I had a really good run.  No major events in the first 24 months of my struggle with Glioblastoma Multiforme (GBM).  I had a few ambiguous scans, but nothing that required intervention until recently. Working part time as a cardiologist and full time as a father and husband, I had a nice little routine.  I would go to work Monday, Wednesday, and a half day Friday, and stay at home on Tuesdays and Thursdays with Staci and Mia. Sometimes I even felt a little guilty about not working more.  Sometimes.

My November 1st MRI showed likely recurrence, but that just ended up to be inflammation / treatment effect on pathology slides according to two neuropathologists.  I recovered well from that surgery, almost back to 100% (but never quite). Each treatment takes you back a little bit. Nonetheless, I returned to work (3 weeks after my second brain surgery, thank you very much) on 12/4/17.
On 12/21/17, the winter solstice and darkest day of the year, I had a grand mal seizure at Starbucks downtown in East Grand Rapids. My first 3 seizures were on 10/29/15, and were all partial seizures. I was conscious for each of them, but could not talk. This one was the real thing.

I met Allison and Ella G (we also call her big Ella in contrast to our much younger and smaller Ella) at Starbucks after school. It took me a while to get there. Allison called when I was pulling out of our driveway, and I made the mistake of driving in front of the EGR High School when it was getting out. She called me again en route. “Yes Allison, I will be there soon.”
Starbucks was packed. We waited for someone to get up to snag their table.  I sat across from Allison with Ella G to my left.  Allison was just finishing off the second part of her bagel with a frappuccino on the side.  I told her that was her “dessert” for the day, no doubt.  I just starting working on a grande iced soy latte.
“How come you get a Grande?” Allison asked.

“Because I am sharing this with your mom…” I replied.

I had worked 11 hours on Monday (7:30 AM to 6:30 PM), 13 on Tuesday (which included a SHMG Cardiovascular meeting, 7:30 AM to 8:30 PM) and then drove to Chicago on Wednesday for a routine infusion with Todd Chassee.  On Thursday, I was tired, but had to do some make up exercise in the morning.   Needless to say, I was tired Thursday afternoon.
At Starbucks, my legs started twitching, but nothing too unusual for me. I stood up to stretch them out, but then felt the twitching rise up. Oh no, these were not just some muscle fasciculations.
“I am going to have a seizure,” I told the girls. My arm tensed up, and I saw the ground get closer, but never felt the impact. Apparently I hit my forehead on the corner of the table and landed on the ground right at the front of the Starbucks line. There I lay in a pool of my own blood.

This Starbucks is a central place in East Grand Rapids. For maximal attention, I was there right after Middle and High School were let out. I know I caused quite a scene because they had to shut down Starbucks for several minutes to clean up my blood.
The first responding officer was asking Allison all sorts of questions about me, many she did not know.
“How old is he?”

“I think 41.” She got that one right.

“Who is his doctor?”

“I don’t know.”

“What medications is he on?”

“Don’t know that, either.”

Finally, Emma Israels intervened. “Her dad has brain cancer, and she does not know his meds or his doctor.”

I just remember waking up in the ambulance and hearing Staci’s voice talking to the driver.  When did she arrive?
“Do you know the date?” the EMT asked me in the back.

“December 21, 2017,” I replied.

“Really good.” The bar was set pretty low at that point.

Apparently, Staci already asked me some questions in Starbucks, but I only answered with a post-ictal blank stare. I couldn’t remember that.

And damn, where is my iced soy latte? I only had a few sips. And Allison only had a few sips of her ridiculously sugary Vanilla Bean Frappuccino with caramel on top. $7 down the drain. And where are my glasses?  And EMS cut off my fleece in Starbucks!

At the hospital, they did a CT scan of my head with contrast. No subdural hemorrhage, and not really comparable to my old MRI which always had subtle findings.

“We can do an MRI, but that may take several hours, and you may need to be admitted for that,” said my ER doctor.

“Nope. I am going home.” Also, I just did not want arrange for my MRI from one institution to be sent to another. And I did not want to be admitted to any hospital.

I learned Ella G’s mom, Danche, had my glasses. I also realized I wouldn’t be driving for 6 months ): Michigan Law. We are already figuring that out, but I may be buying myself a fat tire bike for the winter.

The next morning, I got up early as always, and had my exercise gear on.

“You are not getting on that treadmill,” Staci said.

“Okay, well, but I am going to work.” Why not? I had a seizure, couldn’t drive, but felt fine otherwise that morning. Fortunately, I was working with Jeff Decker that morning at the Meijer Heart Center. I texted him at 6 AM to pick me up, figured the 10 minute detour would be a net benefit for him on overall workflow.

So that’s where I am on this Christmas Eve, 2017. Status post two left frontal lobe resections, radiation, chemotherapy, pembrolizumab, and now a grand mal seizure in the most public space possible in EGR.  I always had a flair for the dramatic.



Figure: 12/21/17.  Left, Allison moments before I had my seizure.  Middle left, looking pretty bloody.  Middle Right, looking much better (with my glasses!).  Right, Connor read to me Wonder as I fell asleep.



Figure:  Mia having a water at Starbucks, and impatiently waiting at the mall (and foreshadowing her dad’s fall).  Queen Elizabeth enjoying a cup of hot cocoa.  Bottom left, boys day at Star Wars.  Bottom right, a rare sisters’ moment.





Figure: Allison’s birthday.  Left, Mom and Mia skate.  Left middle, Ella uses a few too many trainers.  Middle right, Staci and Mia again .  Right, Allison and her 4 grandparents.




Figure: My girls making cookies on Christmas Eve.