhausting, but I do it because I want to strengthen my mind-body connection so I can go back to work at some point.

Even though I met with a neurologist (on wheels) during my second day in the hospital, I was unsatisfied by his assessment. He tried to tell me I had had a complex migraine and that I was suffering rebound headaches from overuse of Tylenol. I didn’t have the wherewithal to argue with him. But thinking about it later, I never told him I overused Tylenol. I said that most days my pain medication was not enough and that I could use extra Tylenol during those time periods (according to my other doctor). Semantics. Could is not did. Also, I know what every kind of migraine feels like. I had no aura and no head pain that day. It was all weakness and numbness. A feeling of disconnectedness. It was after this visit that I began asking to go home. It was clear that I was not going to need anything they had to offer me.

Things I turned down:

• Clot-busting medication, because they never said they found a clot. In retrospect, it might have been okay to have it, because you can’t always see the clot. But I was worried it might cause a bleed, which I have survived before.
• Insulin. They kept pushing it on me because my sugar was high. I remember telling them I wasn’t insulin-dependent. On the second day, though, I finally let them give me a shot of it. I was tired of fighting.

Things I should have turned down:

• Magnesium by IV. No one told me the side effects I would endure. The nurse had said that some people found it uncomfortable. I thought she meant the drug going into the IV. Instead, I found that it gave me a serious hot flash that lasted as long as the infusion, and severe diarrhea. By the end of the seventh trip to the bathroom, I begged for Imodium.

My son was working and taking care of my dogs or he would have been with me, directing the staff. I was pretty much on my own, which is very frightening when you are in that post-stroke state. It was all a blur, and I had a lot of questions thrown at me. I needed an advocate.

My doctor determined that it was at least a TIA, if not a full-blown stroke, according to my test results and diagnosis code. To stave off future events, my blood pressure, blood sugar, and cholesterol will be tightly monitored and controlled. I’m on a new statin and an additional BP medication. I’m on a daily aspirin, which could cause the bleeding to happen again so I must be vigilant. I hate all of it, but I want to live. The next event could be much worse. I was lucky.

I’m hoping I can go back to work soon. I miss my coworkers and my team members. But I know I’m not quite there yet. I am still slow at typing. I’m still having some trouble finding the words. TIA or stroke or whatever, it left me fighting my way back to normal. The terminology does not determine the course. It’s just a best guess.

The discharging physician never even laid eyes on me, not even through a wheeled cart and video conference. She communicated through the nurse only. Were it up to her, I would have been back to work that Wednesday, because she never even filled out a return to work notice. She grudgingly wrote one for a week off, never asking what kind of work I did and never having a discussion with me. How could she have any idea? I trust my primary care physician much more. She had a whole discussion with me, and at the end, she shook her head. Let’s take a little more time, she said. I want to make sure you are thinking clearly again.

The one thing I do know is that this was not related to my shoulder. I saw the specialist this week, and he confirmed that. He gave me a cortisone shot (which has not helped) with instructions to go to PT and see him again in a few weeks.

I’m frustrated by all of this. I’m not old enough for this to be happening to me, but then again, I guess I am. I am this old, and this is happening, like it or not. Part of me just wants to go to bed and sleep until I feel better. I have allowed myself a nap every day during this unexpected time off work, but every time I lie down, I think, I really should just push through the fatigue, because I will need to do that when I’m back at work. Usually I give in and rest. That’s been the advice of every physician and friend.

I’m going to go rest now. I hope that the next time I write to you, I will be all better and back to my usual self. I hope, I hope.

Namaste,
Jude