Remembering What Is Important

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My sister’s brain shortly after the bleed was found.

My little sister and I call her that, not only because she is two years younger, but she is petite, a mere 5”2” (I’m 5’9”). Had we grown up anywhere else but the Rosebud Reservation, most likely she would have been a gymnast, from the time we were little she could do one-handed cartwheels.

And for whatever reason, my sister and I often found ourselves together in trouble for disobeying orders.

She is also funny, fiery, outspoken and force to be reckoned with.

She is the sibling who lived closest to my mom for many years. Once my dad died, she and her husband regularly drove 60 miles to Mission, my mom’s home, to take care of the things that needed done. Eventually, with her husband Bill, my sister moved my mom to a house next door to theirs in Martin, population 937. My brother-in-law died of pancreatic cancer in 2023.

My mom turned 95 on September 21, and my sister arranged the party. She called me on September 5, to tell me the details. She put announcements in the local papers, had recipes pulled so that she could make a white cake, with almond flavoring, a dark chocolate and strawberry cake and there would be ice cream.

Then everything changed.

Around 10 p.m. on September 6, I received the following text from my niece about my sister. “An air ambulance is transporting my mom to Rapid City. They suspect an aneurysm, but they will run tests. Please pray.”

There is a small hospital in Martin, but when there are emergencies, they stabilize the patients and then fly them to a regional medical center in Rapid City, South Dakota.

When the helicopter landed in Rapid, my sister’s older daughter met the emergency crew, and sent a text to the family. “She is very cold, her head and neck hurts. Waiting for the doctor.” My brother and his adult son, an ICU nurse by profession, went to the hospital, too.

“It hurts when she talks and it hurts when we talk,” my niece said.

My second sister, also a nurse, suspected a brain bleed.

The doctor tested her for Covid (she’s had several Covid shots) and meningitis. Negative and negative. They did a lumbar puncture/spinal tap, and the doctor said it “looked like red Kool-Aid.” My sister’s severe headache continued, and more tests were ordered, including neurology – a cerebral angiogram.

She was diagnosed with a subarachnoid hemorrhage. They called it a “thunderclap headache,” which is defined as an extremely painful headache that comes on suddenly, like a clap of thunder. This type of headache has the most intense pain at its onset. People who have had a thunderclap headache often describe as unlike any headache they’ve ever experienced.

Thunderclap headaches strike without any warning and rare, they occur in less than 50 out of 100,000 adults each year. Sometimes there’s no underlying medical cause to them, but other times they’re a sign of very serious underlying conditions that involve bleeding in and around your brain.

It’s important to seek medical attention immediately to rule out life-threatening causes of a thunderclap headache.

Two siblings are in California, one in Wyoming and two in South Dakota. As we waited for text updates from our niece, we googled the different medical terms.

My sister would undergo more tests to determine where the bleed was in the brain. We clung to the doctor’s comment that “blood vessels could heal themselves.”

Over the next week, my sister suffered light sensitivity, leg cramping, severe headaches and went through more procedures. She was put on pain medication.

On September 9, physical therapy came to the ICU and had her stand up.

They did a transcranial Doppler (ultrasound of the head) on September 10, but after two and a half hours, they still hadn’t found what they were looking for. Her pain continued.

September 11, she had another brain scan and was scheduled for a subsequent cerebral angiogram the next day.

Then the neurologist reported “good news” that she had a perimesencephalic nonaneurysmal SAH (Subarachnoid Hemorrhage), which “if you have a brain bleed, it’s the best type to have.”

Regardless of the cause, a SAH is often has a substantial mortality and high morbidity among survivors. Prehospital care is critical and involves triaging the patient with attention to the airway, breathing, and going to a hospital with neurocritical/neurosurgical expertise.

The overall global incidence of aneurysmal SAH was 7.9 per 100,000 person-years. Around the world, Japan and Finland have higher cases of subarachnoid hemorrhage for reasons unknown. In the U.S. it occurs between 10 to 14 out of 100,000 individuals for year.

On September 14, the hospital discharged her. My sister who doesn’t have a dishwasher asked if she could do dishes, And the doctor said “Yes.” That gave everyone in the family hope that she was going to be okay. She was driven the two-hours home by her daughter.

What the medical staff failed to do before discharging her was explain what my sister needed to do for rehab. When they sent her home, she was still in severe pain, her legs were cramping and spasming. She was using a walker. There were no orders about how to best control her pain and the timing for medication. There was no recommendation for how many times she should be getting up or other steps she should be taking to rehabilitate.

My mother’s birthday, which my sister arranged before going into the hospital, went without a hitch. My sister used a walker to briefly see family and then went back to bed.  Every day is a challenge as she tries to deal with the pain. She’s walking more, which helps the cramps in her legs, and also helps the blood drain.

She continues to work on getting back to “normal.”

I can’t speak for my siblings, but for me, I was so scared I was going to lose her.

It reminded me to focus on what I think is important in life, family, friends.  . . .and to be grateful for the people who have helped define who I am.

(Editor’s note: Two months after the brain bleed, my sister continues to improve. She has gone back to work as a bookkeeper at a local motel and the whole family continues to pray for her continued healing.)

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