Death has a way of changing us.

My first encounter of death was of my great grandmother when I was seven-eight years old.  I don’t remember what she died of.  My recollection of those memories only revolved around my discovery and understanding of the concept of death.  I remember wondering why she was just lying there and breathing “weird.”  As a kid, I was wondering why she was lying there when she used to be actively playing with me.  Then she was gone.  We went through the funeral services and burial.  I remember I was wearing a white dress.  I remember a lot of crying.  I remember her being there and then she was gone.  As a child, I wondered why people die, and what happens when we die.  When I grew up, I mostly wondered what will happen after I die.

My next encounter of death was almost my own.

NEW STORY TO TELL

I was ready to start a new job on May 2, 2019.  It was a different role from what I have done in the last 17 years but offers new challenges and an exciting future. I was excited and couldn’t contain it till that day.

I drove that morning from Manila to Clark. Feeling excited from the night before, I was anticipating many things.  Having worked with the team what are officially my “team mates” now, I was excited to see them in country and to do site visits together.  I was excited to find out how I can contribute more in terms of support and in driving excellence. I was thinking, “Starting something new is always exciting.” It brings new perspectives; It challenges you to look at things with no biases; It was a good place to be in. I knew that was a beginning of a new story.

THE “POPPING”

I remember I couldn’t sleep that day.  Must be the excitement. Or it must be anxiety because I was starting something new.  I remember I decided to take a bath around 6-6:15-ish that evening given that the “sundo” (van pickup) was scheduled around 8:30pm.  I was thinking, “I had time” and since I couldn’t sleep, I decided might as well use the time and prepare early.

I was surprised to find myself on the hotel shower room in my hotel. I remember it was around 6:35 PM and water was dripping from the shower head.  I must have passed out while taking a shower. I remember I just finished shampooing my hair and was wondering why I was on the floor. I used to have episodes like this when I was younger but it has not happened for a while.

I got up and was trying to figure out what had happened and I could feel a very intense headache.  It was not the usual migraine that usually initiates throbbing pain. This headache was very different and much more intense.

I kept on blaming myself for not sleeping that afternoon and was attributing the headache because I did not sleep.  I went straight from the bathroom and headed to the bed, this time decided that I will try to nap and was curious to see if that will help with the pain.  I laid on the on the bed only to find myself running towards the bathroom again because I felt like I was gonna vomit.  Made in time and I vomited twice and I could feel like my head was “going to explode.”  It was the worst headache of my life.

Still assessing what was happening to me, I was thinking, “Wait, Kathi. Did you get a stroke?” I was a Psychology major in college and had background with “head aches” like this and possible causes. And I knew vomiting was a bad indication. I kept moving my arms and my legs to ensure I can move all of it.  I kept on moving my tongue and my eyes just to make sure I can move both sides of my body.  When I was sure that I could move both sides, I knew something ELSE was going on with me.

And it was something else.  Something was going on with my brain. It was aneurysm.

FLASHBACKS AND MEMORIES

With the extreme pain I was feeling (that was really the worst headaches of my life!), I honestly thought that was my “time.”  I thought that was the moment I was going to die.  And what they show in the movies, the flashbacks and memories of everything important were flashing in my mind – my family, my friends and loved ones, and things I have done and have not done yet in fast rewind and fast forward.

And in silence, I found myself praying.  My prayer that time was short of the dogmatic ones we know today. In what was happening to me inside my hotel room, the prayer made the most sense. I was feeling helpless and I thought I was running out of time.

My prayer went something like ,

“God, if this is the time YOU will take my life, you can take it.  This is YOUR life and I am happy to give it back.  All I have done so far are in YOUR name and for YOUR glory and this life is Yours.  But if I can make one request before you take this life, can it be that you don’t take it here (referring to the hotel I am checked in).  Please at least let me get to a hospital.  Should you want to take it then, I will surrender fully.  But please do this for the people I love.” 

In that prayer I was thinking it would be easier for the people I love that it ends that way and in a hospital.  I was thinking if I die in a hospital, at least there will be people can explain to my parents especially what “really” happened to me.  Understanding what happens will make it easier for people to move on.  It will lessen the suffering.  I have never dreamt of causing any suffering to anyone I love.  More importantly, I was wishing for their ease in moving forward. Eventually.

It was a moment of surrender. But it was not that easy.

GOD LISTENS

So I got to prepare and got dressed.  Albeit slow-moving, I was able to move from my room and go down to the lobby and to see if the van was there.  I honestly don’t know how I did that with how painful my head was. Luckily, the van was there on time.  I got to the van and was thinking it was my first day on my new work and I have been excited for it for a while and I was there. In so much pain. Of all days.

When we got to the other hotel where my team mates were checked in (there was no more space in Marriott; That was why I ended up in a different hotel), I didn’t get out of the van.  I couldn’t because of my massive headache. Everytime the van moved, there was more pain.

When my team mates got to the van, they knew something was off with me.  They asked how I was feeling and I told them I was having a very bad headache.  Initially asked them I needed to buy some medicines and they were willing to help me out.  I felt like vomiting and I remember somebody handing me a “puke bag (the one that’s available on flights in case somebody was dizzy”.   Finally while on the way to the drugstore, I asked to be brought to the ER. That turned out to be the best decision done by me and everyone on that van that night. I am grateful for these angels on earth for being there for me.

In the ER, they immediately put me in a wheelchair because I was very dizzy, and couldn’t walk. The hospital got my details.  They immediately said they will do some tests.  They were referring to some blood tests, checking my blood pressure and some scans.  I am sure they gave me some medicines but memories of when I was in the ER were hazy.  I knew there were some people watching over me and my stuff.  And the nurses were keeping me awake and kept on updating me with the possible next steps. But the series of events were confusing.

All I remember was I was into a LOT of pain.

THE CLOT

Subarachnoid Hemorrhage.

That was mentioned when the test results came back.

Mayfield defines is as “Subarachnoid hemorrhage (SAH) is a life-threatening type of stroke caused by bleeding into the space surrounding the brain. SAH can be caused by a ruptured aneurysm, AVM, or head injury. One-third of patients will survive with good recovery; one-third will survive with a disability; and one-third will die. Treatment focuses on stopping the bleeding, restoring normal blood flow, and preventing vasospasm.”

Doctor mentioned that there was a blood clot in my brain and what was causing the pain.  When I asked what possible worst case scenario and what I can expect, they said I would have to consult with an expert neurosurgeon so he can assess and give the right diagnosis and recommendations. They specifically said the ‘specialist’ will assess if my case will require a brain operation.  I remember the nurse (I forgot his name) as he was really doing a good job comforting me. He kept on updating me. He made sure I will not sleep and will remain awake for the entire time.

When the doctor showed the scan results, they showed the part of the brain there the aneurysm was and where the hemorrhage was. I knew it was a very risky situation. I just told the ER doctor, “Let’s do what we need to do.  Whether it is operation or medication, let’s do it,” was my reply to the doctors and the nurses. And all the while, I was praying and was thankful “at least I got to the hospital.” At any case, there will be an explanation for those I will leave behind.

They had to move me from TMC Clark to Mt. Carmel because the TMC Clark was full.  I heard one of the doctors endorsing me to another doctor from Mt. Carmel and giving the background of my case (Female, Xyo, Subarachnoid Hemorrhage, etc).  I had to ride an ambulance for the second time in my life (the first time was in college because of extreme migraine. I was also hospitalized for 2 weeks then).

I was surprisingly very calm when all of these were happening.  I knew I was “ready.”  My brothers and my parents were on their way to Clark to see me.  I am sure they were surprised about hearing I was in the hospital.  But in my mind, I was thinking God has granted my wish to be in the hospital and for that I was happy.  As always, He is faithful.  He still was answering my prayers.  God was with me. My guardian angels for sure were on overtime that day.

I knew the risks.  It was explained to me that in aneurysm and when there are ruptures, 33% lives, 33% lives with disabilities, 33% dies.  If there comes a reruptures, that 33% gets down to 10% of those who will live.

I was still thankful – Should I not make it, I knew somebody can answer their questions.  Somebody will be there to explain what happened to me. To my parents, to my friends and loved ones.

THE OPERATION

The operation took three hours.  My family had detailed conversations with Dr. Pagcu on what needs to be done and how it will be done.  Dr. Pagcu was patient in explaining what clipping was, why it was the preferred way vs. coiling.  He explained what the risks were and what the steps were in ensuring that my “risks” are reduced. Post conversations with the doctors and the risks, we were all finally ready for the operation.

My parents and my brothers, and Dots went to the ICU to visit me before the operation.  My brother, Tan, was leading in explaining to me that I need to go through the brain operation.  He was explaining to me why it needs to be done – that I might be “bald” for the operation.  My dad and my brothers were jokingly making statements that if I turned out to be bald post the operation, they will have their heads shaved too.  My other brother, Obet, I knew were taking care of supporting our parents emotionally even if he was trying to manage his emotions too. Sweet gestures from my family but I knew they knew the risks and that it entails a lot of positivity, faith and trust. It was also obvious my mom has been crying. My dad, in his silent strength was trying to be strong for my mom and for me.

Everyone was trying to be strong for me.  I am grateful for that.  I told them, “Let’s do what we need to do.  Whether it is operation or medication, let’s do it.  Please be strong.  I will be okay. Keri lang yan.”  I must have teared up but memories from that night were hazy.

WAKING UP

I remember the doctor asking me to count to 10 backwards. I was on number 8, next thing I knew I was waking up in the ICU.  The operation took three hours.  I woke up approximately 2 hours post operation.

And both of my hands were tied to the bed! And I can feel many things on my face – tubes, a mask-like thing that is making it impossible to talk and other stuff for my oxygen, for drains, etc; There was a tube attached to my head; There was a tube attached to my back; There were tubes in my mouth and nose.  And limited movement because I was literally tied to the bed. I found out later that doing those were standard post operation procedures to ensure patients don’t remove the tubes as a reflex action when patients wake up. Had I not been tied to the bed, I would have removed anything that was in my face. I thought that was a brilliant preparation post operation. Tying the hands eliminate that possibility.

I stayed in the ICU approximately 4 days.

the second day, doctor was very confident that I maybe move to a regular room. His initial check-up post operation went well.  He was happy with the progress and how I was responding: I was texting; I was catching up on what I missed; I was catching up with “what happened.” Aside from the occasional pain because of the “operation,” I felt I was okay. I was concerned about the pain and the scar.

THE GLITCH

Day 1 to 9 post operation. I was texting and was using my phone occasionally from the time I moved from the ICU to a normal room.  I was the usual “madaldal” to my family and close friends during their visits except during times the wound from the operation was painful.  I can also remember I didn’t have the appetite because “I was not feeling well.”  I would be eating 2-3 tablespoons of soup and I would be “full.”  Was eating a lot of ripe mangoes because that was what I can tolerate.  A week after the operation everyone’s hopes were up that I was already out of the woods. Doctors were happy with my progress everytime they do their rounds to check on me.

Day 10. No one can explain what was happening to me. My doctor had to go to the US (wife to give birth). We were endorsed to another doctor but doctor was remotely available. Nurses were clueless and they were like relay communicators to us and the doctors. We needed somebody to explain what was happening.

Imagine not being able to talk and articulate what you want to say and not being able to move your dominant hand (mine was the right hand). I couldn’t say what I wanted to say. Saying or asking for water, for example was a big ask because I couldn’t verbalize it. I remember just pointing at “stuff” and hope that somebody could understand me. I remember slurring a lot and I kept on feeling bad about not being able to communicate what I wanted to say. It was very frustrating.

I also ‘lost’ my right arm. It was a just “dead appendage” during the succeeding weeks. Imagine not being able to hold a spoon when eating. I needed somebody to literally feed me. I couldn’t flip a book; I couldn’t even text right. I remember sending ‘garbled” messages to my friends – either these are row of letters or symbols or emoticons. Even in texts, I couldn’t write in the same way. I couldn’t verbalize what I wanted to say. I usually ended up sending one-word messages, or emoticons just to react. I ended up being fed. For someone who has been independent for so long, not being able to eat or bathe myself on my own felt very wrong. And I hated myself for it while in the hospital. People around me has been supportive but deep down, I was starting to feel ashamed. I was starting to feel like I am a burden to my folks. Many times, I asked God while I was in the hospital, why let me live like “that.” Many times, I will just be in tears and almost giving up and thinking, “Why not just let it end when I would just be a burden to others?”

IT WAS VASOSPASM.

Wikipedia defines Vasospasm as:

“Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia and tissue death (necrosis). Cerebral vasospasm may arise in the context of subarachnoid hemorrhage. Symptomatic vasospasm or delayed cerebral ischemia is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid hemorrhage. Vasospasm typically appears 4 to 10 days after subarachnoid hemorrhage.”

It was my Day 10 after my subarachnoid hemorrhage.

Furthermore, Mayfield describes it as:

Five to 10 days after an SAH, the patient may develop vasospasm. Vasospasm narrows the artery and reduces blood flow to the region of the brain that the artery feeds. Vasospasm occurs in 70% of patients after SAH. Of these, 30% have symptoms that require treatment.

A patient in the NSICU will be monitored for signs of vasospasm, which include weakness in an arm or leg, confusion, sleepiness, or restlessness.  Transcranial doppler (TCD) ultrasounds are preformed routinely to monitor for vasospasm. TCDs are used to measure the blood flow through the arteries.

This test can show which arteries are in spasm as well as the severity. To prevent vasospasm, patients are given the drug nimodipine while in the hospital. Additionally, the patient’s blood pressure and blood volume will be increased to force blood through the narrowed arteries.

If vasospasm is severe, patients may require an injection of medication directly into the artery to relax and stop the spasm.

• Speech and language deficits can make self-expression difficult. Aphasia is a total or partial loss of the ability to understand or use words. It is caused by damage to the brain’s language center. Some people recover from aphasia after a brain injury, while others may have permanent speech and language problems. Less common problems include understanding what is being said or having trouble reading and writing.
• Weakness or paralysis in the arms and legs may occur following an aneurysm rupture. This problem usually affects either the left or the right half of the body and may include the arm, leg, and face. This weakness may improve over time, and rehabilitation may help a patient become stronger and learn to function at the best of his or her ability.
• Visual problems may occur because of bleeding into the eye or damage to the nerves that send or interpret signals from the eye to the brain.
• Seizures may occur after an aneurysm ruptures. During a seizure, part of the body may begin to shake or twist. Seizures usually stop on their own, but medicine is available to prevent seizures or stop them when they are occurring. A person who suffers more than one seizure is said to have epilepsy.
• Side effects of medications may produce rashes, itching, nausea, changes in appetite, and sleepiness. The doctor will review your past medical history to try to determine whether you are at risk of having a side effect. However, reactions to medications usually cannot be predicted, and the first clue likely will appear when you notice something different. Tell your nurse or doctor if you are having a problem that your medications might be causing.
• Fatigue is an overwhelming lack of energy that is commonly seen after a brain injury. The sleep lost in the NSICU also contributes to this fatigue. It may be present for many weeks after you are discharged from the hospital. Fatigue will decrease over time as your physical fitness improves. Regular sleep habits and daily naps will reduce your fatigue.
• Headaches are common after SAH. They tend to improve as time goes by.
• Short-term memory loss may cause you to not remember what you did this morning, or whom you talked to on the telephone. You could get lost while driving and forget how to go home or to other familiar places. You may have problems learning new things and remembering old things.
• Lack of attention and concentration may make it hard to stay focused on a task or problem. You may be easily distracted. Try to focus on one task at a time and do things in a quiet setting.
• Change in perception may make people, places, and things appear different than they did before your brain injury. An aneurysm survivor once likened her experience to coming home after a long trip and finding that everything in the house had changed. The house and furniture was still there, but everything looked and felt different.
• Difficulty with organization may make you forget how to go about daily chores such as cooking a meal, or cleaning your house. It is best not to do too many things at once. Using timers, pillboxes, calendars, notebooks, day planners, and voice recorders can be helpful.
• Personality changes can occur after a brain injury. These changes can range from a lack of get-up-and-go to mood swings to severe depression. You may become more irritable and may cry easily. Signs of depression should be reported to ensure proper professional help and medication.

The following advice comes from physicians and survivors of brain injury: Moderate exercise, a steady sleep pattern, and a healthy diet go a long way toward providing the best chance possible for clear thinking and good conversation. Improving concentration skills and energy levels are two reasons to avoid tobacco and alcoholic beverages.

I was experiencing 10 of 12 of these signs.

It became clear I was going through vasospasm: I was having aphasia – I couldn’t articulate what was in my head. Translation was very different so I end up “quiet” or angry all the time during the early weeks. I had to rely on the ‘signal-reading-skills’ of my parents and my brothers and everyone around me before I can relay what was in my head. I had to point to stuff so I can “talk” to people around me. And there were days I grew tired of it and I will end up just being quiet. It was hard to be not understood, I realize. I also realized that it was harder especially if you want the “person” to get you understood and they couldn’t.

I couldn’t even send a decent message through my phone. During these times, all I can do was send senseless texts to those who were texting me. I wanted to vent. I wanted to ask for sympathy. I wanted to be heard and be understood. But it was useless. I would be able to send “emoticons” but I knew that was not sustainable. I couldn’t talk. I couldn’t write. I felt very helpless.

I couldn’t move my right arm, my dominant arm and hands. I couldn’t hold a spoon which means feeding myself was a task or I ended up being fed. My mom had to bathe me because I had a dextrose attached to me and everyone was scared I might slip in the bathroom. Being independent for almost half my life, I felt angry at myself. I felt I was starting to become a burden to the folks around me.

Aside from these, I was tired all the time. I was still having severe headaches. Sometimes these headaches were waking me up in the middle of the night. I will end up crying on those days and nights. There were moments I wanted to give up. I was feeling tired. I was feeling I was burdening my parents and everyone taking the time to watch over me. I wasn’t eating much because all I was feeling was headache and all I wanted to do is sleep. I was cranky. I was not my usual self. I was very angry. At myself. At God.

WHY ME?  WHY?

I was angry – at my situation. I became angry at God. I felt betrayed by God. In my silence (because I couldn’t express myself), I remember praying to him and asking why not just take me and not let me be a burden to my parents. Why not just take me and take all of me? Why take some capabilities away when he could take it all? Why make me like that “that” when I have offered everything to Him? Why let me suffer? Why do that to my family? Why me?

All these questions in my head and heart. All these without having any means to express myself. All these important key functions that I have used well in His Name. I couldn’t understand it. I was just very angry with the situation.   I didn’t like being helpless. I didn’t like being “dysfunctional.’ I didn’t like being dependent and needing anyone. I was used in having me take care of ‘me.”

ANOTHER MEMORY SAME SITUATION

Then there was a recollection of a memory. I was also in the hospital due to migraine.

I was in college. I was in UP PGH. I remember my room mates then had to take me to the ER because I lost consciousness and hit my head on the floor. I had a concussion and they had to rush me to the ER. The doctor had to stitch me up (around 2-3 stitches only). Because I was having severe headaches, they had to call an ambulance so they can take me from UPD Infirmary to UP PGH.   I remember my parents rushing up from Lucban to UP PGH. I remember being in the hospital for ~12 days. Almost the same experience – I had a dextrose, I was getting medications. I couldn’t eat well. I couldn’t sleep because of the headache. I couldn’t do anything but just to ‘try’ to sleep and rest during those days I was in the hospital. I also almost gave up that time. I also questioned the Grand Plan.

With that recollection, I was thinking that He never left me that first time I was hospitalized. He still helped me get through the experience. I remember going back to Lucban to heal further and get back on my feet eventually. That experience helped me adjust how I was spending my time and how I needed to ensure I was deliberate in watching over my heath. It helped me make better decisions about my time.

So a thought came and I prayed something like this,

“Okay, I am sorry I got angry. I am sorry I am doubting Your intentions on why You are doing this to me. I know this is Your life and I am sure there is a reason why You are doing this. I may not understand Your reasons today. I am sure I will figure it out in Time. Do what You want to do. This is Your life so You can do as You please. I surrender to you. Amen.”

There are many moments that leads us to no choice but to surrender. Those I cannot control, I have chosen to surrender to Him. That in itself lessened the worries. It gave me to be a little bit more patient about myself as I started my speech therapy and some physical therapy. Slowly, I had to demonstrate I was kinder to me as I go through my process. Little did I know that was the key – Surrender.

BACK TO BASICS, FROM ABC AND 123

Alphabets. Imagine letters and pictures. Imagine placards. Imagine starting like a kindergarten on alphabets and what it stands for (A for Apple, B for Bee, etc). At the beginning I was forgetting some letters. I couldn’t verbalize some of the words. I didn’t even know what were some letters. I remember forgetting about Q, P and O. Then forgetting about “9.” I remember them asking me to sing “Happy Birthday” and how I hated it. There was still irritation on some moments especially when I was feeling I was being “mocked (I was not being “mocked.” I was just perceiving it as if they were).”

I was at the lowest point of my life.

I couldn’t help myself. And I felt lost. I was dependent on other people. I cannot sustain myself. I cannot and will not allow that.

But I also knew I had to do something – exert every effort to be “back.” Do it for the people I love and who had their hopes up for me. Remove any sense of “awa” because it happened to me. Try to be better everyday. Keep trying to be better. I know I won’t be able to live like that and not try. I have to do it for myself, too – to bring me ‘back.’

I had to try.

FAST FORWARD TO DAY 18

After 3 sessions of speech therapy and physical therapy, everyone was pleased by progress. I can slowly talk albeit slow but can start relaying my messages. I kept on forgetting some words and would usually think through on it. I remember everyone ‘testing’ me – asking me what A stands for, what number am I holding?, what is this? Etc. I remember them asking me to sing “Happy Birthday” and I keep on looking at them with tortuous looks. Still did it as asked because I needed to check too, if I am already getting better.

I remember my hands and arms starting to “feel like arms” again. My dad and my brother would usually massage it while watching TV or while just staying at my bed side. My dad demonstrated hope for me for the entire situation. He would always say, “Babalik yan sa normal. Basta massage lang tayo. Kaya yan, Nini.” My dad and his silent strength. Powerful source of motivation.

My mom would always be not in sight around 11am. She would return to the room about 12:30ish in the afternoon every day. At first, I didn’t know where she was going. What business would she have in Pampanga? I found out eventually that she was offering masses and prayers for me. And she has asked all she knows to pray for me. She has been in the hospital chapel everyday and has been praying for me.

My brothers were taking shifts in the hospital to support me. They were literally “in shifts” during those time. My brothers showed their dedication and love.  They made sure that I get what I needed everytime I wake up crying because of pain.  They were awake and literally “guarding” me to make sure I was going to be okay.

I have friends who have visited me in the hospital to make me laugh or just to check on me. Or they were these to just silently tell me “they were there for me.” Some will send me messages (some of them I got to really read weeks and months after it was sent to me). Some will be sure to ask for updates from D or I or M or J. Some just sent me their messages asking how I was.

It was overwhelming.

Maybe that is one of the lessons, too. God puts us in challenging situations not to test us. He puts us there to show us how He will help us pull it through. He also puts us there to show us that in those challenging times, He never left us but is working through people around us to show his faithfulness and love.

12 months today.

My wounds have healed. And I am proud of my battle scars.

I am alive. I am thriving.  Thankful for the every good, the bad and the ugly and everything in between.