I awoke suddenly from a loud, dark, and intense Space Mountain like dream. I saw, as if watching a first-person scene from a movie, a hospital gown, arms clad in IVs, and nurses surrounding someone. The person had fainted and was being revived and carried back to bed. Quickly, I realized this was no movie, this was no dream — oh man, this was me. I was an ICU patient in the hospital. And it was Christmas Eve.
Two days earlier I had a stroke. After an awesome 75 degree California winter morning spent surfing with my dad and the dolphins, I was at my parents’ home getting ready to go finish up some Christmas shopping. While in my bathroom getting ready, I recognized that something was very wrong.
My right arm seemed no longer a part of my body. I couldn’t control it; it was limp at my side, like the worst dead arm you can imagine, completely out of nowhere. My boyfriend was just coming to check on what time we were headed out. I exited the bathroom, slumped on the ground, and told him what was going on. Except I didn’t. I couldn’t. What I was saying in my head came out as gibberish. I could not get words out of my mouth! I felt stupid, even laughing at myself, saying, “It’s ok, it’s ok” to him, thinking it might just go away. Not wanting to call attention to myself. But then the reminder that something was wrong set in again. In a whisper, I finally got out the words “call my dad.” He did. My parents happened to be right outside and my father, a physician, ran up the stairs to find us. When he saw me stuttering and holding my dead arm, he called for an ambulance. By now I was crying, perhaps in hysterics, as the numbness had seeped from my arm to my whole right side. I then calmed, stopped tying to speak, as it was frustrating and pointless, and looked into my boyfriend’s eyes saying to him with mine, I may not walk again, I may die, somewhat acquiescing to whatever it was that was happening to me. I vacillated back to survival mode, caught myself and thought, No, that can’t happen, I gotta fight it. I kicked off my boots to try to keep my legs moving and focused my mind on, well, not dying.
The paramedics quickly arrived and as they pulled me on to the stretcher and carried me down the stairs into the ambulance, it sank in that this was happening. Man, was I bummed. This wasn’t part of the plan!
In case you don’t know me, hi. I’m Diana.
I’m a 30-year-old woman. I’m taller than your average girl, probably thinner than your average girl, and more active than your average girl. Yeah I run an ice cream business for a living, but like to think I’m healthier than your average girl, too. No prior medical history. Nothing.
“Well what the hell?”
My first ever ride in an ambulance was uneventful — the hospital is a 5-minute drive from my folks’ house. By now I had somehow regained some ability to speak and answered the EMT’s incessant questions, still stumbling over my words.
Arriving at the hospital it was straight into the CT Scan, where I had plenty of time to lie very still and reflect. Would I be satisfied with life if I had died? Am I doing what I am supposed to be doing in life? Have I been nice enough? A good enough friend/sibling/daughter/partner? Or, man, how different will it be if I cannot function the way I am used to? What the hell is going on?
Which is the first thing I said to my mom and dad upon returning to the ER:
“Well, what the hell?”
“Yeah, what the hell” my dad said, “This shouldn’t be happening to you.”
The doctor surmised it was a stroke based on my symptoms and administered TPA intravenously. TPA is a protein that breaks down blood clots and improves the flow of oxygen to the brain. See, if you are a stroke victim, you’re either suffering from a hemorrhage in the brain, or are suffering from a lack of oxygen to the brain due to a blood clot (an ischemic stroke). After about 1 minute of being deprived of oxygen, brain tissue ceases to function. It starts to die. If left without oxygen for any longer than about 3 hours, the damage is irreversible. So there’s a short window in which the clot-buster can be administered to be effective for ischemic strokes. I lucked out. I got the TPA within 45 minutes of my stroke.
Once the TPA was administered the doctor conferred with my dad, as colleagues, and I overheard him say, “You know exactly where she is going.” The dreaded ICU.
“Stay out of the ICU”
For years, my whole life actually, my father has encouraged a healthy lifestyle, urging us to “stay out of the ICU” as much as we can help it. He’s even now written a book about it. And I’ve heeded his advice my whole life, living a healthy, active, vegetarian lifestyle as I’ve previously described. But never had I really understood his warnings until I was an ICU patient. It’s torturous, and I don’t ever want to go back.
I was a champ though, if I do say so myself, and took everything in stride. The twenty-four hour turned 50-hour bed rest. The IVs in my arms. The oxygen tubes in my nose. The wakeup calls every 15 minutes, half-hour, then hour to do the same speech and movement tests. The ultrasounds of my heart and legs to look for any abnormalities. The worst was the TEE (transesophageal echocardiogram) where they stuck a probe down my throat to check out my heart, which turns out has a hole (called a PFO, which also turns out about 25% of people have the same hole). The MRI which confirmed the stroke with a big white section of unoxygenated brain tissue in the top left part of the brain as well as a smaller stroke at the very back of the brain (yes, not one but TWO strokes, as shown in the titlephoto above). It was a wild ride. I will say, though, I received some pretty impeccable care in my stay at the ICU.
We were going on day 3 and still didn’t know the cause of the stroke.
Was I on birth control? was the first question I had been asked. No — I had actually opted against birth control pills after reading about the possible health detriments caused by it, namely stroke since the pill is a known cause of thrombosis (aka blood clotting). The irony.
Had I hurt my neck? No. Well it hurt on my short nap on my flight from NY to CA last week, but nothing abnormal. And definitely not surfing; our session was a breeze. And sure I’d done yoga last week and did that weird back on a block, neck on a higher block thing, but it hadn’t hurt or anything.
Was it a blood clot in my legs from sitting on the plane for so long? The ultrasounds showed no sign of clots.
Was it due to that hole in my heart? Which could have caused a blood clot? Possible, but the TEE test showed no sign of a shunt, an abnormal pattern of blood flow.
One final test to get to the bottom of it would be an angiogram, cutting a slit in my femoral artery in my pelvis, and sticking a catheter into my artery which would travel up with the blood flow to my neck and then shoot out dye. An x-ray would show whether there was a tear in my neck that could have caused a blood clot, which could have broken off and gone to my brain to cause the stroke.
The thing is though — all that last test would do is give us an answer. It wouldn’t affect the treatment for the stroke going forward. And it’s a rather invasive procedure, as you can see. So do you do it, or do you not?
And herein lies one of the problems with medicine… there’s no right answer. Dr. F, a neurologist and family friend said don’t do it, there’s no need. My doctor, Dr. B, said definitely do it. Dr. K said don’t do it. And Dr. M said do it, it’s the last possible test to find the cause.
Ultimately, I didn’t want another test, I wanted to get the needles out of my arms and get the heck out of there. It was Christmas Eve and I had flown home from NYC for the holiday! But I complied with whatever was recommended so when my father said let’s do it, I said let’s do it.
Two doses of anesthesia and one angiogram later, and we had our culprit. A tiny dissection in the cavernous part of my left internal carotid artery (aka a tiny tear on the inside of the artery on my neck). Actually it was two angiograms because the tear was so tiny so they had to cut into the other side to compare.
So — long story short
I had somehow injured my neck in the last three months. How, I still do not know. A blood clot had formed in the injured artery, and on the afternoon of December 22, that blood clot broke off and went up to my brain, causing an acute embolic ischemic stroke. It blocked the supply of blood to the parietal portion of the left side of my brain (as well as a small portion of the occipital lobe. Remember? 2 strokes…) and the affected neurons ceased to function and began to die. Since the left side of the brain controls the right side of the body and right-handed people typically have their language center on the left, my right arm and my speech also ceased to function. Once the TPA was injected, the clot began to dissipate allowing oxygen to travel to those neurons again, and my speech and arm functionality to return. Not immediately though — some of the brain tissue was permanently damaged from the stroke. So it took two full days for my arm to come out of numbness, and as you can see if you read my original unedited draft of this same post, it’s taking a while to get my typing and other right hand functionality back on track. What’s wild is that it will get back to normal — the neurons that surround the damaged tissue step in and start to pick up the slack. So it’s just a matter of time and training them how to do the things the other guys used to do. Fascinating, huh?
To finish the story, unfortunately I didn’t get to go home on Christmas Eve because I fainted on my first time standing. That’s where we started this whole account. (Remember? Space-Mountain-like dream?) But another night and a few medusa-style brain tests later, and I was free at noon on Christmas day.
I was stoked.
I’m titling this post ”Bad Year for Boars”
because at the beginning of this year, my best friend’s mother warned him that 2013 was the year of the snake in the Chinese calendar and, thus, it would be a bad year for anyone born in the year of the boar (that’s me, in 1983). Throughout the year, we joked about how bad of a year it was, sharing our trivial matters. I even got shirts made for us for Christmas that read “BAD YEAR FOR BOARS.” (Ironically, actually eerily, I wore mine for the first time on the morning of my stroke).
But this isn’t a Carpe Diem story — to remind us all to appreciate what we have, that it could all be taken away in the blink of an eye, so don’t sweat the small stuff. Though, I mean, come on, it’s true! And though I’ve tried to seize each day my whole life, my sense of the sun on my face or sand on my toes is a bit more heightened and appreciated now.
It’s not a cautionary tale — be healthy to stay out of the ICU. This was a wild fluke, like I won the lottery but in reverse, and had nothing to do with my health. Though, really, the ICU does suck. And I’m not advising anyone to stop doing fun or active things to save your neck (literally!). But did you know you can tear an artery doing almost anything? From sports, to yoga, to cracking your neck, to putting your head back at the hair salon… even from throwing back a shot of booze. So, ya know — be careful!
And it isn’t a let’s-be-one-with-the-universe and everything-happens-for-a-reason account. Though there is something uncanny about the events that led up to the incident and the fortune I had with the time, place, and people involved — gosh, I ended up in the same ICU where my father works, after all. And had it been hours earlier surfing, days earlier on my flight, or even just in NYC where I live, I may not be so fortunate as I am today.
This is just my account. About my body and my brain. And the crazy way it all works.