Breathe

There was relief all round that I had made it through the op. I still had a cracking headache and felt grim from the anaesthetic, but my 'Annie' had been coiled and had no more chance of rupturing. There was however a chance of Vasospasm.

Vasospasm is a complication of SAH. It's the narrowing of the arteries in the brain - vasoconstriction which could lead to a stroke. This typically appears 3-10 days post SAH. That meant to me, four hourly Nimodipine for 21 days. Starting at 10am, 2pm, 6pm, 10pm, 2am and 6am! See, zero chance of sleep. To help avoid vasospasm I also had to have 3 litres of fluid. I was thirsty but not that thirsty!

Mum and Sally came to visit me. It was so nice to see them looking relieved. Sally had become my PA and kidnapped my phone, redirecting all messages to her. I needed to rest not be on my mobile all the time. 

My blood pressure wasn't great. That meant a higher risk of vasospasm. I was put on IV fluids to get my blood pressure up.

I dozed continuously in between drug rounds. On Monday night I was awoken my the nurses. My oxygen saturation level was too low. I was sleeping, I didn't know I was short of breath! The on-call doctor was called to see me. I couldn't catch my breath. He ordered a portable chest x-ray which showed I had some consolidation in my right mid zone. I was started on oral antibiotics and kept on nasal oxygen. 

The next day I was coughing up something really unpleasant. I had more IV fluids going through to keep up the pressure, but that night I deteriorated.

I'd been overloaded with fluids and could hardly breathe. 

'We need to transfer you to the High Dependency Unit (HDU) to be looked after by the team there', the on call doctor said. 

An Intensive Care consultant came to see me and agreed. I was transferred straight away to HDU.

It was about 5am when I arrived on HDU. They put me in a side room and I was taken over by nurses and doctors attaching things to me, taking my blood, trying to make me better. I needed another arterial line inserting into my wrist. Four attempts later and it was in my left wrist. The next thing needed was a central line. I'd seen them being inserted at work. This was the most painful thing i'd ever experienced. The pain was different from the bleed because of how uncomfortable it was. The pushing on to the right side of my neck, nope failed. The more senior doctor was teaching the registrar. This was no bloody time for teaching, I was in agony. 'Just do it yourself' I was saying in my head, squeezing hard on to the hand of a nurse, faceless, as i lay there under the sterile drapes. I was crying now, I wanted my mum, this was all too much. As the doctors failed for a second time, I asked them to stop. I needed a break, I needed to sleep.

Ceilings

I've always been a very reactionary person. If you'd have told me I had a Subarachnoid Haemorrhage (SAH - way too much typing otherwise), i should have screamed and cried, because I knew through my job as Radiographer that it's a life threatening illness. Instead I asked to read the report of my CT scans. I detached myself from me as the patient to me as the medical professional. I was calm, a little bit tearful, but otherwise not Jane. I read the reports, photographed them on my phone and sent them to Audrey ( a Consultant Radiologist) so she could get a Neuroradiology opinion. I'd gone into work mode. Whilst my mum called my sister with the news, I updated close friends on the situation, who were all shocked at my diagnosis. 

My nurse gave me Nimodipine, a drug for my bleed and some Morphine for my pain as he prepared me for my transfer to Queen's. Shortly after, my sister Sally arrived - She looked brave and was trying not to show how upset she was. She had been talking to the Paramedics who were waiting to take me to Nottingham. I was transferred on to the ambulance trolley, wrapped up in blankets to protect me from the cold and strapped in to stop me from sliding off. Out of the ward doors and straight into the cold December night air, I was put on the ambulance. I said goodbye to Mum and Sally who would meet me at Queen's.

Surprisingly I was cold inside the ambulance despite heating. Rosie, the paramedic inside the ambulance with me was explaining everything to me. I was nicely sleepy I remember from the morphine, but she kept talking to me to keep me awake. The ride was bumpy, and the sirens blared every time we got stuck in traffic. I don't really remember much else, except how cold it was when we arrived at Queen's. I do remember how yellowy bright the corridor ceilings were. It reminded me of those films where you see it from the protagonists perspective - Serpico when he's being wheeled into the ER after being shot....

I was being taken to Ward D10 - female Neurology, and as I arrived on the ward, the paramedics handed me over to the medical and nursing team. Another ceiling to look at and more faces connecting me up to IV fluids, a blood pressure cuff and a pulse oxymeter. The neurosurgeons examined me,  I was Kernig's positive that's all I remember. I briefly spoke to my mum and sister, and then I was left in the hands of D10.

If you have a SAH you don't get to sleep. Neurological observations have to be performed frequently and Nimodipine is to be taken every 4 hours (for 21 days no less!). I was awoken in the morning, given a bed bath, not given breakfast and informed of my treatment plan. Another CT scan and then depending on the result, I would have surgery in the next 24-48 hours. 

After another CT angiogram and I was visited by an Interventional Neuroradiologist,  Dr Crossley. 

'You have a SAH and an aneurysm of your Anterior Communicating artery.'

'There is a 1 in 3 chance that your aneurysm will rupture in the next 48 hours, so I'd like to operate on you this afternoon.' 

There isn't really a lot you can say to that kind of news apart from 'OK'. I signed the consent form, and reeling from the list of complications, I lay there wondering why this had happened. I didn't have high blood pressure, I didn't smoke, I was the fittest I'd ever been. This was seriously not in my life plan.

Mum and Sally arrived, this time with my Dad who had come down that morning from Yorkshire. Dad looked solemn as if i'd already died. Sally was calm and was updating me with news from my friends. Mum looked worried and sad. I told them the plan and that I would be having my operation sometime in the afternoon, when the theatre porters arrived to take me for surgery. Mum followed me down to the theatre entrance and then I was whisked into the Interventional Radiology theatre.

A different ceiling.

I was surrounded by new faces all wearing scrubs in a nice shade of green. They all introduced themselves to me. It all felt too surreal. The anaesthetists were lovely, especially the consultant who had a really lovely manner, she could tell how frightened I was. Her registrar was carefully putting an arterial line into my left wrist so my blood pressure could be measure during the embolisation - hell it was so painful!  Dr Crossley came and chatted to me and then it was time to start. The remifentanil went in, the oxygen mask placed over my face and the last thing I remember was saying 'please don't let me die' as they were putting me to sleep.

I woke up in recovery. It's all a blur. Oxygen mask, neuro obs, memories of conversations about me and my condition. There had been complications, but overall a success, and I was alive and could talk. 

And so it began....

I hadn't expected 2015 to start like this.
A month before Christmas I'd returned from a once in a lifetime holiday trekking in the Himalayas. I'd left my job as a Radiographer to become a University lecturer. I was at my happiest.
It was literally just as medical books describe it. A 'thunderclap'. It was just after 2am when the headache woke me up on December 27th 2014. My hands cradled my head to try and relieve the pain, but it didn't help. The pain was excruciating and for the first time in over 25 years I cried out for my mum. She came and tried to calm me. I took some paracetamol and ibuprofen but as I had a winter cold the pain was exacerbated every time I coughed. I managed to sleep but on waking again my head felt worse. The sun poured through my curtains and it hurt my eyes. Photophobia I thought or was I just imagining it and thinking it was worse than it really was. To cut to the chase, after speaking to NHS 111 we drove to the Royal Derby Hospital to be seen at the A&E department.
It was the first Saturday after Christmas, there was snow and ice everywhere and the waiting room was packed. I felt like a fraud, yet I knew I needed to see a doctor. I booked in and sat amongst the broken limbs and coughing, still holding my head to stop it falling off.
A male nurse called me through to triage. He didn't introduce himself, he was grumpy and clearly thought I was wasting NHS time. He made me stand up and stamp the floor to see if it made my headache worse. No shit Sherlock, that did hurt. He had no time for me, offered me no pain relief and I was to take a seat in the waiting room. The receptionist I'd seen kept looking at me, she could see my discomfort. A female nurse called my name and I was taken through to the minor treatment area where she did a set of observations. At last a doctor called me in, took my history and examined me.
My neck was stiff, I couldn't put my chin on my chest, and I was increasingly photophobic.'You'll need to stay in overnight. It's probably Viral Meningitis, but given your symptoms and your age, I think you should have a CT scan and a lumbar puncture to rule out a Subarachnoid Haemorrhage.'
I felt a sense of relief. It was probably the former and I wasn't wasting NHS time. I sat and waited to be admitted to the Medical Admissions Unit (MAU). As my pain got worse I was transferred to the major treatment area, put on a trolley and given some codeine for the pain. An hour passed, more observations taken and I was taken for the CT scan. This was weird. Eighteen years of scanning patients in A&E and now I was on the other side. It was quick, the radiographer gave nothing away, just as would have been, and I returned to my cubicle. It was normal I said to myself. About 45 minutes passed when a different doctor came in to the cubicle. I needed to have another scan with contrast. Immediately I panicked, this meant there was an abnormality. I questioned him furiously, but he just said they wanted a clearer look at the Circle of Willis. I needed a cannula inserting and a nurse and the doctor attacked me from both sides searching for a vein so I could have a contrast scan.
Back to the scanner and the radiographer gave me the same explanation I had given patients about the feeling of IV contrast. I lay there waiting for the hot feeling in the groin and the metallic taste in my mouth. Wow! I was not expecting the intensely hot feeling sensation in my body, and the warmth in my groin really did feel like i had wet myself, no wonder some patients didn't like the experience! Back to the cubicle my mum had been joined by a nurse waiting patiently to take a set of blood samples.
Time passed with no results from the scan.I'd been there over 5 hours. I was blocking a space in major treatment so I was wheeled off to MAU to wait for an available bed. Lying on my trolley in the corridor another doctor came to see me amd my mum, who'd waited with me all this time.
'So you've had the results of your CT scan then' he said.
'No' i replied, 'what's wrong with me?'
'i think we should go somewhere more private'
'No tell me now, i've got an aneurysm haven't i?" i said.
'Yes' he replied......'We need to blue light you to Queen's at Nottingham to see the Neurosurgeons".
The next bit is all a bit vague to be honest. I think my new relaxed post Himalayan mindset went into shutdown and shock kicked in. I was way too calm.  I was transferred to a bed and then my body was taken over by the nursing team. I needed to lie flat, be catheterised, have another cannula inserted and be given a special drug. I managed to send a couple of texts telling my friends what was happening. I called my friend Rachel. She said it was nothing to worry about, and that the headache was just because of my cold. My friend Audrey replied to my text and asked if i'd had a bleed. They'd have told me surely i thought, so when the doctor came back at which point I asked him.
'Yes you've had a Subarachnoid Haemorrhage'.
And so it began.