I’m Back

by Paul Robert

Okay it has been long enough for me to realize that everything has really returned to normal. On the Sunday before Thanksgiving of 2005 my brain aneurysm leaked. I was home alone and I had fallen asleep on the couch while watching football. When I awoke and went to get up from the couch I was brought to my knees with severe head pain. I could feel heat flowing throughout my head. My first reaction was that I really didn’t feel well and I should get back on the couch and just rest some more. Fortunately my second thought was that I was experiencing a brain aneurysm. My family has a history of aneurysms. My uncle died at 13 from one and my mother survived one at 59. I have since come to learn that 80% of strokes happen after a period of rest. It is the body restarting systems after rest that can trigger the stroke when conditions are ripe for stroke. Unfortunately many people succumb to that first reaction and resume resting and that is how they are found.

After what seemed like minutes but was probably only a few seconds I decided I was going to call for help. But before I did make the call I crawled very slowly to the bedroom to put on fresh underwear and sweatpants. As long as I didn’t move to quickly or exert myself the pain didn’t increase. I still laugh that during a serious medical crisis I felt compelled to heed my mother’s instructions to arrive at a hospital with clean clothes. I am very lucky that my wife didn’t find me later in the bedroom with one leg in my sweatpants. After putting on the fresh clothes, I crawled back out of the bedroom and as I went by the counter I grabbed my cell phone. I crawled to the front door and unlocked both the inner and outer doors. I didn’t want the emergency crew to have to break down the doors. I crawled back inside put a pillow under my head from the couch and made my first phone call. I called the Bier Garden, which is my favorite bar/restaurant, a couple of blocks down the street. It was around 2:30 in the afternoon and Kevin one the owners happened to answer the phone. I said “Kevin it’s Paul and I’ve had stroke, a brain aneurysm and if I stop talking, get an ambulance to my house” I then told him my address. Kevin responded, “Why on earth didn’t you call 911?” “Well Esther (my wife) is at the theatre and I know her cell phone is off, could you get one of the guys to go and get her”? Kevin said “sure no problem”. I said, “Okay, I’m going to call 911 now” and Kevin said “okay”. I then called 911 and told them I thought I was experiencing an aneurysm and while I was on the phone with the dispatcher she asked, “Do you have a friend named Kevin”? I responded “yes” and she said “well, he’s calling for an ambulance for you too”. I lay there and in the distance I could hear the faint sound of the sirens and then the sound of people running on the sidewalk. As the running got closer I heard Kevin come in and kneel by my side. I tried to open my eyes to see him but the light in the room was too bright and the pain of the light was like hot spikes through my head. I then tried to adjust myself and roll over on my side and I realized I couldn’t move anymore. For the first time in all of this I became very scared that this was it. I could feel my life energy slipping away and I was becoming weaker by the moment. I told Kevin as we heard the sirens get closer that “at least if I’m going out, I’m going with a friend at my side”. The Fire Department medics arrived a minute or 2 later and because I was still conscious I could respond to their questions. I told them that I thought I had an aneurysm and after checking me out they concurred that I showed the classic symptoms of an aneurysm hemorrhage. They started an IV and oxygen, and began giving me morphine for the pain and then they administered what I later learned was the drug that probably saved my life. I was given NIMODIPINE. As I later learned, an aneurysm does basically one of 2 things. It can burst and you bleed out internally in seconds and die or it can leak in which case you have a chance of survival. Years ago before nimodipine was discovered for use with aneurysms, people who had a leak would die within hours because the normal course is for the aneurysm to burst after leaking. Nimodipine makes the blood vessels settle down and lowers the blood pressure. Anyway after working on me for what seemed like a half hour they transported me to the hospital.

I don’t remember much about the ride or what the emergency room people did. I just remember being in a curtained section of the emergency room and seeing my upset wife. I was in tremendous pain. My head wasn’t just throbbing it was on fire with heat and felt similar to being crushed in a vice that was increasing with pressure. At this point I no longer felt my life energy slipping away and I had regained movement. The problem was my pain was increasing even though they were administering what they said was the maximum amount of morphine. I asked my wife to get my family doctor and see about getting me some form of pain relief because I was in such severe pain I knew I was going to pass out and maybe go into a coma. The emergency room physician had diagnosed me with a severe migraine and refused to believe I had an aneurysm even though I told him about my family history. Here’s where having an advocate makes a difference. My wife pitched a fit and demanded that they do a CT scan to be sure of their misdiagnosis. Immediately after the CT scan the emergency room physician came to my little area and he was as white as a ghost. I’ll never forget his face as he told me that it is very rare that a patient self diagnoses their condition and in fact I had suffered a SAH. He informed my wife and I that arrangements were being made to transport me to a trauma center 20 miles away since the closest trauma center’s ICU was full. By this time at least a couple of hours had passed and my pain was still increasing. My in-laws had driven in from an hour and a half away. This first hospital couldn’t get rid of me fast enough. My wife rode with me in the ambulance and my father and mother in-law followed for a while on the interstate. After we settled in to intensive care my father in-law told me he gave up on the interstate when the ambulance started to go above 95 miles an hour. He said it was getting too dangerous to follow the ambulance as it weaved at high speed through traffic. I vaguely remember bouncing around in the back and being happy that I was secured to the gurney. I also remember my wife and the attendant struggling to keep my IV bags from hitting the floor.

It turns out after the fact that I shouldn’t have been brought to this second facility because it really didn’t qualify as a trauma center because as luck would have it, their CT scanner was down. Protocol for an aneurysm calls for a trauma center and a medical center without a working CT scanner does not meet the qualification for trauma cases. So, the scanner is down Sunday night, all day Monday, and Tuesday and finally they get me scanned Wednesday afternoon. During these days of pain I am getting percocet every 4 hours in addition to a full morphine drip in my IV. I didn’t have one of those little buttons to release morphine. I had a full drip to the extent the attending physician told my wife “if I give him any more morphine it will stop his heart”. I didn’t like the percocet and my little sister is a pharmacist and she suggested they change out the percocet to hydrocodone. And they did and this helped somewhat. My pain was still the feeling of my head being crushed in a vice. After the first day I just accepted that this was just the way it was going to be. At times the pain was so great I just cried. If I hadn’t had the constant stream of family and friends visiting I would have just given up and let myself go. I have no idea how some people are able to survive trauma without the help of friends and family. For me seeing my friends and family helped me out tremendously by getting my mind on other things. Even in my drug induced stupor one of my best moments came seeing my brother in-law. There is a Robin Williams DVD that we had listened to the audio portion of maybe a month before. We had laughed so hard then that we had to pause it to catch our breath. When he came we began talking about and repeating some of the vignettes of Robin Williams and we laughed so hard again that my head stopped hurting for a few minutes. Then nurses came and said “I could only have one visitor at a time” and we were making too much noise. I will always remember those laughing moments fondly. One last thing to remember about this whole ordeal, the doctors don’t want me to fall into deep sleep. They are afraid I’ll go into a coma. So, during these days of pain and in fact for 16 days straight I am not allowed to sleep more than 50 minutes. Every hour on the hour, I am awakened from just dousing off and getting ready for deep sleep and rest. They ask me my name, where I am and what day and time it is. Believe me that by the second day of no real sleep and the constant barrage of drugs I am going crazy. I am starting to believe that this is just the way it is going to be.

After the CT scan at facility number 2 the doctor comes and gives my wife and I the news. Sure enough my aneurysm is in a very important and tricky part of the brain. “This surgery is best handled by our ‘A’ surgical team and they won’t be available until next week and you need surgery as soon as possible”. So we were given the names of three other medical facilities. Before he could finish getting the names out, my wife and I both blurted out “UVA Charlottesville”. Arrangements were made and I was transported by medical transport at normal highway speeds the four hour ride to Charlottesville Virginia and the UVA Medical Center. The Wednesday night the night before Thanksgiving, I arrive at around 11:30 pm and there is a team of more than 15 people to meet me where the ambulance pulls up. They immediately check me out and then get a CT scan of their own. What seemed like only a few hours later they came to my wife and I. They explained that because the location of the aneurysm was on the branch of a main artery, it was not a candidate for coils. The only solution was brain surgery and clipping. My wife and I agreed and surgery was scheduled for 7:30 am Thanksgiving day. So in less than 8 hours after arrival, I was scheduled to have this pain reduced. That was all I cared about. You could have removed my leg or hand and I would have agreed to reduce the pain in my head. I’ll admit that brain surgery seemed risky but for my simple mind I had to agree that the pain was coming from my head and it seemed a waste of time to remove body parts when I knew we would eventually have to deal with what was happening inside my skull.

Surgery was performed Thanksgiving morning as scheduled. I was returned to my room in the Neurology ICU around 1:00 or so in the afternoon. I was feeling much better. I sat up in my bed and ate cardboard Turkey from the cafeteria and received friends and family that afternoon. I had a party. For the first time in days my head doesn’t hurt the way it did before. Now my head hurts in a new way that felt like my head had been worked on the outside. The pain wasn’t inside my head any more. The pain and it was considerably less was on the outside. I felt great. I had a very good Thanksgiving all things considered.

Now comes the hard part. During the next three days after brain surgery, culminating in day two and three, everything in the affected area swells. The brain swells, the skin and everything around the area they used to access my brain. Eventually, one of my eyes is swollen shut. The pain is bad again and on top of the morphine and hydrocodone they give me two injections of Fentanyl into my IV. The fentanyl is given twice a day and for about 6 to 8 hours after an injection, I feel about as good as one might feel with a busted head. I’m calling friends and telling them that I’ll be back to work in a few days and all is well. I even hatch a plan to go visit friends. I call a buddy and tell him to get some air bags for the back of another friend’s pickup truck. I tell him to bring other friends and to load my hospital bed in the back. No matter that its 20 or so degrees outside, “just put some extra blankets on me”. For the next 12 days I made steady improvement. However according to nurses, my wife and family, I was IN the TV. I am told that at times I assumed the character from TV shows and was convinced I was going to some crime lab and getting DNA tested. The lack of true sleep as they continued waking me every hour for another 12 days, combined with drugs, kept me spinning. Those days are mostly a very surreal blur.

I arrived home and began to get the sleep I had been denied for more than 2 weeks. I continued eating the same basic food I had during my hospital stay. I ate pineapple chunks. The only food I would eat during this ordeal was Pineapple. I slowly regained my strength and improved. Then I really started to come out from the fog and regained enough strength to walk again. I returned to work the week before Christmas, even though they wouldn’t let me stay for more than an hour and they wouldn’t let me do anything. I did this without therapy and I had stopped using any pain pills, except one at night to sleep. By the New Year I was only occasionally taking Tylenol at night. By the second week in January my pain had gone away enough that I no longer needed any pills. I had survived the adventure. That January was one of the busiest from a work perspective in my life. Because some person had reported to others that I had died, when certain people found out I was alive and well, my telephone rang off the hook. I had to hire 2 people to help out. I returned to full time work by the second week of January. It has taken the most of the last 2 years for me to convince myself that I have returned to normal. This ordeal was so crazy and surreal. I had never been hospitalized in my life before this. I had a cast once and some stitches but nothing that had kept me at a hospital for more than a few hours. I went from a normal relaxing Sunday afternoon during the height of football season to near death and severe head trauma. As I approached Christmas I knew I was very lucky for my outcome, as I didn’t need any therapy. I knew what had happened to me but it didn’t seem real. I knew I had undergone brain surgery because my hair was still coming back and my head was sensitive. But all of my thinking was intact. It was like I had an uncontrolled vacation and time had stopped for a few weeks. When I got home I couldn’t understand why I had a month’s worth of E-mail in my inbox.

January came and suddenly I’m busier than I’ve ever been and I have to hire help to meet the new obligations. I juggle 4 clients and wonder whether I still have the mental power to solve computer problems and talk intelligently to clients. By June I realize that I haven’t lost a thing. I am back to my full abilities. The only thing that kind of kept me back in the spring was self-doubt. I didn’t want to try to reach too far so that if I failed, I wouldn’t have tried everything. I wanted to have something at the end of my ability level to try for later. As luck had it, I found myself stretched beyond my abilities such that I had to learn new things and I found myself passing. The next stage of this ordeal is learning to accept from family, children and friends that you are back to normal. Everyone has burned in their minds how serious you were only a few months before. They know you’ve had brain surgery. They are looking for changes in speech patterns or personality. They are looking for differences between the person they knew and almost lost and the seemingly new person. They are looking for reassurance that they didn’t lose what was the essence of you. In my case I came back no different. After a few hours of talking to friends, children and family you begin to see a smile come to their face as they have confirmed for themselves that they didn’t lose me. My favorite memory is that of my then 8 year-old niece. At 8 they talk pretty honestly to you. She realized that she couldn’t jump on me like before. Then one day she told me that she knew I was back because I made jokes that her mom and dad laughed at. She knew I was back to being her uncle because “you remember the things I like”. She reached out and put her hand on top of mine and told me she loved me. Now granted, I have spoiled terribly all of my nieces and nephews. But one of things that has made me thankful that I persevered through the ordeal has been being able to enjoy the smiling faces of nieces and nephews and other friend’s children. There is such an honesty that small children have. When they give you their smiles and laugh with you, when they call your name and give you a hug, all of your problems melt away and you are reenergized.

For me I know what happened. I know what I went through, but it still doesn’t seem real. It seems more like some bad dream. The further this event fades to the past the fuzzier some memories become and the less important this chapter of my life seems. I will say that without my loving wife and the help of friends I would not have made it. I will be forever grateful to Esther and my in-laws and Esther’s close friends for their efforts. Thank you for helping Esther maintain her sanity. Thank you for dealing with me so respectfully even though I was crazy and completely unaware of my surroundings. Thank you to my friends for your comfort and respect and for helping me realize how much a part of your lives I had become. Look out world – I’m Back.