Sara

Everyone probably knows by now about Sara's fall and concussion.  Here's a full rundown of everything that happened over Labor Day Weekend.  This is really long - sorry!

On Sunday, Sara woke up with a headache.  It wasn't debilitating or anything - we went for a picnic and then a hike and she was fine.  She complained when we got back in the truck about 3:00, so I gave her a Tylenol and she fell asleep.  When we got home, she went back to sleep on the couch and got up about 6:30.  She said her head still hurt some, so Mitch gave her 2 children's chewable Tylenol.  Her friend came over about 7:00 and she put her heelies on and left with her.

About 20 minutes later, her friend called and said that Sara had thrown up.  Mitch and I got in the truck and drove the 3 blocks to her friend's house.  When we got there, Sara was in the backyard. lying in the grass not moving.  Her eyes were open and she was breathing, but she wouldn't talk and move.  Mitch picked her up and carried her back to the truck.  We got home and she said she had to throw up again.  In the bathroom, she was confused.  She couldn't seem to figure out how to sit down on the floor and when Mitch called her name, she looked in the opposite direction.  She couldn't find us.  I looked at Mitch and said "This is not right."  He went outside to get the GPS to find the nearest hospital.

We left Jake at home, because I think at this point, we were convinced she was going to shake this off and be fine.

The nearest hospital is in American Fork, about 20 minutes away.  I sat in the back of the truck with Sara and kept talking to her.  She was fading fast.  Her eyes kept closing and I would call her name about 3 times before she would look at me.  I asked her questions and it took her a long time to answer and her speech was slurred.  We were still less than halfway to the hospital and I was starting to panic.  Being new to the area, my fear was that we couldn't find the hospital, or it was closed, or we'd get there to find out it wasn't a full hospital with an ER or something.  We decided to call 911.

They instructed us to pull over and they sent an ambulance.  Actually, they sent 2 police cars, an ambulance and a fire truck.  We described what we knew, which wasn't much at this point, and there was a lot of discussion between the emergency personnel regarding which hospital she should go to - either the American Fork Hospital or Primary Children's Hospital in Salt Lake City.  They put a brace on her neck and moved her to a back board and loaded her into the ambulance.  I got in front and Mitch went home to get Jacob.  By now we knew this was going to be a long night.

The EMTs decided to take her to American Fork Hospital, mostly because she had had a fall and they were worried about back or neck injuries.  I could hear the EMTs in the back and watched as they started an IV and put the oxygen things in her nose.  She kept saying she was going to throw up, so they gave her something for that.  It took another 15 minutes to get to the hospital.

Once there, she was even less responsive that she had been.  I told them what we knew, that she had been at a friend's and fell and threw up.  I noticed that the nurse kept taking her temperature in her ear.  3 times I think.  Then she came back in and took it orally.  She was given a pulse thing for her finger, which she kept taking off, and the IV was still going, along with the oxygen.  After a moment, the nurse returned with a tech and they took her temperature the only remaining way, if you get my drift.  Her body temperature was 93 degrees.  Her blood oxygen was low too.  A radiologist came in and took her for a CT scan. 

Sara was following simple directions, like looking at you and was able to move herself over from her bed to the CT machine, although she reacted really slowly and seemed to struggle to answer any questions.  She didn't move at all during the CT scan.

Back in her ER room, the ER doctor came in.  He said he'd looked at the CT scan and it appeared she had a brain bleed in the back right side of her brain.  He was going to talk to some other doctors and let us know what the plan was. 

Mitch came back about then and I tried to tell him what they had said, but couldn't get much out.  The doctor saw us and came over.  He said, "Well, here's why I'm not a radiologist.  It's not a brain bleed, it's calcium deposits.  It's probably been there for a long time, most likely a traumatic birth or an old injury."  We felt better, but just barely. 

Sara was still in her bed, now with a warming blanket over her to try to get her temperature up.  She was still unresponsive and we noticed that whenever we weren't actively getting her attention, her head would move over to the left and she would stare at the wall.  They took some blood from her IV line and then said they needed arterial blood, which involves drawing blood from the artery inside her wrist.  It appears to be a difficult and painful procedure.  That was the most response we'd seen from Sara to that point.  After the guy had poked her wrist for the 3rd time and was wiggling the needle around, she reared over to him and yelled "How many times are you going to keep stabbing me with that needle?!"  But she just as quickly slipped back into her silent mode.

The doctor came in and said they wanted to transfer her to Primary Children's Hospital in Salt Lake City, where they would be better equipped to find out what was going on with her as well as better evaluate the CT scan.  Primarys, as they call it, is a pediatric teaching hospital, associated with the University of Utah.

An ambulance arrived and Sara and I left with them.  Mitch and Jacob followed in the truck.

The EMTs in this ambulance were also great.  I rode in the back with her.  The EMT in the back also noted her propensity to slide her head to the left, but we both saw that not only did she move her head left, her eyes also drifted all the way to the left.  He said that that activity could be a "focal seizure".  Mitch later said the ER nurse told him the same thing after Sara and I had left. 

This EMT told me Primarys was the best place for her.  He said doctors come from all over to learn there.  I felt a little better.

At Primary, we told what we knew again.  She was a little more responsive and was able to walk to the bathroom with me just holding her arm.  She knew who she was, where she was, her birthday and where she lived.  The story now was that the calcium deposits were not a result of this injury, but probably from something more recent than traumatic birth.  Our heads were spinning.

About this time, when it was just us in the room, Sara looked at us and said "Boy, that really hurt when I fell off (my friend's) deck."  She remembers coming down the deck stairs, and there were like 5 stairs and a landing, and then 5 more stairs.  She said she was on the landing and her one heelie caught her other one and she launched off the landing and landed on her back in the grass and then her head hit the ground.  She kept saying she didn't fall down the stairs, because she didn't touch the stairs.  She doesn't remember anything after that.

By now, her body temperature was back up and they disconnected the IV, but left the equipment in.  She was off the oxygen.  But her reactions were still slow and she wasn't herself at all.  We waited.  And waited some more.

Finally, they said they wanted to admit her so they could do an MRI the next morning to get a better look at the brain.  Mitch and Jacob went home and Sara and I waited for a room.  A doctor from the floor she was going to came in, and showed me the CT scan.  I don't think any parent should have to look at pictures of their kid's brain.  Just saying.

Calcium deposits on the brain are not uncommon.  It's just that few people ever have a CT scan and have the opportunity to see them.  So the fact that she has it is not a cause for concern.  They want to make sure that it isn't a cause of what's happened to her today.  For instance, did it cause her to have a seizure and fall down the stairs?  Or is it completely unrelated?

About 2:30 AM, they came and took her by wheelchair upstairs to the 2nd floor, the Neuroscience Trauma Unit.  The name about did me in.  We're a little sensitive to head injuries in our family, due to Mitch's sister and all that.  They got her settled into bed, with monitors on her chest and a pulse thing on her toe this time.  After some time, they came in a hooked up an IV since they didn't want her to eat or drink anything in preparation for the MRI.

There's no sleep to be had in a hospital as it is, but I think when you're admitted in the middle of the night, it's worse.  Two different doctors came in between 2:30 and 5:00 to check her out, which involved shining lights in her eyes and asking her questions. 

Her head hurt pretty badly, and they alternated her between Tylenol and Ibuprofen.  She was thirsty and wanted to go home.  She did manage to get some sleep, but just barely.

At about 9 AM, they told us that Radiology was only working on call because of the holiday.  The nurse didn't think anyone would come in to do the MRI, especially since they also wanted her sedated, which would require calling someone else in as well.  She said to expect us to be sent home and have to come back to do the MRI as an outpatient.

A hospitalist doctor came in and I told the story again.  He did all his doctor stuff and then just kind of stood there for a minute.  He finally said, "You know, she has a whole lot of stuff going on - a lot of symptoms - and we're trying to make them all come together to mean something.  But maybe, they won't ever do that.  Maybe everything she's exhibited doesn't exactly add up to one thing." 

It was the first thing I'd heard that made sense since we got the call from Sara's friend.

A neurologist came in about 10 AM.  Again, I told the story.  He did a whole bunch of stuff with Sara, having her follow his finger with her eyes, checking movement in her limbs, asking her questions and things like that.  He tested her peripheral vision by holding his arms out and wiggling his fingers.  He told her to point to which hand was moving. 

She never pointed to his right hand - which would be the peripheral vision in her left eye.  He assured me that these were not scientific tests, and he was going to have his boss come in and look her over.  It was confirmed she wouldn't get an MRI that day (Monday), and we would have to come back.

Mitch showed up then and the doctor showed him the CT scan.  For the 3rd time, I heard a doctor mention Sturge Weber Syndrome.  You can google in, but basically it's a neurological disorder most commonly associated with people who have port wine stains on their face.  The obvious problem here is that Sara not only doesn't have a port wine stain, she has no birthmarks at all, and it generally shows up in children much younger than Sara.

Another neurologist arrived.  He looked like Max, one of the guys I used to work with at the funeral home,  His tag said "Professor" on it.  He did all the same tests, as well as had her do some spacial stuff.  Everything checked out good, except for the left eye.  During one test, he moved his arm over her face from her left and told her to tell him as soon as she saw his hand.  She didn't say "Now" until his hand was over her nose.  He pulled up the CT scan again and showed us that the brain calcifications were located in the part of the brain that processes vision.  Is this why she was having trouble?  How come this was never caught before?  Is this vision thing a result of the fall or of the calcifications?  This is why they want the MRI.  The first neurologist told us to call him when we have it scheduled and he'll come down then.  Then he can tell us to either make an appointment to come into the neurology office or that it's nothing to be concerned about.

She was released and we brought her home.  She slept some, and when she woke up, she felt pretty good.  We tried to get her to eat something, and Jacob read to her, but soon she was throwing up and her head hurt pretty bad.  It was a long night.

Tuesday morning, I tried to get her to eat jello, but she threw it up within minutes.  She couldn't keep down any Tylenol and the pain in her head was a 9 (on the scale of 1 to 10, with 10 being the worst).  I called to schedule the MRI, and then called a local pediatrician to see her. 

They got us in that morning.  He was really great.  And Mitch summed it up perfectly, when he told this doctor, "You know, once they saw the CT scan and the calcium deposits, the concussion was kind of forgotten."  We're not blaming or anything, but it is true.  This doctors said "Let's get her over this concussion first."  He prescribed something to help the nausea and take the edge off the headaches, something they used to give to migraine sufferers.  It's worked well, and she's feeling a lot better. 

We did hear that because there is a family history of migraines - my mom - that Sara's going to be more prone to that.  And this injury may spur an earlier start to these migraines than she may have.

There's a lot of information on concussions out there, so you can look it up yourself for detailed stuff, but basically, she may experience this headache off and on for the next 6 weeks.  Another head injury during this time would be terrible.  She may not be able to tolerate a full day of school for a while, and her concentration may be off .  There's a lot of "may bes" involved and I'll have to talk to her teacher and the school to make sure we don't push her too hard.  Luckily, she seems to be ahead of the school system here, so I don't think it will be a big deal. 

Now we just wait for the MRI tomorrow and what that tells us.

Thank you to everyone for your calls, notes and thoughts.  It's been hard being so far away from everyone during all this, but knowing you're all pulling for Sara has really helped.