Sharp Blue: Transient ischaemic attack


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Yesterday afternoon, my dad was discharged from the oncology ward, after spending five days on intravenous fluids and strong laxatives. The day before he’d seemed pretty strong and healthy, but yesterday he seemed very tired. Apparently, one of the other patients in the ward had been up most of the night and had kept everyone else awake too. So, after dinner yesterday evening my dad went to bed for a nap. An hour later, my sister came downstairs bearing worrying news: he’d woken up and was now talking nonsense. She reported that he’d insistently told our mother to “get down off the answering machine” and then when asked where he was said “on the tissue!”

I rushed upstairs to find him sitting on the edge of the bed stairing into space. After a while, he started responding to questions by saying “I don’t know”. Then my mum asked if he knew who she was: “Yes.” “Who am I?” “My father.” “Where are you?” “In the hospital.” By now, we were all getting very worried. Mum went off to phone for an emergency doctor to ask for advice. They suggested not calling for an ambulance immediately and said they’d get here as soon as they could. Meanwhile, my sister and I tried to keep him company. He drifted in and out of staring into space, but when he was talkative he seemed to be getting more coherent. He appeared to know who we were now.

After an hour, two emergency doctors arrived and gave him a basic neurological exam. By now, he was still confused but no longer talking nonsense or giving inappropriate answers. The only physical symptom the doctors could find was an enlarged pupil on one side. He was still saying he didn’t know the answers to lots of questions: “Do you have any pain?” “Not really.” “Where does it hurt?” “I don’t know.” Finally, my mum and I went downstairs to talk to the doctors and they said that they didn’t think it was likely that it was a reaction to his new medications or something caused by the small tumour in his brain, which the oncologist and radiologists thought had been successfully treated. Instead, they thought he’d had a transient ischaemic attack. This is a disruption of brain function caused by a temporary blockage in a blood vessel. The regions of the brain supplied by the vessel don’t get enough oxygen and so become less active than normal. Within a few hours the blockage usually breaks down and normal function is restored. My dad’s condition seemed to be following this pattern.

The emergency doctors faxed for an ambulance to take my dad to hospital for a proper check-up, including, if possible, a head CT. By now it was approaching 10pm. The ambulance didn’t arrive till 1am, and then my dad didn’t get to see a doctor until this morning. He had to spend the whole night in a chaotic assessment ward. Finally, they decided not to give him a CT because he’s due to have his six month post-radiosurgery MRI soon. They also decided not to put him on any new medication or re-admit him to hospital. Around 4pm this afternoon my sister drove him and my mum home. Fortunately, he seems to be entirely back to normal now, and it’s likely that he won’t have another such incident. The consensus seems to be that it’s just something that happens to people sometimes, and that it’s not directly connected to his cancer.

It’s strange that despite all the times we’ve had bad news over the last eight months, I’ve never really been scared. Whatever bad might happen was always going to happen months or longer away in the future, and there was always an admixture of good news to keep our hopes up. Yesterday evening, though, I was very, very scared. I couldn’t stop thinking that perhaps I was about to lose the father I’ve always known and have a new person in his place, and that I’d never get the old one back. Today, everything is different again. He seems to feel better than he’s felt in a long time, and is very much his old self. A little while ago he said he felt like the tide has finally turned. Let’s hope that it has. It’s about time he got some luck.

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