Center of Attention – The Heart of the Matter

“One Love, One Love” Bob Marley rocked me down Cliff Drive, slipped me into a welcome calm as the ocean and sky touched my eyes with sunset soft blue and transparent orange red hues.  I rocked and reggaed my CRV into the parking space.  Letting the music curl my tongue, I sat back for a minute and then reached for the keys with my right hand.  As my fingers closed around the flatness of the key, I felt a shudder roll through the right side of my body.  What the hell was that?  A minute seemed slow as my mind recorded and registered a shift in my physical being.

Somewhere in between the conscious and unconscious, between denial and wwhoooooaaaa… I called for help; some other identity – one quieted by some oncoming fear took on a whisper; my tongue was caught by the disbelief that my half body shudder could be anything serious; my voice squeaked into a closed window.  No one heard.  What did I expect?  I lived in a quiet neighborhood in a small and quiet apartment building.

Calmly, I did like I do every night; I grabbed my bag from the seat; I opened the door and stepped onto the concrete yard.  I stumbled, but I kept walking aware that my right hand seemed to be losing its grip on its contents and I couldn’t hold on.  In the shadows of my consciousness lurked the recognition that something was slowing down; my right side was pulling at me; it was alien.

I made it to my apartment, but the physical warning that had taken over took me to my neighbor’s door; I rapped weakly and called, but there was no stir and something in the recesses of my mind nudged me to use my cell phone; that took some time as the phone kept slipping out of my hand.  And when I eventually held it I couldn’t press the little buttons hard enough.  I concentrated and slowly success came to me.

Stubborn and light heartedly refusing to acknowledge the slow deterioration of my balance, I called a friend to ask for permission to ignore my body.   I was aware of my own refusal to accept that anything serious could be at play.  After all, I was 52 years old and healthy.  Didn’t I conquer Crohn’s!  I mean, really!  I did not feel ill.  I was suppose to feel ill.

That friend was not at home, but another family member answered; she was older and had had some experience  with danger.  She suggested that I go to the emergency room to be on the safe side.  I refused; I had had an experience at the emergency room that kept me away from the medical profession for years.  I was not willingly going there.  She pushed.  I told her that I didn’t think I could drive; she suggested a taxi; I told her I had no cash on me.  I then told her that I would go in the morning.  She said no.  She said call an ambulance; I was adamant; I was not bringing a noisy disturbance to the neighborhood.  Really!  What drama to find out that it was all for nothing.

My friend sent her brother.  I sat on a stool in my apartment with the door open.  By this time, something ominous was registering somewhere deep in my consciousness as I found myself not able to keep my balance.  I reached for something on the table next to me and my hand behaved badly.  It did not follow my directions.  I kept hitting objects that were not a part of my command.  I trivialized the seriousness of this phenomenon.  I could not be in serious peril.

Andy, my friend’s brother and her sister, arrived and escorted me to the car.  I kept up a running comedy  routine in the car.  I told them that if I died at least I wouldn’t be going to a place that my loved ones hadn’t already visited.  After all, my mother, my best friend, had made the trip in 2006.  This did not get me laughs.

Arrival at the Emergency Entrance of Cottage Hospital brought me back to the real world.  Andy asked if I needed the wheel chair.  And, of course, I didn’t!  That is until my body refused to follow my mind.  I really thought that I could control my body and walk to the wheel chair.  But, to my surprise, my body did not respond and I had to be helped to the wheel chair and pushed into the building.  From there, after registration, things moved fast; it seemed like minutes and  I was quickly in the hands of two nurses.  They were young, blond, pretty and friendly.  And, I, in the midst of trying to deflect fear and anxiety, kept up a continuous and humorous chatter.

A what! A catheter! Where?  You are not serious.  In response to their affirmative answer my chatter got faster and funnier.  Humor was my armor against this loss of independence, this absolute invasion of body and privacy.  I had no control.  I told them that any such action would bypass friendship and go directly to intimacy and would mean the sharing of family details.  They laughed.  I laughed too as tears were quietly pooling inside.  I recognized that I was dependent on their kindness.  I clung to their smiles.

Somewhere, sometime in the midst of my trauma, Dr. Delio appeared.  He seemed to have been woven into a dream.  His presence did not surprise me.  He smiled and interacted with the nurses and he was at ease with the light hearted banter happening in the room.  At the same time, he calmly looked at me and told me directly, “Ms. Bacchus you are having a stroke and I need to know now what  time it started.”  A Stroke!  What could he mean?  I looked at him with some confusion, but I concentrated on his question and I tried to calculate the time spent between my parking the car and the present.  At the same time my query was “why is the time important?”  He explained that he only had a three hour window to give me t-PA – a powerful blood thinner; if he didn’t act fast he would miss the chance and that could leave me with debilitating results from the stroke.  Before all of this, before he could act, he had to get my permission.

The information swam in my brain.  What did it all mean?  I was too numb and deep in denial to do anything like seriously calculate medical information that spoke of possible death; but I had to give permission.  I looked at Dr. Delio’s face.  I saw calm intelligence; I saw concern; I saw compassion; and I saw confidence.  Those things I used to form an opinion and they steadied me.  It was what I needed to give my permission for him to use a powerful blood thinner that could save me in some way; some way that I did not fullly understand at the moment.  Those qualities he exhibited earned my trust.

Time flew.  Vitals were taken and came back normal.  Dr. Delio suspected a PFO; I was sent for a bubble test of the heart to confirm his suspicion.  The test was positive.  I had, unknown to me, a Patent Foreman Ovale = an open flap in the heart.  It made it possible for clots to escape into the blood stream.  A clot had escaped into my bloodstream and headed to my brain.  That clot had broken in two; one headed to the right side (   ) and the other to the left (ansular).  Together they blocked the blood vessels and were slowly starving the cells of oxygen and sentencing them to death.  And, in doing so, they were taking from me abilities I took for granted.

By  this time, there were constant tests = the nurses checking the movement of my feet, my ability to keep my hands up and at the same level, stick out my tongue, smile…..  My right side was losing movement and feeling; my speech was slurring.  Emotionally, I was somewhat removed from what that meant and therefore, I blocked intelligent calculations.  I kept laughing.

Needles hooked me to drips. The nurses gently smiled and apologized as they entered my veins and started infusions.  Time slid over me; minutes moved and became meaningless.  They rolled me to the MICU; needles kept me anchored; the catheter helped me to stay put.  Every hour a nurse engaged with me as she checked my vitals and my responses to tests.  “Stick your tongue out” became a joke.  Somewhere in my brain I was surprised that I felt no panic.  Again I clung….. to their smiles, their patience, their compassion… I clung.

Paralysis stunned me.  My right side was no longer mine.  It existed like dead meat hanging off of my shoulder bone.  Someone had replaced my marrow with lead; my right side had become clay.  The fingers on my right hand could not longer grasp my needs; it could no longer sustain my independence.  In a matter of hours, I was totally dependent on others – for everything – food, toilet, hair, teeth – you name it.  I held on to my smile and from somewhere outside of me a spirit, maybe mine with the help of others, started the a fight for life.

Education.  My hunger for knowledge; my bookworm identity entered this new stage as a firm friend and as my mental stamina.  The multitasker in me became that anesthesia for psychological pain.  I got busy.  Questions formed and spilled out.  My left hand reached for the computer keyboard and I let intellectual hunger find calming food; I googled for information.  I could not panic.  I questioned.

Dr. Delio and the nurses stepped in to supply information to my many questions.

I learned that brain cells die; they just die when injured.  Some of mine were either dead or badly injured.  There was no regeneration to be expected; other pathways had to be taken; other cells had to learn and take over    Under the heavy weight of this information a struggle began.  After all, I was lying in a bed immobilized by a cathether and unable to roll over on my left side.

I had tried.  The sweat appeared on my brow as my body refused to perform that simple act of rolling over and my mind tried to digest the mental shock of this lack of cooperation.  I loved the fetal position at night; it was my warmth.  What could I do?  Too, I could no longer write.

This was not happening!  I focused on movement.  I did not sleep.  I kept talking to my right hand; it had to work; I kept pushing my fingers to open and close.  I just knew they would listen to my body’s signals.  I could not stop; every minute I tried to pinch something, to pick up something.   I willed and I willed..   And they did; those fingers got moving.

The MICU was a three day mental and physical struggle; fingers twitched and struggled; one footed was lifted every minute; it was tested for strength.  The time was a journey I did on my back, staring at the ceiling; it was also a struggle to remember details.  I found myself often startled when in the midst of a visual memory story I could not recall some fact.  I was like having a book and turning the page and finding that the next page was missing.

I kept the constant knock of anxiety at bay with rapid interrogation of this new visitor, my stroke.  To think of that blood clot in my brain; to think that it could happen again, right then right there…. the nightmare of permanent paralysis, to ponder the might of what could have happened had I gone to bed.  That was too much to contemplate.  I lived with repeated and surprised gasps for frightenbed air.

After three days in the MICU, I was moved to the neurological wing of the hospital.  Again the smiles; again it mattered.

The nurses welcomed me into a room of space and comfort. They opened for my personality; they allowed for my individuality and in so doing they kept me whole.  I called; they came.  I talked; they listened; I asked; they answered.

They helped me mend.  Those smiles did their magic; they kept a promise and I held on to it.  Physically it was happening; there was more movement in my fingers and in my foot; I could stand.  Dr. Delio was informed; he gave permission.  The catheter could be removed.  And, they took it; I was free; very wobbly but free. Again, I needed… the smiles, the gentle voices, the arm and the shoulder.  Without them I would fall.  They, the nurses, braced me and did not let me go.

The strength to hand and my leg returned slowly; gingerly I started to the toilet and back; my sense of privacy and independence, caught in the midst of its fray, was overjoyed by the quiet of the closed door.  To sit alone; to think that I could have lost this freedom stopped my breath for seconds.  The reality of that possibility left my heart suspended in time and I could almost feel that dark hole open wide below; I could feel the beat of fear waiting…. just waiting.

And, I clung again… to the smiles.  The nurses laughter mixed with mine and their willingness to be kind; they drew me back into the fight for life, for limb..  I leaned again and again.  I needed them.

One day, I pushed even harder as I watched that walker leaning against the wall.  I figured, if I tried, with some help of course, I could make those short strides; I could, if I tried, wobble over to that other side, put my hand on that walker and take back a part of my life.  When the nurse arrived, I asked if she would shadow my backside, keep my robe from flapping, and catch me if I started to fall.  She stayed close and I made it to the walker.  After that I kept it by the bed and quickly found a limited independence.   Soon enough I attempted to manage without the walker a little at a time.

I was so caught up in my progress that it took some time for me to realize that my healing progress was moving a lot faster than expected.  The nurses were pleasantly surprised and willing to offer encouragement; I took it greedily. The excitement of good news fueled my body and I could almost feel those neurological pathways revealing themselves willing to take over new tasks.

I had a plan and it included Dr. Delio.  I was going to surprise him.  He was expecting walker; I would give him walk.  I was motivated to give him some good news.  Time had given me an understanding of his profession.  A shocking 1 to 2% of stroke victims made it into the Stroke Center within that crucial three (3) hour window.  I could not digest this news.  1 or 2 out of 100 people get the chance I was given.  Stroke was the primary cause of disability.  How could that be?  It was the third cause of death.

It occured to me that nurses, doctors, and therapists of neurology must deal with an overwhelming number of people who are incapacitated by brain injury – a lot of paralysis, loss of cognitive abilities…. struggles with depression.  What must it be like to be that face that someone sees as they try to wrap their minds around incredible loss – of abilities and of independence!  What must it be like to be that thin membrane between a smile and a tear.

In Santa Barbara, in the month of March, in the year 2012, at the heart of the Stroke Center stood Dr. Delio and nurses who kept me steady with their expertise and compassion when an “out of the blue” stroke sent clots to my brain; two clots that gave me an appreciation for life.

They were the heart of what mattered.


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