A Tale of Two Brain Lesions

It was near the end of a long shift and  after plodding along for 10 hours or so we would run the printer on each monitor to obtain a strip for the medical record. I always believed random and routine collections of patient data had limited usefulness, but that's what the bosses wanted so I happily complied.  Suddenly, something strange happened, as I looked up to the waveform on the monitor, it looked like there were 2 or even 3 waveforms plastered right on top of another where I knew only a single waveform could  be  present.  This caught me completely off guard and I began to attribute the multi-waveform  apparition to my end of shift fatigue or some sort of whacky monitor artefact-not likely- but it seemed like an easy explanation. That little voice in the back of my head spoke up and said, "Nothing serious..probably just a brain tumor..he..he."

 As I went about my care, I noticed the monitored patient was lying there  intently listening to a CBS news report and anchorman Dan Rather was in a somber mood relating the story of  Lee Atwater, the head of the Republican National Party. He collapsed  at a public appearance and was subsequently diagnosed with a brain tumor. He was receiving radiation implants and all the latest modern medicine had to offer for such an ailment at  the prestigious Montefiore Hospital in NYC. I made a mental observation to myself that rich people always get state of the art care. I  never used much in the way of healthcare services but doubted I would have access to Lee Atwater quality of care if I was sick. Some people have all the luck.

Lee Atwater was ahead of his time with various political spin jobs  and even fake news. After elucidating the fact that one of his opponents had mental health issues a story was spun that eletro shock therapy diminished his mental capacity. During his illness Atwater found God and joined the Catholic Church. He made frequent biblical references and later it was discovered his Bible was sealed in a presentation box and never opened. Atwater kept  making his pitches and spinning right through an illness that would likely  be a terminal event. Some habits are tough to break.

As time went on more strange things began happening to me. One day I found the back passenger floor of my Subaru littered with 7 or 8 cans of NEHI non carbonated lemonade. I was a Diet Coke person and it was a complete mystery how these empty lemonade cans got there. Maybe someone broke into my car and left their Lemonade cans behind. I didn't even like the stuff.

 Then late one night on the way home from work I had an epiphany while feeding quarters into a vending machine at an out of the way K-Mart in a not so nice part of town. It was me with the Nehi Lemonade consumption. I suddenly developed a craving for NEHI Lemonade, but had no memory of purchasing this  mythical beverage. At least  I discovered how those empty beverage cans found their way to the floor of my Subaru. Oh well..chalk it up to rotating shifts and too much stress. Life sure can be strange.

A couple of weeks later things got really crazy. I began having very vivid visual perceptual distortions. When I looked upward, it looked like I was in a blinding  snowstorm. A really bad blizzard like distorted vision that occurred primarily while driving. I gave myself a mental pat on the back and remember thinking; that's one good reason for leaving the snow tires on all year. This was taking place at the end of June in Pittsburgh. I knew I was in deep trouble because it does not snow in Pittsburgh in June. That thought about snow tires failed as a rationalization for my newly acquired blizzard vision.

Another symptom began driving me nuts (or nuttier than my foolish baseline) and that was itching like I had never experienced. I tried self medicating with Benadryl without much luck. Soon I was totally disoriented and had no idea where I was at.

I don't know how I wound up in the ER of a big academic trauma center. There was  no obvious trauma although there certainly could have been with me driving around in such a befuddled state. I owe a huge debt of gratitude to whoever delivered me to the hospital. I related my complaints about having blizzard vision to the youthful ER doc and soon I was having blood drawn for toxicology studies and promptly admitted to the inpatient psychiatric ward-they had a lot of beds in psych and probably needed the business. I remembered Dr. Slambow, my favorite surgeon always saying that I was a bit different from others, but that's what made me such a good scrub nurse. I guess he had a valid argument and I was coming home to roost.

The psych ward was very nice. I had a private room and the nurses were all pleasantly chatty with chipper attitudes-so different from my sourpuss co-workers in the OR. Just when it seemed like everything was going to be OK a profound sense of tiredness came over me. The cheerful  nurses quickly shed their perky demeanor and quickly  called one of the psych residents who  had an explanation, "The toxicology reports came back and he had a trace of Benadryl in his blood." No fooling! I was itching like someone in the middle of a poison ivy patch and admitted to taking Benadryl. It was more than 25mg. of Benadryl clouding my sensorium.

As my consciousness was  quickly sliding off to LaLa land I noticed an agitated figure standing at the foot of my bed. It was a neurology attending physician and he was not too pleased that I had been admitted to the psych ward.  He ordered a STAT CT scan to be followed by an MRI if the CT was negative. Back in the early days of MRI they called them NMRIs (the N standing for nuclear.) The  neurologist was now apparently in charge of my care. Just when I was beginning to appreciate the perks of a therapeutic milieu on the psych ward, I was slapped unto a Gurney and transferred to the not so pleasant  nuero/neurosurgery floor complete with overworked nurses and overly serious physicians. I liked the psych floor so much better.

The CT scan was normal, but a spinal tap showed traces of what was thought to be an old bleed. The neurologist wanted my head inside that NMRI machine pronto. My next recollection was being stuffed into that long skinny sewer pipe of an NMRI machine. This is certainly cozy I thought as my shoulders scraped the bore of the tube. If I happened to be any wider they would have needed some melted butter to slide me in. The various booming and banging noises reminded me of a motorcycle ride and the tight quarters were just like some of the caves I squeezed myself into as a youngster. The NMRI was turning into a fun little journey down memory lane.

The fun was turning out to be short lived as I was aware of a rush of people into the room. When people started rushing into the OR to see something, it was not a good sign. I figured the same principle applied to NMRI rooms. Here we go again, I thought. Trouble  on the horizon.

Sure enough I had an "impressive"  NMRI according to the down in the dumps neuroradiologist. I remember thinking, maybe you are impressed, but I'm depressed."  What seems to be the problem I inquired and he blurted out, "You have multiple areas of T2 signal intensity in the periventricular area of your right occipital lobe. It looks like a stroke or tumor." That little voice in the back of my head was getting real chatty. "I'm dead meat."  it kept repeating.

I was beginning to regain some of my cognitive abilities and started getting cold feet at this hospital. When they began talking about an open brain biopsy, I asked them if they had heard of stereotactic head frames. They indeed were up to speed but only had CT compatible head frames and my lesion would not image on CT. I pulled my ace in the hole out and informed them I was transferring my care to the internationally known father of Pittsburgh neurosurgery, Dr. Robert G. Selker.

I had worked with Dr. Selker and knew him personally. I did not care for his ultra conservative politics but he was the best in the business. Dr. Selker reviewed my care and just shook his head. "They had you on the psych ward?" he asked incredulously. "That's just plain stupid."

Attempts at a stereotactic biopsy were never successful and Dr. Selker thought the risk of hemorrhage was greater than any benefit. I remember telling him to go ahead and give the biopsy  a whirl because I had 9 lives just like a cat. He thought about it for some time and said, "If that's true what's that pile of dead cats doing under your bed?" The biopsy was off and Dr. Selker said he was certain the lesion was a low grade glioma. "If I were to biopsy the lesion, it's going to come back a low grade glioma and I would not know what to do with it."

I was to have an annual MRI to follow the progress of the mass. The first few years there were small changes. When I had 2 MRIs that showed no change about 7 years after the onset of symptoms, I decided to stop seeing Dr. Selker.

Lee Atwater died in 1990 and Dr. Selker died in 2010. I managed to outlive them both. I guess I was the lucky one and neuro gods really do look after fools like me.  Sometimes good fortune trumps medical intervention.