Lost Words

With the first draft of the book given to the publisher, it’s time to get this blog back on the regular track.

Canary Wharf has a skating rink at the moment and my crewmate and I were sent there to attend to a ‘fall, head injury’.

“Excellent”, we thought, “a nice simple job – nothing complicated”.

We were met by a worried looking ice rink worker who wobbled across the pavement on his skates to meet us.

“We wouldn’t normally bother you guys, but we think it might be serious”.

Grabbing my bags I was led to a woman sitting in the changing area with two youngsters, both of which were looking a little concerned.

“Hello there.  I’m the ambulance, what seems to be the problem”, I normally start with a version of this as a conversational opening gambit.

The patient replied, “Well, I had a bit of a fall….”, she paused, “I…”, she paused again, “Head…hit…migraine…”.

She seemed to be having trouble finding the right words to use.  I quickly examined her, and was happy that she hadn’t hurt her neck and the small lump on the back of her head didn’t look serious either.  So why was she acting so strangely?

“I get migraines”, she told me, “I…lose…um…er…um…words, and I…eyes…eyes…go blind”.

This is a pretty rare presentation of migraines, but not unheard of.

We got her into the back of the ambulance and all my examinations there were normal.  She was complaining of ‘losing her words’ (expressive dysphasia) and of going blind in her right eye.  She didn’t seem too upset by this and had already taken her normal migraine medication, although I’m not sure on how Paracetamol and Metoclopramide would help with these symptoms as I’m not an expert on migraine treatment although I know that Triptans can sometimes be used.

Her symptoms started to get worse, she couldn’t find any of the words that she wanted to use, and so I needed to get a more thorough history from the two youngsters.  They were her nephews and she had been treating them to a trip down to London.  Although young, they were both very mature and helpful and after some prompting from the patient (“Laptop…look…laptop”) we found a patient information card in her purse.  The card let us know that all the symptoms that she was experiencing were indeed part of the presentation of her migraine.

It was a short trip to the hospital, during which she started to make a slight recovery and we left her in the capable hands of the A&E nurses.  Unfortunately for the patient, the hospital was extremely busy, so I’m guessing that she had to wait a little while for any treatment.

The three of them had come from Surrey, so they didn’t know the area well, although we were able to give them directions home from the hospital, we had chosen this hospital over another slightly closer one so that it would be easier for them to get home after any treatment.

A day out into London turning into a trip to the hospital – it happens more often than you would think.

15 thoughts on “Lost Words”

  1. At one stage I was commuting weekly between Cornwall and London and overheard a conversation on the train where a woman was returning from Cornwall to London after taking her friend's husband's dead body back to Cornwall. The friend and husband had come to London for the husband's birthday and the lady was taking the husband to the London Eye when he had a heart attack on the tube and died in the ambulance on the way to the hospital – a rather extreme version!Also, yesterday, I was crossing Chancery Lane tube station twice (to/from Farringdon) and the first time I saw a LAS paramedic on a motorbike (hunky!) and then an ambulance outside the station – guess it was a busy day for the staff there.

  2. Migraines are very odd. Paramax works only for me when I take it during the aura phase of a migraine – taken after the pain starts it does nothing for me. It's just a pain killer combined with anti-nausea since the aura symptoms often make you feel sick as well as the enormous pain in the head – I don't think there's anything out there that treats the aura.I only took Triptans once – after 72 hours of continuous migraines. I lay down, rigid and unable to move* for 4 hours whilst my skin crawled with pins and needles. I've never taken them since as that was worse than the pain 🙂

    I've never lost words like her, but I do lose vision. It's pretty scary sometimes – worst was cycling down High Holborn when I suddenly realised I couldn't see where I was going. Because the brain fills in the missing gaps, it's always a short while before you notice what's wrong…

    *I felt unable to move – this could have all been in my head. No idea.

  3. Mike – yepFirst time it (migraine with aura) ever happened to me was at uni. Very weird and scary, suddenly realising you can't see very much at all actually and it's not just coz you've been looking at bright lights

  4. Somewhat related…my roommates' mother was once in a car accident right as she was trying to come up with the word “windmill”. Minor concussion.Now, whenever she's struggling to look for a word, “windmill” is the one that comes up and gets blurted out first before she can get to the real target…

  5. The first time I ever had a migraine I was about 11 years old, and I had huge white spots in my vision and unequal grip in my hands. My left side was all pins and needles and I could barely move my arm. My mother thought I'd got meningitis or something cos all I wanted to do was lay in a dark room.Thankfully I don't get migraines all that often, but they still won't let me take the combined pill (dammit).

    I can understand metaclopramide because I always feel really pukey when I get migraines and usually end up curled up around the toilet bowl.

    Nasty things migraines

  6. Loathesome things migraines. I agree with Merys that often a darkened room is the only place to be. Not the M40 as I found out once. If I can hit them with strong painkillers whilst at the aura phase they tend not to develop further, but a bad one can take 2 days to get over.Rae

  7. is there a standard format for a patient information card that would be useful to you and your colleagues?I'm guessing: name, date of birth and age, existing medical condition, regular medication (that'd put me on half a side of A4 already) and one or two contact numbers… anything else?

    As it is, I just have ICE number in my phone… ICE1 mum home, ICE2 mum mobile, ICE3 sister's mobile, on the basis that they know all the information about me there is to know.

  8. Have to admit, whilst we aren't officially authorised to use metoclop for migraine, its amazing how many migraine sufferers have nausea!See here for a recent BMJ article on metoclop's efficacy in tx'ting migraine:

    Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials

    Objective To assess the evidence from controlled trials on the efficacy and tolerability of parenteral metoclopramide for acute migraine in adults.

    Conclusions Metoclopramide is an effective treatment for migraine headache and may be effective when combined with other treatments. Given its non-narcotic and antiemetic properties, metoclopramide should be considered a primary agent in the treatment of acute migraines in emergency departments.

    Link: http://bmj.bmjjournals.com/cgi/content/abstract/329/7479/1369

  9. I used to be of the opinion of “It's just a bit of a headache, get over it” with migraines.Mind you, I also used to be of the opinion of “It's a bit of a sniffle, get over it” with hayfever, until I actually got hayfever for the first time in my life, in my mid-twenties.

    I no longer take the mick out of migraine sufferers in case karma decides to bitchslap me again.

  10. Ah, but you see – while it looks daft when you write it down, it actually makes sense (especially for people who don't speak English as a first language) if you say it while walking in through someone's front door.

  11. Makes sense to me. If I'm on the floor with an arm chopped off and blood everywhere (it's only a fleshwound) I don't need your full name or exact title or full list of qualifications, I need to know that you're the emergency service that was called to the scene – ambulance.

  12. Never worked for me either – just puked it up again!If it gets that bad the only thing that works is enough painkillers to knock me out then about 8 hours sleep in a dark room. I've learnt not to ignore the aura and whack it with 3 paracetamol which usually stops it developing. I've also found that cutting out caffeine and taking a taurine supplement has reduced the incidence mightily, from 1 or 2 a week to every couple of months.

  13. Wow. I was a speech and language therapist for a while and I didn't know migraines could cause transient dysphasia. (Then again, I guess if it's transient we wouldn't really have come across it in practice – we didn't see many patients with TIAs either.) How interesting…

  14. My ex-wife suffers with migraines just like this. The first time she had one, she was on the road somewhere. She called her boyfriend at the time, barely able to speak, and managed to relay her location to him with much difficulty. When she got to hospital, they more or less assumed that she had a brain haemorrhage, but luckily it was 'only' a migraine.

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