My younger brother David was the first to see our father after his first stroke. He walked into the kitchen to find Dad staring out the window. He had a glazed look in his eyes, David remembers, and seemed not to recognize my brother at first. Finally he asked what his own older brother, Uncle Jimmy, was doing standing in the backyard.
"Right there," my father said, and pointed. His words were a little slurred. "It's Jimmy. Why is he here?"
Uncle Jimmy had passed away two years earlier.
I thought of that long-ago moment recently when a friend from Los Angeles wrote to tell me that she had come home from work to find her husband, "writhing in pain and grasping his cheek." My friend had once taken EMT courses before becoming a successful actress and producer. She made an on-the-spot assessment, punched in 911, and her husband was under the care of the stroke doctors at the UCLA Medical Center within an hour. Her quick thinking saved his life.
Or, as she put it, "a miracle ensued." She wasn't kidding.
Her husband had suffered what is called an ischemic stroke, when a blood clot blocked the flow of blood to his brain through the basilar artery, which feeds into the brain stem. Half of all people who suffer from blood-depriving ischemic strokes in the basilar artery--as opposed blockages elsewhere in the brain--die. Another quarter are left either comatose, partially paralyzed, or completely "locked in," wherein the patient is sentient but cannot move any voluntary muscle except for his or her eyes. Most famously, the French journalist Jean-Dominique Bauby, locked in after suffering his stroke, "dictated" his best seller The Diving Bell and the Butterfly by blinking his left eyelid to coincide with letters of the alphabet. The book took millions of blinks to write.
Because my friend got her husband newly available treatment so quickly, he is now one of the lucky few who has since walked out of the hospital with, as she put it, "but a bruise to the cerebellum and some hippocampus damage, but nothing that can't be rehabilitated."
Referring to the primary physician who treated her husband, she added, "The brilliant team at UCLA (how many brilliant 18-year-old M.D./Ph.D. actually exist in the world?) expect him to be able to travel to Vancouver to direct a film six weeks from now."
The reason I pass on this story to you today is because when curiosity got the better of me and I rang up my friend's "brilliant 18-year-old" stroke Doc at UCLA--who actually turned out to be the 37-year-old stroke specialist Dr. Jason Tarpley--we had an insightful conversation about how far medicine has come in the treatment of strokes, the No. 1 cause of severe disability and the No. 4 cause of death in the United States.
Sadly, those figures have not changed in the decade since my friend Bill Phillips--now the editor of the Men's Health mothership--wrote this poignant story about the death of his own Dad. The better news, Dr. Tarpley informs me, is that within those 10 years we have learned so much more about strokes and their treatment. In particular, he says, "I cannot stress how important it is that time is of the essence."
"Too many people who suffer strokes don't really know what has happened to them," he continues, "and there is a tendency to try to just ‘walk it off.' Then, by the time they do seek medical help, it's too late. The faster a stroke victim gets treatment, the better his chances of recovery. The basic rule of thumb is, an hour is better than two hours; three hours is worse but it's better than four hours … well you get the idea."
With blocked arteries, Dr. Tarpley explains, more brain will be saved the sooner clot-dissolving medications are administered. In some cases, he added, clots can be pulled from impacted arteries by stent-like devices. But you have to get to the clots fast. He tells me that the UCLA Medical Center's "Stroke Director," Dr. Jeffrey Saver, has studied strokes and stroke victims for years, and has put forward a pioneering theorem that quantifies why speed is such a key.
Dr. Saver's is a sort of statistics-per-minute formula that quantifies just how much every second counts. The human brain has billions upon billions of neurons, and Dr. Saver's research has led him to conclude, for example, that for every minute a stroke victim is not being treated, 1.9 million of those neurons die, never to return. In addition, an untreated stoke victim's brain will lose 14 billion synapses per minute, and in that same 60 seconds an incredible 447 miles of nerve fibers.
He also gave me a tip. The acronym FAST, he says, can help you recognize a stroke and react quickly. It stands for Facial-drooping, Arm-weakness, and Speech … the "T" is a reminder that time is invaluable in the treatment of an acute stroke. "In other words," says Dr. Tarpley, "don't try to walk it off. Call 911. Your friend's husband is the perfect example."
As you can imagine, the stroke was a wake-up call for my friend's husband. He is exercising regularly, and his diet, Dr. Tarpley notes, "is now probably more healthy than mine.
"We're learning more and more about strokes each year, each month, each day. Will we ever ‘cure' strokes? Given the too-many variables, not the least of which are genes, that's doubtful. But as far as treatment goes, we're getting better with every patient."
Every patient, that is, who gets himself or herself to an emergency room. This got me to thinking, of course. As did his comment about carrying stroke genes. My father recovered remarkably from his first stroke, his second one, too. It was the heart attack that killed him.
So if my wife, coworkers, neighbors, hell, even strangers on the street are reading this, all I ask is one favor: You see me wandering around with a glazed look on my face seeing dead people, please get me to a hospital ASAP.
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