At this transition point you have not yet
accessed the labyrinth formally - not knowing what to expect or what the system
expects of you. This changes once you
are designated immediate family of an in-patient under intensive care. You
suddenly belong! Obviously you only have
temporary status but it is an advance on the limbo of uncertainty. Until that moment, it is like sitting in a
waiting lounge of a large transport hub in a foreign land late at night, not
knowing where you are going, whether you have a ticket or what the mode of
transport might be, and whether your partner will join you in time. The novelist William Boyd describes this
unsettling phenomenon in his thriller, Ordinary
Thunderstorms: His appropriately
named protagonist, Adam, enters a hospital ‘city’ in London:
People wandered to and fro in this vast transit lounge – in
transit from health to ill health – some, in dressing gowns, were clearly
patients, others, in multi-zipped overalls in differing pastel shades, with
name badges on their breasts and dangling ID photos hung around their necks,
were orderlies or administrators of various kinds. There were also people like
him in civilian clothes that must have been either visitors or else putative
patients seeking entry in to this self-contained, health-city. The mood was calm and unhurried – like an
ante-room to heaven…Adam felt he was in some kind of human hive, a hive
dominated by signs and acronyms:
everywhere there were signs, signs that made sense and others that
didn’t; signs that were welcoming and
vaguely reassuring, others that provoked sudden dark fears - …signs that
directed him to segments of buildings on this campus where every potential
health need could be catered for – it seemed – in every functioning part of the
human body and its glossary of maladies, from birth to death.*
I suspect these modern medical behemoths excite
similar responses across the planet.
Fear laced its way through all my emotions. The
numbing effects of adrenaline and its cousin hormones wear off unfortunately,
leaving you with the symptoms of hangover.
An extended crisis of the nervous system is a ‘big dipper’ on the
metabolic front. There are added dangers
if you mix alcohol, sedatives and narcotics in the cocktail. I was acutely aware of this and largely
resisted the temptation over the journey, although I succumbed to the
temptation of alcohol at times.
The family of patients in acute emergencies are
a curious phenomenon. Like patients,
everyone is different, and each is drawing on inner reserves to cope. The middle-aged woman who shared the small
waiting room with me had seen it all before. She was used to waiting while
others resuscitated her child, who had a condition that resulted in occasional
fits and seizures. The mother was
‘chatty’, probably as a nervous reflex.
Whenever one of the nurses or doctors would come in, she would let off
steam with a flurry of descriptions of previous events that led them here. I tried to tune her out whilst my fevered
brain struggled with various scenarios.
Was it her heart? Was it a stroke? Would she regain consciousness? Would she die? It is a type of torture - the not knowing. It suddenly dawned on me that I needed to contact Carolie’s sister, the only close family living in the same city. Lou was shocked and left home immediately to join me in the gathering twilight.
Was it her heart? Was it a stroke? Would she regain consciousness? Would she die? It is a type of torture - the not knowing. It suddenly dawned on me that I needed to contact Carolie’s sister, the only close family living in the same city. Lou was shocked and left home immediately to join me in the gathering twilight.
On that first long night, only one other person
knew what was happening and she remained a stalwart throughout. Lou joined me in the waiting room. I described the events of the evening, which
was calming in an odd sort of way.
Downloading stressful events is helpful at times, but not if it has to
be done repeatedly. I knew keeping all close ones informed of her condition and
fluctuations in her prognosis would be a bridge too far, but they mainly kept
their distance. She became a conduit for
family updates and this removed a burden.
It seemed an eternity before a nurse came to
usher us into the Resuscitation unit.
Carolie was sharing the space with another patient, presumably the
daughter of the talkative woman in the waiting area. It was a first inkling of what was to become
our reality over the next months.
Gadgets and monitors surrounded her.
She had a breathing tube inserted in her throat and was receiving a
blood transfusion.
The nurse told us a burst brain aneurysm caused
a massive loss of blood. Carolie was
receiving an analgesic and a hypnotic agent called Propofol, used in the
‘induction and maintenance of general anaesthesia and sedation for mechanically
ventilated adults’. Post-surgery they
would start a drug called Nimodipine, a ‘dihydro-pyridine calcium channel
blocker’ to reduce the likelihood of ‘vasospasm in patients with
cerebral haemorrhage’.
The descriptor 'vasospasm' was to become alarmingly familiar. 'Vasospasm' refers to a condition in which a blood vessel spasm leads to 'vasoconstriction' (a narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels). This can lead to tissue 'ischemia' (a restriction in blood supply to tissues) and tissue death (necrosis). Cerebral vasospasm may arise in the context of SAH. 'Symptomatic vasospasm' or 'delayed cerebral ischemia' is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid haemorrhage. I was to get a crash course in a medical lexicon and pharmacopoeia regime that was a fearsome yet ubiquitous backdrop to the labyrinthine journey.
The descriptor 'vasospasm' was to become alarmingly familiar. 'Vasospasm' refers to a condition in which a blood vessel spasm leads to 'vasoconstriction' (a narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels). This can lead to tissue 'ischemia' (a restriction in blood supply to tissues) and tissue death (necrosis). Cerebral vasospasm may arise in the context of SAH. 'Symptomatic vasospasm' or 'delayed cerebral ischemia' is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid haemorrhage. I was to get a crash course in a medical lexicon and pharmacopoeia regime that was a fearsome yet ubiquitous backdrop to the labyrinthine journey.
The few studies available on the subject of SAH tell us that the incidence of SAH in Australia is 8.1 (with rates for females being 9.7) per 100,000 people. The mean age for an ‘aneurysmal’ event is 57 and 62% are female. Understanding of the mechanisms that might trigger SAH is limited. One study suggested that heavy physical activity might trigger SAH, but that there was no association between transient heavy smoking or binge drinking and risk of SAH. Another found a possible protective role for hormone replacement therapy (HRT) on risk of SAH in postmenopausal women. This finding really surprised me – I had associated HRT with a range of risk factors for menopausal women, which included my wife.#
My limited
research into the subject of SAH confirmed little is known about causal factors
and that the findings to date are not conclusive. The fact that stands out is the incidence of
SAH is not reducing. My wife was 57 at
the time of her SAH, was menopausal, did not smoke or binge drink and had not
undertaken heavy physical activity.
She had worked herself into the ground over years of dedication to her profession and had rheumatic fever and pneumonia during childhood. Possibly these latter events had weakened her arterial wall in places such as the brain, and cumulative stress and tiredness did the rest. Who knows? We now confronted a 9.7 in 100,000 event, about which even experts know very little.
She had worked herself into the ground over years of dedication to her profession and had rheumatic fever and pneumonia during childhood. Possibly these latter events had weakened her arterial wall in places such as the brain, and cumulative stress and tiredness did the rest. Who knows? We now confronted a 9.7 in 100,000 event, about which even experts know very little.
If you are inclined
toward the rational and spend your life in awe of medical knowledge, I suggest
the paucity of understanding of this condition will leave you worried and
disillusioned. If you are drawn
intuitively to notions surrounding non-rational archetypes, any illness can
take on symbolic import. Tacey asserts
the latter response is conducive to deeper healing in the event of
life-threatening disease:
When you stop cursing the
symptoms and get deeper into the images instead, the healing comes. But the healing never starts at the place of
the symptom…First you have to be healed in your soul. The paradox is that the wound, the illness,
is also the treasure. The physical
misery gets your attention. But then if
you go deeper into it, there is much more to it, memories and imagination and
worries that will come. That’s where the
treasure is, in the psychic images that come with the symptoms. The symptoms open you up. They literally tear you open so that the
things you need can flow in.+
I can see the importance of understanding
symptoms beyond the rational exposition provided by medical science, especially
when the exposition is largely limited to manifest symptoms, and lacking real
awareness of causative factors at work.
My rational mind wanted to comprehend what had happened and what was
happening to intervene; my intuitive mind grappled with the spiritual reality
at play. As a profoundly spiritual
person, I knew Carolie would share my interest in a deeper understanding.
To be continued...
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