HJAR May/Jun 2023

CTE 12 MAY / JUN 2023 I  HEALTHCARE JOURNAL OF ARKANSAS — perhaps not wanting to scare me, and absolutely trying to figure out what in the world was going on and how to get it fixed. I wish they had scanned his head. I asked the clinic director if they would. We had a radiologist set up to do it, we just needed the doctor’s orders. I realize now that asking an orthopedist to assess head injuries, no mat- ter how well intentioned, isn’t fair to either the patient or the ortho. I have wondered a thousand times if they didn’t think his head needed scanning because they figured he had CTE and CTE does not show up on scans. If they had, they may or may not have found the tumor that was lurking in his brain. I trusted that the team had Smith’s best interests at heart, and he appreciated being in the hands of people he hoped under- stood the brains of athletes bet- ter than anyone. In fact, the words “The Trust” were all around that center along with the NFL shield. How could you not trust them? Smith was doing somewhat better on the drugs they gave him, and his six-month follow-up at the PACT center led to a down- graded diagnosis, which we found encouraging. But soon he was los- ing muscle tone, and this laidback man was uncharacteristically letting people who were acting shitty bother him. He was becom- ing withdrawn, losing interest in activities that once gave him great joy, and was becoming indecisive. One day, he told me he couldn’t do an updog in yoga class — a sim- ple move for a beginner, let alone a certified yoga instructor like Smith. The next week, he called my name for help; there was desperation in his voice. He began hav- ing a grand mal seizure that lasted 20 min- utes, during which he stopped breathing. I shook him when he stopped, encouraged him to continue breathing, told him help was coming, and that he was going to be okay. The pallor of death appeared on his face during this seizure. He was mortal. When EMS showed up, he was com- ing out of it but was dazed and confused. They suggested I pack a bag and drive to the hospital separately, because he would probably be held overnight for observa- tion. The hospital was an hour away. When I arrived at the emergency department, he was sitting up, cracking jokes with the care team, no urgency, his old self. The physician in charge told me that Smith told them he was working out and thought he had passed out. “It happens to older men,” the doctor explained, patting me on the hand. “Passed out? He had a seizure for 20 minutes, body flailing, his eyes rolled to the upper right, and he quit breathing,” I exclaimed. “You need to scan his head! I think there is something wrong with his head!” I thought he was having a stroke. My increasingly loud medical recommenda- tions to scan his head were not appreciated by the ED doctor, even after I pulled him aside and told him about the experience at the PACT center a year and a half earlier and that he was a former college football player. “I do not have the authority to scan his brain,” the doctor said and told me he was sending him for a heart scan. The best thing Smith ever did was to have a second seizure while having that heart scan, because the plan was to send him home if the heart was fine. It was. It always was. He was in great shape, except for the brain tumor they were about to find. Rural hospitals can have advan- tages and disadvantages. The one near us had one neurologist, who was not at the hospital and had a bad telehealth connection. When that neurologist, who could not hear us on his end, asked that same ED doctor who had refused to order the brain scan, where it was, I just sighed. We waited another hour and a half for the MRI machine to open up. The MRI lasted over an hour. During that time, I was pacing like a caged tiger. I was counting the minutes from the first seizure. I figured every minute that ticked away, especially if it was a stroke, was producing more brain damage. I got ugly looks from the ED doc- tor. I was asked several times if I wanted to go to the waiting room, but since the ED was pretty empty, I decided to stay. I wanted to be there when Smith got back, and I wanted to know if he would come back early because of another seizure. During the second seizure, the attendants wheel- ing Smith back into the ED had called out that he had stopped breathing as his huge TIME IS OF THE ESSENCE Smith was told he had three to six months to live without treatment. Dianne scrambled to take pictures of the scan to send to prominent neurosurgeons across the country, because MRIs could not be sent electronically.