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Wednesday, June 18, 2014

I think the past week is best summed up by saying that if I was thinking of writing an episode of Casualty, then my research would be going really well. I’d already spent four hours in A&E last Thursday, which was not only fun but character-building, so in an effort to really get to know the workings of a hospital emergency department, I decided the best course of action would be to return to work on Monday, spend the morning telling everyone how much better I was, and then end up back in A&E. I was there for ten hours this time. Give it another week, and I'll have my own room.

Of course, a good medical drama needs a decent clinical narrative, so here's mine...

Those notes were written by the specialty registrar in the Acute Medical Unit at 3am on Monday night. Clearly the NHS never sleeps. Possibly due to the constant noise in AMU.

Although not 100% back to normal, my symptoms of vertigo had completely resolved by Sunday, and with the exception of the cold I’d begun to develop, I felt pretty reasonable, so I decided to go back to work the next day. When I got up on Monday morning, however, I looked in the mirror and immediately noticed that my left eye wasn’t opening as wide as my right. I didn’t think too much of it, and despite Amelie asking me why I kept staring at myself in the mirror, I put it to the back of my mind, and headed off to work.

I spent the morning mostly on my own in Crowborough, dealing with a broken fundus camera, but when I returned to the office at lunchtime and started talking to people, I gradually became aware that the left corner of my mouth felt strange, and wasn’t moving as it should when I spoke. Shortly afterwards, one of my colleagues asked me if I was aware that my left eyelid was drooping slightly. I said I was, but being a typical man, I did nothing about it, and headed over to the eye hospital for a bit of slit-lamp practice.

As the afternoon wore on, however, I gradually began to notice that my left cheek was becoming numb. It was fairly subtle at first, but over the next three hours it gradually spread from the corner of my mouth, up the left side of my lip and nose, and across my whole cheek, and by the time I got home at 5pm, I felt as though I’d had a mild anaesthetic at the dentist.

A quick discussion with Lisa, who acts as my main medical consultant, and whose advice I’d ignored that morning by going back to work, resulted in the decision to return to A&E. I grabbed a quick sandwich, and by 5:30pm I was sitting in a crowded waiting room.

Much like two weeks ago, I’d had one of my pupils dilated that afternoon, so my first job was to explain to the triage nurse that it wasn’t one of my symptoms, but having overcome that hurdle, the nurse referred me on to the A&E doctor. I saw him at about 6:45pm, and – not to be too melodramatic – he was immediately quite concerned. He thought a stroke was fairly unlikely, but he also felt that it wasn’t Bell’s Palsy because I could still raise my eyebrows. An ability he then tested by mentioning motor neurone disease.

To be fair, he did explain that in A&E they have to start with the worst case scenario, and then work their way down, but when someone’s just raised the possibility of you ending up like Stephen Hawking, it’s difficult not to worry. Especially when the doctor ignores a packed waiting room full of patients, and says that it’s so urgent for me to have a brain scan that he’ll take me there himself.

Two minutes later, he was leading me down the corridor to the CT scanner, which looked a lot like this…

… but reminded me of this…

The nurse's first words when I walked into the room were "You look very familiar, do you work here?". I’m not sure if she recognised me from my job or my regular visits to A&E, but I confirmed that yes, I do work at the hospital. At least until the MND kicks in.

She carried out a full scan of my head, and five minutes later a different nurse escorted me to a cubicle in A&E. To my surprise, he immediately asked me to take off my clothes, put on a gown, and get onto the bed, at which point he took three vials of blood from my arm, and started fitting a cannula. When I asked him why, he said it’s standard procedure for anyone who could be having a stroke. If my symptoms suddenly developed into a major ischaemic attack, or if the CT scan confirmed it, then they’d want to be ready for urgent treatment.

So this was all a lot of fun. Made more so by the fact that I couldn’t get any signal on my mobile, and had no way of telling Lisa that I was currently undressed in A&E with a cannula in my arm, awaiting news of an urgent brain scan.

Forty-five minutes later, and with no news forthcoming, a different nurse turned up and asked me if I could walk. I confirmed that I hadn’t deteriorated that much, so she said “Good, follow me, we’ve got a bed for you in AMU”. Ten minutes later, having been told pretty much nothing, I was being settled into a full-sized hospital bed in the acute medical unit, by a healthcare assistant who said she expected me to be staying the night. She also took my blood pressure, which, surprisingly, wasn’t sky high.

I’m unsure of exact timings, as they made me take off my watch and put it with my clothes in a bag, but I think I got to AMU at about 8pm. And was there for seven hours. To my complete surprise, Lisa turned up after about half an hour. My Mum had agreed to mind the kids, and having failed to locate me in A&E, Lisa bumped into the doctor who’d first seen me, and he showed her where I was.

The next three hours were both uneventful and stressful. Not least because Lisa kept trying to reassure me by grabbing my arm, forgetting that I had a cannula there, and nearly shoving the needle through my elbow. I was asked to perform a swab of my nose and groin to check for MRSA, which proved tricky, firstly because I wasn’t sure which part of my groin I should be swabbing, and secondly because I’m not used to wearing a dress, and struggled to find my groin through the gown.

When a nurse eventually popped her head in, she confirmed that they expected me to be staying the night for more tests, but beyond that she had no information. So we just waited. And waited. And worried. Until gone 11pm, when a junior doctor arrived.

He looked like he’d been awake since about April, but was lovely, and carried out numerous tests similar to those I’d had on Thursday. He also informed me that the CT scan had shown nothing significant, and the blood tests had come back normal. After half an hour of testing, questioning, writing and thinking, his conclusion was inconclusive. He said he didn’t know what had caused my symptoms, and would need to speak to his boss. So he left, saying he’d be right back.

Half an hour later, when he still hadn’t returned, we spoke to a nurse, who failed to locate him, but looked at my notes and said that they definitely wanted me to stay in overnight, and advised me to get some sleep. It was well past midnight, so Lisa went home, and I attempted to get some rest next to a bloke who was gushing blood from his nose, and a partially deaf man who could only communicate by shouting. I knew sleep was possible, because the bloke two beds away was snoring like an outboard motor, but it didn’t seem likely for me.

Until 2am, that is, when I finally nodded off… and was immediately woken up by two doctors. One was the junior doctor I’d seen earlier, and the other was the specialty registrar. He introduced himself by name, before adding “I’m sure you know me – I’ve seen you a lot in the Diabetes Centre”. It was slightly unsettling, as I barely recognised the man, but I’m clearly the most memorable person in the hospital, so I went along with it.

To cut a long and repetitive story short, he carried out further examinations, before diagnosing Bell’s Palsy. He said it is possible for it to only affect the lower half of the face, so the fact that I can still raise my eyebrows doesn’t rule it out as a diagnosis. And he said that the vertigo last Thursday, and the cold symptoms I’ve developed since, made it all the more likely. Bell’s Palsy is usually caused by a virus, as is vertigo, a sore throat and rhinitis, so he felt it was all part of the same package.

He prescribed me a high dose of steroids for ten days, and told me I have a 90% chance of a full recovery, probably within 3 or 4 weeks. I was there for another hour while they completed all the paperwork and tried to locate the tablets, which they didn’t have in stock, so in the end they gave me the doctor’s report, and told me to take it to my GP who could prescribe them for me in the morning.

I eventually left the hospital at around 3am, and having had virtually no sleep (and even less food), I was back at my GP surgery at 9:30 yesterday morning, seeing my own doctor. She signed me off work until next Wednesday, partly because my symptoms make working difficult, and partly because I’m on such a high dose of steroids that they expect some unpleasant side-effects. Not only do I have to take twelve (yes, twelve) prednisolone tablets a day, but I have to take omeprazole to control the resulting stomach problems. I started yesterday morning, and I’ve felt peculiar ever since. Although I could probably win the 100m at the Olympics if I wanted to.

So there you go. This episode might have cost me an arm and a leg in taxi fares and prescription charges, but at least I shouldn't end up in a wheelchair.


Phil's Mum said...

.......for which we are all VERY thankful - given the number of times the lift in your block of flats breaks down! x

David East said...

Continuing sympathy.
Get Am to read to you. I can recommend a couple of books...