Monday 8th February 2010

Gestation: 19 weeks, 3 days

One year ago.

My mobile rings.

“Hello is that Dr Nethercote?”

“Yes.”

“You’re the doctor who was looking for a radiology report on Saturday?”

“Yes, I am.”

“Well, I know that someone rang on the weekend, but I just wanted to reconfirm that there was no demyelination.  The brain and cord look good.”

“And the hot spot?”

“An haemangioma.  They’re a dime a dozen.  Every second person has one.”

“That’s what I waited for three hours to hear on Saturday.”

“Sorry?”

“It doesn’t matter.”

“Anyway,” he says, continuing, “there is just one other thing.”  My bowels clamp.  “This patient also has a Chiari Type 1 malformation.  But there is no evidence of  craniocervical compression, and no syrinx.”

“Okay.”  My heads spins, as my Roladex does a run again.  “Sorry.  Remind me?”

“Herniation of the cerebellar tonsils through the foramen magnum.”

“Right,” I say.  Suse hovers close, a frown on her brow.

“Thank you very much,” I say.

I hang up.  Suse looks at me, awaiting an explanation.

“What is it?”

“You have a Chiari Malformation.”

“What does that mean?”

“That the bottom bit of the cerebellum – the part of the brain at the back – is poking through the foramen magnum, which is the hole at the base of the skull that connects to the spine.”

She pauses for a second.  I wait for her reaction.

“My brains are falling out of the bottom of my head?”

“In a way, yes.”

“Really.”  She stands for another moment, frowning deeply.  “I mean, this is just ludicrous, isn’t it?  I have a new disease every day.  MS one day.  Then cancer.  And now, my brains are falling out the bottom of my head?”

“Yep.  But it’s better than cancer.”

“Better than MS,” she says.

And then, she grins.

“You know, this is hilarious.  “The other day when I was over at Ella’s house, she said to me: ‘You know what, Suse?  At the end of all of this, they’re just going to tell you that your brains are too big for your head.’  And here we have it.”

“You do have a cute little coconut-sized head.  There’s not a lot of room in there.”

She laughs some more.  “And I’ve always said that one of these days, if I get too stressed, that my brains will explode out of my head.  And now it’s actually happened.”

“It has been a stressful couple of months.”

We both fall apart laughing.

* * * * *

Fifty-five minutes later, we’re in Terry’s office.   But this time, we’re in a different room;  one far less old-world than the one four days ago.  Our doctor of antiquity just has rotating rooms.  The bubble is somewhat burst.

“Well, you’ve probably heard the results ahead of me?” he says, sliding the films up onto his light box.

“I have, I have,” I say.  He looks over at me, waiting.

“No demyelination,” I say, “and just an haemangioma in T1.”

“Oh, yes,” he says, pointing, “but everyone has them.”

I feel stupider by the minute.  Where were all of these experts while we sweated it out on Saturday?

“And we were just told that there is a Chiari malformation.”

I stare at him, awaiting his reaction.

“Oh, yes.  But again, it’s only minor,” he says, tapping the lightbox as he looks.  “There is no cord compression, no medulla elongation.  It’s only a type 1.  Very good, Susan.”

“So they say,” she says, trying not to sound too relieved.

“I know it all sounds dramatic, but we only know about Chiari malformations because there are so many MRIs performed these days.  They’re about one in a hundred.”

“So, they say,” I echo.  “Therefore it’s not the cause of the symptoms?”

“No.  Originally we thought it was a Guillain-Barre type thing, but the nerve conduction was normal.  And then, we thought a demyelinating condition, but the MRI is normal.  So this leaves us with an inflammatory small-fibre thing.  Probably a viral thing.”

“What about a B12 thing?”

“You ask one-hundred people on B12 if they’ve got headache, and fifteen will say yes.  And probably the same for pins and needles.”

“I know.  I know you’re right,” I say.  “Same with the haemangioma.  But you tend to lose objectivity when it’s your wife.”

“Which is exactly why you come to see me.”  He smiles warmly.

“So – just so I can get this straight, the Chiari malformation – no problems with raised intracranial pressure with pregnancy?  Or in labour?”

“Not like this.  Nothing to worry about.”

“That’s what I wanted to hear.”

“Thank you, Terry.”

“You’re very welcome,” he says, shaking both of our hands formally.  He walks us to the door.  “We’ll be in touch.”

“About the small fibre type thing?”

“About the small fibre type thing,” he replies.

We grin and turn, waving as we go, like we’re saying goodbye to our grandpa.

And he watches, as we walk off down the hall, holding hands like two little kids.

* * * * *