Life event logged by Martin Christen
To my dear friends and relatives,
For those who haven’t heard yet: Early in the morning on Sunday, March 21, 2010, I was admitted to the University Hospital Zurich due to a brain hemorrhage and spent a week in the intensive care unit. Following a rapid recovery, I was discharged back home on Wednesday, March 31. However, I am now signed off work for a month and am currently trying to recover from the stress this has brought with it, as well as digest the diagnosis of a “cavernoma.”
So, that was the short version. Now for a bit more detail:
On Saturday, March 20, I had a PC support case at home that I wanted to work on quietly for a few hours. Over the course of the morning, I started wondering about the way my body was feeling; specifically, I felt a tingling sensation in my left arm as if it had fallen asleep, and I also had an indefinable headache. In hindsight, I am not sure how I got through the day, only that at some point my wife sent the client home with her laptop still not fully repaired. This is because my memory blanks out around midday. My wife told me later that I became increasingly confused and gave strange answers. For instance, when asked who had visited us that day, my answer was “Spring.” Which, of course, was true in a way, as the weather had been very spring-like. But the answer was still rather bizarre. Later, around 9 PM, my wife called the ambulance, and from that point on, things moved reasonably fast.
The paramedics took me with them—after first taking their time to admire my sweet cat—and brought me to the hospital of my choice. Since I had been to the Stadtspital Waid before, I would have expected to be admitted there, but apparently, I explicitly requested Triemli myself, so that is where they took me. Upon arrival there, I reportedly said, “How lovely, finally at Waid…” But regardless, I was of course cared for and examined at Triemli (head MRI), and they soon realized that the University Hospital would be better for me because they had specialists there; I had a cavernoma that was bleeding. So, the same paramedic crew transferred me over to the University Hospital, where I arrived on Sunday morning around 4 AM. There, I was extensively examined once again. Apparently, I was responsive the entire time, though towards the end, I am said to have withdrawn more and more.
The situation seems to have played out roughly like this: The cavernoma, which I have probably had since childhood but knew nothing about until now, possibly bled a little early Saturday morning for unknown reasons. Because the cavernoma is located deep within the brain, the clotted blood blocked a passage for the cerebrospinal fluid (CSF). This, in turn, caused the pressure inside my brain to rise, as the constantly produced CSF could no longer flow freely and therefore could not be reabsorbed. The increased intracranial pressure then led to failures in my short-term memory and, later, my consciousness. After a few days, the clotted blood dissolved on its own, the passage cleared up again, and my short-term memory regained its functionality.
With that last sentence, however, we are getting a bit ahead of events. First, the increased intracranial pressure was diagnosed, and my wife was informed that they would likely need to drain cerebrospinal fluid from me, which would require drilling a hole in my skull. By Sunday morning around 10 AM, this had been done. At that point, I had a tube with a drainage valve in my skull, allowing the unabsorbed CSF to be drained at any time. And, naturally, I was now in the intensive care unit under constant monitoring. According to my wife, a total of more than one liter of CSF was drained over the next few days. Apparently, especially at the beginning, they were very afraid I might fall into a coma. In any case, they didn’t let me sleep but woke me up at least once every hour. However, I was supposedly very responsive the entire time; people could converse with me, and I even cracked jokes. That being said, I also repeatedly asked why on earth I was in the hospital, listening patiently to my wife’s explanations each time. But half an hour later, I would ask the exact same thing again, unable to remember that she had explained everything to me just moments ago.
Over the course of Wednesday, my memory kicked back in. From that point on, things no longer had to be explained to me multiple times. And when I recognized the first nurses again (on Thursday), they were absolutely delighted by the improvement in my condition. From then on, my recovery progressed rapidly. On Thursday, they stopped draining CSF through the valve in my skull and only monitored it to ensure the intracranial pressure didn’t rise excessively. When that went well, they knew the CSF reabsorption was working again, and on Friday, they removed the valve tube from my skull. On Saturday morning, I was discharged from the ICU to a regular ward. Nothing further happened over the weekend, nor on Monday unfortunately, except that I felt great again—intellectually and physically just about as well as I had ten days prior. On Tuesday, however, the chief physician explained to me in detail what had happened and was pleasantly surprised by my progress. Now it was a matter of what comes next.
In principle, he spoke about a multi-week stay in a rehab clinic being standard after such an event. This is because there are frequent cases where someone is left partially paralyzed or unable to speak afterward. In my case, however, fortunately nothing of the sort seemed to have occurred. But he wanted to wait for the occupational therapist’s report first. She came to see me a short time later and essentially conducted two exercises with me. One was about memory retention (she read out about 20 words to me like “horse,” “chair,” etc., and I then had to repeat what I could remember. She did this with me several times, and each time I could recall more items and, at some point, structure them better by forming groups like “animals,” “furniture”). She was very pleased with me. Then came a logic task. Different types of lines were assigned numerical values (straight line = 2, angle = 4, diagonal line = 6 points), and I had to calculate the correct numerical sum of several line constructs. I laughed at the therapist and told her I was an IT specialist and that this wasn’t a task to be taken seriously for me. I asked if she had something more difficult. Then I got to work, and she noted appreciatively that I didn’t make a single mistake. My cognitive faculties seemed restored at first glance, and she said she would recommend a discharge. Rehab did not seem necessary.
Back with the chief physician, he agreed that nothing stood in the way of a discharge. He simply wanted to see me again in about three months; then they would have to examine my head thoroughly once more to assess the future outlook. In the best-case scenario, the cavernoma dissolved on its own with this hemorrhage. In the worst-case scenario, further bleeding could occur. Then an operation would have to be considered, but since my cavernoma lies quite deep in the brain, it would be better if that could be avoided.
So, I have a gap in my memory that stretches roughly from Saturday noon to Wednesday. But I know for a fact that I was excellently cared for during this time—first and foremost by my wife, but also and especially by the doctors and nursing staff at Triemli and the University Hospital (Department of Neurosurgery). Now I am home and realizing that I am very tired and want to sleep a lot. Evidently, the time in the hospital was more stressful than I thought. It is only slowly sinking in just how lucky I have been in this whole matter.
I would also like to thank all those relatives and friends who visited me in the hospital. If that visit was before Wednesday, I am afraid I simply cannot remember it…
Postscript from April 1: After my discharge yesterday, I had a significant headache today. I wondered whether it heralded a new hemorrhage or was just “normal” head pain. Because of this, my wife called the USZ (University Hospital Zurich). The response from there was that I had to come in “immediately(!)”, which I did. As soon as I arrived, they did a new CT scan and explained shortly afterward that there was no reason for any emergency measures. The CT looked good, the ventricles in my head had gone down in swelling again, and I didn’t need to worry about a recurring bleed. For the headache, I could take the usual remedies, such as Dafalgan. That sounded extremely reassuring. I went back home, took two Dafalgan, and have had peace of mind ever since.
Postscript from April 16: Today was a follow-up visit with the treating physician. Last Friday, I had been called in for an MRI, and today the doctor wanted to explain the state of my head to me. The news is very good. At the site of the hemorrhage, only a tiny, pitiful remnant of blood (perhaps the size of a pinhead) can be seen. Everything is healing well, and a cavernoma is not visible at all. In his opinion, there may never have been one there in the first place, or it dissolved itself through that single bleed. In about 3 months, however, he wants to have another MRI done for a definitive assessment.
