What does a TIA feel like? A Stroke Diaries excerpt

An excerpt from Stroke Diaries.

by Olajide Williams, MD

The man who did not take his medicine

Pedro was lying on the bathroom floor next to the toilet bowl. Water was still running from rusty faucet, overflowing the sink, and pooling around his body as he lay limp on wet porcelain tiles. Lucy was standing over him and whining. The young black Labrador retriever had not left her owner’s side since the previous night. It was as if she had predicted it, as if she was responding to some perceptible change in his body, perhaps even a “stroke odor” that her heightened sense of smell allowed her to detect.

Lucy had followed him everywhere; she lay awake next to him throughout the night, constantly licking the left side of his body. She rushed after him into the bathroom that morning, before Pedro’s world began to tilt–the visual metamorphosis, tilting up to 180° in second, and developing into a violent vertigo that caused him to slump to the ground, hitting his head against the toilet bowl on the way down.

It was 5:30 a.m. The sun had just begun its ascent above the coastline when Pedro woke up to brush his teeth. And now, hours later, he could not get up off the floor. He could not move his left arm or left leg, and he could not feel Lucy licking his left palm. When he realized what was happening, fear filled his soul like a poisonous gas causing a great panic inside him. Dazed and desperate, Pedro dragged himself into the bedroom, sliding onto the wooden floor with his wet clothes, snaking himself around a large floor cushion, knocking over the standing lamp, dragging himself towards the far window by his bed, towards the sunrays that filtered though half-open blinds. Lucy began barking; Pedro began banking against the window. He cried out for help, thumping the glass with his one working arm, trying to alarm his neighbors or anyone who could have saved him. As Lucy barked louder, the stroke tightened its grip, claiming Pedro against his will, pulling the prize right out of him–a piece of his brain–against the tugging of a frantic soul.

Perhaps death is not deaf after all. Perhaps there are times when death can be frightened away. As Pedro cried out for help, banging against his bedroom window, as Lucy barked louder than she had ever done before, something strange began to happen. It was as though the stroke was departing, releasing its grip from Pedro’s brain, and slipping into the wind that blew through small cracks that had appeared in the window.

Pedro began moving his left arm and his left leg. He could feel Lucy licking him. He could feel the cut above his left brow, which he sustained from the fall, and the blood trickling down his cheek. He could feel his wet clothes from the overflowing sink, and he was filled with indescribable relief.

I met Pedro shortly after he arrived at the stroke center. Even thought he was completely back to normal, his neighbor had convinced him to go to the hospital.

“You had a TIA,” I said, “a transient ischemic attack or ministroke.”

Pedro was in his mid-forties and he maintained an athletic figure. He seemed distracted, agitated, not fully engaging me, even as I explained what had happened to him, even as I told him the results of the tests that he had undergone. Pedro’s brain scans and preliminary blood tests were normal. The only abnormality detected was an irregular heartbeat (atrial fibrillation), which was confirmed by an electrocardiogram.

“I know about that doc. I was diagnosed with irregular heartbeat last year and was given a pill that I gave up on. I think it was called warfarin. There were too many do’s and don’ts, and too many blood tests I had to keep taking. They told me that I could bleed if I hit my head of fell down because the pill made my blood real thin. I work in construction, doc, and us folks get knocks all the time.” After a brief pause, Pedro continued, “I need to get home to my dog. She’s all alone and hasn’t eaten today.”

Eventually, Pedro signed himself out of the hospital against medical advice.

There was nothing I could do or say to stop him, and he declined the help of social services.

When Pedro arrived at his apartment entrance, Lucy’s exuberant barking could be heard though the door. It was a great reunion, full of love and affection. Lucy did not leave Pedro’s side for the remainder of that day. After cleaning up the debris of the morning chaos, Pedro gave Lucy her favorite food to eat. Together, they played on the floor and on the bed, and late that evening Lucy chased him around a traffic cone in Morningside Park. Pedro felt alive–bursting with joy as he ran around in circles with his four-legged friend.

Later that night, Lucy began acting strange. She became restless and clingy, the way she had been the night before. She refused to drink water and became unusually aggressive when Pedro entered the bathroom without her. Sensing her anxiety, Pedro concluded that Lucy’s behavior was related to the trauma of the earlier events. He began to gently caress her coat and then cuddled up against her before falling into a deep sleep on the large floor cushion, forgetting to take the pills he was given that morning.

Then, the unfathomable occurred, appearing like a bad dream. When Pedro awoke, Lucy was lying on top of his right leg, fast asleep. When he tried to remove his leg from under Lucy’s belly, he realized he could not do it. He could not even wriggle his toes. The indescribable relief of yesterday was surpassed by sheer fear. Terrified, he excavated his senses in search for buried hope, but the only think hee uncovered was more and more fear. While Pedro and Lucy were asleep, the stroke had returned to steal a piece of his left brain–the opposite side from his last attack–causing Pedro’s speech to fail and his right limbs to turn flaccid.

And now Pedro was lying on the same stretcher he had occupied when he had signed himself out of the hospital the previous day. It was his second stroke in less than 48 hours, and a more severe form. Lucy had saved his life. Her loud barking had woken up the neighbor who called 911.

Six months later…

Pedro spent 2 months on my stroke unit and was then discharged to a rehabilitation hospital. During his rehabilitation, Pedro barely spoke to anyone. Even though he had regained his speech and partial use of his right arm and leg, he barely said much or did much. And now that he was home, his apathy grew. His only social activity was his daily trip to the animal shelter. Accompanied by his home attendant, Pedro visited Lucy at the shelter everyday–a trip he ad in his new electric wheelchair. Lucy had lost weight, perhaps even more than her owner. She had lost her appetite and no longer desired to play. Instead, she slept throughout most of the day, only to awaken when Pedro visited her, when she would lie awake at the back of her kennel and look at him with long sad eyes that implored him to take her home.

According to a Japanese proverb, a journey of a thousand miles begins with a single step. That morning in my office, after countless visits with me, Pedro decided to open up for the very first time.

“I can’t take care of Lucy anymore doc.”

It was a powerful step–a courageous beginning on a journey of a thousand miles, and all I needed to do was listen. Sometimes that is all we need to do.

Pedro looked down and began scratching his right arm.

“I get these tingling sensations down my arm and I don’t feel myself scratching. Look at these scars, doc.”

Pedro lifted up his right arm with his left hand to show me the excoriation marks on his skin.

“I look at myself and I’m not the same person I used to be. People stare at me on the bus and they make me feel uncomfortable. They feel sorry for me doc. I see the pity in their eyes. I should have taken my medicine, then I wouldn’t be like this.

Using my body language, I encouraged Pedro to continue.

“I see it in Lucy’s eyes, too, doc, and I can’t bear it. I can’t stand being apart from her. I should have taken my medicine, doc.”

There is a time for every emotion and every deed–even misery. And there are moments in life when we are lost in such times. As I traveled with Pedro through his underworld of depression, we seemed to be going around in circles. Was there a dream I could give him that revealed a way out? Was there a way to bend time around his pain and reveal better days? But this was a time to be silent, to lend him my ear, to listen to Pedro’s footsteps on his private journey to recovery, and to learn fro the greatest physician of us all–Time.

One year later…

Lucy was wagging her tail–an effusive expression of her delight as she chased after the ball that Pedro had just thrown with his restored right arm. They were in Morningside park at the bottom of a hillside near a newly planted tree. Thousands of daffodils were in bloom–their golden-yellow petals glistened in the sunlight, covering the field like an impressionist painting. Pedro had found a way out. He had found away to bend time around his pain and see his better days. He had fallen many times, but kept getting up, moving forward, step-by-step, mile-by-mile, on the road to recovery. And now he felt whole again, running around in circles, hurling the ball with his restored right arm, bursting with joy as he played on the grass with his four-legged friend.

Olajide Williams is Associate Professor of Clinical Neurology at Columbia University and author of Stroke Diaries.  This post originally appeared in the Oxford University Press blog.

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