Becoming a statistic

...do it...

...What my disability was apparently attributed to was some unknown combination of drugs or trauma...

...The "Discharge Summary," in fact, continues: "The episode of left sided facial droop and left sided weakness occurred approximately I-2 hours after the angiography was performed....The impression was that the patient suffered an Commonweal 27 March 1992: 21 ischemic event of the right side...

...Since there was now a definite indication of a brain aneurysm, I was recommended to the care of a Boston hospital, where, if events followed their probable course, I would undergo brain 20: 27 March 1992 Commonweal surgery...

...The sensory exam revealed decreased pin prick in the left upper extremity...

...When I walked into furniture and doorjambs and talked about it, my friends would say, "I always do that...

...After the Red Sox had finished the inning, I saw that, strangely, the pitcher was still in—and then I realized that the earlier shortstop had batted for Kansas City and between the two opposing shortstops I had lost four or five players, possibly an entire inning...

...It is one of the lesser mysteries...

...As I write this, I am only sixteen weeks past the angiogram, but it has seemed like sixteen months, both to myself and to my wife...

...The car had begun weaving over the white line and, although I was wide awake and aware that it was, I was helpless to control it...

...Count my blessings...

...No one suggested that in six weeks I would be seeing a psychologist, as the bottom dropped out of my life and I entered depression...

...My wife obtained two books on stroke from the library and the speech therapist provided some literature...

...I once told my wife that I had listened to a two-hour concert on the radio and it had taken me four hours to do it...

...It is possible that during the change in the angiographic room, the nurse who had cut the IV bandages from my left hand had also inadvertently cut off the bracelet...

...Angiography would be required for definitive assessment...

...You also lie to keep my spirits up...

...But since this phenomenon is known, why was there no method in place to catch the 2 percent...

...In the "Discharge Summary" (written after four days in the hospital, not just overnight), there are these words: "The general physical exam immediately post angiography revealed...He was noted to be speaking with slurred speech...

...I attempted to read, but I could make little connection between 22: 27 March 1992 Commonweal adjoining paragraphs, and only the centers of newspaper columns made any sense, the edges right and left were incomprehensible...

...When I told someone I had poured milk over a bowl of Ritz crackers and had taken it for breakfast cereal, he said, "Oh, I do that all the time...

...You've had a stroke," the doctor said, "and if you can say `Methodist-Episcopal,' which is fairly difficult, that may tell us something about your condition...

...When two Red Sox shortstops in a row came up to bat, I turned to my wife and remarked that the Boston pitcher was coming out because a pinch hitter had come in...

...And, although I have made several hundred corrections on these pages, I have managed to type this...

...I no longer bite my lip...

...I had never seen them before, and I was vaguely aware that they had asked my wife to leave the room...

...My words came slowly and awkwardly...

...Discouragingly enough, four months after the angiogram, in reply to an inquiry of mine, the hospital admitted it had yet to identify the doctor who had given me the physical exam...

...My thumb struggled toward my first finger, but the others were orbiting somewhere out in space...

...I was impatient with myself and imagined that people were impatient with me...

...Periods of anxiety overtook me...

...My words were embarrassingly slurred and I kept biting my lip when I ate...

...Only when my wife, who was beside me, jabbed me in the side, did I bring the car under control...

...And luckily, or I might have choked or drowned...

...I was then discharged with no instructions other than to see a speech therapist, and that I should improve rapidly...

...Can you say 'Methodist-Episcopal...

...Because the procedure involved an "acceptable risk," I was asked to sign a consent form, a routine business...

...I have been discharged by the speech therapist, but I still see the psychologist...

...Some patients also have potentially fatal reactions from the dye...

...Confusion of one sort or another continued...

...Haltingly, I have begun to drive again...

...In conversation with my earlier neurologist, he indicated that the more advanced machine, in the opinion of some physicians, had not yet been proven, but there was no harm in getting a further view...

...Soon the hospital was on fire and I tried to leave my room and escape...

...I no longer have to work at making sentences...

...A series of x-ray pictures would be taken to provide a permanent record of what appeared on the monitoring television...

...The stroke, he insisted, had occurred sometime during the afternoon, after I had become settled in my room...

...A nurse said it was no big deal, people die all the time in hospitals...

...My doctor recommended a Computerized Tomography (CT) scan, which "showed an abnormality which was consistent with an aneurysm of the middle cerebral artery...

...I wasn't sleeping well and time and space began playing tricks on me...

...Methodist-Episcopal," I replied after a moment, propping myself on my elbows, realizing that I was probably only partly fulfilling the request...

...The hallucinations did not cease until dawn...

...In the days following I was given another CT scan, an echocardiagram and a final MRI...

...When the dye was injected, according to a handout given me, I might feel a "warm, flushed feeling...

...Three months earlier I had what were described as, for lack of a more fitting term, two "interim seizures...

...An intravenous (IV) system was hooked up to a needle taped to a vein in the back of my left hand...

...Not connecting the two "seizures," I drove home, although somewhat sobered by the occurrence...

...The day following the blood tests, my wife and I arrived at the hospital before 8 A.M...

...When people asked questions, I could focus hazily on the subject but could not find the words to answer...

...One had happened when I was driving on Boston's circuitous, heavily traveled Route 128...

...That was when I threw up...

...I was cautioned not to drive and I was given a prescription for Tegretol, which I never filled...

...Perhaps of less importance was the observation that "over the course of twenty-four hours, his neurological exam was noted to be significant for a left upgoing toe...

...Can you touch your left fingertips with the thumb of your left hand...

...A thin, flexible wire would be passed through the catheter to explore the area of the aneurysm, all the while being monitored on television...

...It also might explain—although I find this sloppy thinking—why the slurred speech noted in the angiographic room was not suspected as stroke-related but of some other origin...

...I went to bed at I0:30 and rose expecting the dawn, when I saw it was not even midnight...

...Curiously, several of the doctors asked if I was left-handed and, if not, was it possible I had been born left-handed and my parents had trained me to be right-handed...

...The findings are highly suggestive of an aneurysm but also the possibility of a tortuous and ectatic internal carotid artery and right middle cerebral artery is raised...

...Q 24: 27 March 1992 Commonweal...

...I awoke six or seven times a night, wondering how long I had been asleep and invariably finding it had been an hour or less...

...I visited an opthamologist and was given a test for peripheral vision...

...Unexplained is the time discrepancy between the revelations of the physical exam immediately after the angiography and the discovery of the "episode" during the afternoon...

...In the morning I trembled in my bed...

...and were told to go directly to the angiographic suite...

...I was told that at least I was alive, I could have been killed...

...He warned me that periods of depression could beset me for another year or so, but I have decided not to believe him...

...Words still have a way of hiding, but they are not as far away as before...

...But time has kindly become more compressed...

...Although I was not aware of all that was going on, I do remember that the nurse said to the doctors that I had begun to slur my speech...

...The later, technical "Discharge Summary" noted: "His angiogram showed a right MCA bifurcation tortuosity of vessels but without aneurysm...

...What's—that—all—about...

...What was going on...

...A medical article in the Boston Globe reported that "Conventional angiograms are invasive procedures that carry a 6 percent risk of minor complications including hemorrhage and a 2.6 percent risk of major complications requiring corrective surgery...

...But to a more mysterious matter...

...There was actually no discomfort for most of the angiogram, but when a streak of flame seemed to scream past my left eyeball and there were flashes like fireworks, it was discomforting to say the least...

...They didn't always Commonweal 27 March 1992: 23 And then it began to turn around...

...I introduced myself and he introduced himself and said that two doctors would be working the procedure together...

...During the first night in the hospital, rows of German soldiers marched across the darkened TV screen hung on the wall...

...A friend of my daughter's had been rendered brain-dead...

...But first he had to get a detailed picture of my brain and a "road map," in his words, to the area of the aneurysm, and this would require a cerebral angiogram...

...I have been back to the hospital to see the neurologist...

...At the hospital I met with a staff neurologist who thought a second MRI was called for, using a hospital machine that was said to be five times more accurate than the one at the suburban clinic...

...The term "angiography" meant little at the time and I viewed it as yet another procedure...

...Later I was told by a speech therapist that I fell into the 2 percent of stroke victims who were cross-handed...

...In the procedure, however, as was explained to me later, something had dislodged a bit of plaque from inside an artery and it had broken loose and blocked the artery, causing all the brain cells beyond that point to die...

...When I spoke with his appointments secretary, however, she said that the doctor was going on vacation and the earliest appointment after the MRI could not be for more than three weeks...

...The interim seizures, or whatever they were, were seemingly no longer of importance and were forgotten...

...My condition was that I had thrown up all over my bed hardly a half hour earlier, my speech was slurred, the facial muscles on my left side sagged, my left hand was not entirely useful, my blood presure was or had been 200 over 100 (nitroglycerine patches had been hurriedly applied to my chest and I was started on Procardia) and I badly needed to urinate but could not...

...The second MRI confirmed what was known from the first and I was scheduled to meet with a brain surgeon a week later...

...At this time I also noticed that the doctor pulling on latex gloves was not the person whom I had met the day before...

...When I requested a meeting two weeks later with the initial doctor who had been going to do the angiogram—the one who interviewed me—he said they certainly would not have sent me to my room if they had in any way suspected a stroke...

...When that position was attained I felt a jolt through my right eyeball many times hotter than through the left, unimaginable flashes of light, and pain like I had never experienced before...

...When I described it to family and friends, I could use no better word than "discombobulated...

...I avoided answering the telephone...

...I bump into furniture less and less...

...I broke into a rash, my speech slurred, my hands trembled, and I was soon rid of the Dilantin, but then put on Tegretol, which, I was told, had no side effects...

...Their impression was again a right-sided ischemic event in a patient with probable crossed aphasia...

...What she didn't say was that, when my brain became fatigued, so did my body, and on several days I could barely manage to get out of bed, even for meals...

...True, I was sixty-eight years old, but I was in general good health...

...During the afternoon of the second day, when I was alone in my room, a young doctor stood by the bed, took my hand for a minute and said, "I'm sorry...

...When I became tired, I mumbled and stuttered...

...Indeed the "Summary" notes: "neurology was consulted...

...The MRI report read, in part: "Unusual appearance of the internal carotid artery on the right and the right middle cerebral artery with a tri-lobed flow void seen in the distal aspect of the M-I stem...

...But the first indication that not everything was in sync came when the hospital neurologist asked me to get an appointment with him as soon as possible after the MRI and he would go over the results...

...I still don't sleep well, but I have expunged most of the demons...

...Immediately as the IV fluids began to flow, they also began to leak onto the table through a broken connection, and the system had to be carried to the other side of the table and a new needle inserted in the back of my right hand...

...Again I noted no sense of urgency...

...The initial doctor involved in the angiogram declared he did not even know an exam had been given until he was made aware of it by the "Summary," and guessed it may have been conducted by "some intern on the floor...

...It was at that point, I believe, that I became a statistic, the one out of a hundred who suffered an induced stroke...

...But soon word came from the x-ray monitoring room (in the voice of the brain surgeon) that there hadn't been an aneurysm after all and there would be no surgery required...

...In any case, when my wife arrived in the room—they had forgotten to notify her when I went upstairs and she had to seek out the information herself—a lunch tray was on hand and the nurse, not having been informed of the stroke (for no one said it was a stroke at that time), told my wife she could feed me...

...Sometimes I become confused at intersections where once I hadn't even bothered to read the street names...

...The days were never so long, the weeks with so many days...

...Sometime during the discussion, however, I seem to remember the doctor mentioning that there was a I percent chance of stroke, but the word didn't jar me...

...The other happened at venerable Fenway Park, where we were attending a night game between the Boston Red Sox and the Kansas City Royals...

...I found no consolation here at all...

...Don't be negative...

...About 3 in every I,000 patients die from the procedure...

...I was then told to lie with my head back and they would take x-rays from under my chin...

...I sought my wife's succor and found I had become impotent...

...I felt the slight nick of the incision in my groin and we were under way...

...a second doctor asked...

...A technician on the second day came to draw blood and noticed that I was not wearing my ID bracelet and refused to take the blood, although earlier technicians had...

...A doctor was quoted as saying that, during angiograms of the head and neck blood vessels, he "used to sit there with patients and I was soaking wet because I was scared to death I was going to kill somebody—maybe give them a stroke or bump them off, and I didn't want to do that...

...Forget the vacationing neurologist...

...one of them asked...

...The cranial nerve exam revealed a left sided facial droop, the motor exam revealed decreased strength to the left upper extremity...

...I had feelings of inadequacy...

...By no means was it a "warm, flushed feeling...

...This, they said, might explain the fact that I was right-brain damaged but I had slurred speech, which is normally associated with left-brain damage...

...I don't know what hurt more, the pain or the indignity...

...When two other doctors entered the room, one said, "Say: `Methodist-Episcopal,'" and the next day when two student nurses came in with clipboards and pens, one asked, "Can you say `Methodist-Episcopal?' By that time I was on cue...

...I was disoriented...

...Five days later I went to the hospital for blood tests and to meet the doctor who would be doing the angiogram...

...When I began hallucinating, I was taken off of that too...

...Because I needed to be awake to receive instructions and to otherwise communicate, there was no anesthetic...

...I was increasingly frightened to be alone...

...I tried to use a typewriter but was so uncoordinated that the keys seemed to be not in their accustomed places...

...Later I found that the literature had its own language, a stroke being a "cerebrovascular accident" or an "ischemic event...

...I climbed onto an x-ray table and was given a sedative...

...When the proper location to receive the dye was located, the wire would be withdrawn and the dye injected...

...He was the doctor I had seen putting on the gloves, who had actually made the incision and directed the catheter into my brain...

...A blue-grey haze spread through a supermarket one day and I nearly fainted while holding onto a shopping cart...

...More than two months had now elapsed since the CT scan, so it appeared that at least there was no sense of urgency, and that was to the good...

...I was turned over to a neurologist, who scheduled Magnetic Resonance Imaging (MRI) at a nearby suburban clinic...

...Friends now began telling me horror stories...

...That was it, I was discombobulated...

...I was in a state of siege...

...During this procedure a contrast dye would be injected through a thirty-nine-inch-long catheter running through my arteries from a small incision in my groin, across my chest and up my neck...

...he speech therapist told me that my damaged brain could only process so much information and, when it became overloaded, it just shut down...

...Within minutes I was telling my wife goodbye and saying I would see her upstairs, as angiogram patients were required to stay overnight...

...I walked into furniture and door jambs and bookcases...

...The following night it was soldiers in El Salvador moving out of the TV set...

...My wife said that the flu was going around, but I knew it was something other than the flu...

...Holding a model of a skull in his hands, the surgeon detailed how he would cut my skull open and flap the bones aside, then "slice" through my brain to locate the aneurysm, to which he would fix a metal clamp and narrow the bulging artery...

...What was stroke but something that involved people with high blood pressure, high cholesterol, a history of smoking and other bad habits...

...My son-in-law's uncle had died on the table during an angiogram...

...At no other time did anyone else among the dozen or more staff who attended me approach my bed to say, "I'm sorry...

...Meanwhile, to stave off any additional seizures—if that is what they were-I was put on the drug Dilantin, which, the doctor assured me, would have few side effects...

...Yet, with these signs, it was decided that there had been no stroke and I was released to my room upstairs...

...No," I said, which was plain enough, and I lay back on my pillow, in some pain and considerable confusion...

...It could have been caused by the tip of the flexible wire or even the surge of the dye...

...I could see the words but I could not bring them in...

...The impotency has reversed itself...

...I felt that my brain had become short-circuited...

...Sometime toward evening of the first day, a nurse came in with her kit and before God and all of my family was soon threading a catheter into my bladder...