The Not-So-Gentle Answer: 11. Walking with the Grimm Reaper

On Sunday 17-Mar-013 I was admitted to Gosford District Hospital ED with febrile neutropenia.


Subdural Haemotoma

A subdural haematoma (British spelling), is a type of bleed on the brain,
usually associated with traumatic brain injury,  in my case chronic
profound shortage of platelets. Blood gathers within the outermost
meningeal layer, between the dura mater, which adheres to the skull, and
the arachnoid mater, which envelops the brain. Subdural haemorrhages
may cause an increase in intracranial pressure (ICP), which can cause
compression of and damage to delicate brain tissue. Subdural haematomas
are often life-threatening when acute. Chronic subdural haematomas,
however, have better prognosis if properly managed.

Note Well: this was not any kind of stroke.


Emergency Department

On Sunday 17-Mar-2013 I was admitted to Gosford District Hospital ED with
a fever, and a throat infection.

On 2013-04-27 I was struck on the head by the IV stand. Over the parietal
lobe. I was rushed off to have a CT scan of my head. This revealed two
things, I had probably been bleeding for a week or two before admission.
And the hit that day had made it worse.

Management consisted of bags of platelets twice a day. Neurosurgery was
impossible, because too few platelets (9 < 90) . (And thus I missed a helicopter
ride to Royal North Shore.) CT scans over the next 3 days showed the bleed was slowly reducing in size.


Aphasia originated from an ancient Greek word ‘aphatos’ meaning[1]

speechlessness” is a disturbance
of the comprehension and formulation of language caused by dysfunction
in specific brain regions. This class of language disorder ranges from
having difficulty remembering words to losing the ability to speak, read,
or write. This also affects visual language such as sign language
Aphasia is usually linked to brain damage.

On Thu 4-Apr-2013 I started having aphasic episodes. Eventually by Fri
5-Apr I had an aphasic episode in front of one of the doctors. This was
considered to be consistent with the parietal lobe damage caused by the
subdural haematoma. By Sun 7-Apr I couldn’t use my laptop. And I started
to get very scared.

Intensive Care Unit

At 3AM Mon 8-Apr, I had a seizure and fell in the bathroom (or possibly
fell and had a seizure), luckily there was a nurse in the adjoining
store room who heard my fall. They worked for some time but at about 6 AM
I was moved to the Intensive Care Unit. I recommend all married couples
arrange Reciprocal Medical Guardianship for each other (when things go
really pear-shaped there will always be some-one to speak for you).
At 4AM MT got a phone call from the a rapid response team doctor informing her of my change of status, they knew she had the Guardianship
and some tough decisions could be required in the next few hours.

I have no memory of my time in ICU this is not uncommon (except for the last
few hours).

It would appear I left my Zen Bu Kan self defense on duty, and bruised
some doctors and nurses. MT apologised but the staff were not upset,
patients who fight back have a much better chance of leaving ICU alive.

The aphasia was pretty much 100% at that point, but one of the nurses
was trying to get Nylstat into my mouth, past a couple of tubes.
Apparently I was able to clearly articulate “piss off”.

(Two days before I went home, MT and I met one of my ICU doctors in a corridor.  She was amazed I was standing, but even more amazed I was speaking so quickly.  It made her day.)


Back to Ward M2

I returned to Medical 2 Ward on Wed 10-Apr-2013,with residual aphasia. A couple of months before I was admitted, I had read Norman Doige’s book on Neuroplasticity. I recognised from the inside that it would take neuroplasticity to fix my speech. Every time something comes out wrong, the only curative course of action is to say it again accurately, make new neural pathways around the damage. That takes stubborness.

The parietal damage is also slightly messing up my typing. It is also messing up some neural pathways that I have used every day for my 30 year career (for writing software), these need to be exercised again and cleaned up.

I was discharged home 19-Apr-2013
I still get daily IV antibiotics through the Hospital’s APAC service.

I am working very hard on finding any junk food I can eat so I can gain as much weight as I can for my next appointment with my transplant doctor.

You may be interested in reading the other Not-So-Gentle episodes: (1) Introduction, (2) CLL, (3) Neutropenia, (4) Platelets, (5) Commensals, (6) Infections, (7) Migraine, (8) I am dying, (9) Living with Purpose.