The obvious answer isn’t always right

posted in: Life and things | 1
My right eye

It should have been just another day in paradise. Breakfast had been consumed, internet had been perused. We headed off for the excitement of the day – a trip to the supermarket.

We were halfway there when something happened to my right eye, as if a frosted glass shutter had been dropped over the pupil. When I closed my left eye, I couldn’t see anything. I told Pete (who fortunately was doing the driving) but I didn’t feel any other symptoms so we carried on. After several minutes (no more than five, probably less), my vision started to clear, at first as though I’d lifted one shutter on a blind, a strip of clear sight. By the time we reached the carpark a few minutes later, I was reasonably okay. The right eye was blurry but one and a half eyes is plenty for picking out bananas.

Still, it was a strange event. I’d been to the optometrist a week before for a new script for glasses and everything had been fine, given ‘fine’ for seventy-year-old eyes. I rang the optometrist and the guy at reception agreed it was worth checking out and we made an appointment for an hour’s time. It now being eleven, we made our usual cup of tea with a biccie. Elevenses, you see. I hadn’t even sat down when the phone rang. It was the guy from the optometrist. He’d spoken to the optometrist and she’d said to go to the hospital. What I’d experienced might well have been a stroke.

So, we drank our tea and went off to Hervey Bay Hospital’s emergency department. We got there at around 11:20 and I was lucky. There were only a handful of other people there. The nurse listened to my story, including that the optometrist had sent me here because I might have had a stroke. She told Pete to take a seat and took me immediately to the hospital’s eye clinic, a small room containing several machines used for eye testing.

Hervey Bay is our major public hospital — small by big city standards, and probably not big enough anymore to service the demands from an expanding population. That is, it’s very busy. It is also a teaching hospital so, like all such places, there are quite a few young, inexperienced doctors, and quite a few students getting hands-on experience. And, I discovered, quite a few casual employees enlisted to cover shortages of staff.

I waited in the eye room for about ten minutes, when a young man appeared, evidently a student doctor. I told my story again and he asked me lots of questions, working on his diagnosis skills. After he’d asked me everything he could think of, he told me he’d report to his supervisor who would appear soon.

I waited, practising reading all the signs with both eyes, then the right eye, then the left eye. I counted my toes. All there. Twiddled my thumbs. Etc. A doctor arrived with a student in tow. The doctor looked around, excused himself, and left the room, leaving the student and I staring at each other. “Um. Well. Can you tell me what happened?” he said.

I was halfway through the story when the doctor (let’s call him doctor A) came back and asked me to start again. Okay, then. I told my tale, then doctor A announced he hadn’t used these machines before, he’d have to fetch his supervisor, who duly arrived, introduced himself and henceforth insisted on calling me ‘dear’. We’ll call him doctor B.

Doctor B did the testing while the other two fellows watched. Chin on chin rest, forehead on bar. Look in here… Then Doctor B asked Doctor A to put in the yellow eye drops. Which he did. We started again. Chin on rest, forehead against bar. Fluid trickled down my cheeks and I asked for a tissue. I shouldn’t have had to ask and wouldn’t have needed to at the optometrist’s office.

Tests finished, Doctor B explained the photos of my eyes would be sent to Brisbane’s major hospital where a specialist would examine them. Shouldn’t be more than five minutes.

Some time later, I’d read all the signs again, counted my fingers and toes, and basically run out of any way of amusing myself when the triage nurse came in. “Your husband is getting worried. I checked with the doctors and they said you can sit in the waiting room with him.” I’d been gone for about an hour and half by then. Pete told me after I’d left for treatment the emergency admin area had filled up. We’d been lucky to arrive when we did. We were sitting in an area amusingly called ‘fast track’. After about an hour we were on the verge of saying ‘bugger it, let’s go home’. Pete tried once more to get some attention and flagged down a passing doctor. He was kind enough to find the fellow looking after me (Doctor A) and told us A was on the phone but would come and see us soon. Eventually, he did. We asked for results on the eye photos and he told us they hadn’t been examined yet. So much for ‘five minutes’. I think he’d forgotten to send them. We asked if we could go home and they could ring us if anything else needed to happen. He said that he could not recommend that because…

I may have had a mini stroke, which was often a precursor to a major stroke.

“Have you taken her blood pressure?” Pete asked. “Because I would have thought that’s the first thing you’d do if you suspect a stroke.”

To give him his due, the doctor didn’t blink but I’m sure that was an ‘oh shit’ moment in his day. I suggested Pete go home. I’d ring him when I could leave. He left and a student arrived with a blood pressure testing machine. They also took my temperature using a thermometer, which I had to put under my tongue in the old-fashioned way, although the machine did the reading. I said I had a gadget at home that I could just point at a forehead to take a temperature reading. Doc A said all the hospital’s such thermometers were broken so they’d had to go back to earlier methods. A nurse told me later that all the more modern equipment had been drafted for covid testing and many units had been stolen.

The blood pressure reading caused something of a stir. I’ve never had problems with BP and the last time I was tested at my GP’s clinic was in late November. If there had been an issue, I would have been told. Doc A demanded to know what my normal BP reading was. I said I didn’t know. This reading was something like 180/100 – in other words, way, way too high. But he didn’t tell me that. He asked if I’d kept hydrated and eaten. Yeah, right How was that supposed to happen? He did rustle up a cheese and tomato sandwich and some water.

Things started to happen. I was sat in a chair and wheeled off to a room where a third-year student inserted a cannula. By this time I’d been in this air-conditioned hospital for something like two-and-a-half hours dressed in shorts and a tee shirt and I was cold, so the vein was hard to find. I asked for a blanket, which he fetched. Eventually he got the needle in and yes, it hurt. But the cannula was a model he’d not used before and the blood started coming out all over my arm and dripped onto the blanket. He pressed his finger on the device to stop the bleeding but then he had only one hand to open the package containing the stop valve. I helped him with that, he got rid of the murder-scene blanket, and cleaned up my arm with alcohol wipes, apologising profusely as he did so. (He actually did a very good job. It was inserted properly, a nurse told me, and my arm is not bruised.) He told me someone would be along shortly to take me for a cat scan.

I counted my fingers and toes again. All present. Read all the signs. Then a nurse appeared to take me to medical imaging. I said I could walk but she smiled and told me to enjoy the ride in the wheelchair. I felt a right prat because as far as I was concerned there was nothing wrong with me. I’d never had a cat scan before so that was all good fun. They even had a couple of black cats stencilled on the ceiling. Then I was sent up to the CDU which I learned stands for Clinical Decision Unit. It’s where they send you after triage and fast track when they’re not sure what to do with you.

CDU is a very new building. It’s basically one very large room with toilets, showers, admin, stores etc in the middle and twenty-four beds with testing equipment around the outside, all separated by curtains. There are no windows. There’s a constant flow of nurses, orderlies, visitors, and even an occasional doctor. My curtained cubicle was directly opposite the staff station and its many computers. I sat up on my bed and the nurse came and slapped about a dozen electrodes on my chest. They clustered into two attachments which plugged into a monitor to graph the signals.

That’s when I found out I was in for the night. I rang Pete and told him the news. He could have brought me down the bag we’d packed at home containing toiletries, my tablet, and a change of clothes but I figured I’d get a hospital nightie and surely they’d have a toothbrush so I said not to bother. That may have been a mistake. You see, I’d been asked if I wanted to be a private or a public patient. I assumed being a private patient would give me some perks. But what it really meant was that my health care fund would be footing the bill, not the public purse. Good for the hospital, nothing in it for me. The clerk thrust three documents at me for signature at the same time that my blood pressure was being taken and I didn’t ask questions.

Served with a mug of minestrone, white bread and margarine, tea/coffee and a banana

Dear reader, it was a very long night. I spent the night in the clothes I was wearing. No TV, no tablet to play on, no book or magazine. Just the passing parade. Dinner arrived on a tray about 5pm. Let’s just say it wasn’t haute cuisine. The ‘minestrone’ tasted like bonox with a few cubes of veg. DNF. But the stew wasn’t bad. I ate the chunks of meat and half the veg, and I ate the banana. The nurse turned up with a couple of statin tablets and a glass of dissolved aspirin. I knew what that was about. Pete’s had to take them for years. I suppose this was a sad moment for me. I would lose my status as a medicine-free septuagenarian and join the ranks of the pill-poppers. My morning ritual would include statins and aspirin for the rest of my days. Oh well. I’d had a pretty good run.

I tried going to sleep but it was like trying to sleep in a railway station. Beeps and bings from equipment, multiple conversations, the muted clatter of fingers on keyboards, wheels rattling. There weren’t any trains but the hospital’s helicopter landed close by at midnight. Every two hours my nurse came to ask me questions like what year is it and where are you, and take my BP and temperature. If I wanted to go to the toilet, I had to call my nurse to unplug me, then I’d walk down the corridor to the loo with a handful of dangling wires. I felt like a cyborg in for maintenance. I couldn’t change position in bed too much because my chest was covered in wires and the cannula in my left arm hurt. I reckon I got an hour of decent sleep. The nurse never had to wake me up for the bi-hourly ritual.

After the visitors had all left and we were into the wee small hours I listened to people snoring and the conversations between the staff, or with some of the patients. One fellow several beds away seemed to be having trouble processing events. He’d been in a motor cycle accident and was worried about the police and his wife. At 4am he wanted to leave and had to be talked down by the nurse. Somebody else was good to go home but was anxious and didn’t want to. The guy who’d been taken down to theatre early in the evening was still waiting to go in because something urgent had cropped up. The team leader had to turn away requests from emergency because all the beds were full. But as I eavesdropped listening to the nurse change-overs I learned that all my bloods (test results of blood samples taken earlier) were good, the cat scan was clear, and there was no problem with my eyes.

Maybe I’d be going home in the morning – well… in daylight.

A Continental breakfast arrived and went and doctors’ visits started. The nursing staff discharged anyone they could as soon as possible, but the beds were soon filled. My hopes soared when I received an official visitor but he was a speech pathologist who wanted to conduct tests for other stroke-related symptoms. He made me eat one of those tasteless cardboard dry biscuits to see if I could eat and swallow properly, and move my tongue on command. All good.

At last it was my turn. I was expecting Doctor A but I was seen by a senior clinician, complete with entourage of two students, around 10:30am. I told my story yet again. I was pretty good at it by now, condensing events into a few sentences. I also told him what I had told everybody else as we discussed events associated with this temporary blindness — I had experienced an ocular migraine earlier that morning.

“What do you mean by an ocular migraine?” he asked.

“It’s a migraine where I get patterns in front of my vision so I can’t see properly. It’s an inconvenience but I find if I lie down for a while with my eyes closed it goes away. I don’t get a headache.”

He looked at me sternly. “That is a migraine without a headache. There’s no such thing as an ocular migraine.” The students and I then got a lecture on migraines, what they are, and what they are not. What I experienced is what’s called a complicated migraine. In fact the doctor said he got them himself and associated with his version were a number of stroke-like symptoms such as slurred words.

But how did that relate to my temporary blindness?

He said the timing was the thing. I experienced the migraine about an hour before the blindness, so he theorised that the two were connected, especially since I had no other symptoms associated with stroke. But he needed the results of an MRI to establish once and for all that I had not had a stroke. (That will happen in early March, via my own GP.)

 I asked about the blood pressure, which had been falling overnight. Via eavesdropping, I knew if it had gone above 180, the nurse would have to report it to the doctors. The first reading I saw on the monitor was 177/88 but now it was 158/102 — still high but not catastrophic. The surgeon went into lecture mode again. There’s hypertension, which is a disease. And there’s high blood pressure. Blood pressure fluctuates according to external factors such as tension or stress. There’s a need to treat hypertension but not an unusual high blood pressure reading.

So. If the MRI returns a good result, I won’t have to take statins and aspirin. I don’t get migraines often enough to even think about treating them.

And the take-home from this long story? There are several. The first is if you suspect a stroke for any reason go straight to the hospital. Looking back, we delayed longer than we should have. If I had suffered a stroke, going shopping would have been a possibly fatal mistake.

The second is don’t assume the obvious answer is the right one. I told everybody I spoke to about the case about the complicated migraine. I’m not even sure if it was recorded. I suspect they never got past the obvious conclusion that I’d suffered a minor stroke associated with the eye. It took the senior clinician to join the dots to an alternative conclusion.

Oh – one more thing; the nurses who looked after me were great. They were all pleasant and good-humored, despite working in stressful circumstances. My main complaint about the first half of my day was a lack of communication – often, I suspect, through overwork. Just as well covid isn’t a big issue here.

For my American friends, the cost of all this was zero. You guys really, really should have a proper health care system.

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