I have stories to write from the last few weeks, but I need time for my brain to process. In the meantime, please have a look at the one below; this is what I went through two years ago. I am an MD who understands fully what it is to be a patient.
It feels like forever since I last wrote. Events of the last few weeks have compelled me back to my keyboard. As some of you know, last week I was hospitalized for three days with what turned out to be viral meningitis. I will never underestimate that diagnosis again in my medical career. Let me tell you the story.
A little more than two weeks ago, on January 9, I flew to Orlando alone to join my husband for 48 hours as the first getaway since my now 11 month old son was born. I had been feeling stressed, exhausted and overworked and needed a couple of days in warm weather lounging by the pool. Two days after returning home, I woke up in the night with rigors (shaking chills) and I began to have a terrible headache. It began as scalp pain, and progressed into, initially, a similar headache to what I get sometimes. Usually, Tylenol and advil nip it in the bud; at the worst, a triptan pill takes the pain away. It never lasts more than a day or two, and I’ve never actually had a diagnosis of migraine.
This time, my headache was intractable. It wouldn’t go away no matter what. Finally, on Saturday we were driving up north for my daughter’s ski lesson the next day when I decided to text a neurology colleague of mine for advice. He said I could see him in clinic Monday if I was still unwell. That night I hardly slept. The headache, which was awakening me at 4 a.m. every night already, woke me and as well I felt terrible nausea. I began to vomit and couldn’t stop. My mother drove up to get me, and by 8:15 I was in the emergency department at my hospital. My headache was so awful that I couldn’t think straight, couldn’t function, could barely walk.
I was immediately taken to an exam room and quickly started on anti-headache medication, anti-nausea medication and fluids. During the day I had a CT scan of my head which showed some signs of elevated intracranial pressure (high pressure in the brain) and finally I was seen by the Neurology service. They sent me home that evening as I felt better and they thought it was just a migraine. I spent the next day suffering at home, and overnight I woke again at 4 a.m. extremely dizzy and with a horrible headache. I drove myself early to work (I was scheduled to start at 8…) in my scrubs, ready to get some medication and work through the pain. However, upon arrival I could barely walk to triage I was that dizzy (yes, it was stupid to drive). In a wheelchair being taken to a room I almost vomited everywhere. I spent another day being worked up by a different neurologist and his team, who decided I had pseudotumour cerebri (benign intracranial hypertension – high pressure in the brain). This is relieved with a lumbar puncture, so they tried and couldn’t get it. After lots of medication I again felt better, so they sent me home to come back in the morning to try the LP again under xray guidance (fluoroscopy).
The next morning, I felt like my head was underwater. My ears and head felt full; as if my sinuses and ears were full of liquid. I went for the LP in the early afternoon. Let me tell you; LPs are nothing to sneeze at. Yes, as physicians we always freeze the skin before putting in the larger needle to go chasing the cerebrospinal fluid, but the freezing is agonizing and even worse are the sharp, burning pains that come with a poorly angled needle. I had 2 LP attempts the day before and my back was very bruised, so when the radiologist put in his LP needle I cried quietly into my arm. Thankfully he got the fluid quickly.
As they wheeled me back to emergency, I was lying supine to avoid a worsening headache post-LP (as often happens). I remember looking up at the ceiling and noticing when we moved from the old building to the new, as the lights suddenly became brighter and cleaner. I remember little conversations, like someone saying the Habs traded Galchenyuk (not true) and an orderly singing “Oh my darling Clementine”. It’s a very strange and almost hallucinogenic experience to be wheeled down corridors lying flat on your back, and I felt enormously vulnerable.
Finally, the neurology team came to find me and informed me that there were 400 white blood cells in my CSF (cerebrospinal fluid) and therefore I likely had viral meningitis (an infection of the fluid and space surrounding the brain and spinal cord). You may have heard of bacterial meningitis – this is the one that kills, and quickly. But viral meningitis is usually described as “benign”, and as physicians we usually treat it as such.
Let me tell all of you: viral meningitis may not kill, but it is debilitating and remarkably painful. I had a c-section where my epidural stopped functioning so I felt the whole thing, and meningitis was worse than that. Worse, because it really really hurts inside the head. Worse, because I felt that there was an alien organism – the virus – in my brain; I didn’t feel like me, I wasn’t able to process thought as I usually would, I couldn’t handle everything as I usually would. I felt taken hostage. Before sleep, during my admission, I was afraid to close my eyes because I would see monster faces there. Stuck in a hospital room on isolation precautions, I felt helpless. Away from my kids, unable to breastfeed my baby, I felt hopeless. It was awful. And throughout it all, I had such guilt that I couldn’t do my work and that my colleagues had to pick up my slack (and I heard about it from more than one disgruntled physician, which to me is pretty disgusting).
I then spent 3 days hospitalized with IV antibiotics (just in case) and lots of painkillers and anti-nausea meds. Finally, I was able to be discharged home. The Infectious Disease staff and the Neuro staff came to see me that morning, and made a big show of ripping down the isolation signs. We still didn’t know exactly which virus it was, but on arriving home and jumping in the shower, I found that I had shingles under my right breast! Shingles (zoster) is the reactivation of the latent chicken pox virus from a nerve ganglion in the body, and can cause both a zoster meningitis and an “aseptic” meningitis (where you don’t grow the virus in the CSF, it’s the body’s reaction to the illness). As well, I was in Florida and had a couple of mosquito bites so this could have also been West Nile.
After finding those lesions, I spoke to ID specialists who started me immediately on an antiviral medication. Within one day my headache was completely gone and I felt a whole lot better. My cultures finally grew zoster in the cerebrospinal fluid. Wow.
Now, I am feeling somewhat better, though going to work three days after discharge did a number on me. At the end of the shift my head was in agony, but as soon as I rested it got better. I have been told that meningitis is like a concussion; the brain needs time to recover that can take weeks. I hope it’s faster than that, as I work tomorrow and overnight Friday.
All this to say; I’ll never call this illness “benign” again. I have a newfound respect for viruses.
Hugs, and hug eachother. Appreciate life. I do.