Impression: Successful epidural blood patches at a total of 4 levels in the thoracic and lumbar spine, as above.
My version of the story has a face-hole and anxiety and nerve-twinging pressure. The medical notes version has clinical language, secret ribs, and exact anatomical locations.
Both of these stories are true.
PART FIVE
Rebound
28
In the hospital, I lie flat on a bed in the recovery area. I’m given crackers, a drink. I talk with my sister, groggy, in a haze, from drugs this time rather than the normal haze of my leaky brain. Dr. Kranz comes in and leans over me, talking about the procedure he just performed, talking about my prognosis, about restrictions on lifting, bending, walking, sex.
I may experience an increase in intracranial pressure, he tells me. My body has been overproducing cerebrospinal fluid to compensate for the leak; now that the leak has been patched—for the moment, at least—it may take some time for my body to realize it, to lower production to more normal levels. This may cause what’s called rebound intracranial hypertension: too much cerebrospinal fluid instead of too little. This usually takes the form of a headache in the front of the head, and may also be accompanied by blurry vision, nausea, vomiting. I think back to the way I felt after my first blood patch, the way my head felt like it might explode, the headaches all over the front of my face. I have been through this before. He tells me that I should try to avoid lying completely flat, try to prop my pillows up to give myself about a thirty-degree slope to lie on—not sitting up, which can stress the dura, and not lying down, which can increase my intracranial pressure; but rather some sweet spot in between. This will help with the rebound headaches, he tells me.
He writes me a prescription for pain medication, and for something to treat nausea, and for something called Diamox, but he folds that paper in half before he gives it to me. “Do not fill this prescription without talking to me first,” he says. “This is for ‘in case of emergency.’” He will call me tomorrow and the next day to check in; if my rebound symptoms are unbearable, we will consider the Diamox—but he’d rather avoid it, if we can. Diamox, also known as acetazolamide, is a diuretic, which can help with the excess fluid; but it’s a serious medication that decreases CSF production and has its own unpleasant side effects. He’d like to see if we can give my body a chance to adapt and readjust on its own before we take that route. And since only my own blood was used in the patching of my dura, and not fibrin sealant or some other biologically based glue, the overall patch itself is a little flexible, and thus may more easily weather the flux of increased fluid. The other option in the case of rebound intracranial hypertension, he tells me, besides just time and waiting things out or taking Diamox, is coming back to the hospital and having my cerebrospinal fluid drained a little, to relieve the pressure. “Let’s go with the healing powers of the passage of time,” I say, and he agrees that that’s a good conservative approach to start with.
“So, what now?” I ask, and he understands I mean to ask the question in the larger sense.
“Now?” he says. “Now we wait.”
It may take two months for me to fully heal from the procedure I’ve just had, and then another two to three months to tell whether or not I might still be leaking. Even with the patching, I could have a very slow, subtle leak, whose symptoms could very easily be confused with the kind of symptoms that are normal during recovery—headaches that get worse as the day goes on, stamina that fades, the need to lie down, pain that improves upon lying down. I could develop a new leak, if my cerebrospinal fluid pressure doesn’t settle, if the patch on my torn dura isn’t able to keep it shut during the surge. It’s just going to take time to know what’s happening, whether I’m healing or still leaking, and he tells me it’s not unusual for patients to return two, three, even five or six times, for repeat procedures.
“What about one time, no repeat procedures?” I ask, and he smiles. “There’s always that chance,” he says. “You could get lucky.”
The absolute best-case scenario—if I truly am lucky and everything goes perfectly—is that I spend a few days in the hotel, return home, recover over the next few months with no recurrence of the leak, and never have to come back.
“And if all that goes according to plan, in the absolute best-case scenario, how long until I’m back to normal? In my brain, I mean,” I ask, and he tells me it’ll probably take about a year to get back to baseline.
A year seems like a long time. Longer than the amount of time I’ve dealt with the pain of this leak, though that seems infinite and thus impossible to calculate. I have the urge to take this deadline as a challenge, to not only attempt the best-case scenario recovery, but to do it faster than anyone expects, to do it better, to win. This impulse is probably an artifact of the Versed and fentanyl euphoria that’s still affecting me, this curious feeling of motivation instead of dauntedness. But for the moment, as I lie there in the recovery bed, my blood clotting around my spine like a living Band-Aid, making the length of it heavy, solid, detectable, and sensate to me in a way it has never been before, I feel as lifted up as I am weighted down.
Eventually I am returned to my clothes, which have never seemed so impossible to put on, and wheeled to the entrance of the hospital, where I wait for my
