I was taking the first bite of my Egg McMuffin when my lips and gums went numb on the right side of my mouth. Until that moment, everything seemed normal. My wife and I were having Sunday breakfast at McDonald's. What could be more normal than that? If anything out of the ordinary had happened, it was that our order had arrived a little faster than usual. Now, all of a sudden, my mouth felt as if I’d had a shot of lidocaine at the dentist. Chewing was no longer automatic. I had to be careful not to bite my cheek. Then I became clumsy. Reaching for my tea, twice I bumped into the cup and splashed some out.
Stroke flashed through my mind, but as a question, not a statement. Heart attacks and strokes were for other men in their mid-seventies. I had normal blood pressure, shirts that dropped to my waist with barely a hint of a detour and people tended to describe me as ‘spry’, by which they meant that they couldn't believe someone my age could still move.
I can't be having a stroke.
Can I?
You may have seen the posters illustrating the signs of stroke, the ones with the initials, F.A.S.T. The F stood for face and there was an illustration of a drooping face. T was for time; you needed to get treatment ‘FAST’ to prevent permanent damage. I didn’t remember, sitting there beneath the golden arches that morning, that A stood for arm weakness and S for speech problems.
I asked Norma, sitting across from me in the booth, "Is my face droopy?"
"No," she said, whereupon, after a quick inventory, I determined that all my extremities were working.
I'm a chemistry professor. To test whether my brain had been affected, I tried to think of something chemical and Avogadro's Number popped out. As a scientist, my default setting is to observe and try to figure out what is happening. Patient-Me was experiencing symptoms and felt apprehensive. Scientist-Me was making observations and recording data points. Think of it as an out-of-body experience or dissonance in which Scientist-Me was watching and taking notes while Patient-Me lived it and wondered what would happen next.
Patient-Me: No pain, just a peculiar feeling that I’m not quite myself.
Scientist-Me: Yet you can't ignore what’s happening, Michael.
Sitting opposite each other in the booth, my wife and I considered our options; should we drive to the ER or should I just go home for a nap, with the expectation that I’d feel better after a rest. The nap won. As we walked to the car, there was no limping or leg dragging but I could tell my gait wasn’t right. Patient-Me informed Scientist-Me that I was flexing my knees a bit more than usual and it was taking slightly longer for my legs to straighten up to take the next step. When I put my hands on the steering wheel, two fingers of my right hand were numb.
Patient-Me and Scientist-Me both wondered: Odd, but why only two fingers?
We drove home, went up in the elevator and started the twenty steps leading to our apartment. After three steps, Patient-Me and Scientist-Me agreed that all was not well. Someone else's legs had been grafted onto my body. Scientist-Me advised Patient-Me — Time to go to the ER and stroke center at the closest hospital. Norma can't drive so I did (a mistake) carefully, alert to any further changes in my condition. I was no stranger to the hospital where we were going. Every time I went there I got a feeling of déjà vu. It was where my first wife, Susan, passed away in the hospice center after fifty years of marriage. She’d been there often enough that I could figure out what service a staff member was in by the color of their uniform — being a seasoned birder helped.
We arrived in the ER waiting room at 10:30 AM. With it being a Sunday morning, the place was relatively empty and I was interviewed almost immediately. Sitting at the small end of the L-shaped counter, a nurse asked my name and checked me out on the computer.
When she asked, "So, what happened?" and I mentioned numbness, I noticed that I’d gained her complete attention.
From the other end of the counter, another nurse asked: "What time did this occur?"
I told him, "It must’ve been around 9:30."
The next time I saw him, he was pushing out a wheelchair, motioning me to sit and wheeling me briskly into Acute Care #12, with Norma trailing behind. I was quickly transferred to a gurney and changed into a hospital gown while a nurse attached plumbing for a possible IV. The PA system blared out, "Stroke Alert in #12." That's my room, I thought.
Patient-Me: I’m worried, very worried. We both know from previous experience, that the patient first goes to triage, then to an ER room and eventually the accompanying family member or friend is brought in to be with the patient. All of this is now being compressed.
Scientist-Me: I believe you’re drawing a reasonable inference there, Michael but try to stay calm and let’s see what the consulting neurologist has to say.
Neurology has made great strides in recent years but the preliminary evaluation for stroke is old school — “Can you close your eyes and touch your nose?...How many fingers am I holding up?" I nailed the second one as soon as I put my glasses back on. “Close your eyes and hold out your hands.” The neurologist measured my hand and foot strength and explained that my National Institute of Health (NIH) stroke score could be calculated depending on the impairment level. An orderly came and wheeled me out for a CT scan — with "stroke alert" sounding again on the PA system as I left the ER. No waiting. I was taken in right away for a scan. Once I returned to Acute Care, the neurologist returned promptly: CT scan was negative. I was not a candidate for the clot-buster drug, TPA. Possible side effects weren’t worth the risk. He added: "You look too good to have had a stroke."
Smiley face! Smiley face! In spite of numbness and impaired coordination, Smiley face!
I was still going to have to spend the night under observation, with an MRI in the morning to make sure the lower resolution CT scan hadn’t missed any leakage. No longer in immediate danger, I found that time slowed down. When I mentioned this to Norma, an ER nurse smiled at us. She knew it would be a while before a bed was available. Meanwhile, the nurse gave me four baby aspirins and told me to chew and swallow them.
Scientist-Me: Chewing crushes pills, surface area increases, more surface area means they dissolve faster; if they dissolve faster, they start to work more quickly.
Patient-Me: Chew harder and faster. Get those pills down.
At least the cognitive part of my brain seemed to be working alright.
A bed with an older man as my roommate became available in the telemetry ward. With it looking as if I were out of any immediate danger, Norma went home. The duty nurse hooked me up to a heart monitor that would send my vitals to a station outside. I was curious about how they’d monitor me if I had another — not wanting to use the word stroke — episode. The duty nurse walked over to a nook, took out laminated pages from NIH, held them up, and asked me to identify some everyday household objects. Then she showed me several cartoons in which I had to describe what was happening; in one, there was a sink full of dishes, water coming out of the faucet, and spilling out onto the floor. They showed me the same cards twice more to see if there was any change. The rest of the day passed. Dinner came, memorable only because it was not awful, as I’d expected it to be. Trying to sleep in a hospital can be well — trying. When I couldn't fall asleep, I joined my roommate in watching America's Got Talent on my TV monitor. If you’ve spent a night in a hospital, you know the feeling of waking from deep sleep to a shadowy presence looming over you every few hours taking your vitals. Finally, after an endless night, morning came.
After breakfast, an echocardiogram — a surprise, as it was the first I'd heard of this. I asked the technician if the problem was in my brain, then why test the heart? She called for clarification. They wanted to make sure a clot in the heart did not cause it. I had a history of AFIB that had been treated with heart ablation — which can cause blood clots. Scientist-Me loved the echocardiogram. Patient-Me felt no pain and the gel for the probe to make contact with the skin was nice and warm. Turning my head so I could see the monitor as the technician pushed the probe around my chest, it was like watching an educational film complete with sound effects: Heart pumping, valves opening and closing as the blood made its way through the chambers of my heart with whooshing sounds. I asked if the noises were real, or just generated by the machine, and she said they were the amplified sounds of my circulation. She took over sixty measurements — I asked.
Next, an orderly wheeled me in for my MRI. Before going into the machine, the technician asked me what music I’d like to hear: "Fifties," I told her. Rock Around the Clock was the first song. Even the shouted vocals of Bill Halley and the Comets were not enough to drown out the unearthly noises generated by the MRI machine. Forty minutes and a dozen songs later, I was on my way back to my room. The neurologist came in shortly afterward with “Great news!”. There was no evidence of a stroke, no permanent damage.
He seemed in a hurry to get to his next patient but I did manage to pop in a question before he left — "Did my brain scans show any brain abnormalities?" I was interested in any brain shrinkage or lesions linked to Alzheimer's and other forms of dementia.
More good news, "No, but your brain does shrink by a small percentage per decade after forty.” My scans showed only standard age-related brain shrinkage.
At no time during the thirty-six hours I was in the hospital did any doctor explicitly tell me I’d had a stroke, or even what had happened. But before being discharged, the stroke nurse came by with a booklet entitled "Let's Talk About Stroke". So that was what we did. Discussing strokes in general, and mine in particular, she told me that the only thing I did wrong was to drive myself to the hospital. If I’d called an ambulance, it would've taken me directly for a CT scan, saving valuable time, and avoiding the possibility that an untoward event might’ve caused an accident.
Patient-Me: Untoward event? What...like another stroke?
Scientist-Me: But if we had a stroke, yet all the symptoms were resolved, and there was no trace of it in our brain, did we really have a stroke?
Patient-Me: Really?
Scientist-Me: Yes, really. I'd prefer to call it a TIA for Transient Ischemic Attack. It’s a more accurate description of events in this case and ‘stroke’ sounds too ominous for you.
A TIA occurs when blood flow to a part of the brain is temporarily blocked, often because of the build-up of plaques in the blood vessels in the brain, plaques that can sometimes dislodge to form small clots.
Patient-Me: Yes, I know what a TIA is; it’s also known as a mini-stroke.
Several weeks later, I had a follow-up with another neurologist. He asked what had brought me to the ER, followed by various tests to check if my brain was working correctly. Then the fun part, at least for Scientist-Me — he took me on a virtual tour of my brain. Sitting me by his side at the computer monitor, he brought up my brain scans. Fascinating. It was like a deck of playing cards, each one a slice of my brain. We traveled through the various levels. I knew that abnormalities would most likely appear as bright spots. There were none. One last trick — with a couple of clicks, he called up the scans of my carotid arteries, ghostly white against a black background with no evidence of plaque. I asked what would've happened if I’d decided to go home and take a nap? His answer— Nothing. Within two hours at the ER all the numbness had disappeared and the first time I walked to the bathroom, my gait was normal. TIAs generally last only a short time and leave no permanent damage. In my case, by Tuesday morning, after a night of deep sleep, it was as if it had all been a bad dream.
Physically there was no change in me. Mentally I had to acknowledge that I was not immune to stroke. I’d had a TIA. What could I do to prevent another? Calculating my stroke risk, I found that I had a one in five chance of having a stroke during the next ten years. All of this shook me out of my complacency. Feeling good and looking good for my age was not enough. Now I take a statin and a baby aspirin every morning to lower my risk. I don’t mind.
Michael De Rosa, a writer from Wallingford, PA, recently retired as a professor (emeritus) of chemistry at Penn State Brandywine. His interests are travel, photography, and birding. Michael was the recipient on the Memoirist Prize in April 2022 where “lil sis & BIG BRO” among other of his pieces have appeared. His essay “Walking Through the Seasons” appeared in Academy of the Heart and Mind.