Honoring those who have survived strokes on World Stroke Day
Surviving a brain injury or "brain attack" is not quite like surviving from any other type of clotting or bleeding problem. Years after a gastrointestinal bleeding episode, you may only have a bad memory, but you don't have to live with the problem every day, or overcome it every minute. In fact, you may have months during which you don't think of it at all. Years after a heart attack, or even coronary bypass surgery, you can still work, do your ordinary activity, and be surprised when someone makes a comment that you have a "heart condition". In fact, my secretary once remarked that she was quite surprised when she came to work with me about how few of my patients were limited by their heart and how few actually died from their heart condition. Unfortunately, I can't say the same for my patients who have suffered a stroke. There can be nothing more frightening or less amusing than finding yourself attached to an arm that won't respond, a leg that won't hold you up, or a mouth that won't say what you want it to. Suddenly blind, deaf or dumb the joys of life are abruptly extinguished.
Strokes come in different sizes and shapes. They can be "transient events" (we call them TIA or transient ischemic attacks) in which there is a loss of some function that lasts less than 24 hours and warn of further loss if something is not done. They can be "stuttering" in which case the symptoms may seem to gradually get worse after seeming to abate. They can be acute and less than 3 hours old and therefore amenable to certain types of treatment. Or they can be "completed" in which case care is directed at learning to live with a disability.
The disability related to stroke is dependant upon the location of the blood vessel that was blocked, or that bled. Who has had such events? We all know of someone. Many famous people such as Franklin Delano Roosevelt, Kirk Douglas, French President Jacques Chirac, died, or lost function because of one. As I write this I think of several patients who overcame the deficits that they suffered.
When I was a medical student I met a patient who had suffered a stroke that left him unable to speak (this is called aphasia). Everything else was fine. He was 78 and had a beautiful and much younger wife. For the entire time that he was in the hospital he was smiling and laughing. Fortunately, strokes that involve only the brain's speech center, and not the ability to move permit complete recovery. Six months later he was back to himself, speaking normally. I asked him why he had seemed so cheerful. He told me "My wife is much younger, and I taught her everything she now knows. I had to see the humor in her now teaching it back to me". I think that this attitude, and his persistence in rehabilitating his speech led to less disability, and more happiness. I have seen this repeated for numerous patients over the years. Those who fight to overcome obstacles do better than those who let their disabilities define them.
I visited the family of one of my patients this afternoon. He had died of a cerebral hemorrhage (bleeding from a small vessel in his brain that was related to age, diabetes, long-term high blood pressure). A banker, he had suffered a stroke 14 years ago that left him without the use of one arm and forced his retirement, he still managed to get to most of the Boston College football games and enjoy his family when he wasn't "wintering" in the South. As his wife put it, he "went out" watching a ballgame that his beloved team was winning, which seemed quite appropriate.
Whether one believes that the purpose of a World Stroke Day is to honor those (like football player Tedy Bruschi, or the legion of ordinary people who have to fight every day to do the things that we all take for granted) who work hard to overcome deficits, to assess what we do to make living easier for those who have suffered a stroke, or to make people aware of a problem that costs Medicare 6 billion dollars per year, today let us remember that stroke is a devastating often preventable illness and a medical emergency that requires immediate hospital attention. Just like a heart attack, this is what your emergency medical system if for. If you think someone is having a stroke, call 911.