a migraine, a seizure, and an apology…
One aspect of my job that has always been enjoyable is the diversity. Although in our office we see many of the same patients week after week, rarely are two visits the same. Activities change, patients progress, and life goes on. The energy created in our VT room is pretty special, and my co-workers are largely to be credited for that. They keep things hopping, and they keep me sharp; either by questioning a process or questioning to progress, they are on the ball. Every once in a while though, our group has one of those days, the ones we’d rather forget. We’ve all been there, where no matter how hard you try or what strategy you put together, at the end of the day you feel defeated. When these days happen to me I usually leave the office with two thoughts rolling around: What could I have done differently? and more practically, I’m glad this day is over.
Last Monday began like any other Monday. A rush to get my kids off to camp, racing to work , some quick prep work for the morning’s patients, and off we go – patient number one starts at 8am.
My first patient of the day is a middle-aged woman who suffered some neurological damage following liver transplant surgery. There are days where she is lucid, sharp, and articulate – then there are the other days. Beyond the motoric concerns, her VT has consisted of a lot of Visual Memory and Information Processing. As you may have guessed, she has days where she is really “on”, and days where she struggles greatly. A former “team leader” of a prominent computer software company, her emotions are often frazzled as she recalls her previous life, and on good days, is aware of how much she has lost. Nonetheless, she is an angel. We joke, we laugh, we share stories of our kids – and yes, we get our work done. Last Monday she began the visit by announcing that she had awoke with a migraine and considered cancelling. Always wanting to be sensitive to a patient’s good days and bad days, I offered to let her reschedule without penalty, but she insisted upon giving her visit a try. Because of her medical condition, and the propensity to “slip” back and forth between lucid moments and states of confusion, she is not allowed to drive. Since her husband was out-of-town on business, she was forced to call a cab to get to us, and cab fare was her motivation to push on. Against my better judgement, I agreed, which proved to be a mistake. Fifteen minutes into our session she became very dizzy, nauseous, and disoriented, telling me that “Imitrex always makes me feel this way”. We sat quietly in the room for several minutes, lights off, and curtains mostly pulled. She was unable to recover, so I walked her outside to her cab and directed the driver to take her home. Session over.
That’s how my morning started.
My final patient of the morning, strangely, has a similar set of symptoms but for a much different reason. She was involved in a car accident last October where she was rear-ended, and among other things, has a vertical mis-alignment in her vision and has developed a seizure disorder. Her session started great, and we “compared notes”, as I shared some symptoms of my concussions from long ago. We even shared a laugh or two about getting old. About halfway through her session, we started trying an activity designed to help her feel and control her vergence ability, when suddenly her eyes glazed over and she began mumbling. At first, it seemed as though she was just talking to herself, but after a few seconds, ,it became clear that something was wrong. Very wrong. After pulling her chair back from the table and asking her if she was “OK” several times with no response, I realized that she was beginning to slump to the right and her eyes were rapidly shifting from side to side. I grabbed her shoulders and held her in the chair, kicked the door open with my foot, and yelled for help. I was quickly accompanied by our receptionist and doctor. As the minutes ticked on, the patient slowly started saying she felt like a seizure was coming, and then would become unintelligible for a few seconds, but never seemed to lose consciousness. About 30 minutes after this all began, our patient seemed to recover to the point where she could hold a conversation, but recalled very little of the event. We walked her to the waiting room where her mother (who drives her to all her appointments) was waiting. We explained what had occurred, and her mother shared that these events have occurred before, but always at home. Her neurologist has diagnosed these events as petit-mal seizures.
That is how my morning ended. Lunch anyone?
My final patient of the day is one of my more colorful, opinionated, and emotionally charged teenagers. Very close in age to my oldest child, this patient challenges me in so many ways – at the forefront of those challenges are wit and patience. The week before, we had a very tough conversation about why VT is important and respectful behavior in the VT room, which has been an issue. That day was tough on both of us, but today, I was happy to receive an apology. I also explained that I understand that I am not perfect either, and if there is something I can do (or stop doing) to not stir those emotions, to please let me know. Both mom and patient obliged, and the two sessions since have been the most productive of the entire program.
I left the office that night feeling completely exhausted and defeated. Not because I had failed, per se, but because I was out of gas, and it was only Monday. A good night sleep did wonders to recharge my batteries though, and the rest of the week was far less eventful. Say what you will about our profession, either good, bad, or indifferent. There will always be one fact that I know for sure…
It’s never boring. 😉