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.

That time my mom had scarlet fever

Before the advent of antibiotics like penicillin, a strep throat infection could lead to scarlet fever. When my mother was a girl, she came down with scarlet fever when she was at school. They made her go home and quarantine until she got better. But then her older brother got it and her younger sister after that. The whole household had to be under quarantine until the infections stopped.

The family was in quarantine for about two weeks. During this time they were not allowed to leave their farm and my mother’s grandfather brought them groceries. My grandfather kept dairy cows and would usually sell the cream they separated from the milk. They were not allowed to sell their cream while under quarantine so my mother told me they gave it to the hogs. When she returned to school she found red spots on her school books from some treatment that had been done to them.

The Fall

It’s 5:36 on the morning of January 31, 2018. I had set an early alarm and am walking out the front door of our house looking at the sky. The security footage shows me linger on the sidewalk in front of the house for several minutes before turning south to climb the hill to the end of our street for a better view of the cloudy sky.

10 minutes later the camera shows my return – carefully walking across the front yard holding my left forearm stiffly in front of me with my right hand. At the front door I try the doorbell three times before finding a way to open the door with my feet.

The inside camera doesn’t catch my entry through the front door but it is activated when I walk through the kitchen and come to rest at the dining room table, forearm on the table. A few minutes later Tina appears and I shuffle out the front door for our trip to the emergency room.

As I watched it for the first time, I was surprised at how little of the pain was visible in those silent images. There is just one moment as I wait for Tina to respond to the doorbell that I throw my head back wailing but the moment passes quickly.


It was a futile quest. Typical Oregon clouds blocked any view of the rare super blue moon eclipse. Even before setting the alarm I knew this was likely but I thought it was worth a try and it was only one hour earlier than I had been waking recently.

As I hiked up the hill I remembered the numerous times this climb had been difficult and now it was easy. When I got to the top, I walked to the next street over and scanned the sky. Nothing. “Where should I be looking?” I wondered as I turned around and began walking back. I pulled up the web browser on my phone as I formulated the Google search phrase in my mind. Before I could type it, I stepped off the sidewalk and into a world of pain.

It was the curb strip and it was landscaped with lava rocks. I was laying face down and my left arm hurt a lot. I lay there moaning and swearing for a bit before attempting to get up. However, when I pushed up with my left arm, I felt no resistance from the ground. Confused, I looked up at my forearm and was surprised to see it was laying at a different angle than it “felt.” Instead of facing the ground, ready to push off, it was laying at a 45° angle the other way and on the other side, a position that is normally not possible because the shoulder won’t rotate far enough. I knew then it was bad.

More swearing and lots of self-recrimination (“Stupid, stupid, stupid!”). My phone was within reach so I called Tina who was still sleeping at home. It was 5:39 when I made the first call and 5:40 when I gave up after the third. I briefly considered a FaceTime call but abandoned that idea when my phone told me I had disabled it for cell data.

I needed to stand and I needed to walk the four blocks back to the house. I needed to keep my arm from flopping while I walked. Once I got to the house, I knew Tina could take over and make the remaining decisions such as whether we should go to urgent care or the emergency room.

I gathered my wits, grasped my left wrist with my right hand and lifted my left arm off the ground. I lurched to my knees, carefully centered my gravity and then stood. “Yes. Good. Ok. Ok.” I muttered as I turned towards home, eyes fixed on the ground immediately in front of me for fear of another misstep.

I had only taken a couple of steps before realizing that my sweat pants had slid down and would be a problem for walking. Except neither hand was free to pull them up. A nearby hedge was just the right height to temporarily rest my bad arm and pull up my pants with the good one.

Half a block later the problem arose again and I looked for a new arm rest. The problem with pulling up pants one-handed is that it is very difficult to pull up the side opposite your hand properly. I managed to get the waistband completely over my left buttock this time and was soon back to walking slowly and muttering encouragement to myself. “Just a little further. Almost there. We got this.” (Yes, I refer to myself as “we” for conversations in my head.)

Halfway home and I realized I was not wearing my glasses. I did not consider turning back to retrieve them. The thought was preposterous.

When got home I knew that I had to be especially careful crossing the yard. If I fell again, it could be disastrous. I walked very slowly and very carefully across the grass, feeling each step fully before shifting my weight forward. I tried the doorbell but Tina was fast asleep so I opened the door with my foot and walked inside yelling Tina’s name.

I went to the bedroom and she still lay in bed undisturbed. I sat on the edge of the bed by her feet, reached over and shook her. I waited for her to rouse and remove her earplugs before saying, “I fell and may have broken my arm. You have to take me to the hospital.” It took her a few seconds to realize what was happening but then she got out of bed and started dressing.

I wandered out to the dining room where I sat at the nearest chair, rested my injured arm on the table and began sobbing uncontrollably. I knew that I had done what was necessary to get help and now I could trust others to take care of me. The entirety of my situation came crashing down and I collapsed underneath the weight. My whole body shook and all my recent failures flooded my consciousness.

I closed my eyes and tried to focus on my breath, a technique used in mindful meditation. Time crawled. Soon I began wailing “What is taking so long?” over and over. The pain was immense and I knew it was not ending any time soon. Aside from the pain, the visceral feeling of danger felt like an existential threat. I was completely in fight-flight-freeze mode and all rationality had been suspended.

Tina came out and began reassuring me. She helped me out the door and into the car. She drove to the scene of the accident to retrieve my glasses and then on to the emergency room. The fifteen minute drive to the hospital seemed to take an eternity but I was calmer by this time and tried intermittently to focus on my breath again. It seemed to work but when I opened my eyes, we were hardly any closer than when I closed them. The swearing and self-deprecation continued throughout. I also came to realize that eventually I might be faced with even more pain while my arm was being put back into place.

Tina parked near the emergency room entrance in a handicap spot and put her placard (which she keeps in her purse) on the dashboard. The waiting room was relatively empty when we arrived and I was admitted immediately. After standing in the admission office for a few minutes (I was afraid you sit because I didn’t know how hard or painful rising from the chair would be), we were walked to a room with a bed on which I sat to be evaluated.

It was quickly determined that x-rays would be needed. I was offered a wheelchair but I declined, still fearing the painful consequences of standing from a low seated position. We walked to the radiology room just outside of the ER where they thankfully had a downward facing projector which allowed me to rest my arm on the detector pad.

My actual x-ray

The x-rays showed that I had suffered a “simple dislocation” of the elbow which essentially means that there were no fractures. Obviously, that was good news but I knew that the possibility of more and greater pain lay ahead during the reduction maneuver that is used to restore the elbow to normal alignment. When the doctor told me that I would be “under” for the procedure, I immediately told him that I loved him. I was only half-joking.

When I awoke from the anesthesia (propofol), my arm was in a splint and a sling. When we checked out a short time later, the pain was considerably less and the events of the morning already felt like a fading memory.


It is now two weeks later during which time I have worn two splints and a brace but now my arm is free again. Physical therapy starts next week.

Dive

The sun bakes the brown skin on my back. I peer through a knot hole at the water below. The warmth feels good but I’m not here for the sun. I’m here for the water.

I place my palms down on the gnarled wooden surface of the dock and hoist myself to my feet. I quickly look around to assess the situation: Who can I impress? Who should I avoid? Who might I frighten with a sneak attack?

I face the shore and stand on the edge of the dock plank, balancing on the balls of my feet. Hands at my sides I take a deep breath and fling myself into the space beyond the dock.

The water is barely six feet deep so the dive must be shallow. Shallow dives don’t allow for much finesse but as I jump, I sweep my arms outward until they meet above my head just before I hit the water. I feel graceful and superheroic never considering that I may look less so.

The water is cool and murky green. My older siblings won’t swim here and some friends level charges of “runoff” and “swimmer’s ear” but I never believe them. This is my habitat.

With eyes wide open I immediately glide to the sandy bottom. I take massive strokes with my arms, inverting the motion I used in the air moments before. My hands pass in front of my face each time I reposition my arms for a new stroke. I feel all the power and grace my non-athletic body will ever manage. I know I am a better swimmer than my peers and that is a great comfort.

I swim silently, slightly above the sand, with no other thoughts in my head but suppressing my desire for air. Eventually that desire will overpower me but I know I’m one step ahead of my future self. When at last I can take no more, I will begin the ascent to the surface, forced to continue swimming by virtue of my position at the bottom. This, I know, will give me an advantage in future underwater swimming contests, should they ever arise.

But none of that is necessary for this dive because the shore arrives before my air supply dwindles. I take one final stroke and glide into the shallow water where it is no longer possible to hide my awkward body from the world. When I can go no further, I raise my head above the surface, taking care not to stir the water unnecessarily or to make any gasping noises with my first breath.

I linger briefly in the shallow water, feeling my body float effortlessly while my belly rubs slightly against the sand. I revel in the moment. I know I belong here. I long for the rest of my life to be this effortless.

Dedicated to Mary Lou, 2016.08.21

Letter to my Uncle Lorell who is dying

September 3, 2011

 

Dear Lorell,

When I was a kid there were few things I liked more than going to my uncles’ farms. Being a “city slicker” (as my classmates often called me), the farm was a completely different world to me. When I visited my Uncle Merlin’s farm it was mostly about hanging out with my cousins who were close in age to me, but when I visited your farm, it was always about you and I spending time together. That is a gift that I will always treasure.

One time when I was there “helping” you, we tried to take a dent out of the local rat population. I’ll never forget when you lifted up a piece of plywood (or maybe it was corrugated tin) that was laying behind the big machine shed. The plywood was laying on a small pile of corn and when you lifted it, it revealed several rat “tunnels” and the rats inside them. I was surprised but you were not because you had a gun and started shooting the rats as they scurried away. Guns, rats, tunnels – everything about being on the farm was so cool.

You’ve always been there. You were at Grandma Christensen’s for all those Christmases with the toys in the bedrooms and the money in the envelopes. And you were at Grandma Ring’s for the oyster stew. I remember sitting in that little living room watching Vitas Gerulaitis play tennis and you laughing when I joked that his name sounded like a disease. Harold was there. And my dad. And Gene.

So many memories I have of you and so little time to tell you about them. You kept your golf cart in Grandma Ring’s garage. You drove that giant green Cadillac. You visited me at my first house in Portland. Remember? You got lost and I told you “find the first bridge you see and cross it.” I was so sad to spend what I thought would be our last birthday together three years ago but now I’m so glad that you have had three more years in this world. I’ve never had a birthday where I didn’t think of you. And I never will.

As I sit here with all these thoughts and memories swirling through my head, I’m desperately trying to figure out how to end this note to you in a meaningful way. I suppose that life mostly doesn’t come to an end in a dramatic or meaningful way so perhaps I should just end this by saying that I thank you for your many kindnesses towards me over the last (almost) 45 years and that I think you’ve been a good uncle and a fine man. I also thank you for my double cousins without whom my life would be lesser. I hope that you reach the end of your days peacefully and without regret. And I love you.

Mick

Sex, Drugs and Rock ‘n’ Roll

If you were a teen in the 80s like me then you probably remember the short-lived sketch comedy series, Fridays, on ABC. Although it only lasted two seasons, it left an indelible impression on my young brain.

Sadly, a DVD release of those two seasons is reportedly held up by Michael Richards. Luckily, YouTube has most of their great sketches including the ones I’ve included below the fold:
Continue reading “Sex, Drugs and Rock ‘n’ Roll”

Page 2: In Which I Explain My Life To The Class of 1985

I’ve been in Portland since 1990 after a short detour to San Diego after graduating from Wartburg. I met and married my wife, Tina, in 1992. We have two awesome boys who dictate how we spend most of our time. Both are very active in Boy Scout Troop 820 (troop820.org) and both play the double bass in the school orchestra after converting from the cello.

Graham is a nerd of the first order and thinks I’m the coolest nerd on the planet. He loves to play video games on our Xbox and Wii but is enthusiastic in almost everything he does — even when I enlist his help in yard chores. Since he was a baby we have known that he is strong-willed and joyous. He’s also very intelligent and somewhat arrogant about that fact, regarding it as a fact of life that he’s smarter than everyone else. I’m trying to work that out of him.

Thomas is more reserved than Graham and less likely to risk looking uncool. A year ago I helped him buy his first electric bass. Since then he has learned to play all of his favorite sons and a few “classics” that I asked him to learn. He can also has pick up Tina or my guitar and play them much better than either of us. In many ways he’s very much like I was at that age: long hair, quiet except with friends, stubborn and often inconsiderate. He’s also very smart but not always willing to work hard for great grades.

Continue reading “Page 2: In Which I Explain My Life To The Class of 1985”

Note for Neighbor with the Black Lab

Dear neighbor:

I am surprised that your dog is still running free and pooping on my and Walt’s yard. You know Walt? He lives across from me and is 85+ years old. He also does not enjoy having to clean up your dog’s poop. I asked him because I wasn’t sure if it was just me. It’s not. NOBODY LIKES BEING POOPED ON.

I say “surprised” because my wife had already told you that we did not appreciate your dog pooping on our lawn. But still he runs free. It appears that you are either too dim or too insensitive to understand her request. Let me make it clear:

WE DO NOT LIKE BEING POOPED ON. Until this point we have not even investigated our legal and civil options. Please do not make us go that far. I have faith that there will be some recourse available to us that will make your life more difficult than it is now. Let’s just stop it here and you leash your dog. Or keep him in your fenced back yard. I don’t care as long as he is not in everybody else’s yard.

Also, I could not be happier that you want to go on walks with your dog. I encourage it. I also would encourage you to have evidence visible that you are prepared to clean up after your dog.

In conclusion, let me just say that you likely know that your behaviour has not been acceptable. If you didn’t know that, you should now. This is what society expects.

Reverse Baader-Meinhof Syndrome

Part One
Some time ago I renewed my subscription to Netflix in order to utilize their streaming video service which is offered “free” to all their subscribers. The service is nice but the selection of movies available to Watch Instantly (their term for internet streaming) is a very small subset of the movies that they have on DVD. Because I’m interested to know of any additions to this subset, I subscribe to their RSS feed for New choices to watch instantly. With that subscription I receive notification in my web browser whenever a movie is made available for Instant viewing. This morning there were approximately 20 new movies available which I quickly scrolled through, clicking open a new tab for each that interested me. One of these was Yojimbo by the legendary Japanese director, Akira Kurosawa, who also directed the seminal Seven Samarai. After reading the description, I clicked the “Add to Instant Queue” button to save it for later viewing. Whenever you add a movie to your queue on Netflix they suggest 10 more related movies that they think you might like. This time, they showed me these (click to enlarge the image):

Netflix Choices

My eyes were immediately drawn to one of the movies on the bottom and in the middle, The Beider Meinhof Complex. The name was somewhat familiar so I read the description but it didn’t interest me so I closed the window.

Continue reading “Reverse Baader-Meinhof Syndrome”