|Life is what happens when you're making other plans…
If life is what happens while you're busy making other plans, then stroke is what happens while you're living that life.
The morning sun streams through the stroke unit windows and across my resident's rumpled scrubs as he presents the overnight admissions.
"The first patient is a 68 year-old retired construction worker who was eating dinner with his wife last night when his speech became slurred and his left arm fell to his side…" As the resident shuffles though papers and presents the pertinent parts of his medical history and neurological exam, my eyes gaze over his shoulder and at the patient, who fumbles with opening the contents of his breakfast tray.
As we enter the room, Mr. W's face brightens as he recognizes me from the emergency department last night.
"Hey doc," he says with a slightly crooked smile. "Look what I can do now." He lifts up his left arm and we both stare, amazed, as he slowly opens and closes his hand. I think back to last night, when we pushed his stretcher through the doors of the Emergency Department, rushing back from the CAT scan to start the infusion of a powerful blood thinner, which would restore blood flow to a blocked artery in his brain and bring his left arm back to life. In two weeks he'll return to my office, with a barely perceptible limp. He'll proudly tell me that he quit smoking since the stroke, and we'll joke about how he can take his wife to Atlantic City with all the money he's saved.
Our next patient is an 86-year-old retired librarian whose daughter found her on the living room floor, confused and unable to move her right side. Her daughter produces a meticulous list of her medications, but I know it's of little use – she won't be able to swallow them anyway. She asks me if she should look into hiring someone to help when her mother goes home, but she can tell by my downcast eyes, even before I answer, that she won't be coming home. "Mom? Mom! Who am I? What's my name?" Her mother's eyes narrow slightly as she studies her daughter's face. "I…I don't know" she says softly. "Just talk to her," I try to comfort her. "She will recognize your voice."
Sometimes my residents ask me why I decided to become a stroke doctor and I try to remember back to five years ago when I took this path. Perhaps it was the fascinating anatomy and physiology of the blood vessels in the brain and the many ways in which a stroke can affect one's ability to speak, move and reason. It amazes me to this day. Maybe it was the assuredness of data from large clinical trials in a disease which is so common that it is the 4th leading cause of death in the U.S.
But with time, I have come to realize that the greatest thing about being a stroke doctor is my patients. They are struck with a life-altering event while going about their business. The determination, the strength, the dignity and the grace with which they recover from that stroke, or unfortunately sometimes succumb to it, is truly extraordinary.
It's late afternoon and it's the last patient of the day in the stroke clinic. A young mother is here with her newborn – two months after a brain hemorrhage during her pregnancy nearly took her and her baby's life. She shows me all the skills she has regained in rehabilitation, while her baby sleeps contentedly in her blanket. I know they will have a good life. I nod excitedly and then slip out of the room to blot my teary eyes.
Kathryn Kirchoff-Torres, MD, is a stroke expert in the Department of Neurology at Montefiore. She also is assistant professor of Neurology at Albert Einstein College of Medicine.
Posted by blogmoderator on 10/28/2013 at 10:27 AM