How it happened

Calm before the storm

Monday 29 Aug: Played a robust 18-holes at Island (SICC) "Balmy weather - Wished you were here" she beamed to another as we trudged up the new clubhouse.
Tuesday 30 Aug: Course closed but "I want to go to the gym - with LL" She did the treadmill.
Wednesday 31 Aug: Played alone round of golf (I was at TMCC)
Thursday 1 Sept: Sumptuous Lunch at Mayim (Hebrew for water) West Mall with J. Someone was also lovingly scolded by her at work- she was in her element. 4.10pm I called her and she said 5.15 at the garbage, Bukit golf location. Her voice was somewhat nasal, as if a cold was coming.

The Incident

5.35pm Teed off Bukit front - nice finish on 1st & second hole. At the 3rd hole her drive was good. After her second shot (6 pm) she stopped walking at 200m point and said "Oh I have a very bad headache...need to sit down". I said "Sit away from the tree, you might have ants there". Then she went down limp, eyes closed - "Oh very bad headache...". Lets stop and I'll call the marshal to buggy us back, I said. "Wave to the golfers behind to pass", she said weakly, eyes still closed. After a few minutes the back golfers drove their balls and came towards us, while I ran ahead to retrieve our balls after calling the marshal for emergency. One golfer tried to lift her but she couldn't move. The marshal arrived as I ran back and carried her wholly onto the buggy. "I need someone to lean on", she barely whispered. 3 of us on the buggy and 5 minutes later the marshal had already alerted and arrived at the emergency treatment room, all this while she was immobile but limp. Another marshal on a buggy was heading back to retrieve our trolleys (her's manual and mine the remote controlled powered cylinder). As she was being carried on stretcher bed a volunteer doctor was already there. Dr. I John was formerly NUH (now living in UK) with his wife, a trained nurse. He had responded from the gym. He check her vitals and found her cold but otherwise normal, while she administered oxygen. 25 minutes have passed and he reminded me that the ambulance must be called. I ran out and found that the call was made at least 15 minutes ago! Must be traffic. When I ran back in the third time I heard her garbled voice about vomiting, not wanting to soil anything. After spilling it out she seemed better but her grim look tells a different tale. By the time the ambulance came (6.40pm?) she was semi-delirious and it was strenuous to see how hard it seemed to transfer her. I was allowed in the co-driver seat. "Neuro-care" must be the word given to the paramedic. It was a wild-ride of my life, sirens blaring thru the 6.45pm traffic. It was traffic! A little after 7.15pm we arrived at TTS, she vomiting most of the way in the ambulance (as I learned later, thank God there couldn't be another more suitable hospital) When I saw her transferred on the A&E stretcher her voice was becoming incoherent  "I want to vomit...OooOh headache" as she passed out. A little while I had to agree for her to be intubated. We languished at admissions for a further hour.

Historical Note: Miranda has no previous history of cerebral or coronary problems, other than the fact that her father's death started with a stroke. Her secretary attested that she has never taken a single day of medical leave and her medical screening would never suggest an impending rupturing aneurysm. What would? Even the brain scans earlier 2011 for her motor movement problems wouldn't. Three weeks earlier on National Day we grieved over PI who died suffering 16 hours from amoeba infection in the stomach. She's the most intelligent dachshund we ever had (I am still grieving).

Restoring the pillar

8pm (Thurs 1 Sept) The life-saving procedure of relieving cranial pressure had started. It would be a couple of hours of further waiting, then more scans. Around 10pm we were introduced to the consultant who explained the initial scans shows a ruptured aneurysm, where is it, patterns of occurrences, treatment and possible outcomes. Haemorrhage white blobs on the scan was still relatively small. After questions he left to work on stabilising the brain.

Snatched from the Jaws

Friday Sept 2: Around 1.15 am we returned to hear from him that the haemorrhaging had not stopped but actually worsened with extreme cranial pressures. In point of fact there was not much that can be done when both pupils were already dilating. We had to wait out the worse. Someone burst into tears. There was a hush as he left meekly to let it sink in. But not 5 minutes later he returned and said the pupils have responded to a drug (thiopentone?) and the brain has a "calming effect". "If there is a time to remove the major clot this is the time", was the pronouncement as he left the room for my deliberations. Please do not shut the door on the Lord, was S's prompting to me. I knew I had to rush out and shouted to proceed. But they were all ready, scrubbed and systems to go for the next 4 hours. By this time all sleep had fled.

Dawn

Friday Sept 2: (5 am) I was not even in the front door of TTSH when I could hear the surgeon's voice on my hp. After he had sat me down he said all was done - the ruptured aneurysm is now clipped with 2 titaniums, the brain is starting to stabilize. There was actually another minor one "outside" the brain but that have to wait another day. She would be in deep coma now for who knows how long. (But God knows)        <I cannot remember rest of this day now>
Saturday Sept 3 (10 am): I could not hold back the rush of tears as I saw the bloated left eye bruised bluish. But that was the extent of invasive correction. She'd lost part of her scalp for now. But everything should start to normalize, physically. But how about neurally and chemically? God only knows, and He does. There is one more scan - radiation with computer tomography - a spin-off application from the FFT (Fast Fourier Transform) technology providing a non-invasive 3D image, revealing any physical defects deep within an object.
Saturday Sept 3 6pm: Given a recovery rating of 5 on a scale of 3-15
 Thanks HL!
Saturday Sept 3 (11.30pm) Ernest's phone call raised me from my bed. I called back the consultant-surgeon and received the first good news of the debacle: the CT scan visually shows no physical damage.
 The brain still swollen, has some residual clots - but this will go away. No infarct - enough to make someone joyful for the day. But what about neural and chemical - how it'll affect cognition? Only God knows - and He does. I slept that night.

Sunday Sept 4 (noon) Philip Y, who had just touchdown from Boston night before was thoughtfully pensive - "Brain vessel ruptures are becoming prevalent..." I had gleefully shouted at Miranda "Here's Philip - time for durians !" She must have heard. The rest of the day I must encourage her friends to talk to her - it could only be good.
4pm - Church elders came and pray - anoint her. Quite a crowd.
5pm - Someone thought she actually saw her eyelids twitched - but touch and talk must be the balm of the day. Nana's loving touch moved her the most.

Next 48 hours is crucial for higher level functions. The process of impaired cerebral recovery is not well known to science and is beyond medicine at his stage. No drug (outside China?) is known to speed cognitive recovery.

House-Keeping

1. Please remember to sanitize if you plan to stroke her and mask when you speak to her. This IS encouraged as healing should begin from the left side. Correction Sept 5 - Somehow too much aural stimulation is not good.
2. Please share this site on with people who knows Miranda (she loves her enemies too) as there may be more medical info leaking in.
3. Someone found using valet parking cheapest for long term (4-5 hours), others use Novena Square if TTS overflows (often). For Wollerton study group members AP's place is only 5 minutes (he may charge a nominal fee!!!)
There will be 2 more upcoming blog posts: "Restoring the pillar" and then "The Road back" As the Lord develop events next week. (He has already heard us - so be it Lord)

Latest (Sunday evening) Running a fever - full sepsis workout/antibiotics now. Visitors please be vigilant. Thanks deeply.

Monday Sept 5 1 pm: Had to do the uneasy task of collecting her bone-flap (non-reusable scalp fragment, pate) from the mortuary. But it was properly wrapped of size 8cm triangular shape. Depressing! But who will throw a part of Miranda away?
Other Blog pages: Restoring the Pillar- The Road Back?- Starting Over- Turning the Corner?- Home Therapy