THE SPACE BETWEEN MY LEFT EYEBROW AND HAIRLINE HAS GROWN TENDER from the absent-minded circles I’ve been drawing on it for days now. I can’t stop replaying the awful image of my oldest sister falling onto the concrete floor of her son’s garage. Sometimes the fall is slow, like time-lapsed photography. It seems almost gentle, her left hand reaching for the ground at the last moment, her left hip and knee absorbing what they can. Other times, the fall happens fast, like a movie, and all I see is the point of impact, her left forehead. And I hear the sound usually described as a “sickening thud.”
I first learned of Ann’s fall the night it happened, October 19, from her youngest son. She was in neurological intensive care with a brain bleed, but conscious and lucid. The family tom-toms spread the news, and we all communicated in various ways. The neurosurgeon on scene in that central Florida hospital told Ann and her sons that if the bleeding continued over the next several hours, a craniotomy might be necessary to relieve pressure from brain swelling. If the bleeding stopped and the hematoma stabilized, then a period of watchful waiting would begin, after which it might be necessary to drill burr holes to remove the hematoma.
“A burr hole for subdural hematoma is performed to remove a hemorrhage (blood clot) from around the surface of the brain. The location of the blood clot is beneath the firm covering of the brain known as the dura mater, and is therefore called subdural hematoma. Generally, when a blood clot is moderately old (at least two to three weeks), it may be drained through a small hole in the skull, and a large craniotomy flap (opening in the skull) might be avoided.
The patient will be taken to the operating room and put to sleep under general anesthesia. The head will be partially shaved, to expose the area of operation. The head may simply rest on towels, or it may be placed in three fixation points (Mayfield head pins). The area where surgery is to be performed is then “prepped and draped” using an antibiotic solution. Next, the surgeon will make an incision, and reflect the scalp over the area of the hematoma. Then, an air powered drill is used to make a hole in the skull. The dura mater (tough covering of the brain) is then opened. The hematoma (blood clot) is now seen, and the surgeon will irrigate some of it out, and may pass a drain around the brain to provide post-operative drainage. The surgeon will then close the scalp.”
Reference from Neurosurgery, P.A., Houston, Texas
I was amazed to be able to speak with Ann on the phone that night, and incredibly relieved to hear her scratchy voice telling me, “I don’t know what happened. I didn’t trip over anything. I guess I just got tangled up in my own feet.”
Late that night, the good word came that the pool of blood had stopped moving. No middle of the night surgery.
After several stable days in intensive care, she was moved to a regular room, and then to a rehabilitation center to wait until the brain healed without surgery, or it was deemed safe to drill the burr holes to relieve pressure and remove the hematoma. Management of such an injury would be complicated with any patient, but a 75-year-old, diabetic woman with a bad heart propped up with two stents is especially delicate. Blood thinners attenuate brain bleeds.
All the while, Ann’s headache remained severe and steady, but her mental status had been clear. Until yesterday. Following a physical therapy session, she returned to her room, went to sleep, attempted to answer a phone call from one of her sons, and couldn’t find words. I think the medical term for this loss of language is aphasia. It resolved quickly, but she was taken by ambulance to the nearest hospital, where a scan revealed a small trickle of new bleeding.
Ann’s a feisty redhead, a widow now for several years. We shook our collective heads and said, “You go, girl,” when she climbed risers to sing with her church choir the day after having a heart stent put in several months ago. Even now, her main interest is getting back home to her own cooking, her granddaughter, and her church buddies — who are burning up the phone lines and the road checking up on Sister Ann. The docs kept her busy yesterday with an EEG, EKG, another CT scan and a panoply of other tests. Even in her pain, the retired registered nurse in her keeps an eagle eye on her meds, looks at the scans and her own chart. I imagine there are some lively bedside debates when opinions diverge.
Fingers crossed, sister. You’ve still got a lot of risers to climb and hymns to sing.