Gatekeepers, part I

“When office people are good,” a triage nurse told me last week, “they're wonderful. And when they're bad, they're horrible.”

She was getting me checked in for yet another ER visit, because my usual arthritic/spasm flare-up had the scary new element of an ugly throb in the middle of the back of my head that made me sick with possibility. Sometimes it felt as if a blood-pressure cuff were being inflated around my neck, making my head and cheeks turgid with blood. Mainly, I envisioned an aneurysm on some weakened vascular structure, although I wasn't ruling out the possibility of some metastisis lurking on my brain stem. I became frightened. I cried. I went to the hospital. Did I mention that all of this happened on my birthday?

My c-spine had been acting up since the first week of March. Had it not been for the unpleasant addition, I would have written it up as standard procedure...I usually have one or two very bad episodes a year, often in conjunction with a seasonal or lifestyle change. The weather had been all screwy and my muscles had been learning to lift a baby; both were likely culprits. I once had an episode after adopting a new kitten who wanted to snuggle between my shoulder and my head, as close to my face as possible, and tried to push my head out of the way as he stretched. It happens.

I made my usual appointment with the neurologist who handles my day-to-day problems. He was more booked than usual, and the appointment wound up being at the end of the month. When the weird, new throbbing started, I worried. I know radiation weakens vessels. What had it done to me? Was the throbbing an ominous sign? Was I going to die suddenly and leave a newborn infant behind? I began moving cautiously and imagining a loose fire hose gushing blood, waving around wildly inside my brain.

I called his office and told the medical assistant what had been going on, that I had these new symptoms on top of my standard experience, and explained that I lived two hours from the doctors office. Should I have my usual MRI early, I asked, so that he would have it ready when I arrived for the appointment? That way, if there were some emergency, he could be alerted by the radiologist at my local hospital. The assistant wouldn't relay the message to the neurologist. She told me I could wait till my appointment.

So wait I did, for over two weeks, and soon my eyes felt like they were bugging out of my head with the pressure. And when I stood up, the throb returned in the center of my brain and my world whirled and I imagined my daughter telling friends, when she got close enough to them, that she never knew the mother who had died when she was less than two months old.

So I went to the ER and stepped outside my MRI-only rules to have a CT done. (That statement would be a lot more impressive if you knew how terrified I am of radiation). Long story shorter, there was no obvious cause of the throb and the pressure, other than “more neck weirdness”, and a few days later it faded with the rest of the inflammation and spasms. I have no idea what happened. Maybe something pinched or pulled something else. I haven't seen the neurologist since before I was pregnant. Sometimes that feels like swimming just out of sight of the lifeguard, into tracherous waters.

I guess I'll find out at my appointment, or after I finally have an MRI. Could the worry and the expensive ER visit have been avoided by the office gatekeeper relaying my concerns to my physician? Maybe. Should she be abstaining from making medical decisions on his behalf? Probably.