Syncope

On February 25, I passed out. It’s still not exactly certain why I passed out. The day before, I had a cold (diagnosed by a visit to my doctor after several days of running a fever) and a temperature of 102°F. That evening (of the 24th), I took Thera-Flu®, my “go-to” medicine of choice for colds and sinus congestion.

There’s some speculation that the decongestant in the Thera-Flu, coupled with the hot shower I took that morning, caused my heart to go into atrial fibrillation, or “AFib.” In AFib, the atrium, or top chamber of the heart, starts quivering without really pumping, which means that the bottom part of the heart has to pump even harder, or else one’s body doesn’t get enough blood flow and, thus, enough oxygen.

What’s more certain is that, after I passed out, I was in AFib. I passed out just after getting out of the shower—I can at least recall that much. From that point on, however, I have only the sketchiest of memories: no visual memories, and only a few auditory ones.

When I passed out (what the doctors call a syncope), I was standing in front of the shower, and I apparently fell forward and slightly to the right. My face smashed into the wall beside the bathroom counter,¹ opening up a laceration from the top left side of my forehead and across my right eye. The front of the sinus over my forehead was crushed, and the bone over my right eye (the orbital) was splintered into several mean-looking shards that were left pointing at my eyeball.

Note: there are some pretty horrific images of blood and bodily damage below. Don’t scroll down unless you’re ok with that.

I also suffered a subarachnoid hemorrhage, which means that my brain was bleeding. This was probably an effect of the fall, but there’s also some speculation that I had the brain bleed first, which then caused the fall and subsequent AFib.

My wife, Anita, had been asleep in the adjoining bedroom, and she heard me fall, woke up, and realized what was going on. She found me curled up on the floor in the shower; I had apparently tried to get up several times; I had also tried to get into the tub at the end of the room, and there was a fair bit of blood all over the place. I was still talking with her and tried to convince her that I didn’t need to go to the hospital (or perhaps that she could bring me there). Luckily, she ignored me and called 911.

After she sorted out with the 911 operator that we didn’t actually live in the city, but instead in unincorporated Snohomish county, she went downstairs to meet the paramedics from Snohomish County Fire District #1 (which happens to be about 100 yards away across the street from our neighborhood). They attached a heart monitor, helped to get me downstairs (in a “stair chair”), onto the gurney, into their ambulance, and thence to the Swedish Hospital in Edmonds, about 10 minutes away. (They also helped get me into some underwear, which apparently I requested, though I have no memory of that.) I arrived in Edmonds around 7:00AM.

In Edmonds, they performed a CAT scan and verified the damage. At that time, I was still in AFib and my heart rate was 188 beats/minute. I had a concussion, skull fractures in my face, and bleeding on the brain. (I also had numerous minor injuries, including lacerations on my chin and right leg and contusions on my foot, knee, arm, thigh, and hip, all on the right side.) The doctors in Edmonds called Harborview Medical Center to see if they wanted me.

Harborview is the only Level 1 trauma center in a five-state area; it handles cases from Washington, Oregon, Alaska, Idaho, and Montana. (It’s also the hospital that inspired the TV show Gray’s Anatomy.) Harborview, which is operated by the University of Washington, is also a teaching hospital, so every doctor is accompanied by a little cloud of medical students. When Edmonds called and asked if Harborview wanted me, they agreed, and I was put on another ambulance for the 20-minute ride to Harborview.

(Now, some of you who are familiar with the Seattle geography are asking yourselves if I made a mistake there. How can someone get from Edmonds to downtown Seattle in 20 minutes? Apparently, ambulances can not only go faster than the speed limit, they can also control the street lights in front of them. So stop asking silly questions.)

When I arrived at Harborview (around 9:00AM), their major concern was the subarachnoid hemorrhage, so I was placed onto the neurosurgical intensive care unit (ICU). The AFib was also a problem, but the cardiology team started working on that. By the early afternoon, I was out of AFib and my heart was working more or less properly. By 3 o’clock in the afternoon, I was lucid, sitting up in bed, and my memory started working again. That is to say, I have pretty much full retention of everything that happened since then, so the only blank spot is between 6AM and 3PM on that day.

The next few days were mostly sleeping and being annoyed with the doctors (and their legions of students) who came in to examine me. On Monday, February 29, a team of surgeons performed reconstructive surgery on my sinus and right orbital. They removed the broken bits of bone and repaired everything with titanium plates and screws. I looked as if I had been beaten to a pulp but, in all honesty, I was doing much better than beforehand.

I was discharged the next day, on March 1, and spent the next couple of weeks at home before returning to work.

It’s been an interesting journey so far. As I’ve gotten older, I’ve been a bit fearful of falling; let’s face it, sometimes your balance isn’t all it’s cracked up to be, and I have tripped and fallen a few times. But this was so totally out of the blue, so unexpected, that I had trouble processing it for a while. But deep scars and bruises on your face help drive home the truth that, yes, you did kind of smash your face.

As you might expect, I have a series of follow-up appointments with various doctors: my GP, of course, and the maxillofacial surgeon, but also with cardiologists and the neurosurgery folks. I was also accosted in Harborview by a group at the University of Washington who are doing a research study to try to find better ways of addressing traumatic brain injuries (TBI), and I agreed to participate. (If my experience can help someone in the future with similar injuries, I’m all for it.) For the U of W study, I had to undergo an MRI and some psychological exams, and I’ll have follow-up exams every few months over the next year.

There’s scarring, of course, and I’ve been told several ways to minimize that (massage the scars as well as avoiding the sun), but I suspect that I’ll always have them. (And it will really help the realism of my pirate costume at Halloween.)

The biggest concern of all the doctors was the concussion: they’ve advised me that, after a concussion, sometimes people returning to work experience “fuzziness” or headaches upon more intense mental concentration. Luckily, that doesn’t seem to be a problem in my case. The worst effect so far has been a lot of tiredness. I can go through a full day’s work, but I’m dead tired when I get home. I imagine that’s because the body is still healing, and there’s only a finite amount of energy throughout the day. The tiredness is receding, however, as the injuries heal, and I imagine that I’ll be back to full strength in a few months.

One of the biggest annoyances (so far) is that the laceration in my forehead “nearly severed” a nerve, and thus my forehead (from the scar up to about the middle of my head) is essentially numb. There’s some hope that the nerve will heal and I’ll regain some feeling there, but that hasn’t happened so far (and may never happen).

Update: 2025

As of April 2025, I still have the scar, my forehead is still numb, but otherwise no major long-lasting issues. Since the incident, I’ve been involved in a long-term “track study,” run by the University of Washington, that keeps tabs on traumatic brain injury (TBI) patients over time. I meet with them for a few hours every couple of years; I get an MRI and they give me a number of cognitive and memory-related tests. According to the researcher, I’m in a group of less than 2% of TBI survivors who have no measurable loss of brain function.

The reconstructive surgery on my right eye has done something to the tear duct. I often have draining and sometimes crusting because of it; we suspect that something was damaged during the incident to cause this. If this is the only long-lasting effect of the injury, then I count myself lucky.