Already by the winter of 2009-10, Barbara's sleeping habits had changed. From being a night person, she became someone who went to bed at 9:00 pm and was even lying in bed during afternoons, though reading much of that time. Since we had met as the only people in the breakfast line of the U. of Michigan cafeteria at 1:00 pm, I found this worrying. But, B did not think in terms of illness, so she refused to see a doctor about this.
Early one morning in late April of 2010, I woke up to find Barbara in a very distraught state. She had a terrible nausea and, after much urging, I got her to confess that she had been awakened by this feeling at 2:00 am. Nevertheless, it was not till 2:00 pm that I got her to call her doctor's office for advice on her continued, totally unproductive, nausea. The advice was to go to an emergency room. So I called our friend medical advisor (his sister had been a veterinarian ) Engelbert for advice about how to proceed. He said that if we went by taxi, we would spend a long time in the waiting room, so we should call an ambulance. B's primary care physician is connected to the NYU Medical Center, so I called there and learned that they did not send out ambulances and that the only choice was to call 911. I did that and twenty minutes later the door bell rang. When I asked who it was the answer was `the Fire Department.' So I let them in and, as it turned out, this was the ambulance crew --- the EMT. We had a pleasant if lengthy interaction but finally set out for the NYU hospital where B was wheeled straight into the ER on a stretcher.
After some time it was decided that Barbara was suffering from a Tako Tsubo Cardiomyopathy. This is a problem with the muscle in the left ventricle. It took a while, but finally a bed was found in the ICU after midnight. She spent a few days there and was then moved into a medical ward for another very few days and then went into the cardiac rehabilitation ward (The Rusk Institute). The cardiologist who dealt with B's case was Dr. Francis O'Brien. He is an associate of B's primary care doctor who never made an appearance and has not been heard from, as far as I know. When we last saw Dr. O'Brien, Barbara seemed to have largely recovered from the cardiomyopathy, though there has been no follow up for two months.
When I arrived at the ICU early on the morning of her admission, Dr. Greenwald (possibly a resident) was examining Barbara and, as they were speaking, she noticed that B was stumbling over words and she reacted immediately. She had B sent for cat scans and an MRI of the brain. These showed an object in the left frontal lobe whose nature was not obvious.
While all this was happening, I mentioned to Dr. Greenwald that I seemed to be bleeding internally and she urged me to go at once to the ER. I objected that I did not need another day like the previous one and that my problem was perhaps that I had not had a chance to eat during our day in the ER. But, being enterprising, she called the head of the ICU, the competent and pleasant Dr. Goldenberg, who lured me out of Barbara's room and persuaded me into a wheel chair for a rapid entry to the ER. Since B's room had an empty bed, I thought it was understood that they would put me in there. This sounded like a good plan to me, so I went along. But, instead, after another long day in the ER, I was admitted to the standard medical ward, not being sick enough for the ICU. Still, it was a great setup for visiting Barbara at all hours. Nevertheless, I was not completely happy with this arrangement, which lasted four days during which nothing wrong was found and I had stopped bleeding. I did enjoy many pleasant conversations with my doctors however.
In the end, B spent eleven days in the NYU facility with good care. While we both there, one of the weekly seminars was devoted to her case but I was not told about it till afterwards, which I found annoying. There was no telling from the MRI scan whether she had had a stroke, an infection or a tumor. So, in early May, after Barbara was released from the hospital, we returned for another MRI. We spoke with the neurosurgeon Dr. M. Smith who showed us both scans and pointed out how the enhancement, as he called it, had changed. Such rapid change seemed worrying to me, but Dr. Smith pointed out that this might be an effect of the steroid that Barbara was taking. The nature of Barbara's lesion remained in doubt.
At Engelbert's suggestion, we tried the apparently standard procedure of seeking a second opinion. Karl Lauby, a fellow chorister of Barbara's, recommended us to his friend Dr. Gutin of the Memorial Sloan-Kettering Cancer Center (MSKCC). He kindly agreed to see us with negligible delay but insisted that we must bring both scans. After chasing after the relevant person for three days (even unto Bellevue Hospital) I obtained a cd that was supposed to contain both scans. However, when we got to our appointment with Dr. Gutin, we were told (to our great embarrassment) that only the first scan was on the disk.
Dr. G. said he could not really diagnose from that alone but that the object looked like a glioma that had been there for quite a while. I spent the following week trying to get a disk with both scans and it was a painful experience. I was told that the radiology department of the NYU hospital was difficult about these things and was given incorrect locations and phone numbers for them. When I finally got to the right place with the help of a friendly guard, I found them extremely cooperative and compliant.
I dropped the new cd off with Dr. G.'s nurse Patsey Yeo-Ranamaker and a few days later Dr. Gutin called to say that his radiologist said that the scan indicated that Barbara had had a stroke and that we would not need him any longer.
I suppose that few people are happy to hear that they have had a stroke but we were among them. And so we went to Cape Cod for the beginning of the GFD Summer Program in Woods Hole. Dr. Gruber had ordered another scan for late June and, though I expressed surprise at the delay, I was not surprised to be unable to understand the answer, as I was by then getting used to this sort of thing.
When we returned to NY for the next scan, we left almost all our summer things on the Cape since we expected to be back in a few days. But, when we were told that the object in B's brain was definitely a tumor, the outlook changed. The NYU tumor group had judged the the tumor to be a lymphoma but the verdict from Sloan-Kettering was that it was a glioma. Both groups recommended a biopsy. The usual brain biopsy is done with a fine needle into the skull. But, since Barbara's tumor is in the speech center, this was too dangerous a procedure and a full blown operation was needed. I asked Dr. Gutin whether one could avoid the operation by simply composing a treatment that would apply whichever diagnosis was correct. (I thought that even a bit of overkill in the treatment might be better than an operation.) But I was told that this was not a suitable approach.
We had then to decide whether to have the operation done at NYU or MSKCC. In the latter case, Dr. Gutin would be the surgeon. Barbara opted for Dr. Gutin and the operation took place on July 8, one day after our 48th anniversary (on which I scalded my wrist and produced a second degree burn). For my part, I was impressed that Dr. Gutin had made the right diagnosis once and felt this kind of experience is very desirable in a case like this.
Barbara's operation involved opening a flap of her skull to scrape out a bit of tissue. Dr. Gutin reported that, at the end of the surgery, a member of the team had dropped a small piece of bone on the floor. To avoid the risk of infection in using that piece, it was replaced by titanium. This kind of thing occurs in 3% of such operations. I decided, with sister Mimi's agreement, not to mention this to B till later. And so the saga began.
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