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Wednesday, August 24, 2011

Bob's Stroke Story

I recently realized that I haven't covered the strange and terrible story of how Bob had his stroke in this blog.  I've touched on it a bit, but have not gone into all the details. Since I have nothing new to report (we are doing our therapy, still dealing urinary problems), I thought I'd take a minute to cover it here.

In September of last year, Bob went into the hospital to have his hernia repaired. As part of the preparation for surgery, he went off his warfarin. (He had suffered a smaller stroke in 2003 and was on warfarin since then. That stroke left him with only some fine motor issues with his right hand.) This was the fourth time he had hernia surgery in the same spot and this time the doctors put a sort of mesh support in the area in order to prevent the hernia from once again recurring. Because the procedure was more intense than usual, they kept him in the hospital for several days for observation after the surgery. During that time, Bob suffered several TIA's (mini-strokes) and an ultrasound was done in which they found that his carotid arteries on both sides were 90% or more blocked. Initially, the doctors wanted to rush him into immediate surgery, but after much discussion, it was decided that he should wait until his hernia repair was completely healed. He was sent home, told to take it easy and the first of what was supposed to be two surgeries was scheduled for October.

The surgery is called a "carotid endarerectomy" and consists of surgically opening up the blocked carotid artery and cleaning it out and then patching it with a bovine patch. This is a high risk surgery, but the doctor involved performs 100's of these each year and is considered one of the best in the field. We were told that the risk was that part of the clot could break off during surgery and cause a stroke while the patient was being operated on. We were told the chance of this happening was about 10% but that if left alone, Bob had a 40-50% chance of having a major stroke in the near future. With those odds, Bob opted to have the procedure done. It was done on October 21st of last year. The surgery went well. Bob woke up from the procedure, talking and moving, and the surgery was labeled a success.

I spent a couple hours with Bob in ICU after the surgery. He was groggy but seemed fine, to the point of complaining about the supper tray which was a "liquid diet" and he said he was hungry and wanted something more. After he ate, he said he was tired and I, too, was exhausted so decided to go home and once there, immediately collapsed into bed. At 9:00 p.m. that night, the phone rang and woke me up. I heard Bob's voice on the answering machine: "Hey Sweets, it's me" and I jumped up to answer it. He told me he was feeling fine and just called to say goodnight and to remind me to bring his razor and his watch in the morning. We talked for about a half hour. Little did I know, that would be the last time I would hear him speaking clearly...

I arrived in ICU the next morning at around 9:00 a.m. Bob's room was dark, but the first thing I noticed was that the chair by his bedside was gone, so I went to look for a chair. I finally got one of the aides to bring a chair in and as I was putting my bags down (razor, watch, etc.) the nurse came in with Bob's breakfast tray. It was then I noticed something was terribly wrong.

The nurse was trying to position Bob to sit up in bed and he kept sliding down. He seemed to have no control over the right side of his body. He was trying to talk, but everything was coming out garbled. The nurse sort of propped him up and left the room and I, first, tried to shake Bob to "wake him up" but I noticed the side of his face seemed to be drooping and large soggy pill fell out of his mouth, so I ran after the nurse telling her that something was wrong with my husband. I handed her the soggy pill and she tossed it in the garbage. She said to me, "Isn't your husband always like that?"

Then, she said, "I thought he didn't look right when I came in."

She went to page the doctor, who was on the floor and came in pretty quickly. The doctor quickly assessed Bob, said "Something is wrong. This is highly unusual." and left the room to put in some orders. The nurse came back in to hang an IV bag and as she was getting the IV set up, she turned to me and asked if I wanted the scissors to take home, because they were just going to throw them out and they were sort handy little scissors. I don't know why, I still remember this. I guess because I thought it so bizarre, that she was talking about scissors, and I was freaking out thinking that Bob was possibly dying before my eyes and she handed me the scissors. I stood there holding this pair of scissors really not knowing what to do with them. I think I put the scissors on the cupboard. Just left them there.

Then a portable ultrasound was brought up and a tech did a quick ultrasound on Bob. Then papers were thrust in front of me to sign and Bob loaded on a gurney and sped away for what I was told would be an emergency surgery. And I was told to wait in the surgery waiting room. It was now around 10:30 a.m.

I waited in the room for what seemed like a thousand years. At one point, I asked the volunteer who was staffing the desk if she knew what was happening with my husband. Was he in surgery? Was he out? She couldn't find his name on the list because it was an emergency situation so she asked who the doctor was and when I told her, a couple sitting in the room told me that that particular doctor was operating on their mother at the instant and had been operating on her since about 10:30. So Bob was still waiting for the surgery to begin. He came out of surgery around 2:30 p.m. He was alert for a little while then slipped into a coma.

Later I was told that the carotid artery that had been operated on the day before and had been cleaned out had re-clotted. That the clot was so long it ran from Bob's heart to his brain. That the neurologist did not know how long Bob's brain had been without oxygen and it could only be pinpointed sometime between 9:30 p.m. when I hung up the phone and 9:00 a.m. when I found him in the morning. That "too much time" had passed without oxygen to his brain.

The initial CAT scans showed 2/3 of his entire brain damaged, the damage having crossed the midline. Initially I was told that if he woke up, he would be paralyzed from the neck down. That he would never breathe again on his own. That they weren't even sure if all his organs would operate independently. That I should prepare myself to "pull the plug".

A hematologist was brought in and test results revealed that Bob's blood is unnaturally thick. That this was the cause of the re-clotting. This was quite possibly the cause of his first stroke in 2003. Probably the cause of his TIA's after hernia surgery as he was off the warfarin. That this is an unusual and most likely a genetic, hereditary problem.

He was in a coma-like state for the first couple of weeks. After he came to, another CAT scan showed that the initial damage had receded, though still, 80% of the left hemisphere of his brain was damaged. The doctors called this a miracle. Many doctors came to view him and look at his records as they had heard about this "miracle man".

He spent a total of three months hospitalized, fighting off several brain bleeds and various infections and two bouts of pneumonia. While hospitalized, he suffered a pulmonary embolism and a separate ischemic eye stroke which left him blind in his left eye. The doctors say this was caused by his "thick blood" but they didn't want to put him on a blood thinner until they were sure his brain had stopped bleeding.

And he's home now. On blood thinners. His other carotid artery is still blocked, but we're certainly not about to have that operated on..... And he's doing better than anyone ever imagined. Even if his recovery progress is "slow" compared to other stroke survivors.

So that's the story of Bob's stroke. Sometimes, I have to remind myself of this story, because, well... Just because....

1 comment:

Jenn said...

Thanks for writing this powerfully emotional retell of those hairy months. It's surreal, looking back, being in the now, and imagining the future.
You asked me if I thought Bob would ever get better and I said "It's possible. I believe it's very possible."
I still feel the same way.
I saw so much potential. You must see it, too!