Day 2, November 24, Tuesday

The MRI confirmed the large lesions on the temporal and frontal lobes but the dye contrast indicated that it was definitely not a stroke or a blood clot. The lesions were on the outer part of the grey matter and not well defined. The location, size (fairly large), shape and other things were fairly “atypical” as the neurologist said. It could be a virus. It could be metastatic cancer. It could be a primary brain tumor. It could be something else. The neurologist said was really unsure, although she was leaning towards a virus. She thought that the clinical presentation was more indicative of a viral infection of the brain, but the scans did not look like a typical brain infection. The doctor in charge of the ICU was certain it was metastatic cancer. He said that the lesions on the outer gray matter were very typical of metastatic cancer, and it was not unheard of to have metastatic cancer be the first presentation of cancer elsewhere in the body. One of the radiologists thought it was more likely a primary brain tumor, given its size and shape. My mom also had an EEG to determine brain activity. The EEG showed continued seizure in the temporal lobes, and so a new anti-seizure medication was added to her regimen. The neurologist also started her on acyclovir just in case it was a viral encephalitis caused by the herpes simplex virus (note: my dad had a cold sore on his lip). She also mentioned that West Nile could have strange presentations (note: my mom had a bug bite behind her ear about 10 days prior that was particularly painful). My sister arrived, and we spent the day basically watching our mom move between asleep and a semi-conscious state. It was a challenging day as my mom’s blood pressure kept dropping to dangerously low levels, and the nurses had to keep intervening -- at times they pumped in saline at fast rates, and at other times they attempted to change her body position. These techniques would work for a short while, and then her BP would fall again. At 10pm they decided to put in a central line because the BP medication they wanted to use is too caustic for the peripheral veins. They felt that her continuing fluctuations in BP were just too unstable. Despite the central line, my mom continued to have BP problems all night long. The alarms in the ICU kept ringing all night. My mom alternated between moaning all night versus saying in a garbled, quiet voice, help me help me help me. While disturbing it seemed like some hope -- that she had some words -- any words -- and some awareness of the situation.