At the end, it wasn’t a stroke
It was gone when I awoke
The symptoms were brief
Avoiding much grief
And I got to tell a crude joke.
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.
Tuesday evening while on call, I got up to play Scrabble and I couldn’t make my right leg work. It didn’t feel heavy, numb or weak; it felt too light so that any effort to move it got exaggerated. I sat down to do a neurologic exam on myself. I found nothing other than my right leg ataxia. I called Bethany from the next room, and told her the situation. She helped me dress, and drove me to the ER.
The ARNP covering the ER did the same neuro exam I did, which wasn’t impressive until I demonstrated my gait.
She did all the right tests. The first EKG showed an old heart attack, which disappeared with proper lead placement.
She also found a heart murmur. It hadn’t been present 5 years ago, but the PA at the VA found it a couple of months ago, and I called her attention to it.
My blood work had no surprises. She offered me the choice of staying in Clarinda or going into Council Bluffs, and I chose to go. In terms of game theory, if something happened in the middle of the night, I wanted to be close enough for timely intervention.
In the process I had to make arrangements for someone else to take call.
I napped off and on for the ambulance ride, which almost got derailed twice by herds of deer. I bypassed the ER at Jennie Edmundson Hospital. At 2:00 AM I had gotten settled, my IV had given me a couple of quarts, the second set of labs had come back and I’d had a good visit with the hospitalist ARNP. Just before being tucked in, I offered the nurses a choice between a clean joke, a clean joke with a bad word, or a dirty joke. They chose the last option, and I gave them the funniest crude joke in my large arsenal.
I don’t get to tell that joke as a physician, no matter how funny it is. But, as a patient, I can get away with it. The punch line drew gales of laughter.
By then, motor control of my right leg was functioning at about 90%.
I slept for a couple of hours and had breakfast.
The neurologist arrived, and with economy of motion, did a thorough exam. He advised an aspirin a day and starting a low dose migraine medication.
The morning parade of tests started. By the time Bethany arrived I had done the basic neurologic exam six times and the symptoms had resolved except for the funny feeling inside my head.
I had an ultrasound of my neck, a consultation with the dietician (whom I amazed with my six pieces of fruit a day and my two ounces of salmon at breakfast), a consultation with the Occupational Therapist, and then the Piece de Resistance, the MRI. In between, I napped because I’d slept so lousy.
The hospital feeds its patients on the room service system; I ordered a lunch of soup, sandwich, and fruit, and within a half hour a young Guatemalan arrived with the food. We had a brief conversation in Spanish, I introduced my wife.
And we waited. The hospitalist came back, and went over the results. Ultrasound demonstrated clean carotids (neck arteries). The MRI didn’t show anything conclusive. He also recommended an aspirin a day.
We waited for echocardiogram results. The hospital public address system announced a severe thunderstorm warning, and then a tornado watch in effect till 10PM. The internet and the TV weather agreed that severe weather approached from the west. At 4:45PM we decided to leave before the storm arrived, without the echocardiogram results. We didn’t want to spend the night in the hospital, nor did we want to risk hitting deer on the way back to Clarinda.
Bethany drove. We enjoyed dramatic skies and listened to a Continuing Medical Education CD. We ate at Clarinda’s premiere restaurant, J Bruner’s, ordering off the appetizer menu.
I returned to work the next day, the episode completely resolved, making it a transient ischemic attack (TIA), also call a reversible ischemic neurologic event (RIND). Except I noticed my handwriting was much clearer.
I don’t think anyone else noticed.