Tuesday, March 14, 2017

A Cause for Cerebration

Late on Sunday night, to celebrate my birthday, I watched "The Inheritors" again, which is my favourite episode from the second season of The Outer Limits. And yes, I did cry at the end.

I finished watching at 4:30 AM, then stepped from my darkened bedroom to the bathroom, where the fluorescent light seem unusually brilliant. When I returned to my computer to write notes on the episode, I found the monitor partially blocked by a dazzling white retinal afterimage. I tried to work around it, but its intensity increased: an effect I had never seen before.

Within a few minutes the afterimage became a white starburst pattern with a violet fringe, and it began to flicker like a strobe lamp. I closed one eye, then the other, and found a similar strobing in each. The flickering intensified.

At this point, I began to worry. In the bathroom, I peered at my eyes in the mirror, raised my arms above my head, stuck out my tongue, spoke aloud. In the hallway, I balanced on one leg, and then on the other: no problem. Then I recalled descriptions my father had told me about migraine auras; they had plagued him, now and then. I had never had migraines in my life, and had no interest in starting. Worry swelled into fear.

I called the Qu├ębec emergency health hotline. As I described my symptoms, the starburst drifted leftward until it was nothing more than a flickering rim at the edge of sight. Within less than a minute, the effect was gone. "I've never experienced anything like this."

The man on the other line went to consult with staff; when he came back, he said, "Get to an emergency room, right now."

And so, at five o'clock in the morning, unshaven and frozen, I waited outside in the cold white moonlight for a taxi.

The driver was a friendly bald man with an opaquely slavic accent; he had been driving taxis for 22 years. "I am not rich," he said, "But I am there for my children. One must always be there for one's children."

At the Gatineau hospital, where I go to have my blood tested for its coagulation levels, I arrived at 6:30, still in darkness. I had no idea how to say "afterimage" in French, and so the nurses found my descriptions baffling.

After two hours in the waiting room (where an old man snored like a faulty jet engine), I spoke with a Dr. Bonneville. He took me through the standard procedure to find any symptoms of stroke, but I was able to follow his moving finger, see his moving hands with peripheral vision, touch my nose with both hands at the same time, and so on. No indication of stroke.

When I told him that I was on Coumadin for my blood clot, he gave me a grim look and said, "There's a problem with Coumadin: it makes you bleed." He spoke about one patient who, like me, had never experienced these visual phenomena before. The cause? Bleeding in the brain.

I must have turned pale. "Was he... all right?"

"Yes, he was fine; the bleeding was minor. And the chances of your having this condition are small. But all the same...."

When he left the room to call a neurologist, I stared at the probes and the tubes on the walls and did what I could to assure myself that my bleeding, too, was minor. By now it was 9:00 in the morning, I had not eaten since midnight, and I was also worried about hypoglycaemia.

The doctor came back, and told me that I was going to be transferred to another hospital for a CAT scan and a meeting with the neurologist at 2:00; the only drawback was that I would have to fast until the procedure was completed. I looked at the clock on the wall: four hours to wait without food, but what the hell. "I can handle that."

After blood tests and a long wait to see if the scan could be scheduled, a nurse put a shunt in my arm, and the staff paid a taxi driver to take me to the Hull Hospital, which happens to be less than a half-hour walk from my apartment building.

The driver was friendly, Muslim, and certain that he would no longer visit the United States. "Trump didn't win," he said, "Hillary lost. And I'm glad she lost." We went on to discuss her foreign policy record, and Trump's political pandering. By the time we arrived at the Hull hospital, we were both happy to be Canadians.

I was able to complete the scan half an hour before my appointment with the neurologist. The scan technician was helpful: she took me through each new step of the procedure before she acted. "Now I'm going to cross over to the other side, and inject the iodine." This made my head feel as if I were trapped under a sun lamp. The deep droning whir of the scanner made me think of a magnetic maelstrom.

Afterwards, when I took off the hospital robe to put my shirt back on, the gruff (but not unlikeably gruff), white-haired woman who ran the department said to me, "The changing booth is over there. This is not a changing room, this is my personal workspace."

I smiled and apologized. The old man waiting beside me for a scan said, "Don't worry about me, I'm not offended!"

An hour later, while I waited in the neurologist's office, I noticed a pair of threatening machines that looked like grinding or sharpening tools from a metal shop. I went up for a closer look; as far as I could tell, they were dental equipment.

The neurologist, Dr. Gagnon, came into the room at a rapid pace. A short, round-faced man with a comical moustache, he greeted me in French and began to talk about my symptoms.

"Pardonnez-moi," I said, "mais je manque un vocabulaire quotidien...."

He laughed, rolled his chair up to a computer monitor, and spoke in perfectly fine English with an accent I could not place -- German? Swiss?

"You've had your scan? Let's take a look at it." As he opened images on the monitor, I feared the worst.

"What we have here is -- oh, pardon me, that's my call." He answered the cell phone, stood up, left the room, and left me seated there. I began to fear the worse than worst.

When he came back after several minutes of worst, I said, in my horrible French, "I was here on the edge of panic, and then your phone rang...."

He laughed loudly and happily: "I love that!"

Then he displayed the scanned images in sequence, which made them look like a cartoon trip through a skull. I felt the strangeness that hits you when you peer at your own brain.

"Ah," he said. "I'm not worried for you. Everything here is the way it should be."

"Can this really show if something's wrong?"

"Oh, yes. It would show us tumours, blood clots --"

"And bleeding?"

"Oh, yes, bleeding too. But there's no sign of anything like that. And see this? Your vertebrae, aorta, they all seem fine. I'm not worried for you."

He explained that what I had seen had been a surge through the visual cortex, an aura without migraine. When people who have never experienced one before suddenly see an aura, doctors need to know the cause. And given my father's migraines, I had been wise to have this checked.

"If you go through this again, don't worry. Just let it pass. You should only be concerned if it leads to headaches or any other violent symptoms, or if it lasts for more than sixty minutes."

And so, nine-and-a-half hours after I had been dropped off at the first hospital, feeling weak, now, but not horrendously hypoglycaemic, I walked home on a bright and very cold afternoon. I thought about brains, about what can harm them, and I noticed all the cars around me, all the dangerous intersections, all the spots of ice on the sidewalk. I had been looking forward to biking season, and of course I always wore a helmet, but would a helmet really save me, if...?

Then I breathed in cold air, looked at the clear, cold sky, and reminded myself that Dr. Gagnon had shown me a healthy brain. This had to count for something. This had to be a cause not only for cerebration, but for celebration, too.

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