Transient Ischemic Attack … ‘I Had a What?’

Monday morning dawned bright and early and I looked forward to going to my physical therapy appointment at 7 a.m. I love driving over Pt. Loma Avenue early in the morning to see the sun coming up over the mountains.

This day was no exception. My therapist, Eddy, worked me especially hard that morning because, after having breast cancer surgery 18 years ago, within the past 6 months I have developed a severe case of lymphedema. There does not seem to be a cure, and we are trying to get the lymph fluid to flow out of the elephantine arm that used to be my left arm. It doesn’t hurt – just restrictive at times.

Following my therapy I had an appointment to see my primary care physician for a routine check up and all was normal. I left her office; did some shopping at Ralph’s, and walked in the door about 11 a.m. One of my former students – Corrine – was coming in the front door as I was walking in the back door. She had an armload of tomato plants with her that she was going to plant in the backyard.

When I said “Good Morning” to her I thought something might be wrong. With me. It sounded funny to my ears. She did not seem to notice and went outside with the plants. In a few minutes I went outside to talk to her and I couldn’t. I could not get the words out to talk to her.

Just about then I noticed I had a headache, and since I seldom get them I was surprised, but it disappeared almost as fast as it had appeared. Then I noticed I must have looked at the sun, because I could not see clearly out of my left eye. At about the same time, my middle daughter, Lynn, called for her daily check-in and asked me what was going on. She is a psychiatric social worker with Kaiser and told me to get to the hospital immediately. I told her I would wait a half hour or so, and if it wasn’t better I would go.

She said, “GO NOW!” She made me go into the bathroom and smile – something I did 20 times at the hospital – and stick out my tongue. (I later found out she was looking to see if there was any paralysis along my mouth.) Lynn was so insistent that I told her I would call my PCP and see what she had to say. After all, the table had to still be warm from my examination a few minutes earlier.

I called Dr. F and she said the same thing Lynn said. Except she said, “call 911 NOW.” I said I didn’t think it was that bad when I was told, “Your speech is blurred.” I told her Corinne was there and Dr. F said. “Get her to take you to the hospital immediately. Not Urgent Care – but the hospital.” Corinne and I left within minutes.

From my house to Sharp Memorial takes about 10 minutes on a good day. This was a good day. Corinne dropped me off at the Emergency Room and I walked into the reception area. By this time my speech was greatly improved; I never had any difficulty with movement; and stood in line for approximately five minutes before being seen. And once the receptionist knew why I was there, the rapidity was outstanding. I was immediately taken into a room in the “stroke” section, although I walked there on my own two feet.

Vitals were taken; gowns were donned; and the first of 3 lab techs came in to draw blood. Except that I am a “hard stick,” and after the first one tried twice and missed a vein, reinforcements showed up. She also tried twice and gave up also. I think that at this point I was more upset by the continual pricking of the needle than I was of the possibility of having a stroke.

Finally, an angel came in – no I had not died – and drew blood on the first try. She then proceeded to put in an I.V. which was also done quickly. However, and this really pissed me off – the I.V. was never used. It was in my arm “just in case” – but unless they forgot to hook me up to a bag, it was only in my arm to annoy me and cause pain. (Note: Because I had lymph nodes removed from my arm when I had the breast surgery, my left arm cannot be used for blood draws, finger sticks, etc. It is too easy for infection to develop because the lymph fluid does not circulate the way it should and cannot rid the arm of infection.)

I actually saw two physicians in the ER. The first doctor I saw said that he would follow my case – they were both “hospitalists” and were assigned only to the ER. If any of you remember my articles about hospice when my husband was a patient, you might remember I do not like the “hospitalist” concept. They know nothing of the previous background; ignore many of the things our regular doctor prescribed; and I feel lost explaining the same things over and over. In case you are wondering what I mean, I take several medications during the day. All of those were stopped and I didn’t resume them until I got home, with the exception of a thyroid medication since I do not have a functioning thyroid. That made me very uncomfortable because I know I need those medications.

The second doctor was a very beautiful woman who seemed to be calling all the shots. She was the one that was called when I said I wanted to know results of the tests; she was the one they called when I asked about my pills; she was the one that wrote my “going-home” orders. But on the day of dismissal, they both had come up to see me.

Within a few short minutes, I was whisked down to the C.A.T. scan room, before being brought to my room in the ER department. Almost immediately after that a portable chest X-ray found its way to the room, having me lean back on the coldest piece of slab I have ever felt. Then a tech came in to check my carotid artery. The images taken were in color, and although I could not see the results on one side, the girls kept commenting on the different colors. When the other side was checked, I was able to view the colors also. They were certainly vibrant, but when asked what they meant I was told that “the radiologist will have to read them.”

No sooner than the machine was moved out of the room I was being wheeled into the M.R.I. department, which, interestingly enough, is not housed at Sharp Memorial but rather at Rady Children’s Hospital. I was certainly glad that I was in a wheelchair; I never would have been able to find my way back to the room if left on my own.

I never got back to the ER because as I was leaving the M.R.I. facilities I was told that a another room had been found for me. Corinne and my daughters Michele and Stephanie were waiting for me in a nice, airy room, with a fantastic view of San Diego Bay. They were sitting on a couch that opens up into a bed or on a comfortable looking chair. Lynn lives in Orange County and we convinced her she need not make the journey at this time.

Also waiting for me was one of the nicest nurses I have ever met. Teri. (Unfortunately I did not have my camera with me so I do not have any pictures of this chapter in my book.) She made sure I was comfortable; took all the vitals again; hooked me up to an air compressor machine to keep the blood flowing in my legs; and then hooked me up to a heart monitor. Almost as soon as that was completed, I received a call from the cafeteria asking me what I wanted for lunch! (As a “food critic” I have to say that meal left a great deal to be desired.)

The menu was sectioned off into breakfast, lunch, and dinner. There were some desserts and some beverages. A subset – always a teacher – of the categories offered only two entrées to choose from. Although I do not remember the lunch – dinner was kabobs or meatloaf; canned corn or canned beans; fresh fruit and, for me, unsweetened pudding. (I took the meatloaf which also had mashed potatoes and gravy.) The meatloaf wasn’t bad but I kept remembering the horse meat story I had read in the morning fish wrap so I only had a few bites. The tea was lukewarm; only kind was a yellow tea; and tepid. The breakfast coffee was the same way.

And then the waiting, asking and waiting began. We wanted to know the results of any of the tests I took. And, of course, no one would tell me anything. They would confirm that they “thought” I had had a TIA (Transient Ischemic Attack) – in layman terms – “a mini stroke.” Two p.m. came, then 4 p.m., then 5 p.m., and still the stock answer I received was “The results aren’t in yet.”

Dinner was served at 5 p.m. but because the nurse was performing the standard vital check, I didn’t receive it for almost an hour. By that time I was going nuts in the hospital bed, with my legs attached to the compression machine. I asked if I could get out of bed and walk around but was told that I was down for “bed rest.” And, if I tried to get up an alarm would sound. And sound it did! Loudly. But by the time someone came in to see what the commotion was all about, I was standing and walking around the bed. Getting back in bed I was served my cold dinner, which I had them warm up in the microwave.

By this time Corinne had gone home and Stephanie and Michele were still with me. I offered them part of my meatloaf but both girls turned it down. And we waited some more.

At 7 p.m. there was a new nurse on duty and we were introduced to “David” – a handsome, male nurse that was a pleasure to watch and talk to. He said he would check to see if any of the results were in, and he said they were almost all there, except the two most important tests – the M.R.I. and the M.R.A. He said the best he could tell was that those in were negative. But until they had all the results, he could not tell if I would be going home the following day or not. We asked if we would be seeing the doctor at all that night, and David said no. We asked what time I might see the doctor in the morning. He said they all come in at different times.

At a few minutes to 8 p.m., Stephanie left, and Michele and I turned on the television to watch a program. David came in one time to check vital signs, but had no additional information for us.

Michele left at 10 p.m., and I knew I would see both she and Stephanie early in the morning.

During the typical night stay, I was woken up for vitals when I was sleeping; watched television when I was awake – most of the night – talked to David when things were “slow” for him. If I slept for a total of more than 4 hours I would be surprised. The noise from the compressor was maddening; and when it finally malfunctioned around 4:30 a.m. with a continual “beep, beep, beep,” David said I could turn it off for awhile. YEAH David! At 5:30 a.m. he was back for more vitals, but still no answers.

At 6 a.m. I was served two pieces of French Toast – that I believe must have been sent to my room via a ship coming from France; honeydew and cantaloupe melon that needed a few more days to get ripe and the God-awfullest warm coffee I have ever tasted. Michele called me about then and asked if I wanted her to bring me something. I asked for coffee. And here is the interesting thing: I seldom drink coffee. I don’t like it, but that cup she brought me sure tasted good.

Around 7 I was introduced to my new nurse – David didn’t even say goodbye – Maria. Would you believe she was completing her 46^th year as a Sharp nurse! She was delightful, as were the entire staff at the hospital. And she said she didn’t have any results but would check on them for me.

I had a visit from the physical therapist to see if I needed any therapy for limbs gone bad. I didn’t. Then there was a visit from the speech therapist to see if my speech was still slurred and to ascertain whether or not I needed speech therapy. Then there was a woman that wanted me to sign that it was OK to treat me. I’d been there almost 24 hours by then. Then there was a man that wanted something signed – do not remember for what. But the interesting person that never came into by room was someone from the billing department. I NEVER saw anyone from there. It will probably take two hands for my mailman to put the bill in the slot.

About 9 a.m. Maria told me that the pictures from the MRI were in BUT she didn’t know how to read them. She showed them to us – and they made absolutely no sense to us either.

A little before 10 the first of the two physicians came into the room. And bless that man’s heart – he wanted to know why I wasn’t dressed which led me into my first risqué statement of the day.

A few moments later the second physician came in to tell us that all the tests were negative. She had talked to Michele on the phone while I was out of the room showing the speech therapist I could walk without difficulty. Yep! You read that right. The speech therapist.

All of the tests were now in, and none of them showed any lasting effect from the TIA. When I asked if there were any restrictions for me they said no. They told me to resume my normal activities. My baby aspirin was changed to “Plavix” – but after reading the possible side effects I am going to ask my PCP if I can return to baby aspirin.

With one or two exceptions, I must give credit to Sharp Memorial Hospital. The concern expressed by the staff while I was there was exceptional. At every turn I felt that my best interests were their focal point. The only complaint that I have was that it took so long to receive the results of all of my tests. If I had had the tests in the late afternoon or early evening I then getting the results the following day would not have been a surprise. But since all of the tests were done before 12:30 p.m., I would have liked to have had the results earlier. And I absolutely dislike the “hospitalist” viewpoint. I was admitted to the hospital; I would have liked to have seen the doctor sometime during that stay. Just a reassuring nod that everything is OK would have sufficed. Instead – nothing. And when I asked about taking my regular medication I never received a satisfactory answer for inform me why I was not allowed to take it.

I also would like to offer kudos’s to my PCP – The following note was waiting for me when I returned home and turned on my computer: “I got report of your stay at the hospital, happy to hear all symptoms have gone away. I will see you next Monday, let me know if you have any questions prior.”

The final caveat: I wrote this article for several reasons. The most important one is to prove to myself that there was no lasting damage from the TIA. Hopefully, you will read this and it will make perfect sense to you; second to alleviate any fear you might have of going to Sharp for a similar situation; and the final reason – because I know I can!