Commentary

A Clinician's View: What It's Like to Have a Stroke

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Five years ago, I suffered a total right hemispheric stroke due to a carotid dissection. This is the most common type of stroke in people younger than 70. It is usually caused by direct trauma to the neck over the carotid artery. Common causes include injuries suffered in a motor vehicle accident or in a hockey game when a stick is slashed over the neck.

My dissection was thought to have been caused by repeated cervical flexion from a severe and protracted cough I had picked up with bronchitis after seeing patients in my internal medical practice. My asthma was exacerbated and my cough lasted several weeks. The persistent and severe cervical flexion eventually tore my carotid artery, causing a complete blockage as the thrombus formed.

I woke from sleep with a severe migraine, not unusual for me. This was an especially intense migraine, but I was unaware of any other neurologic symptoms. I took an oral triptan as usual, but this time I got no relief, even after I repeated it in five minutes.

Fortunately I was home. I got up to get an ice pack from the kitchen, which occasionally helped the throbbing. I got downstairs before the paralysis kicked in, or I would have fallen down the stairs. As I reached down to get the ice pack, I started to fall and grabbed the water cooler, creating quite a noise. My husband woke and came down to see what was going on.

He called an ambulance but when they arrived, they questioned why they had been summoned. I understand their confusion, thinking I was a literal "fallen-down" drunk. There was an open wine bottle on the kitchen table from dinner; my voice was slurred, and I was lying in a puddle of water on the floor.

My husband persisted, telling them there was something very wrong with my face and voice. He saved my life! Only then did I realize that my leg was also numb.

I was then whisked away to our local community hospital. After an evaluation and CT scan, I was taken by helicopter to a stroke center in Philadelphia, about 50 miles away. It was determined that I needed an emergency craniectomy; the stroke was so severe that the inflammation was threatening to cause a brainstem herniation.

I remember being subjected to all those neurologic exams we learn in school. A clinician held my hand in hers and asked me to identify mine; I was astonished when I could not do it.

After the stroke, I suffered from dysphagia; I was unable to swallow clear liquids. I was given thickened liquids. All clinicians should know that this is truly miserable. It is exactly like drinking mucus. I once overheard a clinician call me "the stroke in room 302." That was a dehumanizing comment.

I continue to suffer from a left homonymous hemianopsia, or a total left-side visual cut. It is a very strange type of blindness, and I find that many clinicians do not at all understand it. I am unable to drive because I cannot see oncoming traffic, or cars passing me from behind. I will walk into doorjambs and walls. I cannot see the first few letters in a word. For example, the word "flowers" looks like "lowers" to me. In a string of numbers, I will miss the first one; "1234" looks like "234." If you are standing in front of me to the left side, I will not see you.

Once, I read an entire novel by reading only the right-side pages; the left pages simply did not exist. Needless to say, the novel didn't make much sense the first time around.

Since my stroke, I have been on quite a journey of recovery. I am still unable to work gainfully as an NP, but I volunteer as one in a local free medical clinic. I am so very thankful for this opportunity to practice the profession I love.

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