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Friday, March 13, 2015

Mysterious Origin of Crisis

Having been on the other side of hospital rounds, I know that a doctor and his entourage of students and residents meet a lot of small anxious patient-family units each morning. All are waiting for test results or other crucial bits of information in the life of their loved one. This time, my parents sat nervously chattering as the footsteps approached my room.

Dad stood, of course, deferring to the doctor as if he out-ranked him. The doctor waved his hand, palm-down, as he pulled a chair over to sit by my bed. Even-so, Daddy didn’t take his seat until the neurologist sat.

What my parents hadn’t realized caused me to stop breathing. I knew this doctor well enough to know that he never sat at a patient’s bedside; I sometimes wondered if he ever sat at all. Hearing him take a deep breath, I steeled myself for the news.

“I’ve spoken with the radiologist, at length, and we’ve reviewed your test results. You show every evidence of a brain tumor, but we can’t find it,” he said matter-of-factly. I thought I heard a tiny gasp escape my mother’s lips; her small hand crushed mine like a vice. “You couldn’t be this sick and not have something serious going on; you do know that, don’t you?”

“I just don’t feel that sick, Dr. Roberts*. I have this awful headache, but honestly, I don’t feel sick.”

“For Pete’s sake, girl; you’re blind. How’d you think that happened, if you’re not sick?”

“But, don’t blind people just see a black field where their eyesight should be? I can see a bright-white background behind those strings of colored pyramids waving around in my field of vision. It seems to me that, if they left, I’d see you okay. Is that not true?”

I pictured the physician’s hands combing through his dark curls. I’d often seen him do this when frustrated and searching for the right words. Finally, he spoke.

“Can you see me? No, you can’t. A person who cannot see a hand in front of her face is blind.” I heard his deep sigh before he continued. “Look, I don’t know if your white background will turn to black or not, but we’re going to try to get as much back as we can. First, we need to stop the progression before there’s more than your vision to worry about.”

“Do you mean my headache? I’d really like that to stop. Sometimes I just can’t sleep because it hurts so much, no matter in which position I put my head.”

Finally my mother could stand it no longer. I heard her whispering something to my father. “Doctor, my wife… and I… would like to know about the test results. You said what it didn’t show, but is there anything you can tell us about what it did show?”

“I’d like to know, too,” I said, though I’m not sure I’d spoken loud enough to be heard.

“Yes, the test showed us that her brain is swelling. In the middle of the brain is a place with four chambers. One of those chambers is filling with fluid and we can’t see why. Because the brain is contained in the skull, there is a limited area to offer the brain when the fluid makes the brain grow in size.”

“So, that’s why my head hurts? It does feel like a balloon inside is being pumped up.”

“That’s exactly what’s happening, only it’s not air; it’s cerebrospinal fluid. We’ve got to get that fluid to stop producing more than the brain can handle. The space that’s normally open between your brain and the inside of the bony skull is completely filled now. Your brain is pushing against the inside of your skull. Soon it’ll have to use the space in the vertebral column. You can probably feel the pressure on your back already, can’t you?”

“Yes, I feel pressure, but it doesn’t really hurt like my head. Are you saying it will also hurt that much?”

Dr. Roberts put my hand on his knuckles. He held up his forearm with his hand in a fist. “Your brain and your spinal cord are one unit, like your hand and your arm. If the brain continues to swell, all of the entire unit will swell. There is a tiny space for the spinal nerves to move around inside the bones of the backbone, but the spinal cord is taking up those spaces now. That’s the pressure you are feeling.”

“So, what will happen to my arms and legs if that pressure continues? Will it be like in a car accident?” Reminders of paralyzed accident victims danced before my mind’s eye. I’d seen too many of those in my time riding an ambulance. My heart rate accelerated.

“No, you’re not going to get paralyzed from this,” the doctor said. I let go of the breath I’d not realized I’d been holding. “Do you remember your anatomy? At the base of the skull, what’s there that lets the spinal cord pass through?”

“The foramen magnum.” I said, wondering what my knowledge of anatomy had to do with anything right now.

“Exactly, and through that hole, do you remember what sits at the bottom of the brain, just where the spinal cord attaches?”

I did remember. My own lectures to the Highway Patrol officers on the importance of immobilizing the neck and spine at motor vehicle accident scenes came rushing front and center. I nodded, unable to speak.

“She may know, doctor, but we don’t,” my mother said, squeezing my hand again.

“At the bottom of the brain is the breathing center. If the brain and spinal cord continue to swell, the medulla oblongata of the brain will slip through that hole in the skull. It will act like a tourniquet. The breathing center will be unable to do its job.”

“Okay, we get it; I won’t be able to breathe,” I said. “What can you do to stop the brain from producing all that extra fluid?”

Dr. Roberts outlined the medication regimen that would begin immediately. Heavy doses of steroids and other things, but I didn’t hear anything about pain pills. “What about the pain in my head, please. Can’t I have something for that now that you know what’s wrong with me?”

“We are going to treat your symptoms; we don’t really know why we can’t see the tumor. We need you to stay away from anything that would dull your nerves. We don’t want to miss any changes in your condition because of narcotics.”

The news made my head hurt more; I’d held out hope that I’d be getting something for the pain, if only I waited. He refused me even an aspirin, though I doubt it would’ve mattered with this level of pain.

Swallowing the handful of different colors and shapes of medications started that very hour. The race to keep that medulla oblongata right where it should be was on.

* Name changed

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