Stroke Alert by Michael De Rosa

As I started to take the first bite of my Egg McMuffin, my lips and gums went numb on the right side of my mouth. 

Until then, everything seemed normal. My wife Norma and I were having Sunday breakfast at McDonald’s.  If anything, our order of two egg sandwiches, a senior decaf coffee, senior tea, and two sugars and three creamers on the side had arrived faster than usual. My mouth felt as if I had had a shot of Lidocaine at the dentist. Chewing was no longer automatic. I had to be careful not to bite my cheek. And I became clumsy. Reaching for my tea, twice I bumped into the cup and splashed some out. 

Stroke flashed through my mind as a question, not a statement. Heart attacks, strokes were for other men in their mid-seventies. I had normal blood pressure, shirts that dropped to my waist with barely a hint of a detour, and “spry,” meaning they couldn’t believe someone my age could still move. 

I can’t be having a stroke.  

Could I? 

You may have seen the poster illustrating the signs of a stroke: F.A.S.T. The F stands for face, and there is an illustration of a drooping face. T is for time. I did not remember that A stands for arm weakness and S for speech problems. I asked Norma, sitting across from me in the booth, “Is my face droopy?” “No,” she said. After a quick inventory, all my extremities were working. I’m a chemistry professor. To test if my brain had been affected, I tried to think of something chemical: the Pythagorean theorem popped out. 

As a scientist, my default setting is to observe and figure out what is happening. Patient-Me experienced the symptoms and felt apprehensive. Scientist-Me was making observations and recording data points. Think of it as an out-of-body experience or dissonance with Scientist-Me watching and taking notes as Patient-Me lived through it and wondering what would happen next. 

Patient-Me: No pain, just a feeling that I was not quite myself. 

Scientist-Me: You can’t ignore what is happening. 

Inside the booth, my wife and I considered our options: should we drive to the ER or go home for a nap with the expectation that I would feel better after a rest. The nap won.   There was no limp or leg dragging, but my gait was not right. Knees flexed a bit more than usual, and it took slightly longer for my legs to straighten and take the next step. When I grabbed the steering wheel, two fingers of my right hand were numb.  

Patient-Me and Scientist-Me wondered: Why only two fingers? 

We drove home, went up in the elevator, out the door, and started the twenty steps leading to our apartment. Usually, I have an effortless stride. After three steps, Patient-Me and Scientist-Me both agreed that all was not well. Someone else’s legs had been grafted to my body — time to go to the ER and stroke center at the closest Hospital. 

Norma can’t drive. I drove (a mistake) carefully, alert to any changes in my condition. Arriving at about 10:30 AM to an ER waiting room relatively empty on a Sunday morning. I was interviewed almost immediately. Sitting at the small end of the L-shaped counter, a nurse asked my name and checked me out on the computer:  She asked, “What had happened”: Mentioning numbness, I had gained her complete attention. I have since learned that numbness is one of the most important signs of a stroke. 

At the long end of the counter, another nurse asked: “What time did it happen,” and I told him, “Around 9:30.”  The next time I saw him, he was pushing out a wheelchair, motioning me to sit, and then wheeling me into Acute Care #12 in the ER with Norma trailing behind. I was quickly transferred to a gurney, changed into a hospital gown, a nurse attaching the plumbing for a possible IV. 

The PA system blared “Stroke Alert in #12.” That’s my room, I thought. Stroke was no longer a remote possibility.  

Patient-Me: I was worried, very worried. There was urgency. From previous experience,  I knew the patient first goes to triage, and then to an ER room, eventually the family member is brought inside to be with the patientAll of this was now compressed. There was a reason for me to worry. 

The neurologist came in quickly to evaluate me. Neurology has made great strides, but the preliminary evaluation is old school. Can you close your eyes and touch your nose? “How many fingers am I holding up?” I nailed this when I put my glasses on. Close your eyes and hold out your hands. He measured hand and foot strength. Your National Institutes of Health (NIH) stroke score can be calculated depending on the impairment level. 

An orderly came and wheeled me out for a CT scan — with “stroke alert” sounding on the PA system as I left the ER. No waiting. I was taken in right away for a scan. Once I returned to Acute Care, the neurologist arrived promptly again: CT scan negative. I was not a candidate for the clot-buster drug TPA. Possible side effects were not worth the risk. He then added: “You look too good to have had a stroke.”    

Smiley face! Smiley face! Smiley face! 

But I would have to spend the night under observation with an MRI in the morning to make sure there was no damage missed by the lower resolution CT scan. No longer in immediate danger, time slowed down. When I mentioned this to Norma, an ER nurse smiled. She knew it would be a while before a bed was available.  

The nurse gave me four baby aspirins and told me to chew them and swallow.  

Scientist-Me: chewing crushes pills, surface area increases, more surface area means they dissolve faster; if they dissolve faster, they start to work more quickly.  

Patient-Me: I chewed harder

My brain seemed to be working. 

A bed with an older man as my roommate became available in the telemetry ward. Norma left and I would not see her again until the next afternoon when she and a friend came to drive me home. The duty nurse hooked me up to a heart monitor that would send my vitals to a monitoring station outside. Then the nurse took my history. I was curious about how they would monitor me if I had another — not wanting to use the word stroke — problem. She walked over to a nook, took out laminated pages from NIH, held them up, and asked me to identify some everyday household objects. Then she showed me several cartoons in which I had to describe what was happening; in one, there was a sink full of dishes, water coming out of the faucet, and spilling out onto the floor. They showed me the same cards twice more to see if there was any change. 

Dinner came. Memorable only because it was not awful and I was hungry. Trying to sleep in a hospital can be well — trying. When I couldn’t fall asleep, I joined my roommate in watching America’s Got Talent on my TV monitor. If you have spent a night in a hospital, you know the feeling of waking from deep sleep to a shadowy presence looming over you every few hours to have your vitals taken. Finally, after what seemed an endless night, morning came. 

After breakfast, an echocardiogram — a surprise, as it was the first I had heard of this. Once there, I asked the technician if the problem was in my brain, why the heart test? She called for clarification. They wanted to make sure a clot in the heart did not cause it. I had a history of AFIB — treated with heart ablation — that can cause blood clots and said OK.  

Scientist-Me loved the echocardiogram. Patient-Me felt no pain, and the gel for the probe to make contact with the skin was warm. Moving my head so I could see the monitor as she pushed the probe around my chest, it was like watching a movie complete with sound effects: Heart pumping, valves opening and closing as the blood made its way through the chambers of my heart with whooshing sounds. Asking if the sounds were real, she said they were the amplified sounds of blood circulation. All told, she took over sixty measurements — I asked.  

The orderly wheeled me in for my MRI. Before going into the machine, the technician asked me to select the music I would like to hear: “Fifties,” I told her. Rock Around the Clock was the first song. Even the music of Bill Halley and the Comets was not enough to drown out the noise generated by the MRI machine. Forty minutes, a dozen songs later, a quick stop at the nearest bathroom, and I was on my way back to my room. 

The neurologist came in very shortly with great news, no evidence of a stroke, no permanent damage. He seemed in a hurry to get to his next patient, but I did manage to question him before he left — why waste data. Asking: “Did my brain scans show any brain abnormalities?” I was very interested in any brain shrinkage or lesions linked to Alzheimer’s or other forms of dementia. More good news: “No.” But, he did tell me that after forty, your brain shrinks a certain percent per decade. My scans showed only normal age-related brain shrinkage. 

At no time, during the 36 hours, I was in the hospital, did a doctor explicitly tell me I had had a stroke, or even what had happened. But before being discharged, the stroke nurse came by with a yellow folder with a booklet inside entitled “Let’s Talk About Stroke.” And that is what we did. Discussing strokes in general, and mine in particular. She told me that the only thing I did wrong was to drive myself to the hospital. If I had called an ambulance, it would have taken me directly for a CT scan and saved valuable time. And avoided the possibility that an untoward event might have caused a car accident. 

Scientist-Me: Untoward event? Do you mean like another stroke? 

Patient-Me: If I had had a stroke, but all the symptoms were resolved, and there was no trace in my brain, did I really have a stroke?   

Scientist-Me: Really

Patient-Me: I prefer to call it a TIA for Transient Ischemic Attack — “stroke” sounds too ominous.  

A TIA occurs when blood flow to a part of the brain is temporarily blocked, often because of the build-up of plaques in the blood vessels in the brain, plaques that can sometimes dislodge to form small clots.   

Patient-Me: Yes, I know a TIA is also known as a mini-stroke. 

What would have happened if I had decided to go home and take a nap? Nothing. Within two hours in the ER all the numbness had disappeared. And the first time I walked to go to the bathroom, my gait was normal. TIAs generally last only a short time and leave no permanent damage. In my case by Tuesday morning, after a night of deep sleep, it was as if it had all been a bad dream. 

Physically there was no change in me. Mentally I had to acknowledge that I was not immune to a stroke. I had had a TIA.  What could I do to prevent another? Calculating my stroke risk, I found that I had a 1 in 5 chance of having a stroke during the next ten years. All of this shook me out of my complacency as to my health. Feeling good and looking good for my age was not enough. Now I take a statin and a baby Aspirin to lower my risk of another TIA.  

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