I Finally Get that Brain MRI

I may forget things from time to time but large memory gaps are not something I'm used to. Even so, a few weeks after the events I'm about to relate happened, it became obvious that there were not just a few, but many gaps in my memory of what happened after getting past the ER room triage nurse. I could remember most individual episodes, but I couldn't connect them together into a continuous timeline. And there were some things I had forgotten altogether.

It's hard to express just how scary and disturbing this all was (and is). I'll get to some of the reasons later. But for now, keep in mind that the next part of the story is a reconstruction created with the help of family members who stuck with me big time as I was dragged through by far the worst experience of my life. It's way easy to think of expressions like la familia es todo in metaphorical terms. Things will go wrong and you'll need family to help. At least that's what I used to think. But the hellscape I found myself was another thing altogether. The nonstop chaos, fear, and full-on dissociation from any semblance of reality on that day would have been unendurable without family by my side.

By 8 AM on March 23, I was lying in a hospital bed in a semi-private room in the ER. You know, the kind with a dividing curtain. The kind that lets you hear (and sometimes see) everything happening on the other side.

Given my previous difficulty scheduling a brain MRI, it was a little surprising to learn that I'd be getting a Computed Tomography (CT) scan soon. At 10 AM I was wheeled away for it and was within minutes back waiting for results. Whereas brain MRIs take 30 minutes or more or so to acquire, CT scans are much quicker. CTs are therefore used to screen out those patients who don't need a brain MRI.

I was wheeled back into my room to await the results.

Then, an explosion of people and noise. A team of 15 or so EMT personnel maneuvered a person on a stretcher onto the other side of the curtain divider. The person had had a seizure. A pack of drinking straws was demanded and somehow deployed to help restore breathing. Medical equipment of all sorts was wheeled in, and activated. The patient was asked a series of rapid-fire questions, sometimes more than once, and loudly. "Stay with me" was a common phrase. Walkie-talkie chatter, beeps, and buzzers, added to the cacophony filling the room. People wearing uniforms from health services, law enforcement, and fire departments worked together around the stretcher.

It was chaos.

Eventually things calmed down and the reason for my new roommate's arrival became clear. It's not important except for one detail. This person had had a seizure. More to the point they had had an operation for a brain tumor years before. Brain tumors and seizures often travel together it seems. So here's a bit of hopefully useless advice. If you or someone you care about ever experiences an unexplained seizure, quickly find a facility that can do brain MRIs, demand one, and accept nothing less.

During this time, a procession of staff including nurses, interns, and a few doctors stopped by my bed. They asked me questions and tested my ability to perform some simple tasks. One of them was to close my eyes and stretch out both arms level, palms up, as if holding a pizza. I bombed it. One arm was always way higher than the other when I opened my eyes.

One visitor was Dr Hospitalist. I'd later learn that a "hospitalist" acts a kind of intermediary between patients admitted to a hospital and other doctors. From Yale Medicine:

A hospitalist is a physician who cares for inpatients, meaning they only work inside a hospital. These doctors have often completed residency training in general internal medicine, pediatrics, neurology, obstetrics and gynecology, or oncology. They may also be board-certified in hospital medicine. Hospitalists provide timely attention to all your needs, including diagnosis, treatment, and coordination of care across the many specialists you might see during your stay.

Dr. Hospitalist seemed to mean well, but he was trying to get me to do something I didn't like one bit. He proposed administering levetiracetam (Keppra), an anti-seizure medication. Wikipedia describes it as a "medication used to treat epilepsy."

Having had no history with that problem at all, I refused. I don't even take over-the-counter pain medications in most situations they're recommended. Nevertheless, I already had an IV port (by the way, where the hell did that come from?), and all they needed to do was inject through the septum, the good doctor reassured me.

Nah, I'm good. Clearly concerned, Dr Hospitalist left.

It was my new roommate who broke things down in a way that changed my mind. He explained that the Keppra was a precaution. Having a seizure leads to many nasty complications, all of which are best avoided. Thinking about the chaos in the room just minutes before, I reconsidered and agreed to be dosed.

I would later find out that the prophylactic administration of anti-seizure medications ("prophylactic AEDs") to patients suspected of having brain tumors but without a history of seizures, although common, is not well-supported by evidence. A 2015 retrospective analysis on the subject concluded:

Although some past studies indicated AEDs can be used in patients with brain tumors to relieve epilepsy, present integrated evidences cannot show in unequivocal terms that brain tumor patients can benefit from seizure prophylaxis.

All the same, my worries about taking drugs I didn't need would soon fade into the background. The good news was the CT scan had come back. The bad news was that I was getting that expedited MRI — soon. There was something of concern. At 8 PM I was wheeled away to begin acquisition. By 10:30 PM the images had been "read," meaning that a radiologist had examined them and the results were ready to be reported to me.