Contributor: Leighton Mohl, MD, Neurology Resident University of Minnesota (left); Contributor: Christopher Streib, MD, MS, Assistant Professor of Neurology, Program Director, Vascular Neurology Fellowship Stroke Director, University of Minnesota (center); Section Editor: Michael Reznik, MD, Assistant Professor of Neurology & Neurosurgery, Alpert Medical School, Brown University/Rhode Island Hospital (right)
After finishing work and returning home one day, Sten Anderson was on his way to the gym — “dreading working out, as most people do,” he recalls, as he sits at the front of a packed lecture hall. The date was Oct. 10, 2016 and Sten was, at least at that point, a healthy 24-year-old. After starting his run, he developed the worst headache of his life and decided to return to his apartment, but he never made it back. “I ended up on the wrong floor, collapsed on the ground, just pounding against a random door,” he remembers, before a passerby found him and called EMS.
On March 9, 2018, Sten returned to the University of Minnesota Medical School to share his experience of suffering and recovering from a life-changing stroke for a captivated audience of second-year medical students. Though Sten still has some weakness on his left side, he was able to walk to his seat unassisted, and he sat in front of the students telling his story with clarity and frequent interjections of humor. The following account is Sten’s story, told by Sten himself, along with perspectives from his parents and caregivers.
Five months prior to his stroke, Sten had graduated from college with a bachelor’s degree and had a job working in information technology. He lived with a friend in an apartment in downtown Minneapolis, had no prior medical conditions and exercised regularly. But on Oct. 10, 2016, he found himself lying in a hospital bed as it was whisked to the CT scanner as part of an emergent stroke code activation. Dr. Christopher Streib, an attending physician at the University of Minnesota who was part of Sten’s medical team, remembers the case vividly. “I remember being very hopeful initially … the senior resident had called to tell me Sten had a complete right MCA [middle cerebral artery] syndrome, but that he was only two hours from his last known normal time. We were focused on getting IV tPA started as quickly as possible, and the endovascular stroke team was already in-house prepping for his case [to perform an acute stroke intervention].”
Those hopes were immediately dashed upon reviewing Sten’s head CT. He already had early signs of stroke in almost the entire right side of his brain, indicating that the damage was irreversible, with essentially no viable ischemic penumbra or brain tissue that could be saved. His CTA showed the culprit: a right ICA terminus occlusion. Dr. Eddy Labin, a neurology resident who was also part of Sten’s medical team, recalls feeling his heart sink when he saw the scans. “He was so young and was surrounded by so many people who loved him, all of whom were absolutely devastated.”
“The alteplase [tPA] was already mixed and was bedside and the endovascular team was calling for him,” Dr. Streib remembers. “I was emotionally torn. He was a young kid and we all wanted to do everything to help him, but we knew he was unlikely to benefit from alteplase or endovascular treatment, and given the malignant profile of his imaging, was at high risk of harm from [the treatments]. We knew then that it would be a large stroke and a long recovery for him.”
Tubes Upon Tubes
When Sten’s family was first informed what happened, they were in disbelief. His mother remembers the initial phone call where she hung up on his doctors because she thought they were telemarketers. “They said, ‘Your son has had a stroke,’ and I said, ‘Whose son? Not my son.’” But the severity of Sten’s injury was immediately apparent to his family upon their arrival at Hennepin County Medical Center. “Things weren’t looking real great,” his mother recalls. “He couldn’t talk … but [he] could hear.” They immediately established a “thumbs-up” and “thumbsdown” system to communicate, and knowing she was able to maintain a sense of what Sten was feeling put her at ease, at least to some degree.
After Sten was admitted to the ICU, serial brain scans revealed that the swelling in his brain was worsening. Because his doctors were concerned that this edema was life-threatening, Sten underwent a decompressive craniectomy — a procedure to remove a large part of the skull to allow his brain to swell without causing additional damage — on the second day of his hospitalization. Sten’s mother recounts that as he was leaving for the operating room, she told him she would see him after the surgery, to which Sten jokingly replied, “Maybe!” Despite his neurologic deficits, Sten’s preserved personality and lighthearted demeanor offered some relief to his family and caregivers in a difficult time. “When you hear giant stroke you think, ‘Oh my gosh, is he still in there? Is this still my kid?” Sten’s mother said. His medical team was similarly moved. “Despite lying in bed with the left-side of his body paralyzed, he was cracking jokes,” Dr. Labin remembers. “And that’s how I remember him. He was the victim of an unthinkable catastrophe and yet, still smiling.” (Image left: Post-craniectomy CT)
After the decompressive craniectomy, Sten made a steady recovery. When asked to reflect on his time in the ICU, Sten states, “I have very little memory of my time in there, but what I do have is not entirely pleasant, as I’m sure you can imagine.” Having a catheter in his bladder and a feeding tube placed through his nose were among the low points of his stay. While Sten’s memory of his hospitalization is a blur, his mother remembers things vividly. She spent every single night in the hospital by his side. She felt grateful not to have work obligations, permitting her to focus entirely on Sten’s care. “I knew I had to be there in the morning when the big teams came by. It was very important to me.”
The Peaks and Valleys of Recovery
As Sten’s medical condition improved, he was able to participate in physical and occupational therapy. He recalls a key turning point during his hospitalization: “One of the first times I had any really clear recovery is a couple of the OTs [occupational therapists] came in ... and helped me sit up on the edge of the bed. Which I know for both of my parents was a pretty amazing sight to see.” Sten’s mother remembers having mixed feelings along the way. “Everything is so frightening because you’re celebrating ‘Yay, he’s up! He’s sitting up in bed!’ And then you go, ‘Why is sitting up in bed so hard?’ I flip-flopped like that all the time.” (Image left: Sten’s lighthearted personality made his hospitalization easier on his family, friends, and caregivers.)
After 13 days in the hospital, Sten was discharged to an inpatient rehabilitation facility for intensive physical, occupational and speech therapy. As his new therapists began working with him, they soon became aware of his unique personality. Sten’s mother recalls the time he met his speech therapist. “She brings out a box full of blocks, [and] makes this little Lincoln Logs thing and she says, ‘Now, Sten, can you make something just like this for me?’” To make light of the simplicity of the request, Sten then proceeded to assemble an elaborate Lincoln Logs complex.
Sten’s positive attitude and hard-working personality followed him to rehab. He continuously pushed himself and challenged his talented therapists. Sten was quite fond of his physical therapist, Bryan. “Bryan was huge for me,” he said. Sten’s dad laughed and agreed: “He was a good personality fit.” During a particularly memorable physical therapy session, Sten attempted to get up from a chair too quickly, but Bryan tackled him onto the bed to prevent him from falling.
With the hard work came gains in function. “I got to the point where I could actually use this,” Sten explained as he pointed to his leg, “[and that] it’s not just going to be this weird floppy attachment on my body for the rest of my life.” His strength continued to improve, and he began to gain control over the left side of his body. He was even able to use his left arm to push elevator buttons, which he described as “just so cool” after not being able to use his arm at all. He also remembers an even bigger accomplishment. “One of the huge things for me was actually being able to walk again.” Sten’s mother nodded in agreement, but as she had when he was in the ICU, she felt conflicted. “The first time [he] walked down the hall ... they came down to show me ... and it was just the same thing, ‘Thank you, God. He’s up, he’s walking!’ and then ‘Oh my gosh! My kid who ran cross country, who was a major player on our community theater stage, can barely walk.’” (Image right: Vigorous physical therapy helped Sten regain the ability to walk.)
Getting Ready to Face the World Again
After three weeks in inpatient rehab, Sten was discharged to an outpatient facility where his condition and abilities continued to improve. “I was walking and doing pretty well by the end of my two months at [rehab].” As Sten graduated from rehab and moved in with his parents, he began to notice that there was still much ground to cover before he would be ready to face the world on his own again.
Sten remembers having to learn new techniques for mundane daily activities. “Like opening a jar, you just use both of your hands and do it, but in my position I had to figure out new ways around so many different things.” Another one of those things was making the bed. (His mother playfully challenged the audience, “Try to put a fitted sheet on your mattress someday with your left hand in your pocket, I double dare you!”) These kinds of challenges taught Sten to adapt and to appreciate the input of those around him, like his girlfriend, who suggested moving the bed away from the wall so that he could more easily walk around it to put the sheets on.
As Sten continued to heal and regain mobility, he started working toward getting back on his feet. He was able to return to his apartment in downtown Minneapolis only nine months after the stroke that paralyzed the left half of his body. Even after making the step to living independently, he is still reminded of the challenges he will continue to face on a daily basis. He told the students of a particularly difficult day while out getting coffee with his parents when he had a fall. “There was this ice plane and I just went totally sideways and ended up on the ground and it’s just terrifying,” he recounts. And it makes him question himself: “Can I even go anywhere on my own now? Am I going to end up on the sidewalk somewhere unable to get up on my own?”
Adapting to His Life Now
After moving back into his own place and learning to adapt to the challenges of independent living, Sten has once again begun looking for work in the information technology field. Now 16 months after his stroke, he has found the job hunt to be quite difficult. He is not able to type with his left hand and is working with an occupational therapist to learn different methods of typing. And though he can now drive again and has had his license restored, he had to sell his car because it had a manual transmission. “I am able to drive, I just have nothing to drive,” he laments good-naturedly. “And now I’m not making enough money to get a new car.” He has a new appreciation for Minneapolis’s infrastructure, and says that not having a car “isn’t a problem in this city, thankfully.” Both he and his mother mention their gratitude for handicap-accessible places.
Despite his stroke, Sten feels that he is still “the same old Sten,” but has noted one distinct change in his personality that might represent a silver lining to his story. “I was more of a pessimist before all of this,” he says, and notes that he has since become more optimistic. His mother also describes an increased empathy for others, which Sten has also recognized. “Having this crazy experience really just opens up your mind to other people that you might not have noticed before,” he says. “[It makes me] wonder if something happened to them that’s similar to my experience.” He has participated in support groups, where he met another young stroke victim. “Just meeting all of these people has been really positive to see how many other people who have struggled with similar situations.”
Sten is happy to report that not much has changed between himself, his family and his friends. They are understanding that he may not want to engage in social activities as often as before. “Going out and doing things is just incredibly exhausting for me,” he explains, “so I can’t just go out to the bars and hang out with people for hours on end.”
A Rewarding Reminder
Sten’s story clearly resonated with the crowd of medical students, and there was sustained applause at the end. As the session wrapped up, Drs. Eddy Labin, Chris Streib and I joined Sten and his parents onstage. Sten’s mother thanked the team again for caring for her son, but we were quick to redirect this gratitude back to Sten and his family, pointing out how rewarding his experience has been to everyone who helped take care of him. Indeed, Sten’s recovery is a refreshing reminder of why we pursue careers in neurocritical care. “As a neurology resident, I’ve spent quite a lot of time treating catastrophic brain injuries,” says Dr. Labin, “and people like Sten make it all worth it.” (Image right: Drs Labin (left) and Streib (right), who cared for Sten during his inpatient admission, review neuroimaging at the University of Minnesota Medical Center)
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