Thinking back, I was an enthusiastic 20 year-old phlebotomy student and certified nursing assistant excited for a career in nursing, who had no idea how quickly things were about to change.  I was in phlebotomy class and remember a pins and needles sensation crawling up my left hand, followed by strange movements. I lost consciousness and awoke on the floor, surrounded by classmates who were just as confused, and a friend told me I had seized. As I was rushed to the Emergency Department I was feeling terrified, of both the uncertainty of what had happened and of what was to come. A CT of the head showed a small hemorrhage and I was transferred to the NeuroICU at Christiana Care in Newark, DE. My parents had been notified and met me in the Emergency Department, where my own fears were amplified once my mother heard the results of the CT and began crying.

Initial non-contrast CT head (left) demonstrating a right frontal Hemorrhage and MRI T2 GRE demonstrating a right frontal cavernoma (right)

The rest of my NeuroICU stay was a bit of a blur. A repeat CT was completed and the hemorrhage looked stable. This was followed by a brain MRI, which provided more clues as to what was happening. I had a cavernous malformation. This cluster of abnormal blood vessels was the culprit for both the brain hemorrhage and seizure. It was during this admission that I met Dr. Richard Choi, the neurointensivist who directed my care in the ICU. I was also connected with Dr. Paul Boulos, a neurosurgeon with whom I was going to continue to follow up, although there were no immediate plans for a surgical intervention.

After a few days I was discharged home. Despite having recovered from the stroke with only residual left arm weakness, I now had side effects from the medication that was started to prevent seizures, levetiracetam (Keppra). I was unusually tired and would have intermittent bouts of anger. Despite these challenges I was able to obtain my phlebotomy certification and move closer towards nursing school. My neurosurgeon and I had agreed on a plan of watchful waiting. It had been going well, and after a year of being seizure free I was tapered off levetiracetam while I continued working as a CNA. Unfortunately, about two years after my initial seizure and shortly after discontinuing my levetiracetam, I had a second event.

Reminiscent of the first seizure, I had come home to rest after a night shift and my left hand contracted and I lost consciousness. I remember waking up to find my dog pacing around me. I called 911 and told them I had a seizure. After a short stay in the hospital I was back on levetiracetam, and had no plans to let this setback derail my educational plans. With the help and support of my family and friends, I enrolled in nursing school and graduated in 2017.

My first job was in the cardiovascular stepdown unit, and I was a nurse on this unit for some time before I had my third and final seizure. Just like before, I was at home and felt an initial warning, after which I lost consciousness. Upon regaining consciousness, I called my roommate and told them that “someone had stolen all our food.”  My roommate immediately sensed something was not right and brought me to the hospital. This time, a repeat CT scan of my head demonstrated growth of the cavernous malformation, and this was confirmed with an MRI. It was time to make some scary decisions.

A lot had changed since the first seizure. The cavernoma had grown and the seizures weren’t being managed easily with medication. I met with Dr. Boulos and we discussed the possibility of a surgical resection. My mother was with me in the appointment, and we anxiously listened to Dr. Boulos confidently explain that he believed he could remove the cavernoma without any long-term complications. I decided to undergo elective brain surgery to remove the malformation and my mother was very supportive of this decision. Surgery was scheduled for March 27, 2018. I will never forget how I cried the entire way to the hospital, in the waiting room, while being prepped for surgery, and finally to Dr. Boulos. I begged him to make sure I wake up and make sure I will be a nurse again. I was terrified of never waking up again. I was also worried other more trivial matters, such as how much of my head would need to be shaved, or how the anesthesia would feel, and was glad to find out that only a small sliver of my hair had to be shaved.

Despite my fears, several hours later, I woke up. I had some weakness in my left hand and I hounded Dr. Boulos, reminding him that this had to resolve because I had to go back to being a nurse. He reassured me every day that it would improve and it did—though it did take 6 to 12 months for me to regain full mobility of my hand. Recovery went well with the help of the amazing nurses, providers, and therapists whom I encountered during my short stay. Not only did I return to work, but coming back as a nurse was different this time. It was not because I was different from the surgery, it was because I knew that I had found my calling.

Images from my post-op course after resection of my cavernoma (left, center) and of my haircut after my surgery (right)

Once a position became available in the NeuroICU, I was able to join the team during the summer of 2021, this time as a nurse there. My journey of fear, heartache, resilience, and strength had returned me to the NeuroICU. I looked forward to being able to show compassion and help heal patients in the same ICU I once found myself in. When I hold a patient’s hand and tell them I understand their fear, they know I truly mean it. I have now had the opportunity to share my story with a few patients, and although we have shed some tears it has always ended up bringing them comfort. Their nurse has been through this, came back from it, and is now there to help them with their journey. The calling to serve as a nurse in this very unit brings back a sense of duty beyond the reward of helping others, or the great career benefits. It is the special connection that I can make with each of my patients. I understand them a little more deeply because I was once in their shoes. I have been where they are.

Another incredible part of my story is how things have come full circle. I vividly remember literally putting my life in the hands of care providers such as Drs. Choi and Boulos and experiencing their compassion and professionalism firsthand. Now I get to work side by side with them providing care to others, just as this care was provided to me. I am honored and proud of being able to accomplish this work with the same degree of compassion and excellence that was once afforded to me. When I see Dr. Boulos he asks me how I have been and always smiles. I provide care to many of his patients that have had brain surgery just like I did. He likes to remind me that he still has the coffee mug that I got him. The inscription reads: “Keep calm, I’m a Neurosurgeon!” I am also humbled to work with Dr. Choi, who has been an advocate of my work here, and who was the person who encouraged me to write this piece to share my story with others.

I am incredibly grateful for my journey and I am glad my patients can receive such special care from a nurse who’s been there.

Dr. Choi’s Comments

After you work in a NeuroICU for some time, you realize the mysterious ways in which our memories work. You often have a place in your memories for some of your patients, but not for others. After I heard about Gina’s experience, and realized that I had no recollection of her as a patient, I was truly taken aback by how amazing her story was. Had she not told me, there was no way that I would have been able to tell that she had experienced anything like she did at any point in time. This brought validation to our work, but also to Gina’s incredible resilience and fortitude. I was honored that she opted to seek out work in the very same unit where she had been a patient on multiple occasions, and absolutely recommended that she share this story with others. It is empowering and endearing to see someone use their personal experience as a generator, so that the care they received can be passed forward onto others.