After a few minutes of silence passed between them, Nikki furiously wiped her tears and stoically, stubbornly went back to her research. “ECG/EKG- An electrocardiogram (ECG or EKG)– is a test which checks how the heart is working by measuring its electrical activity. With each heartbeat, an electrical impulse (or ‘wave’) travels through the heart. This wave makes the muscle squeeze and pump blood from the heart. By measuring how long it takes the electrical wave to travel through the heart, a cardiologist can find out if the electrical activity is normal, fast or irregular (referred to as an arrhythmia). By measuring the amount of electrical activity passing through the heart, a cardiologist may be able to find out if the heart is enlarged or overworked. This test is used to detect abnormal heart rhythms which may have caused blood clots to form, detect heart problems, including a recent or ongoing heart attack, coronary artery blockage, areas of damaged heart muscle (from a previous heart attack), coronary artery blockage, and inflamation of the sac surrounding the heart peri…peri…”
“Periacarditis,” Casey finished for her. “It also detects conditions that have nothing to do with the heart like electrolyte imbalances, and heart disease, it helps monitor recovery from a heart attack, progression of heart disease, or how effective certain medications are or how well a pacemaker is working. ECGs also help us rule out hidden heart disease in patients about to have surgery.
“Thanks, I guess I’m getting a little more tired than I thought. What can I expect with this test?”
“You’re not going to call it quits, even for a short break, are you?” Casey asked, already knowing the answer.
“No, what can I expect?” Nikki pushed on.
“The diet doesn’t need to be restricted at all before an ECG, but it’s recommended that patients don’t smoke just before it starts. The patient’s asked to take off his or her jewellery and wear a hospital gown. It’s a ‘non-invasive’ procedure, meaning nothing’s injected into the body. ECGs are painless. Multiple electrodes usually a total of twelve to fifteen are attached to multiple places on the body, including the arm, leg and chest. They’re attached by small suction cups or adhesive patches. Sensors in the pads detect the heart’s electrical activity. Sometimes the test is done while the patient lies still. The results are recorded on a graph and read by the technologist. It usually takes five to ten minutes.”
“With an electroencephalogram,” Casey began.
“A what?” Nikki asked tiredly.
“An electroencephalogram; an EEG it’s a little different. That’s a test that’s used to investigate electrical activity in the brain. The doctor might do it if someone’s had a stroke and the he or she wants to check if any brain damage happened. It’s also commonly used to diagnose epilepsy. The doctor will tell the patient who’s having the EEG to wash his or her hair the night before and not to use any oils, lotions, or hair sprays in the hair. That means no conditioners, hair spray or styling gels. It’s important to avoid any food with caffeine in it for eight hours prior to the test. This means no cola, chocolate or tea.”
With a little smile, Nikki said, “I can just imagine the look on his face if I said no chocolate.”
“Probably not a good idea to do that, you’re right. Let the doctor be the one to tell him.” Casey agreed with a smile.
Sobering, she continued, “It’s a good idea to check with the doctor to see if there’s anything else that should be done before the test. EEGs are usually performed in a clinic or doctor’s office.”
“Victor will certainly like that better-if he has to have one-he won’t have to stay in the hospital for it.” Although she was trying not to let it show, a shadow of the doubts that were beginning to creep into her mind had made its way into her voice.
“You sure you want to hear the rest of this? There’s no hurry.”
“Yeah, I’m sure, Casey. I have to do this. It’s the only way I can help Victor. It’s the only thing I can do for him. He’s stuck in that operating room fighting for his life and they won’t even tell me anything. I can’t see him. I can’t talk to him, so yeah, I’m sure I want to do this. I need to do whatever I can to make sure he comes out of this okay–and right now that means reading all this research no matter now long it takes!”
“Okay, I didn’t mean to upset you. I’m just worried about you.” Casey relented still very concerned.
“I know. believe me, Casey, I’m fine.”
“Okay. I’m here if you decide you need a break.”
Meanwhile, back at the ranch, Vicki paced the livingroom once more. “Where is she? Damn it, Mother! Why aren’t you back yet?” She said to herself as she picked up the phone and jabbed at the numbers.
“Great, she’s not even answering her cell phone! How am I supposed to find out what’s going on if I can’t even get a hold of her?”Vicki bristled.
Fuming, she slammed out of the house and, getting into her car barrelled straight towards Nick’s house.
Back at the hospital, Nikki still refused to heed her sister’s warnings as they trudged on with the research. “So, what can I expect when they do the EEG? What’s that like?”
“Well, he’ll have lie on a table and small metal plates called electrodes will be attached to his scalp. They’ll record electrical waves running through Victor’s brain. During the test, which usually takes about ten minutes, he needs to stay as quiet as he can and not move or speak. The quieter he is, the better the recording will be.”
“Victor; quiet? You’ve definitely got the wrong man!” Nikki said with a small smile.
“I know. But, if he doesn’t want to do it again, he needs to stay still and quiet.” Casey returned her sister’s smile.
Sobering, Nikki continued reading. “Magnetic Resonance Imaging (MRI)– This is a big imaging device that sits in its own room. It uses a non-harmful magnetic field and radio waves to obtain clear, sharp pictures of what’s going on inside the brain. An MRI is used to detect bleeding in the brain, tumors or stroke. It’s also an excellent device for detecting smaller strokes in the back of the brain, that other imaging devices can miss. MRI pictures show even more detail than CT scans, and can be seen in three dimensions on a computer screen.
What’s involved–You’ll lie on a flat bed then be moved inside an opening into the MRI machine. It takes approximately thirty minutes to obtain all the necessary pictures. Some individuals find it challenging to stay still for that long, but the test itself is painless.”
“Magnetic Resonance Angiography (MRA)–This is a newer imaging technique used to find any blocking or narrowing or the arteries in the neck and brain. Like an MRI, an MRA uses a strong magnetic field and radio waves to take pictures of the blood vessels. It makes three dimensional images of these specific veins and arteries and can aid doctors in obtaining very detailed information regarding your stroke.”
“Physical exams–The doctor will probably start by giving the patient a physical examination to help determine the type of stroke he or she might have had. The exam could include: Observing how the patient looks and acts. For example, if his or her skin has a bluish tone, it might mean that there is a problem with his or her heart. If he or she is pale, it might mean he or she is anaemic. Seeing if the patient has any signs consistent with stroke like paralysis or weakness on one side, trouble speaking or understanding speech. The doctor may also listen to the patient’s heart to see if there are any signs which might mean there’s a problem like a heart rhythm disorder. The doctor might take the patient’s pulse in several different parts of the body to determine if there are any areas with blood flow problems. The doctor may also listen to the patient’s lungs and bowels for sounds that might indicate problems.”
Turning to Casey, she asked curios, “What other kinds of problems would they be looking for doing that?”
“Maybe gastrointestinal problems or lung problems.”
“Problems with the digestive system and intestinal tract.”
Nodding, Nikki continued. “The doctor might also tap on the patient’s body to hear the sound it makes. Doctors might also look in the patient’s eyes for signs of haemorrhage (e.g. blood spots), high blood pressure or reduced blood flow (ischemia).”
Yawning a bit, she continued. “The doctor might also take the patient’s blood pressure, check the patient’s reflexes, and ask him or her or his or her family member a series of questions including: what warning sings the patient has; what medications the patient is taking; if there’s a family history of stroke or heart disease; the patient’s past health and medical history; the patient’s risk factors for stroke. Based on the examination, the doctor may order other tests to obtain more information regarding the patient’s condition.”
Taking the binder, Casey continued where Nikki had left off. “There’s another kind of test they can use for people who’ve had strokes. It’s called a transesophageal echocardiogram; TEE for short. It’s a special kind of echocardiogram. It’s usually done when the doctor wants to get a closer look at a person’s heart to see if it could be making blood clots. Like an echocardiogram, a TEE uses high frequency soundwaves (ultrasound) to examine the structures of the heart. A transducer (a unit that directs sound waves) is placed in the esophagus (the pipe that connects the mouth to the stomach). The esophagus is close to the heart, so pictures from a TEE can give very clear pictures of the heart and its structures.
How to prepare–The patient will be asked not to eat or drink for four to six hours prior to the exam and to take any prescribed medications with only a sip of water. Patients should also arrange to have someone drive them home after the exam in case they’re feeling drowsy.
What to expect–Patients may be given a mild sedative to help them relax. They may also be given oxygen during the test. The patient’s throat will be numbed with an anaesthetic, then a flexible tube, about the size of someone’s index finger is inserted into the patient’s mouth and down his/her esophagus. During the test, the patient may feel the probe moving, but it won’t be painful or interfere with him or her breathing.”
“That would be creepy and really weird; to have something moving around inside you, to actually be able to feel it.”Nikki interrupted, still tired but trying her best to pay attention. “Sorry, she murmured as she felt a swift kick and explained, “Your niece thought I meant her.”
“That’s what you get for making smart mouth comments about medical research while you’re pregnant,” Casey teased with a half smile.
“I guess I ought to know better by now.”
“Uh, yeah, you should.” Sobering somewhat, Casey agreed before continuing. “The transducer at the tip of the tube gives off sound waves which bounce of the heart and are converted into pictures on a video screen. The doctor is able to move the tube up, down and sideways to look at different parts of the heart from different angles. The test usually takes approximately twenty to forty minutes.
“I wish these tests wouldn’t take so long, then maybe someone could come out here and tell me what’s going on.” Nikki said with a yawn.
Shaking her head to try and wake herself up, she asked, “What’s next?”
“Next, you get some much needed, and way overdue sleep.”
“Casey, I’m not tired.” Nikki did her best to cover another big yawn.
“Yeah, I can see that.”
“Casey, I can….” Her voice trailed off as, sitting beside Casey, wrapped in a blanket, with her head on Casey’s shoulder, she drifted into a thick fog of sleep brought on by the total exhaustion she’d forced upon herself after hours of reading.
Meanwhile, at the ranch, Vicki had just arrived at her brother’s house. Turning off the engine, Vicki took out her cell phone and dialled. “Come on, Mom, pick up. Pick up! Damn it!” She slammed the phone shut, and slamming her car door shut ran full tilt up to Nick and Sharon’s front door.
“Victoria, what are you doing here?” Sharon asked surprised to see her there so late.
“Hi Sharon, is Nick around? I really need to talk to him.”
“Yeah, what’s wrong?”
“Mom’s missing, so is Dad. I can’t find her anywhere, nobody’s seen or heard from her or Dad.”
“Sis, calm down. There’s a logical explanation for this, I’m sure.”
“Nick, I still haven’t been able to get a hold of Mom. Nobody’s seen or heard from her or Dad at all. They should’ve been home hours ago!” Vicki told him stubbornly, starting to get very, very worried.
“Sis, calm down. What happened?”
“If I could get Mom on the phone, I might be able to tell you!” Vicki exclaimed, barely resisting the urge to throw something. “Mom’s not answering her phone. I don’t know what’s going on. The longer this goes on, the more worried I’m getting Nick.”
“I’ m sure they’ll be home soon.”
“Why don’t you just stay here awhile? You look like you could use some company.” Sharon put in helpfully.
“Yeah, stay here awhile.” Nick agreed, eyeing her worriedly.
“Okay, thanks.” Vicki sat on the couch fidgeting nervously.
Meanwhile, in the waiting room at Memorial, Casey had found Nikki’s purse and was about to check her messages and call the ranch when she noticed something. “Damn! The battery’s dead.”
After searching her pockets, she swore at herself again as she realized, “I don’t even have any money for the payphone!”
Vicki had been pacing Nick’s livingroom for the last few minutes.
“Sis, calm down. Mom will call when she gets a chance!”
“Nick, it’s been hours! She should’ve called already!”
“Victoria, your parents have been dealing with a lot. They probably just needed some time to talk, just the two of them.”
“I hope you’re right.”
“We are, now come on and sit down. Let’s talk about something else.”
“Like what?” Vicki asked completely uninterested.
“How’s Brash&Sassy?” Nick asked, trying to get her mind off her worries.
“What do you mean fine?”
“Come on, humour me.”
“Okay, okay.” Vicki relented as they talked business for the next little while.”
After awhile, Vicki grabbed her coat and headed back to the main house.
“Let us know if you hear anything, okay?” Nick told her as he watched her leave.
“I will. You do the same.” Vicki replied before heading out the door and back to the main house.