Dear First name,
 

On August 30, 2019, Lindsay was home and suddenly suffered the worst headache of her life. She called her mom who called 911 before she lost consciousness.

 

The paramedics came and took her to the nearest hospital. A tube was placed in her trachea to protect her airway and control her breathing. A CT scan was done of her head. The entire space inside the brain normally occupied by crystal clear spinal fluid was replaced with blood.

 

I was sitting in my office when the phone call came. I reviewed the images. I saw her age—35. I heard the helicopter began its descent to the landing pad outside. I remembered an attending neurosurgeon telling me during residency when reviewing similar cases that the mortality approached 100%.

I walked over to the emergency room. Lindsay was not responding. A special study looking at the arteries in the brain called a CT angiogram was done that showed that Lindsay likely had a condition called Moyamoya, which in Japanese means puff of smoke. Essentially, the large arteries that feed the brain become narrow and small, while fragile vessels sprout over time to supply needed blood. The cluster of these vessels look like a puff of smoke on an angiogram. Presumably, one of these small vessels, deep in the brain, was the source of bleeding.

 

I didn’t have an immediate answer to the problem, Sure, Lindsay could go up to the ICU, receive supportive care, and get another head CT in 6 hours. However, what about the blood in her brain, risk for more bleeding, buildup of spinal fluid and high pressure inside the head? Eventually, the situation would leave Lindsay permanently in a coma or dead at 35 with a devastated husband and three young children.

 

Naturally, I did the only thing I could think of to do at the time. I took a walk. I went outside and walked around the hospital grounds. I began to ponder, undistracted, the situation and our options. I forced myself to step away from my panicked emotions and thoughts, I cleared my mind of other issues and problems. I tried to be still.

I considered the condition Lindsay was in. I remembered a couple of times in residency, placing a minimally invasive retractor into the brain to drain a blood clot. We had never done it for this problem, but it could work. I called the rep for the company, whom I had met at a conference earlier in the year. He said the system could be shipped that night and ready the following day.

 

Lindsay remained stable overnight. The next morning, we went to surgery. I placed the tubular retractor into the largest portion of the blood clot and brought the microscope into the field. I could see the surface of the blood clot. I waited and gently applied some suction. Then, a large volume of clotted blood rushed out under high pressure. Once the clot was evacuated, I carefully inspected the area. There was no further bleeding.

Lindsay began to follow commands later that day. Her head CT showed a dramatic reduction of the size of the blood clot. She worked with expert therapists, ICU physicians, nurses, and many others. She received some additional neurosurgical care at the University of Utah, which I am not capable of providing.

 

Two months later, she shot a buck with her husband.

I know many of you face challenging problems. All of us at times have been in particularly difficult situations. As I’ve reflected on Lindsay’s story, sometimes the best thing we can do is clear our minds, maybe even take a short walk, and be still.

 

 

Dr. John Edwards