Amnesia, Covid, Covid-19, Gloucester Royal Hospital, Gloucestershire Academy of Music, Rendcomb College, Southwestern Ambulance Service, Transient Global Amnesia
Yesterday I posted about the early music course I did a couple of weeks ago, mentioning that I had been taken to the Emergency Department of the Royal Gloucester Hospital on the Tuesday. Here is the write up I have prepared about it.
MY TGA, TRANSIENT GLOBAL AMNESIA
Transient global amnesia is not actual loss of memory, but the failure to lay down memories for a certain period. Meanwhile you can continue to function physically and intellectually at quite a high level.
It happened to me on Tuesday, 3rd August, 2021. I was at Rendcomb College, on a music-making course with the Gloucestershire Academy of Music, known as the ‘Beauchamp’ course for historical reasons. At 4:30, we were in four different groups, and a few minutes after that an appeal came to the group I was with for a tenor to move to another one. No male tenor offering, I did. Once I had found the room, I was greeted by the tutor there with a considerable degree of scepticism. Knowing full well that I could sing tenor, and well – I wouldn’t have volunteered otherwise – I was determined to prove to him that I could do so, and perhaps oversang throughout the session.
I am told that in fact you could see on the tutor’s face from the outset that I was doing fine. Unfortunately I did not register this, and, had I done so, life might have been rather different for the next 12-15 hours. I think the TGA must have started around 5:15, because when the session ‘ended’ I remember thinking how very short it had been. However that thought must have come to me at about 6:30, when I ‘came to’ (i.e. started laying down memories again) and found myself in the rehearsal room with three other people: Jill C, the only person on the course who knew me at all well – thank goodness she had been in the same session, and it’s only by chance she had hung around to ask me something – and the two administrators of the course, Jane and Anne. I recognised who Jill was, but I couldn’t place the others, politeness stopping me asking.
Apparently, when all others at the session had dispersed at 6:00, I had just sat there, not knowing where I was or why I was there. They told me they had called an ambulance, because of my bizarre behaviour. Later on, Jill told me that I had been asking, over and over again (because, I now understand, I was not laying down memories of their answers) where I was and how I had got there. Jill had asked me the names of my cats, which I was able to give, and where they were, which I was not able to say. And apparently, I also thought that I still lived in France, from where I had returned 10 years previously. (Ah, so I did have some loss of actual memories.)
They had first called 111, but poor telephone network had severed that, and they had also called the registered GP for the school, who did not want to know, so they just called the emergency ambulance, though they had no idea when it would arrive. I heard Anne or Jane say that they would ask for dinner (normally 6:30) to be put aside, and I insisted that I was fine to eat it then, by now 6:45. I needed help to find my way downstairs and through to the dining room, but I had no difficulty remembering that I needed to take the vegetarian option, and I also remember saying, ‘But I haven’t got a mask on’, to be told that that really didn’t matter in the circumstances. Though later I recall being puzzled that people were wearing masks at all. Dinner finished, we went through to sit in reception for the ambulance to turn up.
I was accompanied by two of them to my room to pack an overnight bag. I felt very confused and concerned that I wouldn’t remember to take everything, but in the event I did, even surprising myself when I unpacked it again at some of the things I had remembered. No doubt I had been helped by the two women.
When ambulanceman Phil ( from the Southwestern Ambulance Service) came, at about 8:15 I think, he asked me lots of questions and did a few tests. I can’t remember everything, but I can remember him asking whether anything like this had happened before, to which I answered no. At that stage, I did not remember the TIA I (may have) had in March 2016, but I did tell him, or possibly Shaun, who arrived around 10:30 in his ambulance, about it then. Phil saw this as evidence of my having much improved, and indeed, I think I was in fact pretty well back to normal by then. (Of course TIA and TGA are nothing like the same. I did not lose any memory, or rather fail to lay it down, at all during the TIA. But I’m sure I would have mentioned it had I remembered it when asked at the outset if anything like this had happened before.)
The reason that a second ambulance had to come is that Shaun, normally Phil’s partner, had not been able to come with Phil at the outset because he hadn’t had sufficient break. (I am impressed that two ambulances were even available, given the current circumstances.) Shaun was needed for two reasons. Apparently, it was above Phil’s grade to decide whether or not I should be taken to hospital, especially if the decision was negative, and also if I were to be taken to hospital, one ambulance person must be in with the patient.
While Phil would have been inclined not to insist that I went to hospital, Shaun said that once an episode had lasted for more than an hour, it was always their recommendation that the patient should in fact be checked out at the hospital. My own main concern was to be back in time for proceedings the next day, for fear that I would not be included in the various groups as they were planned for the Wednesday. Jill undertook to make sure that I would be!
Meanwhile, Jane and Anne were debating whether one of them should follow in a car to get me back again, but I insisted that neither should come. We had no idea when that would be, and I could get a taxi back anyway.
Shaun’s firm recommendation was that I should go, so I agreed reluctantly. By the time we left the school, at about 11:00 pm, I was feeling fine and my memory for everything outside that hour or so was complete, other than a bit of fuzziness, which remains to this day, about the order of things that I’ve just been describing.
At the hospital all things all seemed very calm in Emergency, nothing like those programmes on television, but I was told that they were having a very busy night. After a few minutes standing, I was led to an area where I was laid on a gurney, where in due course nurses started doing tests on me, and on which I was moved to another area, still in Emergency, later on, for more tests. It was to me chilly – not like hot hospitals I had experienced previously. I was told it was because it was still the Emergency area, and also because they were maintaining deliberately a good flow of air, presumably for Covid reasons. They gave me more blankets.
At no stage did I have any worries, or in fact even think, about Covid, although I was wearing an FFP2 mask of my own throughout after dinner. I had already had a lateral flow test before the ambulance set off with me, (the other ambulance had to be left to be collected by Shaun and Phil later) and another, PCR, was done in the course of the night, along with blood tests, temperature, blood pressure, and an ECG, and, once the doctor – for whom there was a waiting time of six hours, for non-emergency emergencies, (my phrase) – saw me at 7:00 am, various questions to test my mental acuity. She apologised for the “stupidity” of them. Anyway, among other things, I knew my name, my date of birth, what a pen was, what a pen nib was and where I was, (including the full name of the hospital because I had asked that as I arrived). She also asked a lot of other questions, which, as I now recognise from my reading, were designed to eliminate other things that might be going on. She wanted to contact Jill to get a full description of exactly what had happened while I was ‘absent’ but unfortunately network at the school was very poor, and Jill could not be reached. When the doctor came back from trying to do so, said she was going to take a ‘pragmatic’ view of the matter, just telling me not to drive until I really had to (which would be Saturday), and let me go back to the course, which I did, £60 the poorer for the taxi.
At 10:00 pm the night before, when the debate as to whether I should go to hospital was on, I said I just wanted to go to bed because I was feeling very sleepy. Now, I don’t know whether that would been better for me. I got only about an hour’s sleep in Emergency and still, 11 days on, feel that I have not caught up fully with that sleep. On the other hand, yes, I do know it was the right thing to go to the hospital just to have everything checked out.
I have done lots of reading on this phenomenon, which was not given a name by any of the medical people. But googling ‘temporary memory loss’ has led me to the clear conclusion that I had an attack of TGA. The symptoms are identical. Fortunately, all the literature indicates that it is pretty rare, and that it’s incredibly rare to have a second attack in a lifetime. I am just at the top end of the age group which is most susceptible to it: about 25 in 100,000 in that age group may expect to have one in a lifetime.
Why did it happen? Given all my reading, (Wikipedia and various mainly American articles) I can put it down to three possibilities, perhaps in combination:
– hyperventilation, as I forced my voice to sing tenor, something I do regularly, but not in circumstances where I’m doubted and thus perhaps forcing;
– the stress of trying to prove that I could sing tenor (if so, where are my priorities?!);
– abnormal breath pressure on the closed glottis.
I am immensely grateful to the medical services, and the three women, for all the care they took of me. It must have been pretty frightening for Jill, Jane, and Anne, more so than for me, as I was just confused, (though also a little worried, as I gradually returned to normal, that true normality might never return). Of course I thanked Phil and Sean as they said goodbye at the hospital, and at the same time I asked them what their favourite charity was. I fully expected them to name some medical charity, but Phil, looking at Shaun, said “Animals? Little fluffy animals?” at which the latter nodded. So I have made donation to the PDSA, which is both animals and medical.
I cut the first session of Wednesday, to tidy up and snatch some sleep (unsuccessfully), and was very careful in any further sessions for the remainder of the week when I sang tenor!