Cryptogenic, Ischemic Stroke—a Love Story (in fragments)
To be independent and secure, a nation needs a good supply of oil.
—one of several sentences the chief neurologist at Strong Memorial Hospital asked Jeff to repeat in order to assess his speech and working memory. He couldn’t say it.
The medical term stroke is shorthand. The full phrase is stroke of God’s hand, an official medical diagnosis codified in the 16thcentury. (Stroke: as in to strike down.)
According to 21st century understanding, strokes are caused by a sudden and debilitating loss of oxygen to the brain.
Hence, God resides in square 8 of the periodic chart of elements and represents 20.8 percent of the volume of Earth’s air.
Strokes can be triggered by bleeding (hemorrhagic) or occlusion (ischemic).
FAST is a mnemonic shorthand that EMTs want us to deploy during the moments when someone near you appears suddenly struck down.
F is for face. Ask the person to smile. If the mouth is crooked, the person may be having a stroke.
A is for arm. Ask the person to raise their arms into the air. If one drifts down, the person may be having a stroke.
S is for speech. Ask the person to repeat a phrase. If the words are slurred, the person may be having a stroke.
T is for time. Every second without oxygen (God) kills brain cells.
If answer to any of the above is yes, call 911.
On Friday morning, May 31, our 14-year-old daughter, Faith, came down the stairs and found her father lying on the floor.
On Friday morning, May 31, I flew to Ithaca from Springfield, Illinois, where, the evening prior, I had been thrown out of the Illinois statehouse for denouncing, from the balcony of the Assembly gallery, the passage of SB 1715, which opens my home state to industrial-scale drilling and fracking.
I had stayed up all night to write a reaction statement and was returning home to Ithaca sleepless and defeated.
The sentence I wrote at 4:11 a.m. was this one: “We know that horizontal, high-volume hydraulic fracking and its attendant technologies… vent hazardous air pollutants that are associated with cancer, asthma, heart attack, stroke and preterm birth.”
No one, including me, understood why I didn’t just fly that morning directly to Boston, where I was to speak the following day, to a convocation of mothers, on climate change as a pediatric health threat. A direct flight would have been so much easier. But I had wanted to spend just a few hours at home, in the unfractured state of New York, before heading back to the airport. At the very least, I could swap out my laundry and walk the dog. And talk to my husband.
Faith picked up her father’s iPhone, googled “symptoms of stroke,” and made the call.
A friend, a neighbor, and an ambulance arrived at our house.
Inside the taxi, I checked my iPhone. The influx of text messages was not about what had just transpired in Illinois.
I redirected the driver to the hospital.
The stroke was clearly visible on the MRI in the peri-ventricular region of the left hemisphere, deep in the corona radiata. An anoxic dead zone. Like in the Gulf of Mexico where the Mississippi river pours out petrochemical fertilizers (which, by the way, are manufactured from natural gas).
But the neurologists at Cayuga Medical had no explanation for Jeff’s dead zone, for the stroke. There were no signs of blood clot. No bleeding. His blood pressure and cholesterol were perfect. The chambers and great arteries of the heart were “pristine,” his carotid arteries without occlusion. No hidden passageways between the atria where an embolism could slip sideways, bypassing the lungs for the brain.
No diabetes. No smoking. No drinking. No cocaine use. No explanation for what had just happened. He was a healthy 59-year-old. A father. A teacher. An artist. A jazz pianist. But there it was: the dead zone.
At that point, Jeff could still make his right index finger tap his right thumb, albeit slowly. But he kept having more episodes. He kept losing ground. Not a typical presentation.
The neurologist and I began to lay plans to get him to Rochester. He needed a cerebral angiogram.
The ambulance driver said, “We can’t give you a ride back to Ithaca, you know.” I threw my sleeping bag on the floor and climbed in.
“I don’t need one.”
The nurse on the neurology unit said, “You can’t sleep on the floor, it’s not clean.”
“Oh, Jeff and I camp in all kinds of places.”
With bears. With tornadoes. With puking kids. Never before with monitors and I.V. drips. But here we were.
When they made me roll up my ThermaRest, I climbed in bed with the patient.
Boston, 1996. On our first serious date—dinner at my place—Jeff noticed the hole in my kitchen wall. He went out to his truck and returned with a bucket of joint compound and a bucket of plaster.
The next night, he showed up with a bucket of fish and a bucket of apples. “I’m going to make you a fish dinner and an apple pie,” he announced and walked past me into the kitchen. Where there was no hole.
At midnight, we ate.
I was making a complicated point about democratic ideals when he said, “Love is a not a democracy. It’s about kings and queens.”
In that moment, I became a monarchist. Which is to say, monogamous.
Which is to say: I fell in love with his hands and his words.
Forty-eight hours after the stroke, Jeff’s right arm was completely dead. Words flew away from him like flocks of birds.
I lay on his paralyzed side, feeling its weight and silence. Is this my new life?
I lay on his unparalyzed side, feeling its lightness and motion. Jeff slung his left arm around me and, in that moment, we were, once again, two living bodies. Between us: Dreams. Plans. Old arguments. Countless cups of coffee. Sinks full of dishes. A mortgage. Six pregnancies. Two children. Sleeping bags. Tent stakes. Art. Science. Music. Speech. The love of the long-married.
Is this my old life?
This is what I pieced together: Jeff’s initial symptoms actually began a week earlier, while in Telluride, Colorado at the Mountainfilm Festival where we had all four traveled over Memorial Day weekend. Suddenly, his arm went numb. But then it was fine again. Maybe a pinched nerve. A few days later, back in Ithaca, while marching in a parade with his students, it happened again. But, once again: symptoms disappeared. Until two days later when they didn’t.
He never told me about the earlier incidents.
Only one of the neurologists at Strong Memorial finds noteworthy the fact that it all started at 9,000 feet—while we were slogging through high altitude issues. Thirty percent less oxygen at 9,000 feet.
The cerebral angiogram comes back normal. No blockages. No inflammation. No spasms. “Perplexing,” says the attending neurologist. EEG also normal.
Tuesday. The attending neurologist greets me at the elevator. “Have you seen him yet? I think his speech sounds better.”
Wednesday. He is moved to acute rehab. The speech therapist arrives to offer an initial assessment. She begins by asking him to name as many animals as possible in one minute.
Sixty seconds later, we have a list with one name on it: triceratops.
“Can you name an animal that might be kept inside an aquarium?”
Jeff thinks. “Bath,” he says. And then he shakes his head.
He can read the face of the clock. He tells us that it’s 3:25. He cannot identify the shape of the clock. Which is round.
I’m allowed to take him outside in a wheelchair. He names all the colors. He names all the parts of the human body—from eyebrow to elbow. He points to the cemetery across the street and says, “epitaphs.”
I show him a statue. He cannot identify it as a horse. But he does correctly note that it is exceedingly bad art.
I place a leaf in his left hand. “What is this?”
“Oh, yes, I see. The edge is scalloped, like a knife blade that you cut bread with. What do you call that kind of knife?”
“A deciduous knife.”
Thursday: During transport from Rochester back to Cayuga Medical in Ithaca, our vehicle passes an Amish buggy.
Jeff looks at me. “Horse,” he says.
Friday: He squeezes my right hand. With his right hand.
Saturday: The physical therapist delights in the fact that Jeff demonstrates movement—however slight—in each joint of his right arm and hand.
“There is every reason to be hopeful.” And we are. And we are.