All in his Head
Diagnosis
Overnight Matt had wet the bed, and when eating some breakfast, most of it falling back down on the tray, he choked on a small piece of watermelon. He was turning blue before the nurses entered the room and promptly dug some forceps into his throat to pull out the offending piece of soft fruit. The NG tube was now going to be his only source of nutrition, Matt could barely swallow anymore. When Kelly arrived, he was informed of the incident, and he hoped the rest of the tests planned would give them the answers they needed, and he hoped those answers would mean Matt would recover, because everything seemed to have deteriorated so quickly and there was hardly anything left of the man he'd fallen in love with. He was unable to even sit up or hold a conversation most of the time.
Matt was wearing a disposable bib when Kelly entered the room. He walked over to the bed, his legs felt like jelly. He had never imagined being in this situation, how was he even supposed to help? This was worse than Matt being admitted to the psychiatric facility.
"Hey, baby," he greeted, putting on a brave face.
Matt didn't acknowledge him, he stared ahead, unseeing.
"I heard about what happened this morning, must have been really scary," Kelly said. "Won't happen again though."
Saliva dripped from Matts chin onto the bib.
"I'm so shit at this… I'm sorry… I don't know what to say… I know you're in there and I'm sorry… I can't do this without you, I can't keep going home to an empty house… I can't sleep without you…"
Matt remained unresponsive.
"I… erm… I met Doris properly last night," he said, trying to compose himself. He gave Matt a smile as he leant forwards to wipe the saliva from his chin. "Heard about your school project, well, a little about it anyway, maybe you can tell me more about it soon. You chose alpacas? I don't know anything about them."
The door opened, and Kelly was actually grateful to see the nurse enter. "Morning, Kelly. Hey, Matt, how are we doing at the moment?" she greeted as she came over to them.
Matt took no notice of her.
"You've got a full body scan now, a porter will be by to take you, and this afternoon you'll have an ultrasound and an EP test, they're nothing to worry about and Kelly will be able to come along with you, but he'll have to wait outside the room each time," she told Matt, with the dual purpose of explaining things to Kelly as well. "And we'll be able to remove the EEG in a couple of hours too."
"What's an EP test?" Kelly asked.
"It measures brain activity in response to stimulations, there's three test, sound, touch and sight," she told him as she disconnected Matt's NG tube from the pump.
"How come he needs it? I thought the EEG was recording his brain activity?"
"The visual test typically helps to diagnose MS, but…"
"MS? I've heard that… multiple sclerosis… is that what he might have?" Kelly asked her.
"The doctor wants to exclude MS," she explained.
"Ok," Kelly responded. "Least we'll get some answers soon."
She gave him a smile, and left the room.
Kelly took Matts hand. "Not too many tests left now then, baby."
Matt became more aware as the day progressed, but he didn't utter a single word. The full body scan took place with no incident, Matt slept through it, he also slept through the ultrasound, and Kelly stood outside the room to give him some privacy. Fortunately, when he woke a short while before the EP test was scheduled, he seemed to understand where he was and was responsive, even if it was just a few nods, blinking once for yes and twice for no, he was aware of Kelly and even tried to offer him a smile.
He could no longer move without help, and the waterproof briefs returned after he lost control of his bladder again. They thought the situation was unlikely to improve and were considering a urinary catheter. Kelly had to take himself away for a few quiet moments after watching two nurses position Matt comfortably on the bed after cleaning up the sheets.
He started drooling again too, his throat muscles were paralysed most the time now, and Kelly received a message from Boden, tentatively asking if there were any updates on Matts condition. How Kelly tell him all of this? How could he tell him that Matt was pissing himself? Unable to talk, or swallow? And when he tried to talk it was slurred gibberish? That his arms had started jerking uncontrollably? That he couldn't even sit up on his own? That they were looking for tumours and doing so many tests Kelly had lost count, and he was only getting worse? How could he tell anyone that?
That night, as Matt soiled the waterproof briefs, completely unaware he'd needed to go the bathroom, Kelly got into a bar fight. He arrived back at the hospital the next day, with stitches over his eye since the two police officers that intervened had dropped him off at the ER. Matt didn't notice the stitches, there wasn't even a single questioning glance at the neat line above Kelly's eye.
"How was he last night?" Kelly asked when a nurse came into the disconnect the NG tube.
"Unresponsive," she began honestly. "He slept a lot though and didn't have any more uncontrollable movements," she added positively.
"He's still wetting himself?" he asked as she lifted up the sheet and gown to see if Matt needed a fresh pair of briefs. He already knew the answer though and it was killing him to see how out of control Matt was. He'd become so dependent, and the Matt he knew was never dependent. This was his Matt though, the Matt he loved with all his heart, but it was breaking his heart to see him like this, and he felt guilty, he wanted to be a better boyfriend, he wanted to be able to handle this, but instead he'd gone out and drank so much he couldn't even remember what the bar fight had been about.
"He seems to have lost bowel control now as well," she said. "It may be temporary."
"Everything's just getting worse then," Kelly responded stiffly.
"Doctor Murphy will be by soon," she told him.
"Thank you."
On Matt's third day in the hospital the doctor came to the door, beckoning Kelly over. He closed the door, leaving Matt alone in the room gazing ahead but not seeing at all.
"How's he doing?" Kelly asked the doctor. "I know you need to look at all the results and stuff… but do you know what this is yet?
"I have looked over all the test results now, they ruled some things out that I had some worries about…"
"I was looking at the symptoms for MS and Matt has a lot of them," Kelly said before she could finish.
"He does, but in most cases patients only have a few symptoms, as I'm sure you figured out; Matt's had most of them, which is why I wanted to exclude MS, as well Lupus and other autoimmune disorders that can present like this," she told him.
"It is autoimmune?" he asked slowly, having come across the word whilst looking at MS on the internet.
She nodded. "Autoimmune encephalitis, his body has been attacking his brain."
"Why?"
"There's no way to know the cause for sure since there's no tumour, but his body mistakenly thinks his brain has an infection and its been trying to fight it off," she explained.
"But there's no infection?"
"All the tests we've done over the last two days have ruled every other cause out, there's no infection, no tumour, no cancer, no other autoimmune diseases. The good news is now that we know exactly what it is, we can start treating it," she said.
"It can be treated? He'll get better?" he asked sceptically.
"At the moment I'm worried about the inflammation in his brain, there could be lasting brain damage," she told him honestly.
"It wasn't like that on the first scan, if it was it would have been picked up, he wouldn't have ended up in the psych facility?"
"No, but this can be difficult to diagnose, it can take months, some people have never been given the right diagnosis," she continued. "We're going to start him on some steroids, methylprednisolone and intravenous immunoglobin. If the swelling doesn't decrease or becomes worse we may need to medically induce a coma and continuing treating that way."
"If his brain wasn't swollen in the first scan why was he having seizures and acting… well, not himself…" He paused and frowned, trying to get his head around it all. "He wet the bed too… when all this started, he wet the bed… just the once, I didn't think anything of it, I thought he was depressed…"
"The more recent seizures were due to the inflammation, the ones he had at the initial phase were unprovoked, which is another reason this can be difficult to diagnose right away," she explained, wanting to answer all his questions. "As for the incontinence. His brain isn't getting all the usual signals it would so there's autonomic dysfunction. Things we usually do without thinking about, those signals for Matt aren't making it to his brain, all the symptoms fluctuate too, but as you know, have gradually become worse and longer lasting."
"He stopped asking to go to the bathroom because he didn't know he needed to go?" he surmised.
"Exactly, there are nerves all the way around his body, letting his brain know when he needs to drink, defecate, eat, even breathe, because his brain is being attacked, his system isn't working like mine or yours would," she told him.
"He'll get better though? He'll remember to go to the bathroom? Know that he's hungry? He can barely move and he's not spoken all day, how is he gonna get better, I just… I… I'm sorry…"
"It's really hard to see him like this, but I'm hopeful. Like I said, there can be brain damage from encephalitis, I can't promise he'll recover 100%, there may be impairments, but we won't know what they are until he starts recovering, and even then he may get better gradually over time," she said.
"How did everyone miss this?"
"You didn't miss it, Kelly," she told him. "And we know what it is now, we're going to start treating him."
TBC