“Victoria, if that were the case, I’m sure someone would have told me by now. I’m sure his doctors would have told me by now. Then again, maybe not; I still haven’t heard a damn thing more than I told you and Nicholas and he was brought in hours ago! They should know by now what parts of your fathers brain were affected and how the stroke affected him!” As much as she wanted to, as hard as she tried, Nikki found it more and more difficult to keep her temper under control and her fears at bey.
Swallowing hard, Vicki fell silent for several moments before whispering shyly, “I’m sorry. I’m doing more harm than good by being here, I’ll just-”
“Victoria, you’re not doing anything wrong! I’ve been testy all night! I’m so worried about your father and what’s going on with him that I’m taking it out on you and everybody else. I’m sorry.”
“No it’s not. There’s no excuse for me to be biting your head off this way; or your Aunt Casey’s.”
“Something happened between you two?” Vicki asked carefully
“Yeah, I snapped on her worse than I did on you.” Nikki told her honestly as she ran her hands through her hair and walked to the window.
“I’m sure if you just talk to her she’ll understand. She knows how much stress you’re under.” Vicki tried to reassure her as she followed.
“I don’t know. I was really hard on her, some of the things I said were really harsh. And, whether or not I’m under stress, there’s no excuse for the way I talked to her earlier.” Nikki told her regretfully, hesitantly.
“Mom, she’s your sister. She’ll understand, talk to her.”Vicki told her wisely.
“I’m pretty sure I already know the answer to this, but don’t you want to take a break?”
“Why not? You really look like you could use one.”
“Gee, thanks.” Nikki didn’t bother to keep the sarcasm from her voice as she stared straight back at her daughter.
“Mom, come on, you’ve been at this for how long?”
“I didn’t bother to set a timer!” Nikki snapped, her temper rising dangerously.
“I’m only trying to help!” Vicki reminded her a little more harshly than she’d intended.
“I know that, I know. But, Victoria, you need to understand something. Every time I close my eyes, every time I even try to get some sleep, all I can see is your father lying on the floor of his office barely breathing. No matter how much I try and forget, no matter how hard I try to block it out, I can’t. It’s all I see, no matter what I do, it’s all I see.” Silently, dejectedly, almost as if she were haunted by the images that had been burned into her mind since she’d first found Victor on the floor of his office, Nikki paced to the window.
Deciding it was better to quietly abide by her mother’s wishes than risk starting an argument, which was clearly the last thing her mother needed, Vicki slowly walked back to the couch and began reading once again. “Being overweight–Compared to individuals who maintain a healthy body weight, those whose body weight is more than twenty percent above a healthy body weight are more at risk of high blood pressure and diabetes. This means they’ve also got a higher risk of stroke. Individuals who are overweight also tend to have other risk factors like physical inactivity, diabetes, high blood pressure and high blood cholesterol levels.
“Hormonal changes–Modern oral contraceptives (birth control pills) are much safer than the forms used decades ago. In women younger than thirty-five years old who don’t smoke, their use doesn’t increase the risk of stroke. But, in a small percentage of women, birth control pills heighten the risk of high blood pressure and of blood clots. The risks are greater if you: smoke already, have high blood pressure, have a blood clotting problem, or are older than forty years old. Recent evidence has found hormone replacement therapy doesn’t reduce the risk of recurrent stroke; but studies continue.” After studying her mother intently for a few moments, Victoria carefully, quietly continued. “Homocysteine– Homocysteine is made naturally in the body as it breaks down protein for fuel. A high level of homocysteine is linked with a higher risk of stroke. But, it’s not yet known if reducing these levels reduces stroke risk.”
“That sounds a little encouraging.”
When Nikki didn’t answer, Victoria quietly set the binder down and walked over to her.
“Mom? Mom, are you okay?” Vicki quietly asked, unable to keep the concern from her voice.
Still, Nikki remained silent.
“Mom?” Vicki said quietly once again as she touched her mother’s shoulder.
Wiping stubbornly at her tears, Nikki took a small, deep breath to try and calm herself down before turning to her daughter.
Unable to find the words she knew her mother needed to hear, unable to offer the comfort she knew Nikki needed more than anything else at that moment, Victoria silently, tenderly wrapped her arms around her mother and held on tight.
Leading her back to the couch, Victoria told her gently, “I wish you’d open up to me. I can see how scared you are, I can see how worried you are. Why don’t you talk to me? I can be a pretty good listener.”
“I know, angel. Don’t worry about me, I’m just fine, the one we need to worry about right now is your father. He’s the one who needs all our support, all our love and all our attention.”
“What about what you need, shouldn’t that count for something? Doesn’t it count for anything?” Vicki asked, knowing it was a difficult question to answer, and more importantly one her mother hadn’t considered since she’d gotten there; one she, for reasons that weren’t entirely clear, wouldn’t consider.
“But what? Mom, what good are you going to be if you’re exhausted from trying to hang on and be there for everybody else when you won’t even let anybody do the same for you? What good will that do anybody, including Dad?” Victoria asked wisely.
“I won’t deny what you’re saying ,I can’t. But, the one thing I know for sure is, right now, I need to put my feelings aside and focus on your father. Victoria, I need to do that. I don’t expect you to fully understand, or agree with me. But, I need you to support me. I need you to do that because I don’t think I can handle this on my own.”
“You don’t have to, you’ll never have to.” Victoria whispered as she wrapped her arms around her mother, holding her close and tight and wishing that somehow, some way, she could take away the pain she saw shining from her eyes.
“Good, because, that’s what’s important, your father’s recovery is what’s important now. It’s the only thing that matters.”
“Not the only thing,” Vicki gently countered as she lay a soft, gentle hand on her mother’s stomach and felt her sister kick.
As tears welled up in her eyes, Nikki cleared her throat and softly said, “You’re right. Let’s just get back to the reading.”
“Are you sure? It’s not going anywhere. Why not take a break?”
“No way, Victoria. Don’t push me on this!” Nikki firmly told her before taking the binder from her and continuing. “Treatment– Surgery–At times, a surgical procedure or operation is recommended as the best means of preventing a stroke. The doctor will be able to tell you if it’s the right treatment for you. The most common surgery is a carotid endarterectomy. This is done to remove plaque from the carotid artery (one of the arteries in the neck). An incision is made to open the artery, the blockages are taken out, and the artery is then closed up. Because the procedure’s considerably risky, it’s only done in rare cases. Only certain individuals can have this type of treatment. Risks with this procedure include: stroke, heart attack and rarely, a brain haemorrhage caused by the surge of blood released by the surgery. Individuals with high blood pressure are at higher risk of haemorrhage. Carotid endarterectomy is usually recommended for individuals who’ve had a TIA (transient ischemic attack) or stroke, have severe blockage of the carotid artery or are likely to recover well from the surgery.
Carotid Angioplasty and stenting– is a newer kind of surgery. It’s similar to angioplasty and stenting that’s commonly done in the heart’s coronary arteries. This procedure involves using a balloon like device to open a clogged artery and then placing a small metal stent to help keep the artery open. It can increase blood flow to the brain. During this procedure, a thin wire called a catheter is inserted through the arteries in the groin area and extended to the neck arteries. A baloon at the tip of the catheter is inflated to widen the narrowed vessels. The vessels can then be held open by a small device called a stent.”
“Prevention–Having a stroke increases the chances of having another, however the risk is different for every survivor. However, the good news is that a lot can b done to reduce the risk. Lifestyle changes, surgery, drugs, hospital care and rehabilitation are all proven means of reducing the risk of more strokes.
If Someone You Love Has a Stroke–It can be very frightening if someone you care about has a stroke. –No kidding! Tell me something I don’t know!–But strokes can be big or small.–Again, no big news flash.–A small one might not cause too much damage and the survivor might return to normal quickly. However, a major stroke may cause big problems with important things like walking and talking. With a major stroke, the survivor might spend lots of time in the hospital. –Which, of course, Victor will love!– Once the survivor is home, he or she might need special care, medicine, therapy, and lots of doctor visits. –Victor’s going to love that!– In some instances, the survivor might have lasting problems with important skills such as walking or talking.” Nikki stopped for a moment and said a little prayer that, that wouldn’t be the case for Victor. But, in many instances, survivors are able to relearn the important skills they lost.” Nikki breathed a little sigh of relief as she felt a little more hopeful. “However, it might take time and patience.–Time and patience we’ve got, as long as we know he might be okay, we can deal with the rest.– So if you know someone who’s had a stroke, encourage them to keep doing the heard work needed to get these skills back. It’s also imperative for you to talk to someone if you’ve got questions or worries regarding someone who’s had a stroke. You may feel sad, frustrated, or angry that this happened to somebody you love, especially if this individual can’t do things with you like before. It’s normal too for someone who’s had a stroke to feel frustrated and upset, particularly if he or she must learn something as basic as feeding him or herself. It can make the individual feel less independent.
When surgery is needed– Following a stroke, the brain needs to get good blood flow. At times a narrowing in the carotid arteries can lead to blood clots forming. These can interfere with blood flow. In this case, an operation named a carotid endarterectomy (ka-rot-id end-ar-ter-ek-toe-me) may be necessary. But, the operation shouldn’t replace other means of reducing a survivor’s stroke risk.”
“That makes sense, they don’t want to go doing any kind of surgery or procedure on anybody if they don’t have to.” Victoria made a feeble attempt at conversation, which her mother completely ignored.
“Medications that can reduce stroke risk–Medicines can aid in reducing stroke risk. Another way of improving blood flow to the brain is to keep clots from forming. Medicines that thin the blood help keep clots from forming. A common blood thinner is acetylsalicylic acid, ASA (i.e. aspirin). It works by reducing the blood’s tendency to form clots, which allows the blood to flow through narrowed arteries. There are also medicines named anticoagulants (i.e. Warfarin) that thin blood.
Medications for ischemic strokes–Blood thinners keep blood flow to the brain going or improve it by stopping blockages. There are two kinds of blood thinners: anticoagulants and anti-platelets. Blood thinners make it more difficult for clots to form.”
“Mom, what’s an ischemic stroke?” Vicki asked hesitantly.
“It’s a stroke that’s caused by a blood clot. and a haemorrhagic stroke is one closed by bleeding.” Nikki told her plainly before continuing.
“Medication treatments for haemorrhagic stroke–The treatment goal is to limit the damage due to bleeding. One way is to use drugs which bring the patient’s high blood pressure down into the normal range. This needs to be done carefully. Bringing blood pressure down too quickly following a stroke can damage brain tissue. Doctors will monitor the blood pressure and bring it down slowly. Below is a list and description of some common anticoagulant drugs. Heparin is administered by injection, normally at the hospital. Therapy with this medication is for short-term.
“That makes sense, strokes already damage the brain, the last thing they want is to cause more.” Nikki murmured half to herself. before continuing. “Warfarin or Coumadin is taken in pill form and is for long-term use. Because both medicines can heighten the risk of bleeding, patients need to be very careful to avoid new injuries and report them when taking blood thinners. They also need to have their blood regularly tested to ensure that the right level of medicine is in the blood.”
“Anti-platelet drugs–keep blood elements named platelets from sticking together resulting in clotting. ASA can aid in keeping this from happening.
Asprin– can have some side-effects, like stomach upset and ulcers. Despite aspirin often being prescribed for survivors, it may not be right for you. For this reason, it’s critical to talk to your doctor. Other drugs can also prevent blood clots from forming. They can be given in situations where a patient can’t tolerate aspirin or, in the presence of aspirin, if the patient still has brain attacks.”
Although her head was now spinning and she could feel a minor migraine coming on, Nikki pushed on, pushed herself as far as she could, not for herself, but for her husband. ‘I’m not giving up on you, do you hear me, Victor? I’m not giving up on you!’ She thought to herself, trying to somehow, on some level, silently communicate with him.
“Medication Tips– Follow prescription directions carefully. Medicines will only work if you use them right. Take your medicine regularly, even if you feel well. Take them at the same time daily. If you miss a dose, take it as soon as you remember. Take the remaining doses at the regular times. if you forget your medicine, don’t take a double dose. Call your doctor or pharmacist for advice. Keep in mind that medicines have lots of different actions and side-effects. Call your doctor or pharmacist if you’ve got questions, or if you notice side-effects. Bring all your medicines with you to doctors appointments. It’s imperative that the doctor know what medicines you’re already taking. There may be changes in your prescription due to interactions between medicines.”
“Recovery–How does a person get better–Recovering from a stroke can happen quickly or can take a long time. How soon somebody recovers depends on how severe the stroke was and how healthy he or she was prior to it. Individuals who’ve had a stroke might need medication or surgery. Later, they might need rehabilitation. Stroke treatment will depend on what caused it.”
“This doesn’t sound very encouraging, I’m starting to get a bad feeling.” Vicki told herself as she paced to the window. “So, how do we know what’s going to happen with Dad’s recovery? How do we know how long it’ll take?”
“We don’t. We won’t know, at least not until he wakes up.” Nikki told her honestly before continuing.
“Medicine–For an ischemic stroke, the doctor may give the patient medicine which things the blood and prevents it from clotting too much. There’s even ‘clot busting medicine’ which can break up a blood clot. This medicine is administered through an IV and works best if it’s administered extremely quickly.”
“How quickly?” Vicki asked curious.
“Within a few of the person having the stroke, I think,” Nikki told her absentmindedly.
“A few hours?” Vicki asked surprised. “That doesn’t give them much time.”
“Victoria, don’t do that! Don’t go down that road! The doctors are doing everything they can and your father’s still alive, don’t you go giving up on him now!” Nikki ordered sternly as she got up to walk to the window and stand in front of her.
Swallowing hard, wide-eyed, Vicki nodded and fell silent.
Kicking herself for losing her patients as she had, Nikki ran her hand through her hair and, putting the binder back down on the table in front of them said, “I’m sorry, I shouldn’t have snapped at you like that.”
“It’s okay, I should’ve just kept quiet. I won’t say another word, I promise.”
“Victoria, that’s not what I want.” With a tired sigh, Nikki continued. “Angel, I know how scared you are, believe me. But, we can’t give up, if we do, we really will lose your father.” More gently she asked, “Do you understand me?”
With tears choking her voice, welling up in her eyes, Vicki silently nodded.
“Good.” Nikki said before pulling her into a tight, and she hoped comforting hug.
Once she was back at the couch with Victoria sitting beside her, she continued.
“Surgery–Doctors might perform surgery to open up a clogged blood vessel to help prevent another stroke later on. If someone’s had a haemorrhagic stroke, surgery may be necessary to take away blood clots or fix weak blood vessels.”
Turning to Victoria and studying her carefully, Nikki asked, “Are you okay? You don’t look so good.”
“Yeah, fine. Why?”
Taking in the sight of her pale face and trembling hands, Nikki again put down the binder and, taking her hands said, “Victoria, look at me. Look at me.”
Slowly, hesitantly, Victoria did as she was told.
Wordlessly, Nikki pulled her into a tight embrace, wishing she could take away even a little of the fear she saw shining in her daughter’s eyes.
“I guess all this talk about surgery and everything else is bothering me a little more than I thought it would. But, I’m okay. Let’s keep going.” She lied, hoping to assuage her mother’s curiosity and more importantly, her worry.
“Nice try. Victoria, I want you to go home.” Nikki told her firmly.
“No way! I’m not going anywhere! I’m staying put until we hear something!” Victoria told her just as firmly.
“Fine, if you won’t go home, then at least go and get something to eat.” Nikki ordered concerned.
“I don’t think I can eat.” Vicki told her wisely.
“Try. Sweetheart, you won’t do anybody any good if you’re in here for starvation.” Nikki told her wisely.
“Same goes for you,” Vicki told her before agreeing. “I’ll be back in a little while. I’ll bring you back something. it’s probably been hours since you’ve had more than a coffee or some tea.”
“Fine.” Nikki agreed grudgingly.
Satisfied that for once, her mother was listening to her, Vicki headed to the cafeteria.
With Victoria gone, Nikki doggedly continued. “Preventing Strokes–Some strokes can be prevented in adults. Some stroke-prevention tips for adults include: Don’t smoke. Don’t drink too much alcohol. Eat healthy and be active. Check blood pressure. Don’t ignore problems such as heart disease, high blood pressure , or diabetes.”
“Makes sense, if only Victor had paid attention when the doctors told him this!”
“Medicines for high blood pressure– There are lots of different medicines used to treat high blood pressure. They fall into the following categories: Angiotensin II Receptors AARBs– AARBs are a family of drugs which relax blood vessels by blocking a chemical (angiotensinII) which makes blood vessels narrow, constrict or tighten. This allows blood to flow more easily through the body and in turn helps lower blood pressure.
Angiostensin Converting Enzyme (ACE) Inhibitors–ACE inhibitors are a family of medicines which relax blood vessels by reducing the production of an enzyme needed to produce a chemical (angiotensinII).
Beta blockers– This is a family of medicines which can slow down the heart rate, the heart’s pumping force and the amount of blood pumped in a minute. These actions aid in lowering blood pressure.
Calcium Channel Blockers or Antagonists–This is a family of drugs which block the passage of calcium into the muscles controlling the size of blood vessels. The action dialates or opens up blood vessels, therefore aiding in lowering blood pressure. Other classes of drugs are commonly used.”
Meanwhile, in the chapel, Nick sat in one of the pews and tried to make sense of all that had happened since he’d arrived. “What’s with Vicki? Doesn’t she get that I’m just as upset as she is? Doesn’t she get that I’m just as angry? Where does she get off talking to me that way? Why the attitude? She’s not acting right, she hasn’t been since…since I don’t know when! She’s got to realize I’m not going to put up with too much more of her garbage! At a time when we should just be focussing on Dad, she’s acting like some stupid spoiled prima donna! Where does she get off doing that and what’s behind it? What do I have to get her to snap out of it?” Nick fumed, his hands balling into fists.
“And what about Dad, why didn’t he just do what the doctors told him? That’s all he had to do! Why couldn’t he just do that? Why? If he had we wouldn’t be in this mess! None of us needs this garbage right now, especially Mom! And Vicki’s attitude sure isn’t helping anybody! She needs to wise up and drop it if she wants to help anybody! Then again, maybe she doesn’t. God knows when she’s this upset all she thinks of is herself!”Unable to sit any longer, Nick rose to pace the chapel angrily.
After a few moments, his anger began to subside a little and he thought to himself ‘Then again, it’s no surprise she’s upset, she’s always been close to Dad. They’ve been practically inseparable at times. I get why she’s upset about this. What I don’t get is why she’s taking it out on everybody else! I know stress can make you do and say things you don’t mean but, this is ridiculous! Every time anybody tries to talk to her-about anything-all she does is swear up and down she’s fine and when we try and get her to see that’s not true, she bites our heads off!’
More calmly, he continued. ‘ Then again, I guess I wasn’t helping matters. I said some things I really shouldn’t have. She’s just so stubborn some times! Why won’t she let anybody help her?’ With a little smirk, Nick whispered, “Because, she’s just like Dad!”
“One thing’s for sure, if anybody can get through to her, he can! We can’t lose him, we can’t! Mom would be crushed, Vicki would be devastated and Abby would be heartbroken.” His last thought was for himself as he whispered, “ And I wouldn’t know where to start to help them pick up the pieces.” With tears slipping silently down his cheeks, Nick lit a candle and began to pray. “I know my Dad’s not the easiest person to get along with, I know that better than anybody! But, if you take him away, a lot of people will be hurt, especially my mom and my sisters! My mom’s already driving herself crazy trying to do whatever she can to help him, even though she’s exhausted. She’s not thinking of herself or her pregnancy, all that matters is my Dad. That’s par for the course with her though.” Nikki smiled bitter sweetly as he thought of his mother’s devotion to her family, especially her husband. “And, Vicki’s about to self destruct! I can’t get through to her, nobody can. The only one who could is lying in that hospital bed fighting for his life. He’s fighting so hard but,” Nick swallowed the lump of fear lodged in his throat, threatening to choke him and continued, “that may not be enough. Please, God, we need your help! Give us the strength to handle whatever comes. But most of all, give us back my Father. I know I don’t pay enough attention to you and I’m always here when I need something, but I’m not asking for myself, I’m asking, no, I’m begging you. For my family’s sake, especially my mom’s; please don’t take my dad away. Please don’t take him from us, not now.” Drying his tears as more fell, Nick sat in the chapel in silence hoping with everything in him that his prayer would be answered.