The One with the Subarachnoid Hematoma

Summary

On Thursday, October 8, I fell while mowing the lawn. I hit the back of my head on the sidewalk. I was unconscious for a short time. Tina drove me to urgent care and then to the Emergency Room at Portland Adventist Hospital. A CT scan showed a small subarachnoid hematoma had occurred in my occipital lobe. I was transferred via ambulance to the trauma and intensive care unit at OHSU where I stayed under observation for 24 hours. A second CT scan showed no additional bleeding and I was eventually released after one full day in the hospital. It’s now a few days later and I feel better. I still feel the effects of the injury but I can tell it’s getting better.

Details

October 8, 15:56, home

I was mowing the section of lawn shown above in the red box. Where the lawn meets the sidewalk there are bricks laid sideways to form a border. The bricks are approximately 2-3 inches higher than the sidewalk. I was mowing diagonally from northwest to southeast with the distance continually getting shorter. As I finished up the section, I did not pay attention to where I was stepping. I must have stepped backwards and placed my foot partially on a brick. I Iost my balance or twisted my ankle or both. I fell backwards and the back of my head hit the concrete.

Everything went black but I was still aware. I could hear some boys down the block shouting to my next door neighbor, Bobby. I knew I had injured myself. My hands were tingling and it felt like they were raised in the air. I tried to lay them down but I couldn’t move. I also couldn’t make my eyes open.

After Bobby and the boys arrived, I managed to force my eyes open but I still couldn’t move. I might have told them that I was OK but I wasn’t. I sat up and felt the back of my head where it hurt – there was no blood which I felt was a good sign. Bobby sent one of the boys to the house to get Tina. He told her I had been “knocked out cold” when she came to the door.

16:00

By the time Tina came out, I felt the back of my head again and noticed my fingers were wet with blood. There was a brief discussion about what to do before I lurched to my feet and walked towards the house. I immediately noticed an unsteadiness in my gait. I also noticed a pain on the inside surface of my right ankle that extended 4-6 inches up my leg.

Once inside, I sat in my chair to recover. I noticed that when I moved my head and then stopped, the world seemed to keep moving as if my head was still moving. I decided I would need professional care.

16:19, Legacy-GoHealth Urgent Care

We departed for urgent care and arrived 10 minutes later. After a short wait, they informed us that they did not take head injury cases. We departed urgent care 8 minutes after we arrived.

16:49, Adventist Health Portland, Emergency Room

Twenty minutes later Tina dropped me off at the Emergency Room. Only patients and caregivers are allowed in the waiting area so I went in on my own. I described the incident to the receptionist and she told me to take a seat in the waiting room. There were a limited number of chairs and they had been arranged per social distancing guidelines. I settled into one where I waited for the next 90 minutes. Since she wasn’t allowed inside, Tina drove to 7-Eleven to get a snack for me.

17:58

Tina returned from 7-Eleven with white chocolate M&Ms, a favorite. I decided to save them for later especially since eating with the mask promised to be awkward. As I waited I noted that I could feel blood drops falling on my shoulder occasionally. I also grew a little chilled. I was dressed in a t-shirt and shorts. There was a fireplace a short distance from where I was sitting, but all the seats near it were occupied. As time wore on, I grew increasingly uncomfortable sitting in the chair but I did not feel confident in walking. I noted that my shoulders and the back of my neck were sore.

18:36

A triage nurse called my name. I went to the triage area and described the incident. Soon they whisked me away for a CT scan for my head and X-rays for my ankle. Ten minutes later, I was back in the waiting room but now the fireplace chair was available so I took it. I also took the opportunity to eat some of the M&M’s, raising my mask each time I ate a few. I inadvertently spilled some during one of these maneuvers but knew that I couldn’t risk picking them up.

19:03, Consult Room 8

I didn’t have enough time to finish the M&M’s before I was called back again, this time to a “consult” room where Tina was finally allowed to join me. They had me remove my shirt and put on a hospital gown. They also put in an intravenous line in each arm and treated my head wound, all at the same time. The vein they chose in my right arm was “blown” so they had to redo the IV in that arm. Because of the soreness in my neck, they put me in a cervical collar as a precaution. All of this was being done because the CT scan had shown that I had a small subarachnoid hemorrhage which could require surgery if it got worse. They were preparing me for a transfer to Oregon Health Sciences University Hospital where the Level One trauma center provides exceptional care for traumatic brain injuries.

19:36

Text message to my family: “I’m ok. Everything is precaution.”

19:52, Ambulance Bay

My ambulance attendant, Levi, explained that it would take about 15 minutes to transport me to the OHSU emergency room. When I arrived, he said I should be prepared for a massive number of people swarming around me because OHSU is a teaching hospital. He also explained the different procedures I should expect. After he was done, I joked that there was no way we were getting there in 15 minutes. His reply: “We will use the lights.”

20:04, OHSU, Emergency Room

19 minutes later they unloaded me from the ambulance and rolled me into the ER where everything happened as he had explained. There were least 20 people in the room with me. At one point somebody asked if I had taken aspirin that day to which I replied, “Every day!” That really changed the mood in the room because aspirin is a blood thinner and made me a “big three” which I assumed is a risk level assessment. After a bit of debate, they decided to “roll” me to examine my spine because of the neck and shoulder pain.

21:16, ER room 26

After the initial kerfuffle, they moved me to my own room temporarily until I could get a bed in the ICU. My nurse assured me that it would be soon but the conversation he had in the hall before he came in said otherwise. Tina was allowed to visit during this time and she brought a bag of essentials including my CPAP machine which allowed me to doze a little. Once an hour they would wake me for a neurological exam that included answering questions, performing simple actions with my feet and hands, and a pupil examination. I became increasingly uncomfortable because I had to lay on my back and did not have any pain meds until just before they transferred me to the ICU.

23:37

First pain meds, dilaudid, delivered

October 9, 01:30 (approximate), Richard J. Mullins Trauma and Surgical Intensive Care Unit, Room 17

A bed finally became available but visiting hours were over and Tina had to go home. After I was transferred to the ICU, a team of nurses put me in a different bed and made me much more comfortable for the duration of my remaining stay. I also got a second CT scan at this time. I dozed some but would wake for the occasional neuro exam. Each time I requested that they plug in my CPAP but that needed to be approved from someone from respiratory. The blood pressure cuff on my left arm would inflate every hour to the point of nearly unbearable pain. I had less painful cuffs on my lower legs that would alternately inflate and then deflate. As I dozed if felt like one of our cats was snuggling up to my leg.

05:41

The second CT scan showed that the hematoma had not grown which means I would be released around 18:00. I had slept some but without the CPAP I do not sleep well. A nurse asked me if I was sore and I told her my throat was quite sore from snoring and can I please use my CPAP? She hooked it up and said “it was like this when I came on shift.”

10:21

“Sitting up and eating an omelet” I reported to my family via text message. It is my first food since the M&M’s more than 12 hours ago. Sitting up made me very dizzy and so nauseous that my mouth started watering as if I was going to throw up but it passed.

Omelet tasted delicious

12:30

My doctor concluded that there is no neck fracture and they remove the cervical collar. I also noticed that the giant “goose egg” on the back of my head has receded completely. The wound itself is an abrasion and did not require stitches. It does hurt and they give me occasional pain killers for it.

13:18

14:13

I moved from my bed to an adjacent reclining chair. I enjoyed a very bland meal of macaroni and cheese, spaghetti squash, a dinner roll and orange slices. I tried to order cheese cake but they said that it exceeded my carb allowance. I remained in the chair for the rest of my stay except to take a walk in the hall with a physical therapist who cleared me for release. My ankle hurt during the test but x-rays are negative for a fracture.

14:35

I passed the cognitive ability test with flying colors and will be released that evening. Estimates for release vary from 18:00 to 20:00.

19:14

Home with prescriptions for Tylenol and oxycodone. I took the week off from work. The healing begins.

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