Background
My husband is 30 years old, fairly fit, healthy and active. He works in IT as a Cloud Technology Consultant. We have been together since 2005 and have been married since Jan 2012, we have a 4 year old labrador.
Dom was born in Southern India and migrated to Australia in 2000. In 2011 he was diagnosed with an Inflammatory Bowel Disease known as Ulcerative Colitis (UC). He takes medications to manage the UC and has been in a relapse since November 2013 - one week prior to the stroke we were considering having him hospitalised so he could receive IV steroids to try to get him back into remission. One of the medications he takes is an immunosuppressant.
So how did he go from a disrupted work week because of the UC flare up to having a stroke?
June 25
6pm
Dom collapsed and had two seizures on the platform at Flinders Street Station in Melbourne. An ambulance was called by 'unknown' and my husband now remembers waking up to paramedics saying his name. They asked him what was wrong. He was very confused and was in excruciating back pain; so that's what he told them. During the trip to Royal Melbourne Hospital the paramedics gave my husband his mobile so he could call me. This was the strangest conversation I've ever had with him. He was in a lot of pain and was extremely distressed; at the same time he sounded terribly confused. I managed to understand that he was in an ambulance and on his way to RMH, so I left work to meet him there, with the understanding that he had hurt his back (he has a history of bulging discs in his lower back, so this was not an unusual as you might think).The only person that was with Dom when the paramedics arrived was an intoxicated man - Dom remembers hearing him asking if he was ok and the paramedics asking him to move away. This man told paramedics Dom had had two seizures, but as my husband was able to communicate with paramedics they disregarded the witness' statement.
7 pm
I arrived at RMH Emergency Department at about 7pm and was taken through to room R3 to see Dom. He was very upset when I arrived and when I spoke to him he didn't make sense. He could pronounce words clearly, but the words he was saying didn't match my question or have anything to do with what had happened to him. He had blood around his mouth and four lacerations along one side of his tongue where he bit it during one or all of his seizures. The nurse informed me that he had a seizure in the ED not long before my arrival - this explained his confusion. I provided the ED staff with a medical history for Dom and this information had them thinking along the lines of a brain infection to explain the cause of the high temperature he was experiencing and the seizure.9pm
Dom had about an hour of alertness and was able to inform the medical staff that he remembered having two seizure on the platform (something he has since not been able to recall) and that he had hurt his back and couldn't sit up due to the pain it caused.
10pm
Dom was taken for a CT scan. This showed a shadow on the front left part of his brain which the staff thought may have been a slight bleed caused by an infection. He was on IV antibiotics. The elevated temperature slowly returned to normal.
I paged his Gastroenterologist, Dr. Connell, to ask for a list of medications. (If you take medications write them on a piece of paper and put them in your wallet or purse - somewhere someone can access them!)
June 26
2am
Dom was taken for a second CT scan. This showed a clot in the brain - superior sagittal sinus to be exact.
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| Source: http://stroke.ahajournals.org/content/42/4/1158.full |
7:30am
Dr Connell rang me for an update. When I told him a blood clot had been found in Dom's brain, Dr Connell asked if it was 'superior sagittal sinus (this was too many 's' words for me especially after having had no sleep for abut 18 hours!) I passed my phone to the Neurologist that works out of the RMH ED - they shared notes and now RMH were aware of the connection between UC and the stroke type known as CVT - they didn't inform us of this news until later in the day after running more tests.
10am
Dom was taken for an MRI and would then be moved to the High Dependency Unit in Neurology. I headed home with the intention of having a sleep...we all have the best intentions don't we? It was nice to have a shower and some food.
I headed back into RMH with my brother-in-law; we met his parents and sister-in-law there.
2pm
Dom was settled into HDU in Neurology. He was fairly unresponsive to me when I returned to his room, he didn't acknowledge me at all (but could form a small smile for his blonde nurse! She was lovely so I won't hold it against her; also very conveniently her name was Jess...).
He was now on Heparin (blood thinner medication through his IV) as well as the IV steroids. The steroid dose was close to double the maximum dosage he has ever taken which contributed to his lack of responsiveness as he suffers from intense mood swings as a side effect to the steroid medication.
4pm
We were informed by the Neurological Resident Dr Matt that Dom had had a stroke, known as Cerebral Venous Thrombosis (CVT). This is a rare stroke with the clot occurring in a vein and not in an artery. This explained why Dom had not been presenting typical clot symptoms - the ones we are told to look for: |
| Source: www.strokefoundation.com.au These are crucial signs to look for if you think someone has had a stroke! Memorise these signs...F.A.S.T! |
6pm
Dom was now showing F.A.S.T symptoms. He could hardly talk and had complete paralysis on the right side of his body. He still had feeling, just not movement.
What were we thinking & feeling?
This was obviously a shock and so unexpected! Dom is 30 for goodness sake! We both had a cry together...we were scared about what this meant for our future. Would he get better? Would he regain what he had lost, and if so how much? Would he be able to play his guitar and sing me songs ever again? Would he be able to play his PlayStation 4 again (I lined up for ages for the bloody thing!), would he ever be able to use a computer again?
Dom couldn't talk...but after knowing each other as well as we have and done for the past 10 years I could read in his eyes his thoughts and feelings - they mirrored my own! But I was adamant we weren't going to dwell on what had happened...instead our focus would be on getting better and coming home! I think the most common phrase I spoke over the next two weeks was "I don't care what he gets back, but I AM bringing him home!" This was my own little motto - its what helped get me out of bed each day, its what forced me to eat when I thought I was going to vomit from stress and worry...it's what I said to Dom each morning when I arrived at the hospital and each night when I left him.
It's not smooth sailing from here though....oh no, Dom couldn't just start to recover, he had to face another hurdle!
7pm - 9pm
We breached visiting hours rules and stayed an hour later than we should have. All of Dom's cousins in Melbourne and both his aunties and uncles came to visit him and tell him to make a speedy recovery! This was very emotional, but it was very reassuring to know we had the support of our family.
Dom had a catheter inserted and had so many IV tubes coming out of his arms I couldn't touch anywhere except his hands! I left with the promise of returning and the determined message:
"We will fight this together. You will get better. You won't stay like this - I'll help you, I promise, I love you always and forever".
June 27
7am
Dr Matt phoned me to tell me the nurses were having difficulties getting Dom to respond to them and he had been taken for a second CT scan. This showed the brain was swelling too much, but after a consult with Neurosurgeons it was decided the a decompressive hemicraniectomy (removal of part of the skull) would not be performed unless absolutely necessary. Dr Matt reassured me that Dom was stable, not to rush into RMH and my estimated arrival time to HDU of 11am was still fine.
9am
A conversation with one of my best friends alerted me to the fact that this whole situation could have been very different if Dom didn't go to work on the 26th - I was in a meeting and would not have returned home until approximately 10pm that night...what if he was at home? What if he couldn't call me or an ambulance for himself? What if he hit is head on the kitchen bench or coffee table when he collapsed? What is he was on his back when he had the seizures? What if he stopped breathing? What would I have found upon my return home? Thankfully all the stars in the universe aligned to give Dom the best possible chance for survival. I am eternally grateful to the positive karma that came our way on June 26.
11am
I returned to the hospital to again have Dom very unresponsive to me (and no more smiles for blonde nurses either, so I didn't take it personally). Within 40 minutes of my arrival Dom rapidly deteriorated and had two facial seizures.
Neurosurgeons immediately agreed that the only way to save his life was to perform the decompressive hemicraniectomy procedure. I verbally consented to the procedure - if I didn't he would have died within hours. While I was signing consent forms Dom was rushed off to theatre - I didn't get to say goodbye. This played on my mind for the next 5 hours, but I refused to think I wouldn't get to see him again.
The procedure was a success - no complications! Dom was taken to ICU and was in an induced coma.
Evening
When I visited him in ICU at about 5pm he was breathing on his own, but had a breathing tube inserted to increase his oxygen levels. Nurses inserted a feeding tube as well.
Knowing he was now missing part of his skull I expected his head to be a different shape...but it was symmetrical still - that's how swollen his brain was!
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| Koh Samui, Thailand - 2013 |
I left ICU at 8pm and retuned home. This was the eeriest experience for me. I came home to an empty house...it was quiet...lonely...I was alone. I had held myself together all day. Shed a couple of tears here and there but I refused to break down, to think the worst. If I thought it, it might happen...so I thought about bringing Dom home...I thought about ways I could help him with his rehabilitation, I thought about changes that we could have done to our ensuite; you know, hand rails and things...anything that would bring him home to me sooner rather than later. But coming back to our house, the home we created together, we designed it, we built it (well the builder did, but you know what I mean), we chose its colours, we used the money from the wishing well at our wedding to landscape the backyard... the backyard our dog was now looking at me from - looking for his 'daddy'. I walked past our wedding pictures, photos from our trip a year ago to Koh Samui(Thailand)...
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| Our wedding, January 2012. |
I walked through our home, everything that was ours and represented us; our years together, the ups and downs: our journey...and I broke down...what if it all ended here and now...what if our journey stopped in this moment? I'm 27 years old - some people see that as too young to be married for a couple of years; it is way too young to contemplate being a widow. For this one and only night I let myself get lost in these negative thoughts....I sobbed while my brother held me...he held me like Dom does when i cry...but he didn't feel the same, he didn't smell the same...he wasn't Dom. (Are there lots of typos yet...I can't see through my tears anymore!) I slept in our bed, on my side, wearing Dom's jumper...I would not let him go...I would not sleep in the middle; can't let myself get used to that...he'll be home soon, so I need to stay on my own side!
June 28
I returned to the hospital and was told that once a CT scan was done and doctors were happy, Dom would be taken out of the induced coma, however, they weren't confident this would happen as he was not responding the way they thought he should. His left hand had to be restrained as he kept trying to pull out his breathing tube (yes, still in the induced coma), and so given this level of movement and coordination they expected Dom should be able to respond and follow the command to squeeze their hand, doctors and nurses had been asking him all morning and got nothing. They said I was more than welcome to try...so I sat on his left side, held his left hand, said I was here and asked "If you love me, I need you to squeeze my hand"...he squeezed that hard I thought my fingers were crushed! Doctors were very happy and at 2:30pm they had the CT scan and were happy to bring him out of the induced coma.
By 5pm he was completely off the sedation medication and was able to answer with his full name when doctors asked "Can you tell me your name?" Dom remained in ICU overnight and I left him at 8pm with my message: "We will fight this together. You will get better. You won't stay like this - I'll help you, I promise, I love you always and forever".
The following afternoon Dom was stable and responsive so he was moved to the High Dependency Unit in Neurosurgery where he stayed for the next four days until he was moved to the RMH Stroke Ward for the next stage of his recovery.
His face was swollen, his head still held its normal shape - he had to have a sticker on the left side of his head that read "no bone". He had 54 staples in his head where they had removed part of his skull. It is a long road ahead, but being out of ICU is step 1.
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