The Stroke

    

I awoke on October 12, 1980 on the floor of a motel room at Keddy’s Motor Lodge in Presque Isle, Maine. I was surrounded by about fifteen other University of Massachusetts Geology graduate and undergraduate students. We were on one of the dozen or so field trips put on annually by the New England Intercollegiate Geological Congress. I felt a little light-headed but considering the drinking and dancing we had done the night before I didn’t think that this sensation was particularly unusual. The NEIGC is renowned for its social events as well as its academic pursuits.
    By 8:00 we were loaded into our van stuffing glazed donuts and guzzling hot black coffee. My light-headedness persisted. It was not unpleasant but was actually rather soothing. I felt as if I was a removed observer somehow disconnected from my body as we drove to the first set of outcrops through a light rain under overcast skies. 
    The trip leader, Richard Naylor from Northeastern University, described the significance of the rocks we were examining as we huddled together in the cold morning dampness. Few of his words penetrated my ethereal state. My enjoyment of the floating sensation diminished and began to concern me. Throughout the morning I continued to act as if I was paying attention but I really comprehended little of what was said.
    By noon the sun had dispersed the clouds and we were treated to a wonderful, clear, but not too crisp, autumn day. Near Washburn, we stopped at some rocks exposed on the side of a small river. After discussing the closing of an ancient sea our growling stomachs returned us to more immediate concerns. I was pooling lunch supplies with a couple of my peers, Pete Morton and Paul Eberly, so I volunteered to return to the van to grab the food and bring it back so we could eat on the rocks.
    I walked over to the base of the road embankment and began to climb up to the highway level. As I started I heard and felt a subtle POP! in my head. I wondered what it was but dismissed it as the van came into sight about 50 meters down the road. Before I reached it, I began to feel numbness in my left cheek. My concentration on this sensation was soon diverted when I realized that my left foot and hand were also getting numb. Impressed with the leftness of these feelings I wondered, “Am I having a stroke?” 
    I thought that was a crazy idea. I was only 27 and besides I didn’t have a headache on the right side of my head. I don’t know why I knew the symptoms of a stroke but I come from a medical family so it is likely that I had discussed it with my wife, mother, grandfather, or father-in-law at some point.
    A feeling of horror swept over me as I realized that I did have a growing headache on the right side of my head. I then recalled that just a few months earlier a pitcher for the Houston Astros, James Rodney “JR” Richard, had had a near-fatal stroke. He too was 27!
    By this time I was in the van. I knew I had to get back to the group but I paused to grab the peanut butter, jelly, and bread, stuffing the jars into my vest pockets. I walked back to the picnic site. By the time I reached the embankment I was having trouble controlling my left leg. Somehow I made it down the short slope and over to my nearby friends. After handing off the bread I reached into my pockets and pulled out the jars. I watched in amazement as the glass jelly jar slipped from my numb left hand and shattered on the rock. “Nice play!” one of my friends said with a smirk. He looked at me and his face changed to shocked concern. “Are you all right?”
    “No, the left side of my body is going numb.” I replied.
    He called our professors, Peter Robinson and Leo Hall, and they got me to lie down. Retching, I vomited some yellow-green bile—the only contents of my empty stomach. Leo quickly (and correctly) diagnosed my condition. He sprinted to the van and drove off to get an ambulance.
    Time ceased to be measurable as I lay there. It must have taken awhile for the ambulance to arrive from Presque Isle. I vaguely remember being carried to the ambulance on a wide board by the rescue squad. As we sped toward the hospital I looked out at the blurred potato fields knowing that these might be my last views of the outdoors I loved so much.
    The Emergency Room doctors confirmed the diagnosis that Leo Hall and I had made. They told me I would have to be sent by air ambulance to either Boston or Springfield, Massachusetts, two of the best hospital towns in Massachusetts. I told them that my father-in-law was a neurosurgeon at Mary Hitchcock Memorial Hospital in Hanover, New Hampshire so, with my blessing, they elected to send me there. I lost consciousness a few minutes later. I was flown there in an air ambulance but I was comatose throughout the flight and remember nothing.
    I vaguely remember my father-in-law, Donald Wilson, shouting my name and seeing his face illuminated in the dark by flashing red lights as I was loaded into the ambulance at the Lebanon, NH airport. I came around again as the Emergency Room radiologist, Peter Spiegel, a family friend, inserted a catheter into my right femural artery to perform an angiogram. When it was over, my wife, Haidee, who was visiting her parents that weekend, came to my side and stoically held my right hand. My father-in-law, later told my wife and mother-in-law that I was probably going to die that night. My pupils had ceased to dilate in response to light shined into my eyes. I remember nothing else from that night.
    I was lucky; my father-in-law was wrong. “Jim, open your eyes!” he shouted at me the next morning.
    I did. I saw a double image of everything—one on top of the other.
    “You had a stroke. You are extremely lucky.” he told me.
    “I know.” I said. But I did not feel very lucky. When asked to move my left toes and fingers I could not, no matter how hard I tried. Regardless of what I did, nothing on my left side would move. My speech was also slurred and I discovered that the left side of my tongue would not move. No, I did not feel lucky.
    The arterial rupture, deep in my brain, occurred near the right ventricle—an open space in the brain. This gave the blood an avenue and space for drainage. The bleeding stopped after the ventricle filled so the pressure never grew to the point where it did large amounts of permanent brain damage although my paralyzed left side was a good indicator that I suffered a major stroke. Don told me that that Dr. Saunders and Dr. Harbaugh would be handling my case.
    Out of nowhere, my parents and brother appeared. They had driven all night from central New York not knowing what they would find but prepared to make funeral arrangements. I started crying uncontrollably. This was to be the first of many tearful episodes. I soon learned that this is a characteristic of stroke patients.
    Later that day as I lay in bed, I developed a horrible headache—far worse than any I had ever experienced. I thought that my head would literally explode. I pushed the buzzer for the nurse. She went for the doctors but they were either in surgery, staff meetings, or holding office hours with other patients. A nurse gave me some pain medication but it only seemed to dull the pain a little.
    I have no idea how long it was before Dr. Harbaugh finally came but it seemed like eternity. I described the pain. He suspected that the blood lodged in my right ventricle had clotted, thereby blocking the outflow of cerebral-spinal fluid. As more of the fluid tried to flow into my brain, the pressure mounted. Once again I was probably in grave danger.
    To test his hypothesis, the doctor ordered a spinal tap. I suppose that ordinarily I would have dreaded hearing those words because I knew it was a painful procedure. The idea was to check the color of the fluid at the base of the spine. If circulation of the cerebral-spinal fluid was unimpeded, it should be pink—tinted by the clot that it was slowly washing from my brain.
    The procedure was painful but not nearly as bad as the pain throbbing in my head. The fluid was clear. The doctor was correct. The clot was damming the flow through my brain.
    I suppose that someone probably told me what would happen next but it did not penetrate my pain. A gurney was rolled next to my bed and the doctors and nurses moved me onto it. I felt a sharp sting a couple of centimeters above my right eyelash as the doctor injected a local anesthetic. He told me to hold very still. A nurse held my head firmly as a cloth was placed across my eyes.
    Suddenly, I felt and heard a grinding sensation. “Are you drilling through my skull?” I asked.
    “Yes, please hold very still.”
    "What are archaeologists going to think?" I wondered aloud.
    A nurse snickered as the doctor said, "Quiet, please!"
    The grinding was over quickly. They removed the cloth from my eyes.
    “This will hurt for a moment.” the doctor warned me.
    I saw him move a lancet to my forehead. I was already in more pain than I could remember in my life but suddenly I was gripped by a blinding white flash of agony. I remember thinking that this must be what it is like to be shot in the head.
    The doctor punctured the arachnoid sac that surrounds the brain and lets it float in the cerebral-spinal fluid. Unlike the brain, which does not have a sense of feeling, the sac is laced with sensory nerves.
     “This won’t hurt but may be a little uncomfortable.” He advised as he maneuvered a tube to the hole in my skull. He plunged the tube into my brain directly into the right ventricle. I saw fluid race out the tube and into a collection bag. My headache disappeared instantly. The excess pressure was relieved.
    The doctors left the tube in my head thinking that I may need to have a permanent shunt put under my skin to my stomach so that the excess fluid could be disposed of by my digestive system. I found this prospect far from thrilling but was in no position to argue against it. Peacefully, I dozed off and on for the rest of the afternoon. 
     By 9:00 PM I started to feel some discomfort in my lower back. I assumed it was from the spinal tap. I complained and was given some pain medication which helped me fall asleep. I slept fitfully as the pain medication gradually wore off and my back became more and more uncomfortable. I tossed and turned as much as a person who is half-paralyzed can do, trying to get comfortable but never fully awake. Suddenly, a panicked nurse woke me up by turning on the light. She told me that in my sleepy discomfort I accidentally pulled the tube out of my head opening up the possibility of allowing infection directly into my brain. She summoned a doctor who seemed concerned but not alarmed.
    When morning came my attending physicians entered and told me they needed to do another spinal tap. I said that the previous one caused so much pain during the night that I didn’t want another. He explained that it was probably not the spinal tap that caused the pain and that the pain could actually be a very good sign but he needed to do the spinal tap to be sure. The tap was performed and this time the fluid was pink. Great news! 
     My father-in-law came in later to explain this result. Circulation of the cerebral-spinal fluid reestablished itself probably as a result of the tube entering the clot the previous afternoon. This meant that my body was washing the clot out of the ventricle. A consequence of this was that the clotted blood was being deposited at the base of my spine where it degraded to a substance called bilirubin, the principle pigment in bile. This same material causes the black-and-blue marks of bruises and their accompanying tenderness. It was as if I had a large bruise at the base of my spine. Sure enough, my pain felt very similar to that of a very sore bruise. Like any other bruise, the body would gradually reconstitute the residue and the pain would eventually subside.
    Because the circulation system was working again, it would not be necessary to plumb a shunt line to my stomach. In fact it wasn’t even necessary to reinsert a tube into my brain. The small incision in my forehead was closed with a stitch. With my finger, I can still feel the small, circular, drill hole in my skull just beneath the skin.
    I lay there in the hospital bed for four weeks, getting up daily for two sessions of physical and occupational therapy. The gross motor function returned to my left side early but my left foot and arm remained unresponsive to stimuli. Two days before my release, the occupational therapist put an ice cube on my left hand. In a reflex response, my hand jerked away. "That's a good sign." she told me.
    My left shoulder was too weak to raise my arm so I had been grabbing  my wrist with my right hand to help lift my arm over my head while lying in bed. The morning before I was released I repeated this exercise and felt a surge of electricity rush up my arm from my shoulder. Magically, my hand opened and closed. I looked at it and tried to move my fingers. They quivered but moved a little, as willed. The muscles were completely atrophied after 4 weeks of dormancy. Tears flooded from my eyes. It was one of the happiest moments of my life. Maybe someday I would play the guitar again!
    The next day Haidee drove me to Springfield, MA and checked me in to the Rehabilitation Center at Mercy Hospital. I was nearly half a century younger than most of the other patients. It was a depressing place but that atmosphere made me want to work hard to get the hell out of there as soon as I could. The program was not nearly as good as the one I had been in at Mary Hitchcock but the people were pleasant. I got along well with the nurses and they were extremely encouraging.
     By the end of two weeks, I was ready to get out. My foot was still paralyzed but I wanted to go home. During my last therapy session I asked that ice be placed on my foot. It was and my foot quivered. That night, at home, in my own bed, it started quivering on its own. I slowly realized that I could move my ankle and toes again… another flood of tears. Everything was working again, to some degree.
    Now, more than 25 years after those terrible days, I look at the person I have become. I still walk with a limp. Use of my left hand is awkward but I can play some rudimentary guitar. I still have double vision but the degree of offset was greatly reduced by surgery in the summer of 1981.

I do not regret the stroke. I like the person I am. Most of my real accomplishments took place after I had the stroke. I wonder if I would be as driven as I am had I not had the stroke. My guess is probably not. I can’t imagine what life would be like if it had never happened. I wouldn’t wish it on anyone but now, at least, I know that I can survive a lot of bad times and still eventually emerge from them with dignity. I think that I've already won the hardest battle of my life.