Back in a Bit

Following a number of unexplained blackouts, there was no longer any use denying that there could be something wrong with me. After the first two, I wondered if it was a dietary thing or, at worst, side-effects of prescriptions I’d been given for something else. But, following a third, I was tired of guesswork.

As good as the NHS is at reactionary care (I still find it remarkable that they can get two paramedics in a fully-kitted van to wherever I’ve collapsed within minutes), it didn’t seem that anyone was getting closer to any kind of diagnosis. Fortunately, I had another option – the company’s private healthcare plan. Sitting in front of my GP, the situation seemed quite hopeless… until I brought out the health insurance paperwork and his eyes lit up. Suddenly, possibilities were plentiful, and waiting lists no longer applied. Would this, at last, lead to any kind of diagnosis?

Only hours later, I was sitting in front of the chief neurologist at the local private hospital. Neither before nor since have I met a man whose appearance and demeanour were more befitting his professional standing. From behind his desk he emitted a very large presence in a surprisingly small office, but was warm, friendly, and somehow irresistibly reassuring. I couldn’t help but notice that the two of us were dressed for business – both suited and booted to give that air of professionalism and efficiency. In my case, of course, there are many tell-tale signs that it’s all a bit of a sham – just wrapping-paper – but the effect of his expensive suit seemed to course through his entire being. I was also struck by the total lack of visual indication that this was a medical consultation: no stethoscope; no rubber-mattressed bed; no anti-smoking posters; and absolutely no pharmaceutically-branded biros. Just two men in an office discussing the business of the day – and yet the consultation about to take place felt more diagnostic than anything I had experienced before.

He sat back in his chair, twiddling his fountain pen as I recounted my recent experiences, interrupting only to ask me to elaborate on certain details. As my story reached the present day, he paused for a moment, and fixed his eyes on a point on the ceiling. Then he looked down to straighten the already immaculately aligned papers on his desk, and began his questioning. “Tell me…” he opened, before a lengthy pause, “…do you find that not drinking alcohol negatively affects your social life?”. I was more than surprised: this was something I hadn’t told him. I realised then that the papers in front of him were the reports from my visits to A&E, and that he’d done his homework. This surprising question had caught me on the hop – for some reason I automatically kicked into job-interview mode and tried to played it down. “Oh no, erm… no it’s erm… well, it’s uh…”. He looked at me intently over his half-moon spectacles, willing me to relax back into brutal honesty: “Well… yes, I do believe on occasion it does”. “Hmm”, he agreed quietly, rocking back in his chair again.

After quizzing me in some detail about the treatment I had received for manic depression, he placed a single cross in the margin of my notes. He then moved on to explore my experiences immediately before the blackouts, asking many leading questions to many of which I agreed. Although I didn’t recall anything unusual before the first episode, I did now very vaguely remember something just before the other two. A strange, other-worldly feeling, I suppose kind of like déjà vu, only less connected with the past, and more a dream-like state. It’s a very difficult sensation to describe, but he suggested it was like a moment of clarity and enlightenment – of activity and inspiration, and I agreed. The content of this experience is ephemeral, like when you awake from a wonderful dream that you can’t recall: you know you had the dream but can’t remember anything about it – and the more you think about it the less you remember. There was something massively reassuring in that he seemed to understand this feeling in some detail.

The more we discussed it, the more I realised that these strange sensations had also happened before, and since. That very morning a similar thing had happened, but I was ignoring them or passing them off as side-effects of some previous treatment. Looking back, I’m surprised I ignored them for so long – but then if something like that is happening and yet you can only vaguely recall it let alone attempt to describe it, it’s understandable. His questioning came around to the most recent episode, in the office car-park, and whether during this ephemeral period I lost the ability to do anything in particular. I recalled that during these “funny turns” (as I’ve come to describe them to family and friends) it became very difficult to understand what people around me were saying, or to say anything myself. He nodded with the manner of a man unsurprised by what he was hearing, before leaning forward to place a tick further down the margin.

Finally he made his diagnosis. He believed I was experiencing seizures or ictal events that were beginning in the language centre of my brain, behind and up a little from my left eye, like the epicentre of an earthquake. He was confident that these were caused neither by medication nor any form of brain damage but, to be certain, he would arrange for me to have MRI and EEG scans, as well as a 24-hour ECG monitor. When all the results were in, assuming nothing surprising came up, he was confident that he could treat the condition by stopping my current medication for bipolar disorder and scaling me up on a medication that would handle both conditions. The precision and confidence of his diagnosis, the information he’d drawn from me that I didn’t know I had, and the very personal manner with which he intended to proceed (that he would review the scan results, and then he could get the thing under control) had me very much on a high. The consultation was clearly winding up, so I went to rise out of my chair.

“You know,” he remarked, “you really shouldn’t drive, don’t you?”. I didn’t, as it happened – the thought hadn’t even crossed my mind. “Yes,” I replied, “it probably pays to be careful”. We got up to shake hands and I left his office, wished a good day to his secretary on my way by, and then got in my car and drove back to the office. Only as I parked up did I realise I probably shouldn’t have done that, but then how else could I have got back?

The MRI department were in touch first, and once again I had jumped the queue. Also, being a private patient, I was entitled to the pictures of my brain on a CD, with which I was very chuffed indeed. One of them even went up on the wall of my office to prove beyond all reasonable doubt that I hadn’t lost my mind. Numerous people commented that my skull sliced in profile really looks like me, which I pointed out was hardly surprising. This period was both cheerful and novel – something about having a diagnosis-in-progress was very relaxing. Several weeks passed with only occasional “funny turns”, but no collapsing. Everything seemed back to normal again. But there was more to come.

More on that… in a bit.