That’s a bit dramatic, isn’t it? Well, judge for yourselves

It probably started on Sunday 6th October. I’d been on a long (65 km) , organised bike ride starting and finishing in Ware, in Hertfordshire. It went well. I was a bit pleased with myself because I actually finished, unlike the previous year when I’d basically given up after about 15 km and found a shortcut back to the start.

Sitting at the designated rest stop half way round I noticed a slightly odd feeling on the right side of my head. It wasn’t quite bad enough to be called a headache but it was something off. I dismissed it as one of those transient things that would go away in its own time.

I kept noticing it as I was driving home afterwards and through the evening.. So that night I took a couple of ibuprofen before bed.

Next morning it was still there. So then I started to come up with possible reasons for it, each of which would naturally mean it would go away of its own accord. I’d had a tooth out a week earlier and I’d been taking a codeine based painkiller. Was it a withdrawal symptom? The internet seemed to think that codeine could provoke withdrawal headaches.

The other thing was also related to the extraction. I reasoned that I’d had to brace my head against the force of the dentist pulling on his forceps and might have strained my neck muscles. Which of course had been masked by the codeine.

But instead of fading, which it would have done if it was either of those it got slowly worse, and by Friday I realised that I was taking too much ibuprofen for too little effect and managed to book myself a slot at the doctors.

I saw a nurse practitioner rather than a GP but I can’t fault her approach. She took my history and checked me over for signs of a minor stroke (which was a rational and plausible possibility.) That seemed OK so she considered the next step. Either she could book me in for blood tests on the Monday or we could try to get me into “SDEC” — Same Day Emergency Clinic–at the hospital for a CT scan of my head. I was all for cracking on. She cleared it with her supervising GP and printed off a letter of introduction to take to A&E, because she couldn’t get through to the SDEC “Gatekeeper” (She admitted they rarely can)

So Karen drove me up to A& E. It could have been worse but it wasn’t fun. It was full, but not horribly overcrowded. It took about half an hour from walking through the door to sitting down in front of the triage nurse, who was less than pleased at the attempt to game the system. But he passed me through anyway. I couldn’t have cared less. I was in.

Wasn’t too much of a wait before someone came with a wheelchair (in general inpatients aren’t allowed to roam unsupervised) and off we all went to SDEC. They took my history, did some quick observations and told me what was going to happen. First was blood tests , then a CT scan of my head, then, something that no one had mentioned before, a lumbar puncture to extract some cerebrospinal fluid for testing.

The LP was a touch traumatic. First I had to sign a consent that detailed (as consent forms tend to do) all manner of horrific but unlikely problems. Then I had to bend over while the doctor shoved a large needle between two of my vertebrae and shoogled it about, MILLIMETRES FROM MY BLOODY SPINAL CORD. Well they managed to extract a few bottles of fluid without paralysing me (Although the tingle that went down my right leg was a bit unexpected) and sent them off for testing. One of them, I discovered went to a specialist unit in Coventry. This will be important later.

It was a bit of a wait, but then we got the results. The CT scan showed no head trauma. The blood tests were average and the CS fluid was mostly normal, in particular there was no trace of blood, which along with the clear CT scan confirmed that I hadn’t had any kind of head trauma. But it did show an elevated white cell count, indicating some kind of infection in the lining of the brain. I was invited to return on the Monday morning to discuss treatment options. But I was told to come back immediately if the symptoms got much worse. In the discharge letter I saw later that was called “Safetynetting.”

We went home.

Sunday morning I woke up and for a short period thought I couldn’t see out of my right eye. Then I realised that although I couldn’t make out much detail I could see the power LEDs of various bits of kit scattered around the room. I wasn’t , thankfully, blind in that eye but it was badly blurred, far more than it usually is with my myopia. I figured that excessively blurred vision counted as worsening, so back to SDEC we went.

They booked me in to see an ophthalmologist that afternoon. He had a good look and told me I had Uveitis, an inflammation of the lining of the eyeball, which can lead to headaches that present as near they eye but not actually IN it. He gave me steroid eye drops and a treatment schedule that extends into December, after which I am to see my usual optician.

Back in SDEC, I think they made an understandable but unfortunate mistake. They decided that Uveitis explained everything and sent me home as MFD. Medically Fit for Discharge, cancelling my Monday appointment. And things did, briefly, seem to improve through Sunday and Monday.

The shit hit the fan on Wednesday. Karen took a call from the doctor who’d seen me in SDEC. (he couldn’t reach me on my phone) Further analysis of my CS fluid, the bottle that I mentioned had gone to Coventry, had revealed the presence of Varicella Zoster Virus. VZV. It’s a member of the Herpes family and is responsible for chickenpox and shingles. I’ve had chickenpox but I seemed to be wide open to shingles, and here it was in my head. It was now certain that I had viral meningitis. I had to go straight back back into SCED with an overnight bag.

Overnight. Right.

After booking me in, the very first thing they did was punch a hole in my right arm and insert a cannula, which I would have for the next six days, Then they ran in a bag of saline with a shot of Acyclovir, a common antiviral agent known to be effective against Herpes family viruses.

They kept me in for the first night in a single room in the short term admissions ward, but very late on the next day I was moved to a 6 bed unit in general medical. I arrived at about midnight and I should probably apologise for the noise I made blundering about in the half dark trying to get myself ready for bed.

I’d had four bags of Acyclovir on Thursday and then three bags every subsequent day. 6am, 1pm and around 8pm The 8pm could be annoying because while they were very good at remembering to put them up, they sometimes forgot to check whether they were done and it would get to bedtime with me still hooked up. Charitably, they were overworked.

When they hooked my up to the first drip, they gave me a rundown of the possible future progression of my treatment. They needed to see just how bad the infection had got and how firmly it had me in its grip. If it hadn’t really taken hold, then I could get a few bags of IV Acyclovir and go home with a box of pills. Oral Acyclovir. The way to do that was to have a better look inside my head. That meant an MRI scan of my brain which they hoped to schedule for Thursday.

Well I asked a couple of times but it didn’t happen until Friday, which had a slight knock on effect.

On Friday morning I spoke to another doctor, the consultant in charge of the ward and she clarified that I’d have the MRI scan, which would be reviewed by the “Infectious diseases specialist” (who I never saw) and it was their decision whether I could be discharged with oral Acyclovir. The problem was that the infectious diseases specialist didn’t work weekends so I was there until at least Monday. Oh well. But I did at least get the scan on Friday morning.

The weekend passed off uneventfully. Three bags of Acyclovir a day. I was starting to feel a bit better. The previous Thursday the headache had been really awful but it was now fading into the background. I started to get into the rhythm of the ward. Breakfast at 7, morning meds round, drip at 8, lunch at 12, drip at 1, coffee and biscuits at 3, tea at 5, drip at 8, evening meds round and bed. And at regular intervals someone would come round with a trolley and take my blood pressure. In amongst all that I had to organise going to the bathroom to do my eye drops. Six times a day. Karen came in every evening to bring me good cheer and fresh T shirts and underwear. One blessing was that I didn’t have to wear one of those undignified hospital gowns that open at the back. And I had my phone and tablet to keep me occupied. I could even, by using my phone as a hotspot, stream various TV shows. The phone signal was good on the 4th floor. (They discourage streaming on the hospital WiFi network) On Saturday a doctor told me the MRI showed me clear of any long term damage but the decision to discharge me or not was still in the hands of the infectious diseases specialist on Monday

Monday morning I had a drip bag and then a blood test. I was assuming I would be ejected after lunch

No.

Just after lunch a nurse came and started me on a giant bag of pure saline that she said would be up for eight hours. So I wasn’t going home. Something to do with my kidneys.

Later, a doctor came and explained. It’s a known and quite common side effect of IV Acyclovir that the kidneys can get slightly clogged with its metabolites. It might have been better if I’d drunk more water, but no one said. That’s what the saline was for, to help flush the muck through. They gave me another bag overnight and said that should fix it. I’d have another blood test in the morning and depending on the result, I could possibly go home in the afternoon.

And to cut a long story short, that’s what happened. The first I knew about it was when a nurse came after lunch and took out the cannula. Then they gave me an envelope of paperwork and enough oral Acyclovir for three more days and waved goodbye. I called up Karen for a lift and that was it.

It’s been nearly a month now and while I’m feeling much, much better than I did, there seems to be quite a long tail. I still get, not exactly headaches, but a feeling of a bit of a stiff neck. And I think there’s a little bit of a reaction to the steroid eye drops I’m still taking and will for a couple of weeks yet. It’s a bit two steps forward, one step back. Subjectively it seems to correlate roughly with with tiredness and stress.

And that I think is the main reservation about the treatment. They staff at the hospital were focused on getting me well enough to push me out of the door and free up the bed. Which is understandable I suppose; no bed in my unit was ever free for more than a couple of hours. But maybe someone could have sat me down for ten minutes and told me what to expect going forward.

So. Was that a “brush with death”? What would have happened if if I’d just carried on swallowing ibuprofen? One possibility is that my own immune system might have dealt with the infection eventually, just like it does with other viruses. But at what cost? The first doctor I saw was slightly concerned that I could have scarring of the lining of the brain. That sounds scary.

Or maybe I’d have developed other symptoms that couldn’t be ignored until it was too late. But that all happens in the other leg of the Trousers of Time. In this leg, I seem to be virus free–or the virus is dormant. As I understand it Herpes family viruses never really go away. They just shut down. I don’t suppose I’ll ever know why it suddenly woke up. It’s a slight worry that it could happen again. It may be worth investigating the shingles vaccine.

There’s a coda.

The day before I was discharged I started to notice a slight soreness in my right elbow. Obviously I ignored it. My best guess was that it was caused by holding my largish tablet up so I tried to stop doing it.

It wasn’t that. After a couple more days I couldn’t ignore it any more and got someone at the GP surgery to look at it (again, not a doctor; a paramedic practitioner) One look and he diagnosed “infective bursitis”. Antibiotics and ibuprofen gel. He thought it was rather likely that it an infectious agent had tunnelled in through the site of the cannula and worked its way round but that’s something else I suppose we’ll never know for sure. I did find out later that cannulas aren’t really supposed to be left in place for six days. They should be removed after four or so days and a new one put in somewhere else. Anyway the elbow cleared up in a few days.

And there we are. I’m starting to feel better; I’m reintroducing myself, slowly, to the bike and I’m enjoying it. I think I’m going to be OK.