ER in the Gloaming

Sunday morning I noticed when I got up to pee around 5 am that I was developing a headache. While never any fun, headaches are fortunately rare for me. I made sure to drink a glass of water before returning to bed and figured that would take care of it. (The most common etiology for headaches, at least for me, is insufficient hydration.)

Unfortunately, that simple remedy didn't work and the headache gained in strength as the day arrived. As there was no trauma I could trace it to (I hadn't bumped my head into a door jamb, for instance) it was baffling to figure out what was going on, and what to do about it. At 9 am I started turning to my optional pharmacology. First I tried extra-strength Tylenol, but it didn't make a dent. At noon I took a muscle relaxant (Robaxin) that has been reliably effective in providing relief from back pain, but it also was ineffective up against my headache. Now what?

I tried going back to bed and that helped insofar as reduced movement equated to less pain, but my neck was getting stiff from holding my head so still. The whole experience was debilitating and I was losing ground on three fronts:

a) I was tired of the pain and had no clear pathway to relief. I get headaches so rarely that I didn't have much personal experience to guide my expectations.

b) In addition to the acute pain, after half a day of it there was also an accumulation of pain and the weary prospect of more to come. I didn't know how I was going to sleep that night.

c) I'm a cancer patient who is undergoing chemotherapy that involves my regular consumption of heavy-duty drugs, some of which can have serious, if unintended, side effects. Was that in play? Did the headache signal something even more serious related to my cancer?

As you can see, I had a lot of unpleasant thoughts dancing through my head, such that after 16 hours of coping with a headache that still hadn't crested that I was ready to ask for help. Fortunately, the oncology team that I work with in Duluth is on-call 24/7, and there was a doctor available to talk with me right away, even at 9 pm on a holiday weekend. My guy was worried about the possibility of bleeding in the brain (unlikely, but possible) and recommended a trip to the ER, which we dutifully took in the failing light (the sun sets late here in the North Country as we get close to Summer Solstice).

In situations like this the main strategy of emergency care medicine is to secure relief from pain and to discover, or rule out, dire causes. So ER docs are taught to look for boogey-men and then test for their presence—hopefully to eliminate them as being in play, but to respond promptly to them if they are. In my case, the docs were principally worried about bleeding in the brain, so that meant a CT scan of my head, followed by interpreting the results. Unfortunately, it took us until 1:30 am to get that far, and we still weren't done.

It happens (I didn't know this until yesterday) that CT scans are notorious for not giving a clear read on what's happening at the back of the head—which was the very spot in question. Ugh. That meant that the negative result was not conclusive, so the docs huddled and decided a lumbar puncture was called for, to see if there was blood in my spinal fluid. Double ugh. More fun yet. 

Though the puncture only took five minutes to perform, we didn't get it accomplished and the results examined until 4:30 am. Triple ugh. The end result of all this, I'm pleased to say, was that there was no indication of blood in my brain; I just had a garden variety headache of unknown origin. The upshot of this was that I could go home and enjoy the rest of my night. Whew!

Susan and I wearily drove home, just as dawn was beginning to lighten the Eastern sky.

It was a Memorial Day to remember. We were most grateful to be able to sleep in until 10 am.