By Jo Ann Soliven, The Medical City, Philippines
It was my turn to personally test-run the Acute Stroke Response System through the Brain Attack Team, this time as the real patient. I was in a meeting with colleagues when I experienced sudden dizziness and, later, double vision. This was communicated to the Emergency Department of the hospital where I worked.
On standby at the triage area of the ER were members of the Brain Attack Team. I got out of the car and laid myself on the stretcher. While I was being wheeled in, I asked the resident to "have my blood pressure taken, to hook me to cardiac monitor." I felt some tightness in my chest before I was brought to the car.
The Radiology Team was waiting to do a cranial MRI. This took some time because I was sick repeatedly. The MRI took a long time, and I started suspecting they were seeing something that didn’t look good. They were telling me that an artifact that might be coming from the button of my blouse was confounding the images! When they finally said the test was finished, the people who entered the MRI room were flashing bittersweet smiles as if they were comforting me. One said, "It looks like we need to administer thrombolytics," and I responded "If that is what's needed." I was suffering from a cerebellar stroke, a condition I never imagined to happen to me. A part of my brain was injured because of impaired blood flow.
I was brought back to the ER for thrombolysis and the medication was administered well within the golden period of three hours.
I saw mentors, friends and colleagues, ER friends, all close to my heart. I wanted to wish they weren't there because it only meant I was facing great danger. On the other hand, seeing them around, some attending to my needs, even providing necessary care, provided reassurance and gave me courage to hold on as I was hoping I'd soon join the success stories in the specialty. I wasn't even interested to ask about the stroke. I didn't want to scare myself. Knowing the possible courses of the condition, i focused my mind trying to sustain strength for the incessant vomiting and severe dizziness.
The next thing I remember, I was being brought to the Acute Stroke Unit (AcSU). My memory of the next few days is clouded. My vomiting continued the whole night. My attending neurologist came at the AcSU to remind me to be watchful of what can be the red flag signs or danger signs, the possibility of bleeding that can be secondary to the clot-dissolving medication or, a possible extension of the brain injury.
I quote a line from Plum and Posner's book on "Diagnosis of Stupor and Coma," "The limited time for action and the multiplicity of potential causes of brain failure challenge the physician and frighten both the physician and the family, ONLY THE PATIENT ESCAPES anxiety." But this is not true when the patient is a physician and suffering from an illness she is used to treating.
I am a neurologist in the early years of practice. I suffered from a stroke, was given thtombolytic medication, had a minimal hemorrhagic transformation and underwent decompressive craniectomy and ventriculostomy for edema and hydrocephalus. I needed extra effort to fight that anxiety as I anticipated the worst things that could have happened.
Day three after the stroke, aside from persistent and severe headache, my blood pressure was also rising. But I would still answer correctly and joke around, hence everyone thought I was doing fine. I could hardly endure the pain and its accompanying discomfort. I was just focusing on the hope that I'd get relief at some point. That must have been the reason why I was anticipating the decision to operate. I was participating in my own management, only to later realize that I couldn't recall many of these conversations. Together, with changes in my blood pressure and heart rate, the headache gave my care team the hint that something was getting worse. Close monitoring continued and attempts were made to decompress my swollen brain.
One thing I can't forget in those critical days was that my mind was empty, rested and devoid of worries. I had nothing to worry about except the endurance of pain and fear that I will no longer be able to see and talk to the people around me.
I became fully awake and conscious three days after the craniectomy. Rehabilitation in the form of physical therapy was started at this point. I was discharged from the ICU eight days after the stroke or five days post-op and eventually discharged two weeks after stroke. I underwent physical therapy for five and a half months, after which I went back to work.
A year and a half after the stroke, I am now in another country (Singapore) undergoing fellowship training in stroke. I have always wanted to become a stroke specialist. What irony! My passion for stroke care was further galvanized by what happened to me. Now in the second month of a yearlong fellowship, I am building my confidence. I am living alone and trying to overcome fears of stroke recurrence. Yes, there is life after stroke and life must go on! #LeadingInsights #StoriesofHope #JoAnnSoliven