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ralph robert moore
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Copyright © 2002 by Ralph Robert Moore. All rights reserved.
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september 28, 2002
This past Tuesday night, Wednesday morning (it was a little after midnight), I woke up to the familiar phantom of Mary working her way around the foot of the bed, passing by my pillow, heading down the depth of the long bathroom off our bedroom, to urinate.
I stayed half awake, as lovers do. Especially since her stroke.
I heard the toilet flush in the darkness, then Mary let out a cry.
"Are you all right?"
I turned on my bedside lamp.
She was outside the toilet alcove, sitting on the carpet in front of the double vanity.
I yanked down the sheets, stumbled into the bathroom.
She had passed out. She was conscious now, but disoriented. She thought she was in the bedroom, rather than the bathroom.
I felt dread.
I got her to her feet, my heart thumping. The little chair she sits in while she gets ready in the morning was down on one knee, one of the front metal legs bent from her grabbing onto the chair for support as she fell.
"Are you all right?"
Because of her aphasia, which is getting better but still there, it took a while to get a sense of what had happened.
As she finished urinating, she saw a bug on the carpet in front of the vanity (the worse time to see bugs, just after midnight). She flushed, unrolled some toilet paper, and got up quickly, bending over to crush the bug. Lost consciousness, fell.
As she finished saying this, her cheeks bulged. She started vomiting.
When she was finished, I helped her back into bed.
She touched her forehead. "My skin."
I put a hand on the side of her neck. Cold, wet, clammy.
"Are you all right?"
More details now. As she made her way to the toilet alcove, she had seen bright lights all around her eyes. Just before she passed out, she had been convinced she was actually in our bedroom, and had been feeling in the darkness for her edge of the bed, confused as to why it wasn't there. I felt another thump of dread.
"Are you all right?"
She nodded, collarbones still sweaty.
Call 911, or no?
"Are you numb anywhere?" I was thinking, could she have had a second stroke?
I watched, frightened, as she felt her arms and legs through her pajamas. "No."
"Can you count to ten?"
She did so right away, quietly, to herself, without having to use her fingers, which normally she needs, now.
"Do you want to go to the hospital?"
She thought about it. "No."
Her color was coming back. I asked her again to tell me what had happened.
The thinking she was in the bedroom rather than in the bathroom, that confusion, disturbed me. Call 911? Don't call 911?
"I feel better now."
"Could you have been sleepwalking?"
"No, I don't think."
She's never sleepwalked before. She was on her period, and it was a particularly bloody one, attributable to the Warfarin she takes to keep her blood from clotting. She had stood up suddenly, then quickly bent over, to kill the bug. Could those sudden actions, combined with her blood loss, have caused her to black out?
In the end, we decided not to call 911. She didn't have any of the signs associated with a stroke, numbness or difficulty speaking (beyond her normal aphasia). Her skin had dried, and was again warm to the touch. This wasn't the first time since her stroke that Mary had exhibited symptoms which could be something, or nothing (That's the problem. We all exhibit symptoms every day that could be serious, a momentary forgetfulness, a brief pain in the chest, a feeling of light-headedness, or could be just a normal part of living in bodies). We finally wound up going with our intuition.
We went back to bed. I stayed awake, in the gray rectangles of the darkness, until her breath was regular, until she had fallen back asleep. I pulled the blanket up over my shoulder, which usually helps put me to sleep, and in the interior blackness behind my shut eyes tried to think of something relaxing, imagining us in the fifth floor stone room of a castle, the windows of the room, slanting inwards at their tops, showing the purple ocean far below, scalloped line of phosphorescence slowly pulsing on the beach.
I woke up a few hours later. She was lying next to me. I watched her, waiting for a breath from her. It came. Another. She looked fine.
When I woke her up half an hour later, she seemed okay. Any numbness? No. She counted to ten again, this time using her fingers, but again, that was how she now normally counted.
While we drank our coffee we pulled out and read stroke literature I had gathered over the months. Some of the symptoms she had exhibited, the passing out, disorientation, could be associated with what's known as a "mini-stroke", meaning, officially, a transient ischemic attack (TIA). From the literature: "Although TIA's only last a brief time, it is important to call 911 right away. They could be the sign of an impending stroke."
Though she seemed fine now, we decided to go to the emergency room to have her checked out. Just in case. While Mary was showering, I gathered up all the cash in the house, in the event it was needed. Ninety-seven dollars. We dressed quickly. There were hospitals nearer, but I decided to go to the emergency room at Medical City Dallas, about an hour away, because that's where Mary had been hospitalized following her stroke. They had all her medical records.
The drive in was murderous, the worse part of rush hour.
At the hospital, I parked in one of the lots and we walked hand in hand into the emergency room. The rows of seats were empty except for one older Latino man, who had his palm propped under his chin, nodding off to sleep.
We walked up to the triage window. I had rehearsed what I would say during the drive, and now went through an orderly explanation with the nurse, that Mary had had a major stroke in April, had been here for nine days, then described what had happened last night, the bright lights in her eyes, passing out, the disorientation, the vomiting, the clammy skin.
We were brought inside the triage's office. Mary had her temperature taken, her blood pressure checked. Normal. The triage nurse led her over to a large floor scale, one that had a chair on the scale itself, I never knew there was such a thing, and had her sit in the chair, then recorded her weight.
"I'm going to take your wife in back, to one of the beds. After you finish admittance, come back here and I'll take you to her room."
I went out to the emergency room proper, walking over to the admissions window, sat down. There was a thick sheet of glass between me and the admissions nurse sitting on the other side, for security, I assume, a narrow slot at the bottom only a few inches high through which I passed Mary's driver's license, her insurance card, and mine.
The admissions nurse asked me the standard questions, which turned into one of those moments of grim comedy that occur sometimes when we're in a stressful situation, since there was an old man directly behind my chair running a noisy floor polisher over the tiles, noisy enough to where, combined with the thick glass, I had to ask the nurse to repeat each question.
I was led back to Mary's stall in the emergency room complex. Hers was the only bed occupied at this early hour. She was undressed already, lying in bed in a hospital gown, all sorts of wires and cables hooked to her chest and arms, the monitor above the bed recording her blood pressure, respiration rate, pulse. It was all so familiar from her stay in April. A bare needle had been inserted into a vein on her left forearm, and taped in place, in case they needed to quickly inject a drug.
Mary was alert, and in a good mood, considering. One of the emergency room nurses came in. I explained what had happened. She told me an emergency room doctor would be there soon.
When he arrived, I explained what had happened again. He took notes, did a brief exam.
"I don't think this was a mini-stroke. There usually isn't a loss of consciousness with a TIA. There is a type of stroke where there is a loss of consciousness, the stroke originates in the brain stem, but the consequences of that type of stroke are immediate and severe, not like what we're seeing with Mary. But any loss of consciousness could indicate a serious medical condition, including a cardiac condition, so we want to run some tests. It helps that you brought her here, where we have immediate access to her records."
I supplied names and phone numbers for Mary's general practitioner, her neurologist, her cardiologist, as well as giving him a quick run down on the results of Mary's recent coumadin tests (Mary gets a 'blood stick' test for her coumadin levels every other week. The level of coumadin in the blood is a major factor in determining the likelihood of another clot forming. Strokes are caused by blood clots. We don't eat spinach anymore, or anything else high in vitamin K, which increases the clotting factor).
Mary pointed at the white wall behind me, where, high up, a paper sign was taped. "Rolling stools are reserved for staff." It took me a moment to make sense of what I was reading. I looked down. I was, in fact, sitting on the only stool in the room, one of those contraptions where the round cushioned seat is supported by a vertical shaft underneath, which at its lower end sprouts out into five horizontal legs with wheels. I switched to a nearby chair.
The nurse came back to tell us the results of the blood tests would be ready in forty-five minutes. From a few drops, looked at through dozens of filters, they would be able to tell almost anything about Mary's state of health. Everything's written in the blood. As I had been during Mary's stay in April, I was impressed with the efficiency.
"Will Mary be in this room until then?"
I squeezed Mary's hand. "I'm going to the car to use the cell phone, to tell your speech rehab center you won't be in today." We kissed.
Walking through the hospital lobby on my way to the lot, I recognized the smell of the hospital from Mary's previous stay, an actually quite pleasant smell, almost like a spice.
The doctor returned in an hour, having by then spoken on the phone with Mary's neurologist, and her cardiologist. He and the neurologist agreed Mary's symptoms did not indicate a neurological problem (so no mini-stroke, thank God). However, her cardiologist wanted Mary to wear a halter monitor for twenty-four hours, to make sure the fainting episode hadn't been caused by an irregularity in her heart beat, rather than simply standing up too fast.
So we drove over to Mary's cardiologist, about a fifteen minute drive, and had her fitted. A halter monitor is an array of wire-connected circular electrodes, each of which is taped to a specific location on the chest or sides of the rib cage, looking a little like an electronic octopus. The harness is worn over the shoulder, with the data fed to a small device about the size of an old-fashioned transistor radio, strapped to the waist. Prior to attaching the electrodes, the nurse lightly abraded Mary's skin at each location with a sandpaper-like square, to aid adhesion, then swabbed each area with alcohol. The nurse showed me the on-off switch for the device, turned it on, told me to turn it off in twenty-four hours. She also gave us a slim, paper diary, asking that we make an entry each time, if any, Mary felt dizzy. We could ignore the regular instructions in the diary, which required entries for a wide variety of events, including eating, drinking, sleeping, urinating, defecating and "sexual activity". "Remember to record the time using the clock on the monitor, not your wristwatch." The lower loops of the wires, each a different color, hung out the bottom of Mary's blouse as we exited her cardiologist's office.
We had left home for the hospital around seven in the morning. By the time we returned, both of us hollow-eyed from being up in the middle of the night, and the stress of the emergency room, and all the waiting, it was after twelve.
I helped Mary change into her pajamas, carefully pulling the straps of her bra down her arms so as not to dislodge any of the electrodes. She shook her head good-naturedly, grinning, looking down at the thin, colorful octopus on her chest. "Jeez."