The story relates back to my time as a patient in a German University hospital in 1990 after a significant head injury. The accident happened whilst working on my MD in the University virology laboratory. A probable “pain syncopy” with loss of consciousness resulted my head hitting the concrete floor. The impact caused an occipital fracture and several frontal contrecoup bleeds. Needless to say it was the start of a frustrating, but ultimately lucky, journey.
On the Other Side
That was the start of it. Running around like a demented ape. I have to get the experiment started before the scientists get going. Only another 30 minutes left. I’m not going to make it. Not at this rate. I’m slow today. Too much red wine last night. Aldi stuff, cheap and potent. I can’t imagine being a student without Aldi. Basically, I wouldn’t have the money to stay alive. Exaggeration!
Regardless, I turned up to work. With coffee on board. Lots of it. No food, just coffee. Who needs food? I’m walking along the corridor at a brisk pace, my ELISA plate in hand. Need to get to the plate washer. Not much further. Except, I run my elbow straight into the corner of a wall. It stuck out, damn thing. It hurts like hell, I struck the ulnar nerve. The pain is severe, but I just keep going. Along the lab corridor to begin the next step in the experiment …
Still Day Zero
My eyelids flicker, a guardian angel smiles at me. Or is it a nurse? I can discern a blue uniform and the empathic smile that occasionally comes with it. I’m in luck, I can see empathy.
Someone holds a kidney dish next to my mouth. I gratefully aim for the dish and deposit the contents of my stomach into it. Drool runs down my chin. The turmoil in my stomach settles for an instant only to churn more powerfully a minute later. What’s happened to me? Where am I? Why do I have an empathic nurse collecting my vomit – a mixture of bile and coffee?
I’m in motion now without moving my legs. It feels like I’m being wheeled around, lying on my back. My head is filled with empty space alongside nebulous recollections of past events. I’m unable to fill all the gaps. Retrograde amnesia. How long has it been?
It dawns on me, suddenly, like a veil lifted to reveal a truth, my truth: I’m on the other side! I’m a patient.
Lying in bed is bliss. The bed is still. It doesn’t rattle my brain. The worst so far has been the travel to and from CT scanners. My traumatised brain feels every tiny vibration of the stretcher rolling across the floor. A lumpy surface translates to major shockwaves through my head, followed by excruciating pain. Feels like blunt knitting needles inside my skull racing to knit a pair of mittens. It hurts so much I could scream my lungs out, but oddly, I can’t seem to want to. I’m annoyed, but can’t seem to get really annoyed. Where is my temper? I had it the last time I remember being me. Now, I’m feeling pretty relaxed despite the dreadful knitting needles inside my head. Damn it! What’s going on? A machine alarms. The sounds gets to me. I wish someone would come and turn it off. Some poor bastard is in trouble, I chuckle silently. I hear voices approaching. One shouts, “She’s down to 30. Get the doc!” A face hovers over mine, “Are you alright, love?”
“Yeah,” I whisper. I seem to have lost the volume control for my voice. Why wouldn’t I be ok?
An age later a man in scrubs leans over me to look at a machine. He takes my right wrist to feel the pulse. A smooth motion and all of it without even glancing at my face. What a slick bastard. He drops the wrist and mumbles to the nurse. Something like, “Normal in head injury … need to get the pulse up … could end badly.”
Someone is in trouble. Maybe it’s Loud Person in the bed next to me, who shouts a tirade of obscenities aimed at someone by the name Karl. Karl must have been a bad one. Someone you wouldn’t like, because Karl drank a lot and then he became abusive. Mind you, Loud Person is pretty abusive about Karl. I wish they would stop shouting because it really hurts my head.
I have learned something. When it really hurts badly, I can call out. All I have to shout is “Tramadol” and someone will turn up with a syringe. So, that’s what I do. I shout for Tramadol until some health care slave attends to my urgent wishes. And, it works so well. The pain subsides quickly. I have no idea if it is minutes or hours, but it goes. That’s all that matters. And with the pain disappearing, a feeling of calm fills me. It reminds me of the slogan “Keep calm and carry on”. It’s just like that. The drug works and I carry on. I look at the doctor, who inserts a large bore needle into my vein without so much as blinking. I remember, funnily enough, seeing these horrid things inserted into people’s vasculature whilst on elective as a medical student. At that innocent time I felt sorry for the patients and quite smug for not being in their place. And look at me now. Still, the Tramadol helps. I drift off to sleep wondering when my pulse will drop to 30 next. Will I know? Will I be conscious enough to realise?
Yeeha! I have finally made it off the neurology ICU. Discharged onto a “normal” ward. Only drawback, I’m in a six-bedded room. Good news is that only five beds are occupied. Bad news is that one patient is a Recklinghausen’s patient with limited ability to stay quiet. She’s about 40 and all exposed skin looks knotted. I imagine that the knots I see are mirrored in her skull-protected brain, because she is very erratic. I feel for her though. What a life! No one looks after her and she seems lost. She just walks around and occasionally shouts unintelligibly. Eventually, that gets the nurse’s attention. Not much else does. They are understaffed, I hear. That’s unlucky for my bed-fellow, a woman with multiple sclerosis. She hasn’t had a wash in days and her incontinence dampens both her bed and her spirits. I get pretty sick of Madame von Recklinghausen getting all the attention and my friend in the next bed lying in her own excretions. Not much I can do about changing the sheets because I haven’t got any spares, but I have soap and shampoo and water from the tap. I treat her to a soapy wash and a head massage with scented shampoo and conditioner. The newly fragrant world feels better for both of us for just a while. Actually, no. It’s only different for her because I can’t smell anything any longer.
The neurological “normal” ward is a thing of the past. I’m now on cardiology, but still unable to smell or taste a thing. No-one but me seems concerned about my total loss of olfactory sensation. They think my heart might be funny. Malignant arrhythmias is today’s speculation. Really? I never had any trouble before. I was just this ordinary medical student who drank too much, smoked too much, studied too much and didn’t have enough of a life beyond focus on the next exam. Heart problems? Not me. So, in comes a nice looking cardiologist to explain that I will have a cardiac catheter. Just a small procedure with only a small risk of a cardiac arrest. But, nothing to worry about, because, really, everything needed to deal with an arrest would be right there. The cardiac catheter would be used to stimulate my “His” bundle – amongst other things. I didn’t think my “His” bundle needed stimulation. In fact, it sounds really unappealing, but I sign the consent form anyway. What else was I to do?
The other two women in the room chuckle. They have had cardiac catheters before. One of them might need another one, because she has a hole in her heart. I don’t think she understands that’s bad news for her. Even after the doc spends half an hour explaining why the hole in her heart needs fixing, she is still not really worried. She quietly confides she didn’t understand a word the doc said, but what a nice man. What a waste of 30 minutes!
The cardiac catheter finds its way to my “His” bundle and I can almost literally feel my heart in my throat. A powerful sensation screaming to my already dodgy brain “something is poking around inside my heart and I might die”. I don’t like it, but eventually it is over and I’m still alive. My “His” bundle is exhausted and if I could scream for Tramadol, I would. Instead, I’m busy worrying about the heavy bag pressing down on my unhappy, pulsating femoral artery. I hear footsteps and I hear a tray rattle down beside me. I open my eyes, see food and smell nothing. Irrationally annoyed, I think “What good is food if you can’t even taste it?” I really don’t feel like eating. I feel like shoving the offensive tray off the table, like ripping the pressure bag off my thigh, like screaming and hammering my fists on the bed in a sobbing, childish tantrum. I wonder again if I could at least swap the tasteless blobs on my plate for some powerful sedative to let me slip into blissful oblivion where I might fantasise about a life resembling normality. My life, before I became a patient, my life as a high-performing medical student, a person with dreams and aspirations. I have been boiled away, condensed, reduced down to an injury, a condition, a syndrome. I’m a non-smelling, or is that tasteless, individual. My only remaining aspirations are not to bleed to death, not to vomit from the recurring dizzy spells and to tentatively wonder what it might be like perhaps, one day, to enjoy the scent of roses again.
Nearly there. Approaching discharge. About time or I might start killing people just for a bit of privacy. The smell-thing is troubling me greatly, but now for a different reason. I awoke this morning to find everything around me has the odour of rancid butter. The jury is out on olfactory hallucinations versus recovery of olfactory nerve ends. Perhaps I’ve learned to appreciate the lack of smell. Typical! The grass is always greener … I’m unsure if I should be happy to go home at last. What will I do? I can’t read a book for more than five minutes before dropping off to sleep. I can’t indulge on food and drink because now the rancid butter smell puts me off. I can’t run because I feel tired and my head wobbles on a scrawny neck when I take off the brace. Where to next?
25 years later
I haven’t been a patient since and I have no desire to be a patient again. I’m happy I have been on the other side though. A month in hospital as a patient taught me more than six years at medical school and I’m very grateful for it. My brain has healed … almost. I can still get tired easily and night shifts would not be a good idea. My sense of smell has improved, but never to the pre-head injury standard (which was pretty good). Still, there is the advantage of breathing easy when changing stinky nappies, mopping up vomit, or even working in microbiology when the anaerobic jar is opened. There is always a silver lining.
– Anja Werno, MD PhD FRCPA
Anja is the Medical Director in Microbiology at Canterbury Health Laboratories, Christchurch and ASMS branch president for Canterbury. “On the Other Side” is Anja’s second contribution to The Medicine Stories Project.