You win this time, baby.

"Syncopal Event" So a couple of nights ago I ended up unconscious, on the floor, dreaming about a duck and a witch debating over who should mow their lawn. Incredibly unprofessional. But apparently these things are common on Ob-Gyn rotations. But I don't understand why these things have to be common for me. Here's my track record so far: In a week of working pure shifts I observed a c-section and helped out with a normal spontaneous vaginal delivery (NSVD). I nearly passed out in one, and definitively passed out in the other--I was on the floor dreaming about ducks. That means right now the score is: seven pound neonates 2, Elora 0.

When the scrub nurse told me I needed to leave the table during the c-section because I was leaning on the patient and I was passively crossing my eyes, I gave my retractor up and I had at the time told myself my blood sugar was probably low. Type 1 Diabetes fail! I sulked out of the room--very slowly so that I wouldn't fall onto any of the nurses standing cautiously around me. And then I had found my way to a patient fridge which are really just stock piles of assorted milks, jellos, and juice cups. One chocolate milk and one orange juice down, I found a dark, quiet unused part of the family waiting room and slowly collected the sweat pooling off of my face onto the collar of my oversized, hospital recycled scrubs. Excellent example of an acute hypoglycemic event--so perfect I didn't even think about checking my blood sugar. And then I actually passed out for real during a NSVD and upon regaining consciousness enough to check my blood glucose, I was perfectly normal--better than normal… 176 mg/dl. So now everything is in question!

DID I REALLY ALMOST PASS OUT DURING THAT C-SECTION? Even my potential as a future family practitioner should be questioned. If I can't handle pregnant people and kids, then I will have to become a… oh god… an internist? I would rather die than do something that boring. I HAD SUCH HIGH HOPES FOR OB-GYN. I've more or less "mastered" (for a third year medical student) the pelvic exam (I can find your cervix! If you have one). Vaginas don't creep me out at all! Vaginal products don't really creep me out either. Senior year of high school, as a swim team captain, I had picked up, with my bare hands, a bloodied feminine napkin that some noob had left on our locker room floor. This merited me a great gag gift at the end of the season. But it also kind of made me think that I could handle a large amount of grossness associated with the female reproductive tract. I still don't think vaginas or uteruses are my problem.

Which is why I think my real problem is… babies. When I had returned to the floor station after passing out during the NSVD, and the nurse wheeled the less than one hour old baby past me, I pointed at it and declared: "You made me pass out, baby!" What the hell is wrong with me? THEY BARELY MOVE! They are pathetic. Me and a baby in an actual fight? I would probably win, right? Gah. Maybe not.

This is the bruise left from my syncopal event.

 The midwife, the residents, and a ton of nurses have been very supportive of the fact that I am not, in fact, a very imposing six foot tall woman, but rather a pathetic, spineless, inexperienced medical student. Every one has stories of passing out and watching other people pass out. It makes me feel better to know that this isn't rare. But I don't want to feel normal. I want to actually be good at maintaining consciousness in unpleasant situations.

Talking with my friend, Cindy, who was also on shift with me, who had also watched this baby emerge into the world, who had also, like me, held the mom's legs back to flatten the pelvic floor and increase the size of the pelvic outlet, and who is a very small five feet tall, but who had NOT passed out, suggested something like, maybe it's not the actual sight of a baby entering the world--because they are pretty ugly looking in an adorable way--but maybe it's the smells of deliveries that really knock me out. Possible. The c-section lady had smelled pretty gross before the operation, and during it, she hadn't smelled that much better. And during the NSVD, I was literally holding up a thigh as the woman kept exhaling directly into my face. I shouldn't say anything. If I had been in labor for the last thirteen hours, yea… I probably wouldn't have spent time brushing my teeth, either. But then it was all I could smell and I felt like vomiting. And when the baby came out I kind of stepped out into the corner, leaning against the window sill. I was thinking to myself "hypoacousis: the thing that happens to me when I'm really happy/manic when driving and I have to turn up the radio all the way because everything sounds so quiet" because that's what was happening to me at the time. Everything was incredibly muffled. There was no longer blood in my ears, apparently. Nor was their blood in the rest of my body, because my arms and legs were moving very slowly. I managed to make it to the window sill and was just kind of waiting for the aura to subside. But it was a prodrome. And the next time I opened my eyes, I was staring at the ground and a nurse was propping me up against the wall with a blanket, and another was going out to get me orange juice. "I don't know what just happened," was my response to "Are you alright?" And Cindy was giving me a pity smile. The patient's family members were mildly freaking out, and I wondered if when the kid asked about her birth they'd tell her that she made a medical student pass out.

Later I would have to fill out an employee injury report, and although I had a small, 1-2 cm laceration ion the lateral aspect of my forearm, and my hand was really sore, I was tempted to write "ego" in the head of the anatomical model of the human body, and circle it to show where I was in fact, most hurt.

And That's Delirium!

Recently I found out that hypoglycemia can precipitate the mental state of delirium. As a well controlled diabetic, I have a lot of hypoglycemic events, so I am versed in the various physiological and psychological events that coincide with a drop in blood sugar. However, the number of times I've been delirious because of hypoglycemia? It's hard to say--I only just discovered what delirium is (thanks clinical neuroscience!)

But I'm going to say I've been completely incapacitated by delirium secondary to hypoglycemia twice: once in the central rain forests of Costa Rica, and once again in the sixth row of Finch Auditorium at Rosalind Franklin University.

The first time--in Costa Rica, was innocent enough. I had lost a lot of weight rather precipitously. The temperature was always in the low eighties and I had to hike about ten miles everyday under the weight of climbing harnesses, bio-tags, poorly prepared, non-Skippy peanut butter sandwiches, and gallons and gallons of water. Regardless, when I returned to the states briefly to take the MCAT, I sidetracked and took a shopping trip to the Gap, only to realize I was a size four, which means I probably weighed about one-hundred-and-forty-five-pounds, placing my BMI at 20. Although still in the normal range, when you consider my amazing, incapable-of-becoming-osteoporotic bones, a BMI of 20 is deadly. Or at least deadly for a diabetic since I didn't have any excess stores of glycogen in my liver. All hypoglycemic events had to be dealt with by myself--not the glucagon my diabetic body was still capable of making.

Essentially this just meant waking up with hypoglycemia frequently and having to drink more gatorade. But one morning, I woke up with a huge existential crisis hovering around my incapacitated body. I will never know how low my blood sugar was--all I remember is that my roommates had already left for breakfast and I found myself alone in the jungle, surrounded by the creaks and caws and chirps of forest dwellers and the hot and sticky and humid air of the tropics. Oh yes, and an existential crisis.

There was a journal by my bed. I wasn't really recording much in it: we had actual journals to take down actual data--like the types of epiphytes on the branches held up by the forty meter tall trees we climbed. I had a journal to take down various soil measurements (soil is so cool! But that is neither hither nor thither). But by my bed was a journal of just short little ditties--observations really, of a rainforest. Or at least, that was all that was in it--ditties--until my blood sugar was freakishly low and I somehow located a pen and started tearing at the pages with it. I was terrified, in that moment, of death, without knowing why. I had no idea my blood sugar was low, just knew that God was holding me in his hands at that very moment, pondering whether to keep me on the planet or toss me out, into the abyss of Hades.

And I was terrified. My mind flashed, somehow, and without anything more than incredibly tangential reason, to Cat Stevens, and how he had decided to dedicate his life to god and become a muslim after he had almost died swimming in the atlantic ocean and got caught up underneath a rip tide. So I wrote a prayer, a plea, and a mantra on the quadrille lined pages of my yellow journal, demanding that god forgive me for all that I had done and to allow me to live a little longer.

Delirium had made me a sniveling religious fiend.

I eventually escaped such a fate when I--fortunately--started chewing on sugar tablets sitting next to my bed. I then made my way to a late breakfast, where my advisor berated me for my tardiness and my rather dulled affect. Oh, but if only I had known then what I know now: "I mean no disrespect, but unlike the rest of you, I just spent the last hour in delirium."

Anyway, the second delirious state happened literally an hour ago.

Having awoken five minutes before class started, I had no time to locate my test kit. But I had a headache, and I had gone to bed with a bowl of popcorn recently consumed, so I assumed that my blood sugar was the cause of the headache and thus I needed insulin. Well, within the next thirty minutes I realized that my blood sugar had probably been fine when I started feeling the chest tightening spasms of hypoglycemia. No matter! I had fruit snacks!

And thinking that I had avoided the ills of hypoglycemia, I settled in to taking notes on a lecture about epilepsy.

And here's where it gets interesting: Somewhere--about an hour and a half into lecture--I stopped being able to understand the slides I was reading on my computer. And then, shortly after that--the lecturer stopped making sense. I wanted to raise my hand at several points along the way--I wanted to clarify what he was saying because I was sure he was saying it wrong, but I didn't. Instead I just sat in awe that everyone else seemed to understand what was going on.

And then the madness truly sat in.

We switched to a new professor for a new class, and my head wouldn't stay straight on my shoulders, my neck wobbling side to side. I became obsessed with the fear that the professor would notice me in what would have looked like a sleeping position and that I'd be kicked out of class--or that I'd automatically get a 0% on my next exam. So I snapped my head up and sat up straight as possible. But it was useless, because inevitably my eyes would close and my head would fall forward and I'd look like I was sleeping again.

I tried to focus on my computer, on my notes, but they no longer made sense. I tried to play a little game on google+, Triple Town, to see if that would wake me up, but I was exhausted and I quickly closed the tab on my browser and was unable to pull up anything again. I was exhausted; not tired, just thoroughly incapable of movement or thought.

I soon became incredibly confused and scared. Didn't anyone else feel this way? Why did nothing make sense anymore. I could hear the words my professor was saying, but they didn't make any sense. I became preoccupied with a feeling that I didn't exist, or that if I did, I existed on a plane unlike the one everyone else seemed to belong to. Kind of like I was the only one who realized that this world was simply a matrix, and that I needed to find my way back to reality. But how to get there?

I needed help, but from whom?

I decided that I needed to go to either the counseling/health center at school--a five minute walk away from my current location--or to my mother, who I was beginning to doubt was actually my mom at all.

But at both locations I would have done the same thing: fallen on the ground and started yelling that this wasn't real and that someone needed to find out what was wrong with me. "Run all the tests!" I imagined yelling to anyone who would listen. There was something terribly wrong with me, I just didn't know what--but I needed to know. 

My daydreams kept escalating in preposterousness until I imagined grabbing a knife and stabbing myself in the heart to regain entry to the "real" world that was hanging just outside my grasp. The thought of stabbing myself terrified me. And that simple feeling--intense fear--called my logic to attention.

What if this was just hypoglycemia? So I formed a plan while my professor kept garbling through his lecture on... what was it? ... anticonvulsants?

Step 1: Get Food
Step 2: Wait to Feel Better
Step 3: Feel Better? If no, go to Mother
Step 4: Feel Better? If no, stab self in heart

Fortunately, after eating a snickers bar, a twix bar, one reese's peanut butter cup, and a can of coca-cola, the delirium surrounding me started to fizzle away. I was capable of speaking, although my tone and volume were way off when I asked one of my friends sitting in the row in front of me, nearly incoherently, where today's pathology quiz was going to be administered. But I was conscious, and the fear that I didn't exist or that I existed in a parallel universe or a mirror reality, quickly became nonsensical and strange. Shortly thereafter, I was conscious enough to begin writing this, an assessment of my mental status as it descended once again into a state I wouldn't recommend for anyone. And that's delirium for you.




(a little bit more for the intrepid reader):

so delirium can be caused by anything that wholly affects the brain. usually when i have just bad hypoglycemia (so not life threatening but unpleasant), i act like i have a frontal lobe lesion: poor planning, flat affect, avolition, etc. however, the two times i've become "delirious" from hypoglycemia, it's possible that I was under the spell of global cerebral ischemia (so involving the entire brain). And while it appears that to get global cerebral ischemia from hypoglycemia, low blood sugars have to occur chronically (i.e., insulinomas), I fully believe that an hour of really low blood glucose could knock a person delirious.

(the end)

Going Over

This is awesome.

This is also terrible.

But still kinda awesome.

Child psychopathology is actually super fascinating. Unfortunately, lecture has gone over by 24 minutes. This might be a record.

Regardless, usually I wouldn't care. I love it when classes go long--if they're interesting. But today something else is amiss. My blood sugar is low (it's 55 mg/dL). And I need to go get a Coca-Cola.

OH! Class just broke. Great!