Before I get into the story of “the day,” the one when everything changed, I have to backtrack a bit to another story and some background info. This one is the story of carpal tunnel, or maybe it’s carpal tunnel, or most likely it’s carpal tunnel but it doesn’t really matter.
I’m not sure exactly when but early on in his cardiology career Mister was diagnosed as having a cervical rib. Way before we were a couple and just coworkers I remember talking with him about it. It’s basically just an extra rib that comes off a cervical vertebrae, so in the neck just above where most people’s first rib is. Unfortunately it can cause something called thoracic outlet syndrome which can manifest in different ways depending on what is getting squished up there in the neck/shoulder area by that extra rib. His was neurogenic meaning a nerve was getting pinched causing numbness and tingling down his arm, sometimes all the way to his thumb. And of course this was on his right side which was also his dominant arm. Surgery was discussed but he felt the risk associated with it was too much. So he opted for physical therapy and learned over time how to cope with it.
During this work up he was also told that he had mild carpal tunnel syndrome in that wrist. Not bad enough to warrant surgery but just to be aware of it. So that was also always there in the back of his mind.
Healthcare in general is an extremely physically demanding field. Our’s in particular is even more so. Long hours on your feet standing on hard floors covered head to toe in sterile garb while wearing lead skirts and vests underneath is not for the faint of heart. Add in long hours sometimes without breaks and sleep deprivation from call ins at all hours of the day and night and it’s not hard to see why people in our field are always looking for ways to ease one pain or another. New shoes, new orthotics, new lead, better belts to keep the lead off your shoulders, massage therapy; you name it and a Cath lab person will try it for some relief. Just like nature’s evolutionary process, we learn to adapt to our environmental situation in an attempt to be more comfortable, have less aches and pains.
So that’s what he did. Stretching exercises to keep that space in his neck open. He found hard soles shoes made it worse so switched form Merrill’s and Dansko’s to sneakers and then eventually to Croc’s. His crazy colored Croc’s became a signature “Mister-ism” which so few people knew the story behind.
Before he took his last position in Massachusetts he did some locum work in Hannibal, Missouri. Don’t worry, there are plenty of stories to come about we New Englanders heading out on a road trip, Baxter in tow, to spend some quality time in the great state of Missouri. Anyway, he mentioned to me a couple times over the course of that summer that his carpal tunnel was acting up. He had some numbness and tingling in his right arm again but it was the pain in the center of the palmar side of his wrist that definitely pushed him toward the carpal tunnel. As usual, he just coped with it when it would flare up. It never seemed to last long and a lighter work load mixed with time off between assignments seemed to keep it manageable.
So I guess it came as no surprise that when he started his Mass job that the symptoms worsened. He was working more and busier when at work. He found a neurologist and had an EMG which is a test for muscle and nerve function. Like all physicians, even the ones in specialties, he had already diagnosed himself before his appointment. Hearing the neurologist say that based on the EMG that his carpal tunnel space was very tight was exactly what he expected. They talked about the fact that his numbness distribution wasn’t exactly consistent with carpal tunnel syndrome but he chalked that up to possibly the cervical rib. I mean, of course, right? So he was referred to an orthopedic surgeon for a quick ligament release and then we’d be on our way. Easy Peasy.
We scheduled his surgery on the Friday of a holiday weekend so he’d have an extra day at home to recuperate. He had a great surgeon and was scheduled first case of the day. Everything went without a hitch and we were out of there before 10 am. The early winter storm with sleet and freezing rain made the drive back to Maine a little more interesting but overall the whole thing was a breeze and we were back in Chipmunk Lane to recuperate by the middle of the afternoon.
In my mind and I’m sure his, we had made it past this hurdle and were in the clear. We could proceed with life worry free, right? His incision healed, he was back to work. Everything was right back on course. Except for that one minor detail, the only one that actually really mattered. His carpal tunnel symptoms weren’t any better. So we were left wondering, was this his cervical rib? Would PT help? All the while this terrible ugly monster had started to whisper to us “hey morons, over here.” We just couldn’t quite here him yet. It wasn’t much longer before he reared his ugly head.
So on that fateful day, my punch in the face day, as I listened to him describe his seizure all I could think was that it had to have something to do with his surgery, which was only 4 weeks prior. It was what’s called a focal or partial seizure. It’s not the kind most people think of when they hear the word seizure, not the kind you see on tv when a person falls to the floor convulsing. A focal seizure affects just a small part of the brain thus causing symptoms very specific to that region.
He was at work getting ready for the Cath lab cases for the day as he was the doctor on call when it started. His hand flipped over palm up and started to contract all on its own. His hand just kept opening and closing, like he was trying to grab something, over and over again. He told me he stared for a few seconds and then just stood up and started to walk toward the Emergency Room all the while staring at his hand making these bizarre completely involuntary motions.
You see, the thing is guys, he said he knew as soon as the seizure started what was happening. He knew the second his hand started to move on its own that he had a tumor in his brain. Before he had any imaging or a neuro consult. Let that sink in for a minute. However long that walk was, 2 minutes, 5 minutes, whatever, he spent the whole time knowing what was coming, anticipating that hammer that was coming down after his scan.
When I talked to him on the phone and he told me about the seizure my mind went straight to his surgery. I asked him if it could somehow be a complication of it. Even though he answered emphatically no, I still spent the two hour drive to him trying to connect the two things, two last hours of blissful ignorance.
That’s where I’ll wrap up the story for today. Mister in the ED knowing, me driving to Massachusetts not knowing. This all will lead us into the story of “The Hardest Part.” Depending on if and how well you knew my husband, that story may surprise you.