Saturday, 29 October is World Stroke Day

“Every six seconds, regardless of age or gender – someone somewhere will die from stroke.”

Let me take you back with me to July 12, 2008…

At this time I was 26 years old and life was full of promise.  It “was time” to get married, so I thought.  This day was a day of celebration; an engagement party brought together my family and friends.  Apparently everyone was having a great time, because the party did not end until about 3 a.m. the next morning.  My father was seemingly proud that his oldest child, his forever little girl, was moving forward in life.  I remember my mom and him leaving the party and he told me, like he did at the end of every conversation or departure, that he loved me. 

I awoke on Sunday, July 13, 2008 to my phone ringing.  I had no idea how much my life would change at that very moment on that day.  On the other end of the phone, I heard: “Your dad is being taken to the hospital.  He is slurring his words and he is stumbling.  You need to get to the hospital!”  I knew immediately at that moment that my father was having a stroke, also known as a cerebral vascular attack “in medical terms”.  I rushed to the hospital, the same hospital where I was doing my third year medical school clinical rotations, in the same brown sundress that I wore the night before.  I arrived before the ambulance.  As I heard the sirens, I felt a deep feeling of angst knowing that those sirens signified that my father was in need of serious medical attention.  I waited with anticipation and I felt fear at the uncertainty of the situation.

The next several days were trying to say the least.  From my father, there would be tears of frustration, regret, worries, need for reassurance, and finally acceptance of his fate at the young age of 53.  From my family, there was disbelief, fear, concern, desperation, anger, and overwhelming sadness that accompanied a decision that no family should ever have to face.  From the physicians, there was concern, optimism, and unfortunately, false hope given to my family.  For myself, there was: a separation from my role as a daughter, walled-off emotions, in depth reading and communication with my father’s physicians to ensure the most effective patient care, a role as my father’s patient advocate, being the only witness to my father’s acceptance of his fate, and my own self doubt for not being able to prevent this from happening. 

My family and I watched initially as my father struggled to express his words, which is known as expressive aphasia in the realm of neurology.  This was due to the fact that the left side of his brain was not functioning properly.  I watched my ever-so-strong dad cry.  This was only the second time that I ever witnessed this.  The first time I saw my dad cry was four months earlier at the funeral of his sister, who finally lost her battle with metastatic cancer of four years in duration.  These tears were tears of frustration and remorse for what he felt he was putting our family through.  He continued to tell us not to worry and that he would be okay and that he knew what he needed to do.  It broke my heart to watch my father cry, to express that he knew what he needed to do to change his lifestyle, and to feel helpless to his situation.  This Sunday evening showed some signs of improvement.  It appeared that the tissue plasminogen activator (tPA) that was given within the first hour of onset of his stroke, was working.  There was a sense of hope.

 A few memories from his hospital stay…

• My dad loved coffee.  I remember how excited he was that I was able to understand his desire for coffee the day following his admittance to the hospital.  This memory still makes me smile.  So I thought I would share it with you.
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• Another memory I have is the fact that my father would never regress in health when my mother, his loving wife of 28 years was present.  “I will go, I do not want her to worry” he said, as he looked at my mother across the room.  Clear and concise his words of acceptance were surfacing.  I watched the exchange as I sat next to his bedside.  She was distracted and without sleep, so I am not sure she even heard his words.  However, I did.  My mother then left his room, for a matter of maybe twenty minutes.  We maintained hope that my father’s condition would improve with time.  With her no longer present, he looked at me and said, “Will the kids be okay when they get older?”  I replied, “Yes Daddy, we will be okay.”  Those were his very last words.  His face now drooped on one side and he entered into a state of silence.  His condition progressed and I alone, watched him accept his fate.    

Although my father’s condition worsened, his doctors continued to say that his condition would improve.  I asked his prognosis and one of the neurologists replied, “He will likely regain 95% of his initial capabilities.”  I again reassured my family and my brothers, however, I watched as each detrimental factor that could occur in such a stroke case, occurred.  He had positive clinical signs that there was damage to his brain, he developed a fever which was likely due to a urinary tract infection secondary to the foley catheter insertion, and he began to vomit due to increased intracranial pressure and consequent brain stem involvement.  Then at approximately 2:00 a.m. on Wednesday, July 16, 2008, my father was intubated and put onto a ventilator.  The follow-up CT scan revealed the severity of damage.  His entire left side of his brain infarcted, the brain tissue was dead due to a large embolus, or blood clot, which blocked his middle cerebral artery.  Furthermore, there was such a great deal of edema, or swelling, that his brain herniated down his spinal column.  I too was able to witness this, with his physician and the radiologist.

As a family, we had to make the decision to remove my father from the ventilator.  This is a decision that no family should ever have to make.  My father’s brother, Paul, was working in Switzerland at the time.  He was the only one who had not yet made it back to see his brother; however, he was on his way.  Our family decided to keep my father on the ventilator until the next day when his youngest brother arrived.  My family could have been selfish, we could have left my father on that ventilator, and we could have kept him here on Earth longer.  However, those were not his wishes, he would have had no quality of life, and we loved him and respected him enough to let him go as God had called him from us.  I remember sitting in the ICU waiting room that night, knowing that if my dad made it through the night, then tomorrow would be the last day of his life.

On Thursday, July 17, 2008, we asked that my father be extubated and within six minutes, his heart came to rest, his flesh transformed and grew cold, and his life beautifully came to a peaceful end.  Death, a concept that had frightened me in the past, was ironically beautiful.  My father did not suffer and during those six minutes, I lost the fear of dying.

Just as my father experienced acceptance, my family and I have all had to learn to accept that he is no longer physically with us.  This has brought great pain and suffering.  These three years since his death have been difficult and his physical presence has been missed on many occasions including: birthdays, holidays, anniversaries, new births, broken engagements, graduations, weddings, and trauma.  For my mother, she lost her soul mate.  I pray for my family’s healing and for strength to live life as my father would have wished.  He wished for us to be okay and until he received that confirmation, he could not accept his own fate.  My father was very much liked, he was vocal and outspoken, and he was hardworking and family-oriented.  His spirit is still present and his memory alive.  My family and I miss my father every day. 

Stroke Prevention and General Well-Being Recommendations:

• Do not take life for granted.  Death is a guarantee, so live each day with purpose and gratitude.  Say “I love you” to those who are important in your life.    
• Do not allow stress to control your life.  Find your own inner peace and prioritize life with faith, family, and love.
• Be responsible for your personal health.  This includes regular exercise, proper nutrition, and medical management of risk factors including: hypertension (high blood pressure), hyperlipidemia (high cholesterol), heart disease, and diabetes.  If you smoke, please put the effort forward to quit.
• Know the signs of stroke.  Time is of the essence when it comes to stroke care, so seek medical attention immediately and call 9-1-1. 

Signs of Stroke

• * Sudden numbness or weakness of face, arm, or leg,
•    especially if only one side of the body is affected
• * Sudden confusion, trouble talking, or understanding speech
• * Sudden trouble seeing in one or both eyes
• * Sudden trouble walking, dizziness, or loss of balance or coordination
• * Sudden severe headache with no known cause

To my reader:

It is my hope that this message will make you aware of the potential detrimental effects of stroke, to be aware of the fragility of life, and to motivate you to take the necessary steps towards prevention. 

Thank you for reading this message.  Please utilize my father’s story to motivate yourself or others to make necessary lifestyle changes.  Do not count on a second chance. 

To my father:

Thank you for teaching me about death and acceptance.  All of my life you stressed the importance of education; and, you taught me more than you could have ever realized when you were here on Earth.  I pray that your spirit stays with us always and that our family will continue to heal knowing that you are indeed, okay.  I love you and miss you Dad.

Resources:

National Institute of Neurological Disorders and Stroke

World Stroke Campaign