What Happened Before and a Little After (Part I)

by irms

The email you’re about to read is long and I’ll be using words I don’t fully understand so brace yourself.  You’re receiving this for at least one of the following reasons:

  1. I have recently flaked on something I said I would do for or with you, including but not limited to
    1. a website I said I would build
    2. a presentation I said I would give
    3. a meeting I said I would attend
    4. a letter I said I would write
    5. a computer I said I would fix
    6. some numbers I said would crunch
    7. a meal I said we should have
  2. You were not notified immediately of the events described below, but I still think you would want to know
  3. You have heard of the events, but you’re getting the details wrong, so I’m here to correct you

I’m also hoping this email serves as an appropriate explanation/apology for those of you who fall into categories one and two, so here we go:

The Short Version
For Those Who Just Need The Facts 

On Saturday April 26th I collapsed and became ill in a public place for no apparent reason.  I was taken to the hospital via ambulance and stayed there for four days.  Because healthy 27 year olds aren’t supposed to just pass out for ‘no apparent reason’, they kept me there and ran a bunch of tests.  The verdict seems to be that due to an incomplete Circle of Willis and an inexplicably occluded cartoid artery, I am at high risk for a major stroke.  I am otherwise perfectly healthy (blood sugar, blood pressure, heart rate, weight, cholesterol — all good), but they have put me on some pills to help reduce the risk of more bad stuff happening.   It looks like I may require surgery, but no one in the Central Valley does the specialized surgery I need, nor do we really know if it can be done thanks to the close proximity to the brain.  The neurologist that diagnosed me recommends aggressive treatment so she’s sent out my case to major hospitals in California to see if a brave soul out there wants to take a chance on my condition.  I have spent the last several days doing low-impact stuff activities avoiding non-physical things that tire me out (i.e. talking on the phone, programming), but this week, God willing, I will start to get back into the flow of regular days.  Tuesday the 6th I have an appointment with the same neurologist to talk about options.

The Long Version
For Those Who Need The Dirt 

On Saturday April 26th I was shopping in Fig Garden for a graduation gift when I began to feel a little wobbly.  The kind of wobbly one experiences when he or she has skipped a meal. Nothing serious.  Since I was waiting for a sales associate to help me, and since he was busy with another customer, I decided to excuse myself and go grab a bite to eat.  In the 50 feet between the door of the jewelry shop and that of Me N Eds, things went fast in a bad direction. I became cold and sweaty, my vision began to blur and I started to feel like my legs might give out.  Once inside the pizza place, I leaned on the counter and tried to wait for the lady ahead of me to finish talking, but she just couldn’t spit it out fast enough.  Things were getting worse with my vision turning almost all yellow and feeling as if I was swaying though I was perfectly stationary, so I decided to interrupt. I can’t tell you why, but I was dead set on asking for a meatball when I collapsed.  I don’t even know if they serve meatballs.  When I came to, I could hear them saying they should “call it in” and to “leave her where she is”.  Propping myself up on my elbows (apparently I fell backward and took down a chip rack of some sort with me) I started to feel nauseas.

Despite the fact that I couldn’t have prevented the scene, I knew I had made one and I was reluctant to start throwing up right in the middle of the restaurant.  I stood up and fell against the salad bar, but used it to lean on and make my way to the restroom where I fell again.  Oddly, the not-that-clean-but-cool-floor of the public restroom felt refreshing so I stayed on it until I heard someone knock at the door.  I made my way to the door on my knees and people started asking me questions (I found out later that it was the fire department).  When they asked me to sit up, I complied, but was immediately sick and began heaving into the toilet as they asked my name, age and whether or not I was pregnant at least a dozen times.

I don’t know how long I was in there, I don’t know how long I was vomiting and I don’t know why I said I would go, but an ambulance arrived and took me to Fresno Community Hospital.  I told my sister and she told my family.  I requested she tell four other people that I wanted to be aware, or that I knew would need to know.  (Beth, Negean, Ian and Derek, I’m talking about you guys.)  There are a lot of details to give up, but the gist of it is that on the two separate occasions that someone tried to discharge me, another more senior doctor would come along and said, “No way.  Healthy 27 year olds don’t just pass out and vomit for ‘no apparent reason’.”  And then they would move me to another spot in the hospital and order more tests.

During my luxury stay in the medical palace, I was moved from wall to hallway to 2nd floor room to neurology on the 9th level.  They drew blood on eight different occasions, gave me morphine, benadryl, pills for headaches, pills for severe nausea, and dye for my viens.  (By the by, when they push drugs into your I.V., you can taste it in your mouth.  Just a little trivia for those who want that little pearl of wisdom.)

At first I was orthostatic (became dizzy and light headed due to a sudden change in blood pressure) each time I stood up, then there were migraines which caused a different kind of dizziness with light sensitivity and nausea, then things began to improve.  At different points during my forced vacation I was given an MRI, MRA, neck CAT scan, and dopplers (ultrasounds) were taken of my heart, neck and brain.  I wore leads so they could monitor my heart at all hours.  My vitals were checked every four.

All of this so that the neurologist could tell me on Monday (28th) that I had a rare situation going on with the arteries leading into my brain.  As fate would have it, 1 in 5 people are born with an incomplete ‘Circle of Willis’, which isn’t a big deal most of the time and many people go through life not even knowing if their circle is complete or not.  Mine isn’t.  What makes this situation so critical is the cartoid arteries that climb up the neck and supply blood to the left and right sides of the brain, will use that circle to compensate should one of the pathways fail.  Again, fate, with her not-so-funny jokes, has left me with a narrow artery.  What that means is, if one side should fail, become blocked, pinched, or just narrow (as mine is), that incomplete circle cannot compensate for the side that is not receiving enough blood.  When people don’t receive enough blood to the brain, they have strokes.  I’m told that if I were to have a stroke, it wouldn’t be a small one, it would be paralyzing, and possibly life-threatening.

Clearly, this isn’t the best news, but there doesn’t seem to be a reason to sugar-coat things since it’s all true, so I’ll continue…

They don’t know if the narrow artery is a new thing or if I was born this way (it’s likely that the incomplete circle has always been incomplete), but the underlying message is that it’s a good thing that I passed out.  And not just that, it’s great that the only thing that happened was I passed out.  With all that’s wrong here, it could have been, and could be in the future, much, much worse.

Dr. Warwick, the neurologist, has sent my chart and images to different places in California hoping someone out there might be willing to operate and open up this artery that is causing the risk.  Because of the way things are crammed up into the neck, that area is a tight squeeze and operating under those cramped conditions may be too dangerous.  We don’t know if an operation is possible at this point, but we do know that if it is, no one in this area does it.  So we’re seeking elsewhere for a steady hand and a scalpel.

How I’m Feeling

Before you ask (and thank you for asking), I just want to let everyone know that I’m feeling pretty good.  I feel tired and zapped of my usual strength but even that is improving every day.  Emotionally I feel optimistic.  There are moments when I feel scared, but I can see the worry and concern on the faces of the people closest to me and that’s the hardest part so far.  I know they are freaked out pretty much just terrified, but I still feel pretty good myself.  Psychologically, and in the interest of full disclosure, I am a little concerned about what is going to knock me down next time.  Should I be worried about the hot sun? Should I not go jogging?  Should I not do things by myself? What if my stupid artery can’t supply my brain the way it’s supposed to?  Not that I have answers to any of these questions, and by the way, I’m not really thinking you’ll have those answers either, but it’s all true so I’m writing it down.

What Happens Next
On Tuesday, May 6th at 8 am I have an appointment with the neurologist who diagnosed me.  I’m hoping she’ll tell me what to do next, but she could just tell me about the latest movie she’s watched, bill me for it, and get away with it.  Regardless, the way I see it, there are only three ways this meeting can go:

  1. “Whoops.  We were wrong, there’s no problem and you’re not in any danger.  Sorry you passed out.”
  2. “No one is crazy enough to operate on this abnormality.  Sorry you’re a freak of nature, but it’s for life.”
  3. “Pack your bag, you’re going to xyz city,  Dr. Abc thinks he can fix you.  Sorry for the outrageous bill you’re about to get.”

No matter what happens, I’ll keep those of you who wish to be posted, well, posted.  The rest of you will likely find out anyway from people we both know, and there’s a good chance some of the details won’t be right, but what the hell? You didn’t care that much in the first place, remember?

Thanks everybody, for the love, support, prayers, flowers and jokes that keep me laughing when I should be terrified.

For the first time seriously,

Irm Jr.