Thursday, March 5, 2009

It could happen to you: surviving a stroke

Presented to the Club in 2007 by Brad Spear

I’m going to ask your patience this evening, as I am going to devote my paper tonight to something that happened to me…not out of a sense of self-indulgence, mind you, but instead, as a cautionary tale. You see, this evening’s story is not really about me and how wonderful I might be. Instead, it’s about others and about how their composure, their thoughtfulness, and skill have made it possible for me to be here this evening.

I am proof-on-the-hoof that you can suffer a significant stroke, and be ready to talk about it nine months later…with almost no apparent aftereffects.

First a caveat: thanks to the fact that among my fellow members are those who practice the art of medicine, I will avoid being technical. In fact, I may get a term or two wrong. But what’s important about my tale is what happened to me…and what, if you are as lucky as I was, those around you must do to help you. You see, it could happen to you.

At the time of the stroke, I was 55 years old. I'd quit smoking cigarettes some twenty years before. In the previous three months or so, I’d made an effort to lose 25 pounds. As has been my habit before and since, I'd made a point of getting daily exercise…anywhere between and hour and ninety minutes of vigorous aerobic and anaerobic exercise. And though I was and I’m still fond of a nightly martini…I'd been minding what I ate.

In short I’d been doing what I was supposed to be doing. And yet it happened all the same.

It was the night before Mother’s Day. My wife, Ellen, who runs Hancock Shaker Village had been fussing all day over the details of the opening reception for her major exhibit for the summer season…Handle with Care…a collection of common objects manufactured in the 18th and 19th Centuries by the Shakers…and the private collection of a dentist from West Hartford, Connecticut. The objects are the beautifully designed and crafted tools of daily life…dust pans, hand saws, brushes, kettles….

The opening of the new exhibit called for a special preview for the corporate donors who made it possible, for the members of the board of directors for the village, for the West Hartford dentist and his wife, for important friends of the village, and for the senior staff. Oh, and I managed to wangle an invitation, too.

The affair was pleasant enough. We sipped on wine and munched on hors d'oeuvres, all the principal participants, my wife Ellen, the village's curator, Christian Goodwillie, and dentist/collector, all had a chance to speak their piece, and those who attended were able to preview the exhibit the night before it was due to open.

Ellen's plan was to take the principal participants to dinner at Rouge in West Stockbridge. We traveled in separate cars and reassembled at the restaurant… twelve in all. The staff had prepared a long table for us in the back room, and all were in a triumphant mood. The reception had been a success, the exhibit was well-received by those who had attended, the accompanying catalogue had been written, edited, laid-out and published successfully. 'Twas an evening to celebrate.

To facilitate conversation, we staggered the seating, asking each couple to have a person other than their spouse sit across the table from them. I sat against the wall with the board chairman's wife to one side and the dentist/collector's wife on the other. Across from me sat the dentist and to his left (my right) sat my wife.

The wine flowed freely, although I had no more to drink than anyone else. We ate appetizers, drank more wine, ordered our entrees, and had a thoroughly lovely time.

For an appetizer, I'd ordered snails, having enjoyed them in the past and not having had them in while. For the main course, I ordered Maryland soft-shelled crab. Interestingly enough, both my appetizer and entree seemed incredibly salty. However, as no one else at the table had ordered the same things, I made no mention of it. My job at my wife's work affairs is to add to the atmosphere, not detract from it. The table was buzzing with laughter and conversation. All seemed to enjoy each other's company.

While conversing with the dentist's wife, I felt the back of my neck tighten, a feeling which spread forward to my temples. Never having had a typical migraine headache, I thought to myself, this must be what's happening. What a time for this!

The tightness increased, and it felt almost as the back of my head had become a component in something mechanical...perhaps electric...some mechanism buried deep in the middle of an electric razor, buzzing, buzzing, buzzing.

To my embarrassment, I began to sweat profusely. The room hadn't been especially hot or close, and yet my brow was beginning to drip. I sought to discreetly mop my brow with the linen napkin on my lap...and discovered I couldn't raise my right hand more than an inch or so. I transferred the napkin to my left hand and blotted my forehead.

By this time, the table had been cleared of the main course, and the waitresses were taking dessert orders. My brow continued to perspire, and I continued to blot it dry. But in a matter of moments, it felt as through someone had smeared a peppery paste across the upper half of my face...including in my eyes, which tingled painfully.

The waitress worked her way down the table toward me. I felt panicky. Had I had too much to drink? Was I suffering from a reaction to the shellfish I'd eaten? How in the world could I extract myself from this without embarrassing my wife, her institution or myself?

The waitress was standing across from me now, holding her pad and pen, looking sternly in my direction. She had taken the dentist's order, his wife's order, and now it was my turn, “What is it that you would like, sir?” she said expectantly.

I'd ruled out having dessert, for I'd only recently lost the weight and I'd been particularly conscious of portion control. Coffee, that's what I'd have. Yes, coffee...that wonderful elixir that can seemingly revive the dead. And not some fancy pants coffee, either. Good old American coffee.

I raised my face to address her...only to discover that I couldn't summon speech.

American coffee...that's what I wanted to say...please! American coffee!

My lower lip trembled for what seemed an eternity as I looked to harness my vocal chords, my tongue, my lips and my teeth to speak. I pushed and pushed. Nothing. I pushed again. “American coffee” damn it, that's all I want to say. Nothing.

The pause was unbearable. The waitress began to look at me oddly. I pushed some more. Finally something came out, “Kaff!” was all I could manage. Oh Lord, I really had had too much to drink...and here I was so out of it I couldn't speak!

The folks around me found my outburst amusing, and they resumed their conversation. Luckily, the ladies on either side of me were quite voluable, and I was able to remain silent, participating in the patter by simply nodding and smiling.

By this time my wife, who'd been engaged in conversation with the other end of the table, noticed my odd behavior...the mopping of the brow and the sudden quietness that had overtaken me. She looked at me in puzzlement and mouthed the words, “What's wrong?”

Though I hadn't been able to vocalize a moment or so ago, I was able to mouth back, “I'm sick.” In reply, she mouthed, “Stand up.” I mouthed back, “I can't.”

She later told me that it was at this point she thought to herself, “Oh, brother, he's pooped in his pants!”

The desserts arrived...although my coffee never made the trip...and my wife made an effort to settle the bill then and there. She deftly got all to finish their meals, grab their coats, and say their farewells. I managed to lift myself to my feet behind the table...and nodded and gestured good-bye with my left hand.

My wife turned to me, as the last person departed. I had managed to get myself from behind the long table and out on the floor, but my right leg was floppy, and I couldn't use it to bear my weight. She came to my side and propped me up. “What's wrong?” she asked, thinking I'd had too much to drink. Somehow I was able to vocalize the words, “I’m awfully sick; I'm sorry.” You see, I too, was still thinking I'd had too much to drink.

She helped me out of the restaurant, and I asked her to drive home. There was no way I could have managed.

On the trip, she began to ask me what was happening. To the best of my ability, I attemped to tell her what was wrong. She later told me that all throughout the conversation, I'd manage to articulate clusters of thoughts...which suddenly in mid-sentence would switch to jabberwocky...and then, just as suddenly, would switch back to cogent speech. In my mind, what I was saying was all quite cogent, thank you very much. But apparently by the time it crossed my lips, it wasn't.

We drove up Swamp Road in West Stockbridge, making our way north to our home in Pittsfield. Ellen felt compelled to make me talk, fearing that I might pass out. I obliged her as best I could. But what had affected me so in the restaurant, seemed to pass, then to well up again.

As our then-eleven year old son Ben had been at home waiting for our return, we both agreed that it would be best if we went home. If I was feeling better by the time we got there, then we'd stay and wait whatever it was out. But my wife insisted that if I still was in the throes of whatever it was, we'd tuck Ben into bed and head for the hospital.

It was still coming and going in waves by the time we pulled into the garage. When it was waning, I could walk and speak with little but some difficulty. When it was waxing, my speech was garbled and my right side would flop around.

The symptoms in the restaurant had struck around 10:30...and by now it was approximately 11:15. Little did we realize that the clock was ticking...and that the worst thing we could have done was to remain home to wait it out.

I'd made it into the house on my own power, and my speech was beginning to return. However, once inside, the symptoms began their return. It was clear to both my wife and me that I should go to Berkshire Medical Center.

Ellen put Ben to bed, told him we were off to the emergency room as his father was very ill, but assured him that I was going to be all right. Though worried sick that the truth was otherwise, little did she realize how prescient she was being.

From our house off Holmes Road, it's less than 15 minutes to the Emergency Room. She helped me get into the car and we drove there directly. We parked in their garage, and as I got out of the car, I discovered I couldn't walk there by myself. Ellen propped herself beneath my right arm, and we slowly made our way into the waiting area.

Though it was a Saturday night, there were only a handful of prospective patients waiting for treatment. You may not realize how fortunate we are to have a fully qualified emergency facility that is not perpetually overwhelmed by patient demand. Were we in Albany, Springfield, Hartford, or any one of the Longwood-area Harvard teaching hospitals in Boston...the wait for medical attention, unless you are brought in by ambulance, is long and frustrating.

An attendant immediately seated me in a wheelchair, I was processed by an RN, and I was admitted to care in the emergency room within ten minutes.

Once in there, I had my basics (temperature, weight, blood pressure, etc) taken by a nurse, was asked to lie down in a room separated from the main area by a curtain, and within minutes was examined by the physician on duty.

It's at this point that many of the details of the events that followed are a bit hazy. I believe I received an injection and was given an aspirin the size of a horse pill. I also was examined by the neurologist on call. At her direction, I was wheeled to a small room, where I received a CAT-scan of my head.

As the physicians among us can attest, a CAT-scan is rather cursory device in this application, used primarily to see if I was suffering from bleeding in the brain. Luckily I wasn't.

At this point, about 1:30 am, the neurologist decided to admit me to the stroke unit. She consulted with my wife, who decided to go home to be with my son.

The physician promised she would call if I were to take a turn for the worse.

Not long after arriving in the stroke unit...which is a three-bed room with an attending RN at a desk in the room with you...I was once again wheeled off to another small room...this time to receive an MRI.

If you've never had an MRI, you lie on a table on a track that slides you into a tube. There you lie for about twenty minutes as all manner of pounding and clanking goes on about you.

I'd had an MRI before. I knew what to expect. Unfortunately, I am a claustrophobe, and the previous MRI I'd had some ten years earlier was an unbearable experience.

These days, before such a procedure, you take a sedative in pill form about an hour before, which causes you to be as serene as the Dali Lama. Unfortunately I wasn't able to tell the staff that night of my fear of enclosed spaces.

It was a bit of a struggle, and I balked at first. But once given a sedative intravenously, I became a compliant patient.

They returned me to my room, made me comfortable, and let me sleep.

The next morning there was plenty of poking and prodding. I had to demonstrate to the attending neurologist my grip and my leg strength...which, though lessened by the events of the night before, seemed to be on the return.

An occupational therapist came in to grill me about my eating and exercise habits.

My primary care physician came in to examine me.

My wife and my son came into the room around 8:00 am, and brought the
morning papers. I managed speech throughout all of this, though I noticed I was having difficulty organizing my thoughts. When asked a question, there seemed to me to be a delay between the time I recognized what was being asked, and the time it took to formulate and then utter a response. “Some way to celebrate Mothers' Day,” I told my wife.

While Ellen and Ben were with me, the neurologist who would ultimately oversee my case came in to see me. He explained what he believed had happened after having read the results of my MRI. He told me that I may have suffered from what's termed a “dissection” of the carotid artery in my brain stem. The artery is a tube within a tube, and a split in the inner wall can occur, collecting blood cells and bulging inward...eventually bulging enough to lessen and even cut off the blood flow to the brain. The substances I'd been given when I first arrived in the emergency room had succeeded in busting through the bulging dissection, restoring the flow of blood in the brain stem.

He later told me that the dissection was one of two possible scenarios. The other cause may have been a small hole between two chambers of my heart, which allowed a clot returning from my extremities to pass into the chamber which pumps oxygenated blood from the lungs into the brain. A later procedure conducted by a cardiologist confirmed that I do, indeed, have a small hole between the incoming and outgoing chambers of my heart...the cause of the stroke suffered by New England Patriots linebacker Teddy Bruschi.

I remained in the hospital for another two days, improving all the while. After being discharged, I spent the next week or so at home.

After yet another visit to the neurologist, I was given permission to return to work on a half-day basis and to resume my exercise regimen at roughly half the intensity of what I'd been doing before the stroke.

The physical symptoms were the ones that seem to diminish the fastest. My strength in my right arm and my right leg were back within the ten days. My ability to summon speech and organize and express my thoughts, though still labored for the following month or two, returned gradually. The one aftereffect that has all but disappeared...and lingered longest....was the tendency to tire after prolonged concentration. Nine months later, through probably 95 to 99%
recovered, I still don't have the mental stamina I could command before the stroke.

Lessons to be learned from all of this?

First, we are fortunate, indeed, to have a facility like Berkshire Medical Center in our midst. As I learned from Ron and his wife in the bar at Spice some months later, BMC has made a concerted effort to beef up its ability to respond to stroke emergencies. If you have a stroke, there's no better place than the Berkshires to have one.

Second, learn to recognize when either you or your spouse is having a stroke. I'm passing out a cartoon-y little brochure that uses the mnemonic device F-A-S-T to detail what you ought to do. It's a sixty second read...and one that may help you save a life. The bottom line is simple, if you can obtain treatment within three hours of the onset of a stroke, you, like me, stand a very good chance of recovery.

Third and last, be aware that no matter how long ago you quit smoking...or how properly you eat...or how much vigorous exercise you do...which we all must do to maintain good cardiovascular still may end up suffering a stroke.

If it happened to me, it could happen to you.

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