Hemorrhagic Stroke (4)

Neurosurgeons are always called to clear clients who have had surgery and need to fly.  

This is mainly because air that remains in the skull following surgery can expand rapidly as the pressure in the airplane drops during flight.

This is especially dangerous during ascent, when the pressure can drop rapidly.

Patients have been known to get significantly nauseous as these changes in pressure happen and in some cases, this phenomenon can be life-threatening.  

Pressure

I had cleared Mr K for flight, because it had been months since his surgery.

 As I contemplated on the answer he had just given me, I was struck by the fact that he could become more confused during the flight and that the airline staff had not been alerted on this possibility.

If the pressure changes caused him to shout or worsened any headaches he had, I was going to be completely exposed.

All the nightmare scenarios whizzed through my mind and all I could do was pray.  

My first prayer was answered when the third seat on our row was left unoccupied at the time of take off.

 It meant we had some wiggle room if Mr K wanted to lie down.

 Agent Confidence had assigned the aisle seat to Mr K and the middle seat to me, there was no way a passenger would get past us to the window seat.

Soon after take off, Mr K did want to lie down.

He had been sitting in the wheel chair for the last three hours and I completely understood.  He had healing bed sores he had been sitting on.

He is a tall man, so his head ended up being on me for the next hour or so, until meals were served.

I was relieved when he sat up okay and ate everything on his plate.

He sat a while and then wanted to lie down again.  

The scenarios continue to whizz in my mind… what if the changing pressures disordered his bowel and he got diarrhea and needed to be changed?

How were we going to get to the washroom without a wheelchair on board?

What if there was an unbearable smell if he let go into his diapers?  I just had to pray.  And God was faithful.  When the captain announced that we were descending, I almost let out a whoop.

I propped him up and got ready for landing.  I did not have any questions for him… I just continued to trust.  

Agent Confidence, in his bombastic optimism, had booked so that we had one hour of transit before our next flight.

Since it took one hour for the wheelchair crew to take Mr K off the flight, and we also had to go through customs since this was our main port of entry… of course, we missed our connecting flight.

Our next flight was going to be in four hours.

The wheelchair assistant took us to the waiting area and we settled down.

At about the two hour mark, the hitherto stoic and quiet Mr K, said he was hungry.

I wheeled him over to the eating area and then we both got a hot drink and a muffin.  Again, I was impressed that he finished his food.

When we had finished and I was wheeling him back to the gate, he uttered the words I had been dreading… he wanted to go to the bathroom.  

Actually, this was just the best place for him to say them.

At least I was going to get some assistance from the nicely uniformed assistant who just passed  by at the right time.

He politely pointed to the nearest restroom and continued on his way.

Mr K and myself were in the washroom for the next one hour, sorting out his business. 

He came out feeling better and cleaned. I came out sweaty, flustered and hoping I would not do this again.  

So when 30 minutes to the arrival of our flight, he said he wanted to go back to the washroom, I sternly advised him in Twi, to hold himself together till we got to Koln.

There was no way we were going to miss this flight.  

He did, all through the two hour flight to Koln and JP was at the airport waiting… alone

Koln

As the plane started descent towards Koln Airport, a wave of relief swept over me.

I had left home in Ghana at 2p.m. the previous day, after a busy morning at work.

We had now been on the road for 12 hours and I could see the beginning of sunset through the airplane windows.  

I was not fooled by the shards of light flitting through the clouds because the screen indicated a seven degrees Celsius afternoon.

The landing was soft, but we were to wait another hour before we were finally taken off the plane.

As we cleared customs into the arrival hall, I must have been expecting some kind of consortium of African looking people waiting for Mr K.  

It was just JP, standing and waving as soon as he saw Mr K in the wheelchair.

His smile seemed to light up the whole room, his Ghanaian face glistening in the caucasian sea of people gathered to meet family and friends.

He walked enthusiastically towards me and shook my hands hard.  

I expected an ambulance to be waiting for me as we got to the exit.

There was no ambulance, but JP reassured me that he was getting one right away as he picked his phone up and made the call to the ambulance service.

Every conversation was in German now and I was acutely aware of the fact that I was in another country. 

Suddenly I heard the sirens and I felt my hair lift this was the famous German efficiency at work.

It was just a few minutes after the call and here they were, two paramedics half jogging towards us with tubes, cables and monitors in both hands.

The last thing they expected as they hurried towards us, was Mr K in the wheelchair, looking at them calmly, fully awake.  

They broke out in German with JP when they reached us and it was obvious they were not pleased.  Before I could attempt to understand the drift of their animated discussion, the police had arrived.

He went straight to JP to ask in German and then explained to me, that an ambulance had been called for a patient who was not having an emergency in anyway.

JP was not piping down and it looked like his insistence that the Mr K sitting calmly in his wheelchair looking on, was the emergency, was not winning him any sympathy.

Finally, I had to step in as the physician, speak to the policeman and ask for options.  

Things quieted down now and he sent the ambulance away, and then used Mr K’s insurance card to call a patient transport company.

My heart sank as the ambulance drove away.  We got back into the warmth of the airport and it would be another hour before the policeman directed the new team to us.

At this point, I had to do another full introduction, hand over Mr K’s documents and then we were allowed on this new ambulance.

There was no seat for JP, so he offered to meet us at the hospital by train.

It was now almost 4 p.m.

I was not to see JP until almost 10 p.m.

The next five hours were traumatic.  

We got to the first hospital which the consortium had used for the visa application.

They did not have a record of the letter that promised care for Mr K.

They did not have a bed waiting.

The best they could do was to offer us a place in the urgent care queue to be seen by the ER Physician.

So we did, I sat with Mr K in the queue, reassuring him that he would soon get to go to the washroom.

Mercifully, he continued to control himself quite well and sat calmly.  

When it was finally our turn, it was dark outside.

The physician assessed him and was satisfied enough with his clinical situation, to admit him, but there was no bed in his  hospital.

He had made a call to another hospital and secured a bed.  

We would have to wait to be transferred there.

It was another two hours before we got transferred. 

This time the team was waiting and they took Mr K in smoothly.

Just when the nurses had settled him in and changed him into clean hospital linen, JP sauntered in. 

He was complaining about the inefficiency of the German Railway system.

The writer  is a Neurosurgeon