Being thankful

In contrast to my previous post, where I rambled for a long time about the horrible consequences of what happened… now it’s time to do the opposite and be thankful ūüôā

When those first headaches started happening back on the 22nd of March, none of us had any idea that it would lead down the path that it has. Rather incredibly, I had a triple whammy of a bleed – intra-cerebral (in the brain tissue), intra-ventricular (in the ventricles) and sub-arachnoid (in the space that directly covers the brain). There was a lot of blood leaving my vessels and entering where it shouldn’t be. By rights, I could have died. I could have suffered from permanent paralysis, or visual loss, or loss of feeling, or a personality change. But no, I had a stroke and all I had to show for it was some memory loss (maybe I should get a T-Shirt made…). That in itself is an absolute miracle that I still cannot believe! Everytime I see my scans, I just cannot comprehend how relatively little I suffered when it could have been much,¬†much worse. It’s amazing. Even the doctors seemed to be in slight disbelief – I would have “Are you¬†sure you don’t have double vision?” thrown at me almost daily.

My team at NHNN and the staff at the Royal Free A&E have been absolutely incredible. Especially on the ward, all involved in my care were diligent and compassionate to my situation, something that was comforting to see as a student on the cusp of becoming part of that world. There was such a great community amongst the patients on the ward too – I guess some form of bond would naturally form when you’re living in a room with several others for be it a day, a week or a month. We saw each other at our weakest, at our most vulnerable, at our most helpless – but we also saw each other push through it all and get stronger every day. We saw each other be prepared for surgery and recover from it. We were each others’ eyes, ears and hands – if one patient started vomiting, or being in too much pain to call the nurse using their call button, we would then take it upon ourselves to let the nurses know. And the nurses! The nurses were great. At the time of writing this post I have been to hospital three times now, each time admitted to the same ward. I got to know all of the nurses quite well, which made each subsequent stay easier – it was like having a close friend look out for you. It’s amazing how much brighter the nurses made the ward feel. There is just something very, very humbling to have somebody willingly give you a bed bath, or clean up your bodily fluids with a smile on their face. My only complaint is we would be woken at 6:30am for observations, but I’ll forgive the nurses for that – it is their job after all!

There’s a whole online community that I discovered during my down phase that helped immensely. After being told I had a rare condition, it was hard to talk about how it had affected me because try as they could, nobody could¬†really understand. Which makes me sound like a petulant teenager, I know, but it was frustrating. Then I discovered¬†this¬†site, where thousands of other people with AVMs gathered to support each other. ¬†Cheesy as it sounds, it was amazing to discover I wasn’t alone in how I felt and how Ralph had affected me.

I’m also so thankful and grateful to my friends and family. When Ralph first exploded back in March, I have no idea how word spread so quickly because I was in no state to say anything, but it did and the response was both overwhelming and humbling. Thank you so much to everybody that texted, emailed, messaged, sent cards, cupcakes, flowers, tweets – I read and loved every single message and it really helped me push through the pain I was in at the time. It’s amazing the effect a few words can have. I was also shocked by those that took the time out of their day to come visit me – special shout out to my sister, who visited London from Devon, and my close friend, who visited from Cornwall. I thought I was hallucinating or my brain was playing tricks on me when I woke up and saw you. Also to my lab group that I had worked with for the three months prior to my stroke, who sent a beautiful bouquet of flowers and the sweetest card. That made my day ūüôā But I think the group of people that deserve the biggest thanks of all are my mom, my boyfriend and his parents. My mother, who travelled halfway across the country to be with me in hospital, was with me every minute that she could. I can’t imagine what it must feel like to be a mother and see your only child barely conscious; she has so much strength, from which I feel I draw upon. My boyfriend and his parents have been so incredibly generous – they took us into their home and let myself and my mother stay there, and we have been doing so for the past three months. They have been so supportive, helping me in every way possible¬†and expecting nothing in return. It’s wonderful to be surrounded by so many people who care so deeply for me.

 

So at the end of all of that slushy stuff, I’m left feeling a bit like a pageant queen tearfully giving her thanks. Sorry about that! But I do have a very serious message that I would like to generate from this post – and that is the importance of being thankful. What doesn’t kill us truly does make us stronger, and even though Ralph has closed many doors, he has simultaneously opened a few. I have reflected so much these past few months (because let’s face it, I’ve had a lot of time on my hands) and I feel like it’s made me a better person. I used to do CCF (Combined Cadet Force) at school and every time we had to do something tiring or hard, our Pilot Officer¬†would call it “character building”. Well, this is character building. To those of you reading who have never experienced anything life changing or drastic, be thankful. Be thankful of your youth (or experience), be thankful of your brain still keeping you alive, be thankful of those around you. You never know when it might be taken away. And those of you reading who have experienced something like this – be thankful too. I’m sure it will affect you in more ways than you expect, but if you look at it the right way, good can come out of anything ūüôā

Consequences

Consequence¬†/ňąk…íns…™ňĆkw…õns/

noun

A result of actions, especially if such a result is unwanted or unpleasant.

 

Receiving a diagnosis of an AVM leads to a lot of consequences. A lot of them have been unwanted or unpleasant.

My neurosurgeon, Mr Shieff, explained many of the issues surrounding AVMs very thoroughly to myself and my family. Unfortunately, despite appearing to have the capacity to retain the information and understand at the time, I soon discovered that I wasn’t lucid at all during this process and had to rediscover information slowly post discharge. Fellow med students, this was another learning point for me – always, always, always explicitly write down if you have gained consent from a patient, because even though all my notes say that I gave consent to having an angiogram done when I came in, I do not remember it. My boyfriend told me that when they gained consent from me I understood and I even spoke to them about the procedure, but I have no memory whatsoever of this.

Anyway, I’m getting side tracked.

I had so many questions about the implications of my diagnosis. Obviously studying was out of the question for the time being – I had just had a brain haemorrhage, that much was obvious. I had missed an assessed presentation that took place during the week that I was in hospital and I remember getting quite agitated over that, sending email to the relevant people. Somehow my BSc module supervisor and the BSc co-ordinator had already known about my condition though, and assured me that assessments could wait. Mr Shieff had instructed me very strictly not to do anything university related, and to just focus on recovery for at least 2 months. “Recovery should be¬†fun“, he told me. But what could I do in the mean time? That depended on the physical, cognitive, psychological and life consequences of having an AVM, as I found out the hard way.

Physically, I was very weak. Having spent 10 days in a hospital bed, barely moving, had meant that a lot of my muscles had atrophied (wasted away). I lost 6kg in hospital due to this and to my inability to eat for the first few days. Once I was discharged, ¬†getting through each day became a struggle. I spent most of my first few weeks post-discharge sleeping. Walking up stairs would fatigue me to the point where I would have to sit down for a few minutes and afternoon naps suddenly became glorious. Simple actions that didn’t require any thought previously now became more complex, such as sleeping – sleeping flat caused me to wake up with a severe headache, so I had to construct a pillow mountain so I could sleep upright. If I dropped something, I could no longer bend over to pick it up as that caused a rush of blood to my head that lead to dizziness – I became very good at squats. Even walking and taking stairs started needing more thought as I dealt with having less muscle in my legs. I was told that exercise was good, advisable even. But I should avoid things that raised my blood pressure too high, things that involved bouncing, things that involved balls or anything that could hit or knock my head. So that’s most sports. The biggest blow was the realisation that I had to quit cheerleading, a sport (yes, it is a sport!) that had been part of my life for the past four years. Part of my livelihood had been torn away from me, and this took a long time for me to come to terms with. The video below is my team, my family. Oh how I miss it!

Cognition became very, very difficult. I expected to have problems with my memory (short term memory was virtually non-existent), concentration (reading became impossible) and focus (unless if it was one sentence, I couldn’t follow conversations, films or TV programmes anymore). I did not expect the constant feeling in my head that dogged me from the minute I woke up to the minute I fell asleep. It was hard to describe – my family and I ended up making a lot of weather analogies, with me saying that I was “feeling cloudy” when it was bad. It felt like there was a constant fog swirling in my head, but sometimes it felt… fluffy. ¬†The closest approximation I can think of is that state between being tipsy and being drunk, when your head feels simultaneously heavy and light, nothing feels stable or concrete. I also found that when the clouds in my head did clear and I managed to do anything vaguely mentally taxing, it would cause me to become physically very tired. Multitasking was out of the question. And I became incredibly scatter-brained and sometimes didn’t make sense when I was speaking. An interesting, albeit temporary, symptom that I noticed myself experiencing was something called dysphasia – the inability to communicate or process language properly. I was constantly forgetting words, or having words on the tip of my tongue that I couldn’t get out. But this was only spoken dysphasia – I was still as eloquent as before in the written word. I also briefly experienced prosopagnosia – the inability to distinguish between different faces. I would watch a programme or film and everybody would look the¬†same, and whilst this was happening it would make me feel very strange – to the point where I couldn’t watch any more. Of course, my “diagnoses” of dysphasia and prosopagnosia weren’t done “officially” by a neuropsychologist or my consultant – I found myself analysing myself (perhaps it’s med student syndrome!). But¬†analyzing my cognitive defects was utterly fascinating, for I had only ever read about things like this in textbooks or Oliver Sacks books and it was odd to experience them and recognise it so effortlessly!

When I was discharged, my family and I were warned of the physical and mental effects that I would suffer. We were also warned I would experience severe mood swings, which soon showed. But nobody prepared me for how deeply affected I would become¬†psychologically. It descended on me like a ton of bricks one evening in April. This was actually happening. This was actually happening to¬†me.¬†I would have to deal with this for a good part of my life and suddenly I had to rediscover who I was, because the two things that I felt defined me – cheerleading and being a med student – had been torn away from me. I spent a lot of nights crying and entered a state of… well I wouldn’t call it depression, but something quite close to it… for a while. All motivation had disappeared, replaced instead with apathy. I had so much time to do things now, but I couldn’t physically, mentally and emotionally do the things I wanted to. My boyfriend managed to persuade me out of this state though by getting me to start knitting!

Finally, Ralph had caused life consequences. My bleed happened in March, my dissertation was due in April and exams were in May. All postponed now. My BSc organiser had told me I could hand in my dissertation “when I was ready” (does this mean I had an unlimited deadline?) and exams were postponed until the August session. My graduation was also cancelled. But even taking exams in August was subject to my neurosurgeon giving his blessing. Socialising became temporarily quite difficult, as too much noise or sensory input made me feel very uncomfortable. And then there was the small matter of how to deal with Ralph. There were essentially only three treatments for AVMs – surgical removal, endovascular embolisation (sticking a needle into the artery in my groin, threading it up to my brain and filling the AVM with glue) or Gamma Knife radiosurgery. My AVM was too deep within my brain for the first option and too complex for the second, so that just left the gamma knife. The idea with gamma knife is to target the blood vessels that supply the main body of the AVM with a high concentration of ionizing radiation, which will kill the cells in the walls of the blood vessels, causing them to thicken and effectively choke themselves – starving the AVM of blood. Unfortunately, this process takes up to 2 years… and even then it’s not 100% guaranteed to work and could require multiple doses of radiation. There’s also the slight problem that gamma knife works best in AVMs smaller than 3cm, which mine is not. So it looks like Ralph and I are going to be together for a long, long time – it’s time to make life adjustments accordingly. I’m now one of those med students that has “special circumstances” for their clinical placements, something that I never thought that would happen. And travel is now difficult – I’m not even sure if I’m allowed to fly! I’m typing this post three months post the initial bleed and every day I’m still discovering strange consequences and changes that have to be made due to my pesky new friend.

 

It’s funny how going through a serious illness affects you. It seems like such an abstract, detached set of words when you hear about somebody else falling ill or having an accident, until it happens to you. I am learning a lot from this experience. Even though there are a lot of negative consequences, it is human nature to¬†persevere and adapt. And so have I.

Meet Ralph!

So it’s been very well established by now that I’ve had a stroke at an unusually young age. But why?

My whole life, I’ve been fascinated with the brain, its anatomy, how it works, just everything to do with it. When I suddenly found myself with a neurological condition… on the one hand, yeah it’s utter crap that I’m going through this. But on the other hand… I couldn’t believe the irony! I found it so ridiculously¬†cool that I could study myself!

It turns out that I have a condition called an¬†arteriovenous malformation, or AVM for short. This is a congenital condition, meaning I was actually born with it, and is pretty rare – only about one in a million have it. So when my boyfriend tells me I’m one in a million… I guess he’s been right all along! An AVM is an abnormal tangle of blood vessels that should not exist. Instead of blood going through arteries, then the capillary bed, then through veins, there is a direct flow of blood from artery to vein. Which is¬†bad. This can cause blood to be taken away from its intended destination, which when that destination is the brain… can cause dramatic consequences. Furthermore, when high pressured arterial blood goes directly into the thinly walled veins that are more accustomed to low pressure blood, the veins can dilate and get stretched out. The thinner the walls are, the more likely they are to rupture. Which is what happened in my case – imagine like a water balloon that was filled too much. AVMs tend to be discovered by accident as they don’t cause any symptoms – until they become too big and either rupture, or steal blood from a part of the brain to cause seizures, headaches or other weird effects. They do however tend to be discovered around my age group – the 15 – 25 group – as that tends to be the point at which the AVM becomes sizeable enough to cause a problem.

In order to make light of the situation, and to have something to blame, my boyfriend and I decided to name it. Ralph. He came up with the name – perhaps inspired by the titular character of the film Wreck it Ralph. Because let’s face it, Ralph has kinda wrecked my life! But I was still fascinated. I had to know everything about it. The opportunity arose for me to get a copy of the scans and of course I took it! The radiology report was as follows:

“There is a large, deep, diffuse right temporal lobe AVM. The abnormal vessels are centred on the right anterior temporal pole, with a maximal diameter of the malformation at over 3.7cm. Multiple feeding branches from the right middle cerebral artery are noted, and there are both deep and superficial draining veins. There are several aneurysms arising from the abnormal vessels, the largest measuring 1.8cm in the temporal white matter arising from a vein that continues to drain to the deep venous system converging with the great vein of Galen. The large aneurysm demonstrates surrounding parenchymal haemorrhage, and this has dissected into the temporal horn of the right lateral ventricle. There is blood tracking within both lateral ventricles, third and fourth ventricle, with some blood extending into the subarachnoid space. There is early mild hydrocephalus.”

Which can be basically summarised as: My AVM is HUGE, and bled a LOT. It scared me to read that the main arterial supply to my AVM came from my right middle cerebral artery (MCA) – the MCA is one of the main arteries that supplies about 1/3 of a hemisphere. So if that blows… there’s no coming back. It was also a shock to read how big Ralph was. There’s a grading system for AVMs to help determine the course of action, and whether or not to leave it alone. Mine is Grade IV, and the worst – Grade VI – is essentially seen as untreatable. Things are pretty serious.

Even though I understood the radiology report and understood how large Ralph is, I didn’t quite¬†appreciate how big it was until I saw the images:

Ralph, plus the aneurysm

Ralph, plus the aneurysm

That beautiful tangle? That's Ralph

That beautiful tangle? That’s Ralph

Normal on the right, Ralph on the left

Normal on the right, Ralph on the left

These three images show just the blood vessels in my brain. In the image above, the dotted line represents a line running through the middle of my brain. Everything on the right of that dotted line is normal. Both sides are meant to mirror each other. Yeah. That’s what a 4x3cm AVM looks like.

Blood in the 3rd and 4th ventricles

Blood in the 3rd and 4th ventricles

This is what a haemorrhagic stroke looks like

This is what a haemorrhagic stroke looks like

Blood in my lateral ventricle

Blood in my lateral ventricle

These three images show the bleeding that happened in my brain – the white stuff that I circled in red is blood. The ventricles are normally filled with CSF, the liquid that bathes the brain. But there’s only a limited space for fluid, so if that gets replaced by something that isn’t meant to be there – like blood – the poor patient suffers from excruciating pain, vomiting, dizziness, neck stiffness… much like I did. I was not surprised in the slightest that I felt so awful after I saw these scans!

 

Even though these images came out of a truly awful situation, I find them really beautiful – especially the CTA scans of my blood vessels. It’s almost like abstract art, but it’s so strange to think that that alien like blob is still in my head and very much active.

Welcome to the other side…

I have been through 3 years of medicine, and one year of a BSc now. The 2012 Р2013 academic year was  my first clinical year, and I spent a LOT of time in the hospital getting experience, shadowing consultants, talking to patients, just really soaking up clinical medicine.  So I thought I was quite well prepared and had a good understanding of what being in hospital was like.

Oh how wrong I was.

I can assure you, no amount of clinics, lectures, seminars or tutorials can ever prepare you for the patient experience.

After my rather sudden admission to hospital, I spent 10 days on the Victor Horsley ward at the National Hospital for Neurology and Neurosurgery (NHNN). During this time I experienced many procedures that I myself had done to patients during med school – taking blood, putting a cannula in, putting a catheter in – and also had many investigations that I had observed – CT/MRI scans and angiograms. I now realise that every patient that I had catheterised in the past and told “this might feel uncomfortable, but it shouldn’t hurt” I lied to. Catheters hurt! I am going to apologise profusely to any patient I will have to catheterise in the future from now on. It was also really interesting being on the receiving end of neurological exams in a context that¬†wasn’t OSCE practise. They say doctors make the worst patients and from what I have been told of how I was, this was true for medical students too. As my bleed was in the right temporal lobe of my brain (responsible for memory, language processing and visual recognition for any non-medics reading), the first week I spent in hospital is a complete black hole that had to be filled by my family retrospectively. According to them, the 2nd and 3rd day on the ward I kept demanding from the nurses and doctors to know if they had done this test or that test, what my results were, and why they weren’t testing me for¬†dysdiadochokinesia! In a way I’m quite proud of my little brain for, despite being injured and high on morphine, still being able to enter “med student mode”. I really am amazed and fascinated by the brain’s ability to function – all I can remember from the first few days was being in a permanent fog of pain and nausea, yet when I look at messages that I had sent during that time I was still able to form coherent sentences for the sake of Facebook! The worst symptom I had, which I do remember, was the dizziness and vertigo. Every time I turned my head, the whole room turned upside down, which then made me nauseous. I couldn’t move, I couldn’t wash, I couldn’t even be wheeled anywhere without experiencing it. At least for the pain and the nausea there was symptomatic relief, but nothing made the vertigo go away apart from days of sleep.

 

At this point all I was aware of was the pain, the nausea and the vertigo. 

Something that really struck me as a patient, that I didn’t expect, was how infrequently you saw a doctor as a patient. Having been in clinics and on ward rounds, from the student’s perspective it seemed like all we did was see patients all day. But the inverse was true – I only saw my team once a day, on the morning ward round. The nurses were the true saviours of my stay. I have always had respect for nurses, but now I am in absolute awe of the sheer amount that they provide to the patients and to the ward. If there are any nurses reading this: I applaud you. You deserve so much more respect than you get.

 

I feel that during this week I also gained a small insight into what it would be like to live with Alzheimer’s disease. ¬†My 2nd day on the ward was a Sunday, and every day I was asked the same questions: Do you know who you are, do you know where you are, do you know what day it is. I was able to answer the first two correctly but every day I insisted it was Wednesday. It wasn’t until it was¬†actually Wednesday and my subconscious was satisfied that my clock began running again. There was also the amusing cupcake incident. A box of beautiful cupcakes had been sent to my ward, courtesy of my cousin who was currently in Turkey. When my mother showed me, I was overjoyed and insisted on sending a message to said cousin to say thank you. The next day, I discovered this box of cupcakes and insisted on sending a message to my cousin, having forgotten I had already done so until I saw evidence of the message. The next day, this happened again. This continued for 4 days in a row until my memory finally caught up and I actually remembered the events of the previous day. I found this interesting; at the time, I was¬†so absolutely certain of myself that I knew where I was and what time it was, when in reality I was actually very disorientated. I will definitely hold on to this memory (unless if I have another bleed!) and bear it in mind in the future when I will be dealing with the elderly or anybody that suffered a condition to make them disorientated.

 

I can safely say that these 10 days were the hardest 10 days of my life. I was in a lot of pain and confusion for most of it. I would not have recovered half as well if it wasn’t for the patience and support of my mom, my boyfriend and my boyfriend’s family, who have all been amazing. Without them I would not be able to look back on this experience so positively or gained half as much psychologically from it. This post is dedicated to them, and with their help I will continue to learn and grow from all of this.

Explode

There are two things that define my life right now:

  1. I am a medical student, with a little bit of an obsession about neurology and neurosurgery.
  2. I am a cheerleader, also with a little bit of an obsession of the cheer world.

On the 22nd of March,¬†both things combined in the most drastic of ways. This Saturday started as any other Saturday might have ‚Äď with cheer training. My boyfriend needed a lift to the cheer gym and I was happy to oblige ‚Äď the plan was to just drop him off, go back home, finish writing my dissertation and pick him up once training was done. The first part went to plan, but when he discovered that one of his team, who had consistently been missing practise, had yet again not turned up, he asked me to stand in for her. Which was unexpected but fine. I subbed in for roughly half of the session¬†but soon realised that I had developed a sudden, severe headache. Instinct told me that this headache was unusual ‚Äď I have had headaches before (hasn’t everybody?), but never experienced like this, and it was so severe it was worrying. Every jolt, jump or catch made hurt even more. But I didn‚Äôt want to be petty and trouble the session for the sake of ‚Äújust a headache‚ÄĚ and instead put it down to being dehydrated, drank some water and carried on. I then got dragged out of a stunt and fell to the floor, landing first on the bottom of my neck and, due to the sprung floor, rebounded and hit the back of my head. Which really didn‚Äôt help the headache. I sat out after that, wondering if I had been concussed with whiplash ‚Äď my head and neck did not feel good!

 

Thankfully, the end of the session came shortly after my fall. I returned to my boyfriend‚Äôs house, feeling quite sorry for myself and in a lot of pain. The headache had continued to get worse, as did the neck stiffness, nausea and dizziness. I was absolutely certain at this point I had a concussion, but my boyfriend dismissed it as “medical student syndrome”. When back at the house, I went to the toilet ‚Äď and as soon as the pressure was relieved on my bladder it was like a switch had been flicked and I entered a whole new world of pain. I felt something in my head go “pffft” and suddenly it felt like somebody had thrown a hammer at the back of my head. I suddenly realised that what I had just gone through was a “thunderclap headache”, a term that I had encountered many, many a time in textbooks and clinics. I remember thinking “I must be having a subarachnoid haemorrhage if I just had a thunderclap headache…. nah, that’s just med student syndrome surely”. Unlike anything I had ever experienced, the pressure on my head was enormous, as if I was wearing a skiing helmet that was several sizes too small. It felt like a great pressure was compressing my brain and pushing down on my shoulders, and in addition I had started shaking and feeling incredibly nauseated. I went to sit on the sofa with my boyfriend, crying in pain, asking him to make it stop but succumbing to the nausea instead and retching and vomiting several times. He had never seen me in this state and we decided then to go to hospital, something in hindsight we should have done much earlier.

 

Fast forwards 20 minutes or so and I was in the A&E department of the Royal Free Hospital, still in a great deal of pain and still bringing up stomach acid. My memory is very fuzzy from now on so I’m relying on what I was told ‚Äď I can vaguely remember being given a vomit bowl and throwing up when they were trying to take a history from me, and I remember them putting a neck brace on me when they discovered I fell on my neck. But everything was very uncomfortable and painful. My boyfriend tells me they gave me a lot of painkillers and anti-sickness medication, but I can hardly remember any of this. What I do remember is receiving an anti-emetic intramuscularly, in my gluteal, and wondering if they used the spread hand technique that we had learned to avoid hitting the sciatic nerve. I also had a CT scan at some point, which I don‚Äôt remember, but I do remember somebody telling me the result: I had a subarachnoid haemorrhage, which was exactly the condition that is typified by a “thunderclap headache”. To most people this would just be an abstract set of words, but having already done a year of clinics I had seen this condition in patients before and it struck a great sense of dread into my heart to hear this, having seen first hand a young patient with a subarachnoid haemorrhage die. I remember my first thought after hearing this was genuinely “Am I going to die?”

 

The next few hours or so were a complete vomit and pain filled blur. The next thing I remember is being log rolled into an ambulance and being blue-lighted to another hospital, the National Hospital for Neurology and Neurosurgery. Having travelled in an ambulance under blue lights as staff before had been an exhilarating experience, but I can guarantee it was nowhere near as cool as a patient ‚Äď if anything, it was one of the most painful and disorientating parts of the whole experience. Especially when the route was full of speed bumps, the ambulance was being driven with urgency and I had an excruciating headache!¬†My final memory before passing out from the pain and medication was of the dim interior of the ambulance, my boyfriend squeezing my hand and telling me everything was going to be okay, and the rhythmic pulses of the blue lights. I don’t know what time we arrived at NHNN or what happened after that, but when I eventually woke up the next day I was greeted by my neurosurgeon, Mr Shieff, who informed us that I had an arteriovenous malformation. I now had something to come to terms with: there were three things that defined my life now.

  1. I am a medical student, with a little bit of an obsession about neurology and neurosurgery.
  2. I am a cheerleader, also with a little bit of an obsession of the cheer world.
  3. I have a time bomb in my head, that has already exploded once and could do so again.