So, last month I went blind. I know, I know, not the way many of you expected this article to start. Many people know me as a quiet provider, one who’s worked in special rescue as well as some other, even quieter roles throughout the industry. Most ‘famously’, I’m the guy who went on stage at the World Extreme Medicine conference and announced to the world that I suffer from PTSD and that for the prior three months I’d been grounded from deploying due to mental health reasons. Yet, talking about mental health to several hundred other medical professionals made me realize that I didn’t need to be afraid so much as I needed to lean on other people. So here I am, trying that again. Think of it as a radical experiment in… something. I’m not sure what right now, but maybe you can help.
My Background in Special Rescue
For those of you who don’t know me I’m seventeen years into my career with the last ten being almost exclusively in special rescue and operations. My students think I’m this cross between Tracy Kidder and Indiana Jones. In reality I’m just a nerdy medic who occasionally makes bad life choices and ends up in dicey situations. I do take pride in specializing in austere and wilderness rescue and I think my medicine is pretty good. I teach pre-hospital and trauma resus and occasionally give lectures for various organizations. I’ve trained special forces teams from around the world and have gotten to work on a few myself. Often it feels like I’m just the okay guy at the right time. I’m proud I get to count some legends as friends but I’m nobody interesting myself.
Descending into Blindness
So that brings us back to the beginning of this little story; last month I went blind. Not full-on blind, mind you, just blind in my right eye. It happened gradually, starting one morning when I woke up feeling as if there was a minor case of conjunctivitis. A little pressure around the temples but nothing unexplainable to a person with a history of seasonal allergies. Over the next 36 hours though I lost almost all color saturation as well as significantly increased blurriness. To be fair, the color loss was pretty cool; I had my own Instagram filter and all I had to do was open and close a single eye. Awesome for a few hours at least.
The next day my vision was worse, I was tired, and I had a strange, sudden bout of chest pain. Like any good medic, I disregarded the first two issues and drove to a nearby fire station where I politely asked if I could use their EKG. Because the bond between prehospital providers is strong here in the US, they agreed and me and two other medics watched little squiggles dance across the paper for about ten minutes. Nothing. Not even a PVC.
The Tentative Diagnosis
I went to a local eye-doctor the day after this all started and dutifully reported on the acuity loss, the color loss and the increasing headache and pressure feeling. The doc dutifully reported after examination that my optic nerve was not only inflamed but had “poor pallor” and that with the increase of blurriness and acuity, I was down to around 20% of my normal vision. He also casually asked if my multiple sclerosis had ever manifested this way before.
“Uhh, I’ve never been diagnosed with MS,” I replied.
He looked at me and I looked at him rather awkwardly, like two teenagers at their first dance. Eventually he said, “I need to make some calls, and I think you should too.” I agreed, though had no idea who I should call and so instead pulled up my kindle and read an adventure novel until he came back in. He diagnosed me with optic neuritis and suggested, since I’d never been told that I had MS before, that it was clear my optic nerve had a previous history of insult, and I should contact my primary care physician. He also scheduled me for an MRI. I thanked him, left, and drove home, not really sure what was going on but realizing that everything had changed in my life, nonetheless.
Pursuing a Definitive Answer
That afternoon I reported what was going on to my PCP and she, the excellent physician she has been to me for the last twenty years, took me immediately at my word and contacted her larger hospital’s neurology department. The next morning, I was meeting with a neurologist who, aside from being the chief of medicine and a top MS researcher, is a wonderful clinician. We talked for more than an hour. Afterwards, I started an insane four days of steroid treatment to reverse the optical neuritis. I’ve never had infusion steroids before and was shocked when the dose of each bag hung was in grams instead of the milligram doses I’m used to delivering in the prehospital world.
I also had more blood drawn from me than if I had donated to the local bank, and over the next week watched as my differentials kept returning negative. My personal favorite was coming back negative for syphilis. By that time, I was wearing a temporary eye-patch to help combat the strangeness of incomplete vision and I couldn’t help but think how awesome and pirate-like getting syphilis would have been! Think about the street-cred combined with the patch! It would have been amazing though for some reason my partner didn’t find it as funny as I did.
The Confirmation
Ten days after I went blind (the vision cleared up back to 100% around four days after the steroids started) I squeezed myself into a tube for a 45-minute, double MRI study. I went straight from imaging up to my neurologist where, clear as day, you can see around five lesions in my brain and another two in my spine. Multiple sclerosis. In fact, it was such a good image of it my neurologist requested to use it in her lectures. She told me that based on its progression and several other incidents I’d had over the years which had always been chalked up to deployment wear and tear, I’d been suffering attacks for at least four years.
Grappling with the News
I’m still grappling with this information. Over the last four years, I’ve undertaken numerous deployments to combat zones as a medic; I’ve performed some pretty intense rescues and worked in incredibly dangerous situations. And apparently, I’ve been doing it all while living with MS. On one hand, that’s kind of cool. On the other hand, it’s a big shock. Realizing I didn’t know enough about MS, I did what any good medic would do—I started researching. After a few hours and reading a dozen or more articles, I closed my tablet. I didn’t need to know just how severe it could get, how daunting living with a degenerative neurological disease could be. I didn’t need those statistics about mobility issues, cognitive decline, failure to thrive, and all the other potential complications.
I tried to set aside the information and become a patient. Luckily, I have a great care team and they understand me. They understand that I’m a medical provider first and foremost. That I’m medically literate and they can be blunt and clinical. I can separate my medical knowledge from my personal experience. Kinda. I at least like to think I can.
Confronting Fear
What I didn’t expect was when I finally made it home, the next day as I fought fatigue and malaise from the steroids, I tripped. For the first time in my life I didn’t laugh at myself as being the klutz that I am. I wondered if my MS was the cause. Even after a week and being cleared for duty as a firefighter/medic in my hometown, I would bump into something and be terrified. I’m still terrified. I know intellectually that I’ve done truly amazing things while having this disease, but still, I’m afraid.
I also know that I’m going to be alright. I know that the treatments available to MS patients have never been more numerous or effective than this moment in history. I know that my friends and family have my back. I know that it may be years before I ever have another flare-up.
But then I trip. But then I find out that the job at a fire department I’ve been applying for is out of reach; MS is a disqualifying condition if you’ve had any disease activity in the last three years. But then I realize that I’m going to be perceived differently when people find out. But then I realize that I perceive myself differently than before. Then I get scared.
Hiding Out
I’m writing this right now on “vacation”. Technically I’m lounging by a pool at the famous Waikiki beach in Hawaii. I came here to relax, to recover from what has been a truly brutal few months. But in reality, I’m here because I’m hiding. I’m scared and unsure about the future. I’m one of the most highly-trained, bad-ass special rescue operators in the world, and I’m hiding in a beach cabana.
Choosing Vulnerability, Again
But just a few years ago I went on a conference main stage where I told every person I professionally and personally look up to that I have PTSD and struggle with depression. Instead of shunning me, they welcomed me. You all opened your arms to me when I was vulnerable. So I’m going to try it again. I’m going to be vulnerable in the hopes that others who may feel afraid can see that they can open themselves up to our colleagues and be welcomed regardless of what struggles they are facing. I’m going to live up to my ethos of special operations and do the hard things. I’m going to persevere. I’m going to continue even with a degenerative brain disease.
So here goes nothing. My name is David and I’m a special rescue medic, and I have PTSD. Oh, I also have MS. See you out there on the next one.
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