Climb Every Mountain by Susan 4/23/18
After almost a year of sleep interrupted by phone calls, emergency room visits, and other crises with family members, my husband and I were able to schedule a vacation trip to Yosemite National Park. A few days before we were scheduled to leave, I got a call from the facility where my father lives, letting me know they were treating him for green toe syndrome. When I checked, his toes were black, and we debated whether to cancel the trip. I took a break from packing the day before our scheduled departure to check again. Dad was much improved, the infection superficial with no concern about amputating his feet to interfere with our plans. By that time, not even good news stopped the adrenaline flood, triggering yet another night of interrupted sleep.
We flew from St. Louis to Fresno, drove to Oakhurst, where we rented a cottage about an hour from Yosemite Valley inside the park.
Changing time zones and altitude increased sleep apnea problems, but I woke the next morning, October 4, 2017, eager to get to the park for breakfast and a morning watercolor class. After breakfast at the Yosemite Valley Lodge, we returned to the car to pick up my backpack full of art supplies and two full, reusable water bottles. Ray kissed me goodbye at the arts center, then headed off to explore the park until time for the photography class he planned to take.
And then I opened my eyes inside the back of an ambulance. The EMT introduced himself as Tim and checked muscle strength in my legs and arms, my ability to follow instructions, and whether I could smile and move my eyes in sync. I was familiar with the neuro check from ED visits with my elderly parents and from working as a hospice chaplain. I knew he was looking for evidence of a stroke or brain injury but, for the first time in months, I did not feel anxious. I was able to answer questions about recent events that he told me I had been unable answer in the clinic. I had no recollection of being in a clinic, and assumed Tim had given me the disposable water bottle in the gurney with me.
I asked how long it would be until we got to the hospital because I needed a bathroom. Tim said it would be around an hour and a half to Fresno, but he could arrange a bathroom stop.
My recollection becomes fragmented and hazy from the time I stood up from the gurney until I walked toward what I assumed was the same ambulance parked in a different place: There was a doorway; a fuzzy Asian-looking lady waiting outside the stall, pointing to the sink, then the door. Then nothing from the time I reached the gurney until they pulled me out at the hospital, except a short blast of the siren and feeling the ambulance slowly weave around something. When the ambulance crew said goodbye, there was no Tim, only strangers.
I went in and out of sleep in the noisy, busy hallway of the emergency department. Eventually, I woke to find my husband, Ray, sitting beside me. As I listened to him repeat the story to doctor after doctor, I recalled “dreams” that seem to be snippets of memory. There are still holes, but this is apparently what happened:
After Ray left me at the arts center, he walked to the Majestic Hotel in Yosemite Valley. He was inside the lobby about an hour and a half later when he got a call from me. I told him something was very wrong, probably due to the increased altitude, and asked where he was. When he told me he was in the lobby of the Majestic, I told him I was outside by the valet parking lot. He found me there with my backpack. One of my repeat questions was how did I get there. His response was that he didn’t know. I also wondered why Tim had given me a bottle of water in the ambulance when I had an IV running. Ray told me I had the bottle with me when he found me on the parking lot.
The “dreams” started to make some sense. A blurry lady saying we would go first to the Majestic Hotel to look at the lobby but spend most of our time outside painting must have been the watercolor instructor; I must have walked to the hotel with the class. Finding myself in an alcove so bright that colors looked washed out, with vending machines and a table with water bottles, and a crackly, staticky conversation must have been about taking a bottle from the arts center for the class. The “dream” about trying to find our rental car to wait for Ray and deciding we would not have paid for valet parking must have been standing by the sign at the hotel.
Ray described my ride from the hotel to the first-aid station in the hotel manager’s car and the exam that took almost an hour. He said I answered every question that related to the past; where we lived; our children’s names and ages; who was the two-term president in the 1980s. I passed strength and balance tests with flying colors. I could not remember when or how we got from St. Louis to California, but was able reason that we probably would have flown because it would have taken too long to drive that far. He told me we had to change from the National Park ambulance service to the regional service at the entrance of the park, where a kind Asian lady in the restroom had offered to assist me.
At the hospital, I slept between tests, which included CT scan, blood work every time I woke up, an MRI, and frequent questions about the date and what I had for breakfast. Ray sat in a hard, plastic chair beside my gurney in the hallway, where we spent the night.
My waking periods were floaty and hazy at first, but became clearer somewhere between four and six hours after onset. During one conversation, the doctor asked if I had experienced any memory or other kinds of difficulties recently. Ray told him about difficulty I had reading scripture at mass a few weeks earlier. I reminded him that my glasses were way overdue for changing, and that the problem was common with blended lenses. He also brought up my forgetting which day we had agreed to sign up for watercolor and photography classes. I reminded him that we had vacillated between Wednesday and Thursday for weeks before signing up in the midst of debating whether we would have to cancel the trip to get Dad’s black and green toes amputated. My brain was back to its argumentative baseline.
By the third day, all my tests had come back negative except the MRI. That showed a very small abnormality in the hippocampus. The neurologist said the blip was too small to identify or be significant. Her diagnosis was transient global amnesia. She asked about head injuries or stress. I described retiring from hospice and hospital chaplaincy seven years earlier, at age 61, to care for two parents with dementia, and expressed concern about any kind of memory loss. She assured me the prolonged stress from those kinds of caregiving was the more likely cause. She also assured me that TGA usually does not recur, and if it did, that would be soon enough to look at other possible causes.
Looking back, the most memorable thing about the whole event was my freedom from anxiety. When a wave of fear or grief washed over me, I was able to use the techniques I had learned for dealing with PTSD to breathe through them within a few minutes. I recognized the compassion surrounding me, from my beloved husband spending the night by my side to the busy nurse who took time to listen while I talked and wept about my fear that dementia was beginning to shrink my horizon. Recollections of sights, sounds, smells, even the taste of the enchilada they gave me for supper, are vivid, if a bit disconnected.
Ray confirmed my serenity. He was surprised by my insistence that he go back to get some rest during the second day at the hospital.
I was released on the third day and told to go enjoy what was left of our vacation. Mostly I enjoyed sleeping, but we did get outside to drive around and do some light hiking. Ray was able to take a few pictures. I was able to doodle a bit and write notes about the strangest vacation I ever hope to take.
During the past several months, I tire easily and continue to sleep more than I had prior to the event last October. When I am tired, I have more problems with word retrieval and keeping track of time. I had hoped that taking a watercolor class would perk up my attempts to write. Instead, turning off my memory for a few hours has provided unexpected inspiration.
On our last visit to Yosemite before returning home, we stopped near the base of El Capitan to watch a climber suspended about halfway up the face of the cliff. Ray took pictures while I contemplated how like the climber my life had become. The climber spent a good half hour in one place beside his gear bundle, going neither up nor down. I was betting he would descend, but no—went up, secured his position, and pulled his gear behind him.
I have no idea whether I am about to ascend toward blazing colors of the autumn years of life, or about to descend into the netherworld of dementia. Today I will attend to today, believing that whatever happens, I am not alone, but surrounded by the compassion of both family and strangers on the journey.