Saturday, January 24, 2009

And we found a strange thing in your brain, and...

[Continued from a post on Wednesday, January 21, 2009- After seeing my psychiatrist today...(It's actually yesterday now)]

There I sat for what seemed like days, and waited, and waited and waited...

I was in daydream la la land, and I heard a voice call my name. Was it that beautiful young woman, with long and shiny brown hair, seated in a lounge chair to my left, a scant 15 feet away, at the resort on the beach in St. Martin? No it wasn't, for as the fog began to clear, I was awakened from my deep cerebral daydream, and there she stood, in her mauve scrubs, the radiology tech, repeating my name again. Granted there were only 2 of us in the waiting room, and the other person was a female, so I think she deduced that I was the patient waiting for the MRI. She led me through another pair of doors, and we made a hard right. She took me to a changing room, where I was to take off all my jewelry, watches, belts, shoes, and anything that might have metal in it. I was lucky because I was wearing sweatpants, t-shirt, socks and sneakers. I least I wouldn't have to change into one of those lovely white hospital gowns, that are tied off in the back, with my ass hanging out the back. I was having flashbacks of an earlier time many years ago when I was in that precarious situation. It's a long story.

When I was done, I was to continue walking down the same hall, and enter through these really large and heavy doors, with all these hospital like warning signs all over them. What had I gotten myself into, I thought. I forgot the tech's name, but she was very nice, and professional. She asked if I ever had an MRI before, and I said no. She explained what was going to take place, and about how long it would last. Good thing I went to the bathroom before I got there, because it was going to take awhile, unlike an x-ray. I laid down on this skinny examination table that was attached to the MRI machine. The machine's name was Siemens, or something like that. So, I laid down, with my head closest to the Machine, and she gave me headphones to wear, and asked what kind of music I liked. I thought that was very caring, not realizing how damn loud these MRI machines are. Then she put this plastic, or plastic coated cage over my face, and it sort of reminded me of when I played football and wearing a football helmet. Lastly she gave me a hand-held buzzer squeezy bulb thing, in case I had any problems while I was in the machine. She told me that about halfway through this MRI procedure that she will slide me out and give me an intravenous shot of this gadolinium, which is a contrast substance that shows some changes before and after you get it injected into your system.

So there I laid, ready for this machine to work it's magic. At that time, I thought nothing about having anything wrong with my brain, just my neck and back. The MRI machine started it's "Symphony in D Minor". I think it is an experience everyone should have at least once in their life time. Not really, as it means you might have something wrong with you, and that's not a good thing. The headphones were a godsend, because it is incredibly noisy in there, and if you are claustrophobic, use some type of medication, because it feels like you are being placed in a noisy, and bright coffin. About half way through this event, the tech stopped the machine, and slid me out to give me the IV. It seemed like I was in there for a very long time. They were doing both my c-spine and brain, both before and after the gadolinium, or maybe just my brain with the contrast. I forgot, but I know it was something like that. Back I went into the machine, and the "Symphony in D Minor" started again, with Part II. One important aspect that I had left out earlier, that being you can't move, at all, because if you do, you screw the whole thing up (At least that is what they told me.) and you have to do the whole damn thing all over again. Oh, that would be fun. Not really, it would suck!

Finally, after what seemed like a couple of hours, the ordeal was over. I asked the tech why they gave me the IV, and her explanation was that it's like my brain cells are having a party, and it livens them up, and cells being like little magnets lining up, and on and on, to produce a contrast in certain areas, or something like that. To quote Rich in Casablanca: "Louis, I think this is the beginning of a beautiful friendship." Yes, me and the infamous MRI machine were going to meet again, and again over the next 5+ years. My MRI examinations have numbered in the dozens, and still counting. I have had MRI's done of my brain, c-spine and lower back area (L-5 and S-1). We are starting to get on a first name basis lately, but the positive thing about all these tests is that I am still alive, and I'm lucid and cognizant, both a plus. I know more today then I did almost 5 1/2 years ago about MRI machines, and MRI images. I've seen pictures of my brain, which I thought was pretty cool, and was even able to pick out that strange thing in my brain. I know, it sounds a little warped to say it was cool, but it was. How many people get to see picture of their brains? Not that many. This first MRI took place on October 14th, 2003, the day before the day that changed my life forever.

Well, I finally got out of Sheridan Memorial Hospital, and I was running behind schedule, like I had one to begin with. By schedule, I mean my "New Beginnings Program" at the VA, whose class time had already started by the time I got back. I hated being late. As I walked into the small conference room where our classes were being held, Dr. Ashear asked me if everything went OK, and I said yeah, and sat down in my seat. I had done my homework from the previous day, and that was what we were going over when I finally arrived. So, no harm, no foul! The rest of the day was uneventful. I had no idea how long it would take for Dr. Trahan to get the results, so that we could plan our next course of action.

October 15th started like any ordinary day for me. The unit I was in was called SNU, or Special Needs Unit. It was the politically correct version of psychiatric care unit. It was a none locked down unit, except after 10pm and before 6am everyday. So, my normal routine was as follows. I would get up around 5;15am, and go down to the med room to get my morning meds, then fix myself a cup of coffee, and time for the three "S's", s%$t, shower and a shave, although the shavers were locked up in the nurses station, and they only let you use battery power units. Over time, if you weren't a suicide risk you could use an actual razor blade, like those disposable Bic types, but you had to did it in the bathroom that was adjacent to the nurses station. I know, they really made it tough on us, but the reality was that there were some seriously mentally ill patients on this unit. They did have another psychiatric unit, over in Building 8, and that was a totally locked down unit. I spent my first 10 days there as they evaluated me, and thought it was safe enough to send me to SNU. Oh, where was I, oh yeah, I took my shower, got dressed, and fixed up another cup of coffee in the patients kitchen. I had this big 64oz. mug, the standard hospital issued drink device, with all the ounces and milliliters marked on the side, just in case they needed to monitor a patient's fluid intake. I usually drank black coffee with some Sweet and Low. By now it was almost 6am, and they would be unlocking the doors to the outside.

It was 6am, and they unlocked the doors, so off I went, to the elevator that was about 12 feet from the now unlocked door. I had put on a jacket, or more like a Arctic parka, as it was the middle of October, and it had been pretty brisk outside over the last few weeks. My folks had sent me my clothes up from Florida over the previous 3 months, so I now had a stockpile of clothing for all seasons. I originally came back to Wyoming in July of 03 with just 2 suitcases, one large, and one medium. Now I had boxes of stuff, and the staff use to kid me, and say, Hey Bill, do you need a separate room for all your stuff? Not really, as I could store some of my stuff down in a place where patient could store some of their property. I got off the elevator at the ground floor, walked out of the little elevator alcove, and hung a left. I passed the intersection of another hallway, to my left, that led to the main hospital, and the other dozen or so building connected by an enclosed network of hallways and tunnels, to link the entire hospital, because we were in Wyoming. And it would be really tough rolling a gurney through 6 foot snowdrifts in the winter, with the wind blowing at 40-50mph. Nope, can't be done. To my right was the hospitals canteen, and cafeteria. It wasn't the same cafeteria us patients ate at, at least the ones who were ambulatory. It was mainly for the hospital staff, which numbered over 300. A few more feet, and I stepped to the outside world. The exit/entrance to the ground floor of building 86 faces in a southeasterly direction, so you can catch the morning sun. It usually wasn't up yet when I got out there, but that was OK. To the left when you walked out the door, about 25 feet away stood our veterans butt hut. As you weren't allowed to smoke in the hospital, and a lot of veterans smoked, they had a few of these throughout the campus. They were pretty simple, with all 4 sides encased in large, seam to seam vinyl, or Plexiglas windows, a sliding door for handicap accessibility, benches around the inside perimeter, and a couple of picnic tables. They also had heat, and an exhaust fan located at the peak of the roof to suck the smoke out. I know, it's a hospital, and you shouldn't be smoking, but these guys and gals had more important things to deal with and worry about here, and stopping smoking would have been an added stressor. They also had a couple of benches and tables outside the butt hut, which were nice during the day when it wasn't to damn cold or snowing.

The Sheridan VAMC is a 203-bed medical center, with 54 buildings on a 296-acre campus. Their primary catchment area extends to veterans from Wyoming, Montana, Colorado, Utah, and portions of Idaho and it serves as the psychiatry tertiary referral site for VISN 19. The bed complement includes 50 psychiatric, 23 medical, 50 extended care, 40 mental health residential beds, and a 40 Domiciliary Residential Treatment Program for Homeless Veterans.

I sat outside in my parka, and wearing a pair of glittens (A combination glove/mitten hand wear.) I drank my coffee and smoked a few cigarettes. Occasionally one of the guys would join me, usually because they wanted to bum a cigarette, but that was OK. Most of us were classified as indigent, but I had the luxury of my family supporting me while I was there by sending me money and cigarettes, along with tons of clothing. I stayed outside until about 6:45am, and then headed in to drop my coffee mug off at my room. I then headed to the chow hall, which I could have went to in 2 different ways. First, I could use the outside route, and walk past the butt hut and head in that general direction, northeast, which would lead me to building 6 where the patients chow hall was, or take the inside route, and head down that long hallway I talked about earlier, and when I got to the end, hang a right, and the chow hall would be about 50 feet ahead on my left. Every patient saw a dietitian once they arrived, and numerous times while they were there. I had initially asked to be put on a 1750 calorie diet because I knew from previous VA hospitalizations that I gained a lot of weight while I was an inpatient. Mainly because I wasn't moving around a lot, like when I was in a manic state, and/or working. So, that was my cross to bear.

Breakfast was at 7:00am, and I was usually one of the first dozen or so to arrive. Most times we had to wait for the chow hall folks to open the door, but it usually wasn't a long wait. Breakfast went well, as did the rest of the day. I was anxious to see what these MRI pictures told us, and what the heck was wrong with me. I kind of knew there was something wrong with my neck, and for me that was a given, but this one of the brain, well I had no idea what was going on there. But I waited, and waited, and waited...

It was a little after 5pm, and my classes and sessions were done for the day. My plans were to go to dinner, and then head back to the unit and do some painting. My favorite was to paint these little plaster or gypsum statue figures, mostly of animals, and I would spend hours doing that. It kept my mind and hands busy, and I took great pride in the ones I finished. I still have some to this day, and I also gave a lot of them away to fellow veterans, and staff. The lady at occupational therapy had all kinds of crafts and artwork for the veterans to do. She was kind of nice to me, because she saw I actually did them. When I was done painting these statues, I would go down to occupational therapy and clearcoat them. That was my plans for the evening, something nice and simple, because the last 25 years of my life were far from that. Deep inside my brain laid the history of one wild and wacky life, but that would soon be put on it's end in a little over an hour later.

I walked through the chow line, grabbed my diet card, snagged some silverware and napkins, a milk, some fruit, and on to the main course. I forgot what we had that night, but most of the food was OK, and they had a different menu everyday. I walked out of the room that housed the chow line, and made a sharp right to grab a glass of ice-tea. It was self-serve, which made it nice, as you could have as much as you wanted. I scanned the chow hall to see where I wanted to sit, and saw a couple of my friends on the far side, so there I went. The chow hall had these big round tables that seated 5-6 people. I took my seat, greeted my friends, while a couple more veterans sat down to join me and the others for dinner. One can make a lot of friends while in the hospital, as we all had a common bond, we were all veterans. Sure we still kidded each other about what branch of the service we were in, but that went without saying. But there was this camaraderie that is hard to describe unless one has actually gone through it, and served in the military. I know there have been countless studies done about this, but the bottom line was that we all, at one time or another, took an oath to protect and defend the Constitution, and our country against all enemies, with everything we had, up to and including our lives. Not too many jobs have that as a requirement. So, there we sat, chowing down on some fine VA Hospital grub, talking about only God knows what, and continuing our bonds as veterans.

I was just about done, and nobody really rushed to get done, because, once the kitchen decided that everyone had gone through once, they opened up the line for seconds. Most times I passed, and today was one of those days. I was seated with my back to the chow hall, and me facing the people across from me and the wall, and windows to the outside world. Most times I sat with my back to the wall, but not tonight, for whatever reason I do not remember. All of a sudden, to my left, I catch someone approaching. I look up and to my left, and it is Dr. Seymour Thickman, a spry 80+ year old primary care physician. He had been my primary care doctor from when I first arrived in Sheridan back in March of 1992. He was originally from New York, and he would always ask me when I was going to open a New York style deli in Sheridan, and I would respond with, well, show me the money. It was our own little back and forth that went on for years. It looked like he was coming over to me, and I just figured he saw me and wanted to say hi. Boy, was I wrong. When he got to me, on my left side, I looked up at him and said hi, and he responded, "Billy, we just got your MRI results back, and this is what I want you to do. I have sent over a Philadelphia Collar, so when you get back to SNU, and I want you to put it on immediately, and don't take it off. I have tried calling the Denver VA to speak the chief resident in neurosurgery to get you set up to go down there as soon as possible. I'm the duty officer tonight, and I should hear something back from him soon. And, they found some strange things in your brain." And then he left. I was speak less for a short while, and one of my friends asked, "What's wrong with you?" I said, "I have no fucking clue, you heard him, so you know as much as I do." I really couldn't finish what little food I had left. So, this is great, I have to wear this Philadelphia Collar, whatever the hell that is, and there is strange things in my brain. No need for me to eat dessert, as I have more important things to do. So, off I went, back to SNU, chain-smoking, and having racing thoughts going through my mind at light speed all the way to the unit, and all night long. So much for my bi-polar medication helping with my racing thoughts.

So on October 15, 2003, one door opened as another door closed, and so began the next chapter in my life...

1 comment:

David C. said...

I really appreciate you posting the story of your diagnosis. I started my clinical training with a month of internal medicine at a VA hospital and also rotated through a VA mental hospital as a student. I still, almost 30 years later, remember some of the VA patients, and I learned a lot from them.

There are days when I am reading large numbers of MRI scans without thinking about the lives of the patients. Your writing gives me some perspective.



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