Month: September 2008

Sunday morning, around 1am, I got nailed by a crushing headache.

Unlike my migraines, this started in the back of my head, right by the place where your spine goes into your skull. It came out of the blue, with no warnings, and no sudden escalation – it went from not being there, to being there, in full-on agony.

It felt like someone stabbed a screwdriver right in that little gutter between your skull and your spine, pointing upwards towards your forehead, and was wiggling it back and forth. The back of my head felt flush – hot even, though it wasn’t hot to the touch.

Now, I’ve seen Six Feet Under – I’ve done tons of work on my migraines. I know this is a bad thing, potentially a really bad thing. I iced the back of my head, popped some advil, and after about 20-30 minutes, the pain faded to an ache, and I was able to go to sleep. I was not prepared to do a midnight trot anywhere, but determined that I would call my doctor in the morning. I did. He is booked until November.

Sunday was headachey, but nothing that a couple advil coudn’t cure. The whole day, in the back of my head, by the dull ache, was this little demon of doubt jabbing at me muttering “Looks like coital headaches finally caught up with the rest of your migraine symptoms.” (There is a large crossover in population in recurrant migrane sufferers and coital/orgasmic headaches). I didnt want to think about it. Considering it made me queasy. When I’d start to agitate myself into nausea, then the demon would stop for a second or two, and whisper: “Maybe you had an aneurysm” (nausea is often a sign). Sunday I went upstate to visit my sister, and it took me like 2.5 hours to get home thanks to Sunday night traffic. If that didn’t make me pop, I can’t imagine what would.

Yesterday, I still had a headache. Not bad, but there – persistent.

I called a neurologist. My neurotic side was getting the better of me. My intution and sense of self-diagnosis is not coming from someone trained as a medical professional. Sure, Ive read a lot of the same literature, but I haven’t seen cases in the wild, I haven’t crammed procedures into the end of a slee-deprived 36 hour shift, I might be missing something. Something this doctor might see.

He sucked. He basically agreed that it seemed unlikely that I had an aneurysm, but, since I was now his malpractice liability, he suggested that I go get a CT scan, and a spinal tap. I should have known that he would be a waste of time when I started the interview. He didn’t have a computer. He used a fountain pen, and had to have his secretary make a xerox. He’s probably in his late 50’s. When pressed, he admitted that the only reason he was prescribing this course of action was due to insurance liability. He further went on to admit that a spinal tap, on me, was going to be hell on earth (my spine isin’t exactly cutaneously exposed), and that I should probably go for a Radiologist and a fluroscopy. When I asked him if he thought they would have one at the ER that I would have access to, he shrugged, and told me to ask the attending. I never saw the attending.

For those not in the know, if you’ve had an aneurysm, a CT scan catches it about 90-95% of the time. At the location I’m describing, with the size of my vascular network, I’d be happy to bump that north a percentage point or three. The spinal tap? That is for the remainder. Honestly, it is to prevent malpractice. The methods of detecing aneurysm haven’t improved much, at all, since someone figured out you could catch them on a CT scan.

So, this doc, who I picked because he was close to my office, and could see me same day, has a relationship with St. Luke’s Roosevelt. He calls the ER ahead of time, and tells me to do a walk in. I got to the ER ~ 6ish.

The ER was a total nightmare. Filth, disarray, disorganization, short tempers, too many people, nobody knowing what they were doing. I finally saw a doctor at about 8:30. She went through the same song and dance I went through earlier. If I had an aneurysm, it is the most localized one at the base of the brain stem in the history of diagnoses. I ask her how long it will take. She shrugs, and says she can’t tell. I know this is hosptial doublespeak for, “If I tell you, you’ll kill yourself with that speculum cord.” I ask her to nod if she things, not professionally, but personally, if she thinks it will be more than four hours. She nods. I ask six hours, she nods again. She didn’t nod when I said eight.

It was around that time that I found out that the woman in the bed across from where they had me sitting next to a hamper of pee-soaked sheets, had been waiting for a chest x-ray since 1pm. She checked in at noon.

The only reason I didn’t go there yesterday was because this local crackpot luddite neurologist made it seem like he could work the system from the inside. By work the system, I think he meant he was sleeping with one of the orderlies or something, because there were about five times as many of them as there were nurses – I only saw a doctor once in five hours, from far away as she tried to convince an elderly Chinese woman (through her translator) that she was pretty sure that the elderly woman had had a mild heart attack, and she should stay to be tested. The old woman was tired of waiting. She said she had been there since two, and it was more than a day since she had her problem – if she wasn’t dead already, she didn’t feel like she needed to wait to die “in a place like this”

I hate hospitals, I loathe doctors, and can’t stand Emergency Rooms. The admixture of the desperate sick, young ideaologicals, and neglegent wealthy _makes_ me sick, even if I’m not in the ER for myself.

I was not asked to be registered as a patient until 9pm. At that point, I had been in the hospital for three hours,with a call-ahead from a dcotor, saying I was at risk of death without an investigative procedure.

I checked myself out against medical advice. My chances are very low, and, if, in the worst case, I need something operated on, I don’t want it done there.

I’m feeling much better today. Part of me wants to ignore this whole thing. Part of me wants to take a cab over to NY-Presbyterian and get it done there (which is where I normally do my neuro stuff). I’m stuck between what I see as a calculated risk, and subjecting myself to the belly of the healthcare system again.

Mostly, I just want to go home and drink.
Best-case, this was a one off.
Mid-case, I have to deal with a chronic sitation which is worse than most STD’s in terms of how it affects the psychology of sex.
Worst case, I won’t wake up some morning.

My gut is telling me to take my chances, and ignore the local hack. Ignorance, in this case, may be bliss.