Marilyn Bontempo - How life resumed as usual after stroke
According to new guidelines from the American Heart Association/American Stroke Association, more patients could be eligible for critical treatments like Marilyn had to remove or dissolve blood clots that cause strokes. Read more about the guidelines on Heart.org.
At 6 a.m. on Wednesday, Feb. 18, my world came to an abrupt halt. Instead of returning to bed after a routine trip to the bathroom, I found myself lying on the marble floor unable to get up. I just could not lift my head up off the floor nor could I move in the direction of the bedroom. As hard as I tried, all I could do was rotate my body around in circles on the slippery floor.
Somehow, I finally hurled my body into the hall, which was a major step in the right direction. But that effort robbed me of all my energy and I lay there in the sixty-degree temperatures for what would be half an hour until my husband of 32 years awoke and realized I had not returned to bed. I could hear him rushing from the bedroom into the hall and feel him picking me up and carrying me back to bed. Then, sharing his thoughts out loud as he often does, he tried to figure out what was wrong with me.
All I could do was lie there and watch and listen. I had no curiosity about my condition whatsoever. I was in a semi-vegetative state, unable to speak or react in any way. After trying to warm me with his body, he did the only thing any intelligent person would do, he called 911. I could hear him asking for an ambulance. Then I heard him running up and down our stairs, out into the front yard over and over and then calling 911 again in a panic-stricken anxiety over how long this was all taking. Finally, I could hear several voices and a man sitting on the bed next to me asking me questions.
My lack of response must have been extremely frustrating for everyone; especially me. Finally, I felt them gather the blankets from the bed and wrap me up so they could carry me on a stretcher down to the first floor. In my husband's state of terror and confusion, he completely forgot to give me a coat to wear even though it was less than zero outside. He also forgot that without my glasses my vision would be a constant blur, as nearsighted as I am. He had luckily had the presence of mind to put some pants on me
I wasn't moving and I wasn't talking. If I could, I would have told them all how cold I was. Out in the front yard, the frigid air was brutally stinging as I awaited the final heave into the ambulance. The same EMS worker who had tried to pry some information from me on the bed, continued his attempts in the ambulance.
I assumed we were on our way to Putnam Hospital which is about 20 minutes away. All I could think was this was it. I would be going to a nursing home where I would exist as a vegetable for the rest of my life. The ambulance lurched forward and stopped at what I imagined were stop signs or traffic lights. The only focus I had was how cold I felt. That concern consumed me.
Finally, I realized we must have arrived at the hospital because they removed my stretcher from the cold ambulance and I was descended upon by an army of workers, poking tubes into my arms, trying to remove my many layers of clothes I had worn to bed to try to keep warm and getting me ready for whatever was next. I had no idea. All I could think was that whatever they were doing to me inevitably would be an exercise in futility on a total vegetable, a frozen one at that.
Having just turned 65 and become eligible for Medicare, I had just committed to an insurance plan that if I ever needed it, would render me a pauper on the first illness, with unimaginable deductibles and copays designed to rob me blind. In my comatose state, I believed they were performing every expensive procedure they could so I would have no money left when this was over.
I remember two faces distinctly among the many who had sat at my side only inches from my face where I could see them plainly. Both were women. The one on my right searched my face for some sign of comprehension, something, anything. Soon, I would feel them push me into what seemed like an MRI machine, or maybe a CT scanner. I've had plenty of experience with each in my past after a falling accident.
Still, I did not think about what had happened to me and why I was here. I had no choice in the matter. I could not communicate. What seemed like only seconds later, I could hear them telling me that I was out of surgery, and shortly thereafter they would remove all the paraphernalia from my mouth.
They asked my name, which I croaked out. Did I know the date? Feb. 18th. The year? 2015. Day of the week? Wednesday. And who is the president? Obama, I said. And do I know where I am? I said, Putnam Hospital?
They said, actually, Marilyn, you are at Vassar Brothers in Poughkeepsie. My husband explained that I must have been aware when he called the ambulance but the EMS crew, Tim Martin (Paramedic) and Andrew Ludwig (EMT), had advised that I would receive much better care at Vassar Brothers.
I asked, "Did I have a stroke?" How unlikely that I, a very fit, healthy woman of 85 pounds, who exercises religiously every day, who obsessively eats an extremely healthy diet, doesn't smoke or drink alcohol, has low blood pressure, and has no heart disease, would suffer a blood clot to the brain, rendering me incapacitated, a state described by Dr. Sarabu, Director of Cardiothoracic Surgery at the Hudson Valley Heart Center, as "a near-death experience."
It was all apparent to me now. The entire terrifying reality of it all came rushing over me in crystal-clear perspective. I had been a victim of my genetic heritage, having a father and grandfather who both suffered strokes, at 95 and 50, respectively, the latter a fatal blow to a man in the prime of his life.
But why? As the first case to arrive in Vassar Brothers Medical Center's new ground-breaking, multimillion-dollar stroke unit of NeuroInterventional Surgery, introduced to the Hudson Valley by a team of innovative thinkers at the helm of Health-Quest's pursuit of medical perfection, I became a major focus of concern. Previously only available in Albany or Westchester, this life-saving initiative was the brain-child of people like Ann McMackin, Vice President of Operations, who recruited Dr. Alison Nohara, the interventional neuroradiologist who is responsible for the cutting-edge surgery and the brilliant care that saved my life.
The surgery she performed involved the insertion of a catheter into a major artery in my groin which was then followed on a digital monitor as it traveled up into my brain to eradicate the clot where the CT scanner had discovered its location. This is a major departure from the conventional treatment stroke victims usually receive via an agent to dissolve the clot which can take hours. But in most cases, as was in mine, immediacy of resolution is critical to preservation of health, and obviously what not only saved my life but totally restored all my functions.
Having arrived at the hospital in a state of critical unresponsiveness, to emerge from the depths of a major stroke and brain surgery to normalcy in every way was hard for everyone to fathom, most particularly me! I had heard of people found lying on the floor hours after a stroke with horribly life-threatening residual effects from which they needed many months of rehabilitation to try to overcome, some not so successfully. But here I was, speaking articulately with all my vocabulary readily accessible, with every part of me moving and working the way it had prior to having suffered a massive stroke.
I was overjoyed. I had my life back! In fact, later that night in the Intensive Care Unit, I was emailing from my laptop and paying my payroll taxes in between frequent readings of my vital signs, a routine which would go on endlessly for two weeks thereafter robbing me of my sleep, but certainly a small price to pay under the circumstances. I was told that my body temperature was dangerously low when I arrived at the hospital. No surprise there!
After the first week I was moved to the Post-Cardio Unit where I was given a private room from which I conducted business as usual from my oversized iMac my husband brought me from home, accessing the hospital's wi-fi network, and enjoying room service and housekeeping as a bonus! Vassar Brothers Hospital was a dream come true! Not only was their care and hospitality the best I've ever experienced, better in fact than some of the best hotels in the world, I was treated like a celebrity by every echelon of the hospital hierarchy, from the CEO of Health Quest to the lovely woman who performed housekeeping; from the leaders of the administrative unit of Vassar Brothers Medical Center to the cordial waitstaff who delivered my meals.
And after checking with the financial office, I learned that my insurance was covering everything regardless of how long I needed to stay, with a minor fee my only responsibility. I was flabbergasted at that news! The hospital also allowed me the dignity of an independent exercise routine where I was able to briskly walk up and down a long, quiet hall 12 laps at a time, four times a day, 20 minutes each, to rebuild my stamina, all while they had my vital signs digitally available on their monitors in my unit. And despite the common opinion of typical hospital food, I found both the menu and room service at Vassar Brothers Medical Center excellent in every way. My husband and I dined together each evening in my room on salmon, delicious vegetables, quinoa (the pricey new protein-rich grain which resembles couscous in taste and texture), sweet potatoes, yogurt, soy milk, and other wonderful, healthful choices. My husband's dinner cost $8, including the addition of a brownie for dessert. Of course, my husband had brought me blueberries and balsamic vinegar from home which I added as dietary enhancements, in lieu of salt, sugar and other decadent foods I avoid.
As president of Mid-Hudson Marketing, a firm offering diverse services in marketing, advertising, public relations, graphic design, social media, website creation and SEO management for some 40 years, I have run this business from an office in Poughkeepsie for all but the last five years after having moved to my home in Pawling. My mind, my design talents and my computer expertise are what people seek through my services. With clients worldwide, I work from the moment I wake up until long after other people go to bed. As a workaholic, my work is my life.
The last thing I expected at this stage of my busy life was a stroke, yet it had happened to me. The Vassar Brothers Medical Center team quickly discovered why. Thanks to Dr. Harrison of the Hudson Valley Heart Center who performed a TEE (Transesophageal echocardiogram), a sophisticated test which allows a glimpse inside the heart, the reason a blood clot found its way to my brain was through a hole in my heart. It seems I have a PFO (a patent foramen ovale), which is a very common congenital defect that approximately 26-percent of the population have but don't know it, I being one of them.
However, still baffling to everyone was the source of this blood clot. Several ultrasound exams of my legs discovered no blood clots there, leaving this question an unsolved mystery. Since the likelihood of another stroke at my age is fairly high, it is recommended that I undergo open-heart surgery to close the hole in my heart, the gateway to my brain. Why open-heart surgery when there are a number of choices of less-invasive procedures to perform this task? Another clot forming during the course of any one of these could be the clot that kills me the next time around.
This is why the first step to prevention of the next stroke began immediately with the administration of Coumadin, a blood-thinning, anticoagulant medication which has been used for years with optimal results. While other drugs have hit the market over the years, Dr. Nohara said that this tried and true method was best in my case so they could monitor its results, slowly, gradually and very carefully.
Also known as Warfarin and ironically also used as rat poison, Coumadin presents many challenges with diminished effectiveness when combined with vitamin-K-rich foods like spinach, brussel sprouts, broccoli and other leafy green vegetables which overwhelmingly comprise my diet. It also has been implicated as a possible risk of increased fractures in people with osteoporosis, a disease from which I also suffer, responsible for my overall bone reduction and loss of weight.
However, with perseverance, after two weeks of very minimal results, Dr. Nohara agreed to let me leave the hospital since my INR levels had finally reached a "therapeutic" level and a final MRI of my brain showed major improvement in the healing of the site of the clot. With the plan of eventually closing the hole in my heart, the need for long-term use of Coumadin ultimately may be eliminated.
So it was with bittersweet emotion that I returned home, much weaker than when I left, but determined to fully recover to my former level of activity despite the frigid temperatures, icy road conditions and continual snowfall. The people who had cared for me at Vassar Brothers Hospital had made an indelible impression on me, not just as highly skilled professionals, but as members of a compassionate, kindhearted team all sharing the same goal, from the sympathetic nurses who tenderly offered their concern in the ICU at all hours of the night and day to the cordial staff from every department in the hospital who stopped by my room to express their utter amazement at my incredible recovery.
Remembering my entree to the Emergency Room: the face on my left, Dr. April Horton, the excellent anesthesiologist; and the face on my right, Dr. Alison Nohara, the doctor to whom I owe my life; there can be no greater reward than memories of this profound significance, this culmination of care from so many sources of expertise.
My life is so much richer as a result of this humbling experience, which has given me a new perspective on the goodness of humanity and the generosity of the human spirit.