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STROKE

STROKE
The Basics

The Center for Disease Control and Prevention provides the following statistics on strokes: https://www.cdc.gov/stroke/facts.htm

About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked.

For example, if a carotid artery sloughs a piece of plaque, and that piece causes a bleed, and that bleed forms a clot that travels into the the brain, stroke damage occurs because brain tissue dies.

There are two forms of stroke: ischemic – blockage of a blood vessel supplying the brain, and hemorrhagic – bleeding into or around the brain.

In other words:
A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells.
Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause.

Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.2
Stroke is a leading cause of serious long-term disability.2 Stroke reduces mobility in more than half of stroke survivors age 65 and over.
Someone in the United States has a stroke every 40 seconds. Every 4 minutes, someone dies of stroke.2

2 Benjamin EJ, Blaha MJ, Chiuve SE, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e229-e445.

Let’s Get Personal

Every stroke is different. By now I have heard close to one hundred stroke stories, and NONE are the same. Whether it occurs at night while sleeping, or at the end of a long day, or the victim collapses suddenly in the hardware store, or falls down while walking out to collect the newspaper—the result for the stroke victim and surrounding family is upsetting— life changing, disruptive, shocking. Those of us who’s loved ones have had a stroke know well the lack of warning that precedes many strokes. Here is one story, and it’s personal.

Survival

PART 1

I heard a noise or felt an odd movement beside me, or sensed something in my dreams— I cannot recall. I called out my husband’s name, reached for the bedside lamp, and discovered my beloved, churning, his left arm and leg rotating like windmill blades without traction. His right side unmoving, his mouth uttering indistinguishable sounds, coherent words lost. His eyes filled with fear. I thought of stroke imagery on posters in the doctor’s office and knew instantly. I dialed 911, and as I described the emergency heard the wail of the volunteer’s siren, attached to the building directly across the rural lane from our home, outside our bedroom window. It felt surreal, as I held the phone to my right ear, realizing this siren was for us.

My husband of forty-one years, suffered a stroke early Thursday morning at 2 AM, while at home in bed.

Standing on the front porch in my pajamas, door ajar, barefooted, awaiting the first vehicle to approach, I can feel the silence of the night, the crispness of the air, the damp of woods sleeping. Peaceful, and yet electric with the static of danger. Frozen in place, I know nothing for certain. Perhaps I need a sweatshirt.

Within five minutes the volunteer-firemen arrive. Six tall volunteers, the youngest a trained EMT, ask brusque questions. When did he go to bed? “Ten,” I say.
When did I notice the stroke? When did you last speak with him?
I do not tell them that I had stayed up writing until 11:15 PM. That I had made a decision to sleep with him that night instead of the bed where I often slept due to a painful knee problem. That when I tucked in next to his warm body and kissed him goodnight I had said, for the only time I can ever remember in over forty-five years, “let’s hold hands.” And we had, until I fell asleep. That would be the last act of normality for months to come.

I can see them calculating something, chatting back and forth among themselves, arguing quietly, professionally, eyebrows raised, seemingly oblivious to my presence. I am embarrassed with the mess in our bedroom—clothes half-packed in opened suitcases, ready for travels—his to Vancouver and mine to France in three days.

I was packing for an historic, spiritual pilgrimage walk on the Camino de Santiago, with my breast-cancer-survivor sister, my troubled-middle-daughter and my neighbor-whose-husband-died-two-months-prior. I imagined soul-searching, time to consider the span of decisions made in a lifetime, the good ones and the stupid ones, and perhaps rejoice in my perceived future. “Sounds like it could be a movie script,” my doctor had quipped.

Now instead we would be starting a very different pilgrimage into the unknown. France has morphed into Seattle. We would not be crossing the Pyrenees after all, but the boundaries of wellness after a debilitating ischemic stroke.

They carry him, strong arms gripping straps along the white-cloth stretcher, down the thirteen steep stairs, from the second floor to ground level, and load him into an aid car. A woman has magically appeared and tells me to find his things: a wallet, cell phone, medications, underwear, his C-Pap hose. And then they drive off into darkness. On the side of some rural road closer to town they meet the Medic One ambulance, make a deliberate yet delicate transfer, and race onward to Skagit Valley Hospital where I presumed I would meet him. Although in that moment one knows nothing. The mind goes blank, adrenaline or shock kicking in. I grab things and throw them into a backpack, but forget his shoes. Later I realize he will not need them for some time.

In the ten minutes he is inside the ER before I arrive, they scan his contorted body. “A very large blood clot in his brain, on the left side,” the attending ER Doc says to me when I arrive. Or perhaps he said, “He has a big-ass clot in his brain.” I really don’t know now which way it was.

“He’s going to Seattle, after we possibly administer a TPA injection. A clot buster. He’s just at the edges of the time-elapsed window. What do you want us to do? It has a 3% chance of killing him,” the Doc says. I look at my neighbor, Tod, who has appeared beside me. We look at my husband of forty-one years and together say, “Yes, give him his best chance.” Tod puts his arm around me.

I kiss my husband gently as they plunge the life-altering drug into the IV. I think I prayed, hoping we made the right decision.

To save him they say he needs quick air transportation to a stroke center. We know he loves helicopter rides, but this was not going to be a ride up the ski slope to make fresh tracks in crisp sunshine. He always loved watching the noisy passage of helicopters in the sky. Always wondered what sort of a mission they were on— medical emergency or otherwise. His eyes were trained on the skies often, although never a pilot. He loved his Flight Tracker app on his cell phone, although I never understood why it matters where a sky full of planes are headed unless I am on one.

Tod, who I learn later lied his way into the ER, claiming to be my husband’s youngest brother, asks me if I want to go to the rooftop to see the helicopter lift off. We stand, with the hospital orderly, in the darkness of the rooftop-landing pad, watch the pilot and nurses carefully load the gurney, close the door and lift up. And then we pause in silence, each of us considering our next move. A few months later husband and I will meet one of the pilots at the county fair, and he will gift my husband a hat with the air service’s name emblazoned on the bill, which he wears with pride. A medal, of sorts, for survival.

The helicopter flies to Swedish Hospital Cherry Hill, in Seattle, Washington, where a team of neurosurgeons, who will perform heroically for three and one half hours, meet him. The chief surgeon, a tall man with Scottish bearing, Cameron McDougall, meets me in the basement waiting area, to explain how it went during the surgery.

“We tried this,” he said, “and it was worse case scenario. Then we tried this, and worse case scenario.” With each comment my hearing grows less reliable, my mind wanders and wonders whether he is still alive. “I’m so sorry,” he concludes. “We did what we could. His speech center took the hit from the clot. We removed what we could. He’s in recovery now. Look up neuroplasticity.” And he departs.

For fifteen days and nights I live in a barracks-like room, at the Inn at Cherry Hill on the fifth floor of the hospital. A narrow room with three twin beds for my children and me, it does not smell antiseptic, but odorless. It feels clean, quiet, and restful. There are two windows out of which an expanse of Seattle is revealed, and a private bathroom with a yellow-tiled shower, undoubtedly a former patient room now converted to lodging. We are witnesses to stroke and after care. The Inn has a free washer and dryer, a lounge, microwave, fridge. Not quite home, but it will do. It is a sanctuary. A place to hide, protected while we consider the next move.

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Category: Non-Fiction

About the Author: Ann Bodle-Nash: A free-lance traveler since the age of 11 months, little moss grows on her soles. With relatives and friends scattered across the globe, she finds frequent excuses to travel. But travel in the West is best--those quiet corners of weirdness are like light to a moth, burning with intensity, encouraging curiosity and discovery. She imagines the glory of 30 days of continuous floating and fly fishing on the Yellowstone River after watching a documentary on same. Currently living in Washington State with her husband.

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