Back in the waiting room, completely unaware that Nick was in his own personal hell, Victoria and Nikki sat where they had been for the past few hours, still absorbed in research as they ate, although Nikki did so disinterestedly.
“Mom, come on, you know you need to eat.” Victoria told her firmly.
“And I am.”
“You know what I mean. You’ve barely eaten anything since I got back.” Vicki told her, unable and completely unwilling to set the subject aside.
“Victoria, drop it!” Nikki told her hotly.
“Fine!” She answered petulantly.
Satisfied she could get back to what she thought really mattered, Nikki again began reading. “Stroke Treatments–Stroke treatment depends on the type of stroke you have, the severity of the stroke, your age and general health, and how soon you got to the hospital after the stroke. There are three principal emergency treatments for stroke: tPA–a drug which is capable of ‘stopping’ a stroke caused by a blood clot by breaking it up. Commonly referred to as a ‘clot buster,’ the name tPA is short for tissue plasminogen activator. It can only be administered to patients ho are having a stroke caused by a blood clot and needs to be given within three hours of the stroke.
Surgery–In some instances, surgery may be needed. It may be done to remove blood that’s pooled in the brain following a haemorrhagic stroke, to fix broken blood vessels, or to take away plaque from inside the carotid artery.”
As the thought of Victor having to undergo yet another surgery entered her mind, along with the terrifyingly detailed images that went along with it, Nikki shivered and hugged herself protectively.
“Mom, we need to stop this, it’s not doing you any good!” Vicki told her adamantly.
“Wrong, Victoria, it’s doing me more good than you know! At least I know more about what we may be dealing with!” Nikki told her just as adamantly, though she couldn’t keep the exhaustion she felt from creeping its way into her voice.
Shaking her head, Vicki told her firmly, “The key word here is may! We don’t even know what kind of stroke it was!”
Deliberately ignoring her daughter, Nikki stubbornly continued. “Surgery to remove blood clots–A haematoma is a collection of blood (that can be clotted or mostly clotted) found in the brain following a haemorrhagic (bleeding) stroke. Because there’s not a lot of extra room in the skull, a haematoma can dangerously increase pressure on the brain resulting in further brain damage. Surgery might be necessary to take out the haematoma and relieve brain pressure.
Surgery to fix blood vessels–Some haemorrhagic strokes are due to a burst or ruptured blood vessel in the brain. Two common kinds of ruptures are aneurysms, where there is a weak spot in the wall of the blood vessel, and arteriovenous malformation or AVM for short, where the blood vessels have thin walls that are prone to leaking or breaking). In some cases, surgery may be necessary to fix ruptured blood vessels. non-surgical procedures are also sometimes an option to repair them.
Non-surgical procedures–Some individuals may benefit from treatments which are done through a thin, flexible tube called a catheter that’s inserted into the blood vessels or the brain. Lots of these procedures are new and experimental and not all hospitals may be able to perform them. Catheter-based procedures are being developed to take away plaque buildup from arteries (cerebral angioplasty) and to treat aneurysms (weak spots in blood vessel walls which can bulge outward and burst).” With her palms sweating and her stomach tumbling around inside of her, as tears burned her eyes, Vicki rose to pace the waiting room.
“Victoria? What is it?”
“Nothing,” she whispered as she stared out the window blindly.
“I know that’s not true. Come on, tell me.”
As her hands balled into fists, Victoria stormed out of the waiting room.
“Victoria wait!” Nikki walked as quickly as she could to catch up with her.
“Damn it, I’m sick and tired of waiting around! I can’t just sit around like a good little girl when Dad might be…he might be…” Unable to force the words out, Victoria wrapped her arms around herself as she began to shake from head to toe.
“Your father is just fine, we have to believe that. We have to believe that.” Nikki told her as firmly as she could before leading her back to the waiting room.
“I’m trying, but I don’t know how much longer I can take this, I don’t know how much longer I can hold on Mom. I know that’s not what you want to hear, it’s the last thing you want to hear, but I can’t help it. I can’t lie, Dad might be slipping away and there isn’t a damn thing I can do! There’s nothing!” Furious at herself as much as at the situation, Victoria bit her lower lip to try and stem the flow of tears threatening to overtake her.
“The thought of them doing all these tests and putting him through all that I can’t stand it! To them, he’s just another name in a file, another list of symptoms. He’s not! He’s my dad and he could be dying!” Vicki was beyond caring how her behaviour or what she was saying seemed to anybody as she swallowed almost convulsively and wrapped her arms around herself, rubbing them quickly to try and rid herself of the chills that were coming from within her, ones she was helpless to rid herself of, regardless of how much she wanted to.
“Bradley deserves to be here not Dad! Damn it! Dad doesn’t deserve this! He doesn’t!” Victoria railed bitterly, desperately searching for answers, for some clues as to what to do, how her father’s situation would turn out.
“The thought of him being put through all these tests and the surgery and everything else, being used as a damn pin cushion or a damn science experiment or whatever’s going on in there….”
With her chin trembling, her voice trailed off for a few moments before she quietly yet valiantly continued.“Mom, the longer we’re out here without any news; without any news at all, the more my imagination starts to run away with me, the more I keep thinking what if he doesn’t make it, what if–” Shaking her head, she ran to the window and, with her back to her mother, let bitter, furious tears fall.
“Victoria, come on, come here.” Nikki tried to coax her soothingly, gently.
Breathing fast and hard, harsh even to her own ears, Victoria shook her head silently.
“Victoria.” Nikki tried again, this time a little more firmly.
Not trusting her voice, Victoria again shook her head, this time a little violently as she bit her lip so hard she drew blood. “Damn it!” she swore softly as she turned a little to search for a tissue in her purse. With trembling hands, she pulled it out as Nikki walked up to her and wordlessly turned her around to face her.
Closing her eyes for a few moments as her heart broke a little more at the sight of the fear and pain raging through her daughter, shining brightly, brutally in her eyes as it tore at her own soul, Nikki tried to swallow the bitter taste of fear that had insidiously slipped into every corner of her mouth.
Shaking her head a little as she opened her eyes to see the tears spilling from her daughter’s eyes, Nikki gently took the tissue from Victoria’s ice cold hands and dabbed at the blood on her lip, trying her best not to hurt her before pulling her into a tight, and she hoped comforting embrace, as her own tears began to fall. Then she silently, tenderly dried her tears with her thumbs and lead Vicki back to the couch, hoping her legs would carry her there, despite the feeling she had that they’d suddenly turned to rubber. Lovingly, tenderly, she held Victoria in her arms and gently rocked her back and forth for a few minutes, hoping that would calm her down somewhat. After several minutes, Victoria was indeed a little calmer.
Now that she’d calmed Vicki down somewhat, Nikki continued. “Stroke rehabilitation– Rehabilitation’s a critical part of stroke recovery. The purpose of a rehabilitation program is help patients regain as much of their independence as possible. This doesn’t mean they’ll return to precisely the way they were prior to the stroke.”
Fearing the worst, as her imagination ran away with her, Vicki said, “So, what, Dad’s going to be some kind of vegetable, someone we won’t even recognize? Is that it?”
“Victoria! Stop it! Stop doing this to yourself! Your father will be just fine, do you hear me? Do you hear me? Playing that what if game won’t help anybody, especially your father so just stop!” Nikki scolded her angrily, trying to keep her own fears from getting the best of her.
Silently, trembling, Vicki walked over to the window and stared out it blankly.
Kicking herself for losing her temper as she had, Nikki once again put her reading aside to go to her daughter. Silently, tenderly, she wrapped her arms around Vicki while she cried in her mother’s arms.
After a few minutes, Nikki lead her back to the couch and, taking her ice cold hands in hers and holding them tight, told her, “Angel, I want you to listen to me, alright. I know how scared you are. I know, but you have to remember one thing. Your father loves us, all of us! He loves you and he’ll do whatever he has to do to come back to us, so we need to just stay focussed on that and not lose sight of it, okay? Can you do that for me?” Nikki asked her quietly, tenderly, yet firmly.
Silently, as she tried her best to swallow her tears, knowing she couldn’t trust her voice, Victoria nodded and tried to control the sick feeling that was making her stomach roll around inside her. Without another word, she slowly rested her head on her mother’s shoulder and tried not to think about how close they were to losing the one person they’d all been able to count on; no matter what else was going on in all their lives.
Nikki was helpless to do anything but sit with her arms wrapped tightly around her daughter rocking her back and forth to try and calm her down.
After what seemed like forever, Victoria did finally calm down enough for Nikki to continue her research. “Rehabilitation–Rehabilitation can’t cure damaged brain. But it can help you relearn the best possible use of your body.
How long will rehabilitation last–Nobody can say precisely how long a stroke rehabilitation program should last. Each program is adapted to meet each stroke survivor’s individual needs. A program may also chance as your condition gets better.
Speech Therapy–Relearning speech and language–If a stroke damage the language centre in your brain, you’ll have difficulty understanding, speaking or making sense when you speak, read or write. You may also find it challenging pronouncing words. This speech challenge is referred to as aphasia. It’s common in individuals who’ve had a stroke involving their left cerebral hemisphere.
If you’ve got aphasia after your stroke, a speech therapist will work with you to relearn how to use language or develop other means of communicating. Even though your language skills may come back on their own during the first three months following your stroke, a speech therapist will likely become involved early on to make the most of the communication skills you do have. They’ll also help you improve your ability to swallow, and develop problem-solving and social skills you’ll need to cope following the stroke.”
“It sounds like they have to be well versed in everything, not just speech.” Nikki murmured, thinking aloud.
“Other ways of communicating–First, your speech therapist will assess your situation and the degree of your impairment then develop a strategy that’s best for you. This may include communicating via pictures, gestures, body or sign language, or something called a word board. This is something which displays single words or short phrases which somebody can point to so they can communicate with those around them. They work best for those who know what they want to say but cannot form the words themselves. Another means of improving communication may also include a mix of intensive exercises like repeating the therapist’s words, practising following directions, and doing reading or writing exercises. Computer-assisted communication is also sometimes utilized.”
“Long term goals– Once the speech recovery has stabilized after three months, the speech therapist will work with you to make the most of your remaining language function using a variety or a combination of strategies that fit your specific needs.”
“At least we’ll have some help then, that’s a comfort, right Victoria?”
When Victoria said nothing, Nikki again called her name, this time a little more forcefully; still nothing. Taking a closer look, she realized her daughter had finally, thankfully fallen asleep with her head on her shoulder.
Taking a nearby blanket, she wrapped it around Victoria and kissed her on the top of the head before pulling her close and taking a few moments to recognize just how lucky she was despite all of the turmoil in her life at the moment.
Refocusing, Nikki again threw herself into the research in front of her with a vengeance, although she did so quietly. “Medications–After your stroke, you might be prescribed one or more medications. It’s imperative you understand: what medicine(s) you’re taking, why you’re taking them; how you should take them (i.e. should they be taken with food?);when you should take them; what you should do if you forget to take them, are sick or run out; and what side- effects you should watch out for and report to your doctor. Most side-effects from medicines aren’t serious. But, some side-effects you should watch for and report. Ask the doctor or pharmacist to explain to you what side-effects you should watch for and report. The doctor might be able to make suggestions that can lessen or eliminate side-effects. The pharmacist can also help. Side-effects can sometimes happen because one medication is interacting with other medications you take, including over-the-counter/non-prescription or herbal remedies. Be sure your doctor (and/or pharmacist) know about any over-the-counter medications, herbal remedies or vitamin supplements you take. Never stop taking your medicine or change the dose without consulting your doctor. In some cases, suddenly stopping your medication can be dangerous.”
“They’re probably talking about drug interaction and withdrawals or some other side- effects.”
“Hi Anna, is there any news?” Nikki asked hopefully.
“No, sorry, not yet. I thought you could use this,” the nurse said as she handed her a bottle of juice and a sandwich.
“I don’t have much of an appetite, but thank you.” Nikki told her as she set them down on the table beside her.
“If you need anything, I’m at the front desk.”
“Thank you.” Nikki answered politely before watching the sweet woman walk back to her post and turning her attention back to her reading once again.
“Blood pressure-lowering medicines– These medicines are known as anti-hypertensives because they treat hypertension or high blood pressure. There are lots of different kids of blood pressure-lowering medicines. The doctor will work with you to find the medication, or combination of medications, that’s best for you. It’s important to take blood pressure-lowering medicines regularly, as directed by your doctor.”
“No kidding, otherwise they won’t work!” Nikki snapped, feeling the familiar signs of exhaustion, anxiety and frustration creeping in once again.
Deciding to take somewhat of a break, Nikki let her mind wander back in time, back to when she’d married Victor for the last time and then to when they’d found out they’d be parents again. She smiled at the memories and then felt a familiar, strong kick.
“It’s amazing how they can pick up on my mood.” Nikki thought to herself aloud with a small smile.
“And they’re definitely happier when I’m in a better mood.”
Another strong kick caught her attention. “Apparently they like it better when I’ve got a full stomach too.”
Taking the none too subtle hint, she began to eat as she continued with her reading. “Blood Thinners–Blood thinners help to decreased the development of blood clots that can cause strokes. There are two categories of blood thinners: anti coagulants and antiplatelet medicines. Anticoagulants include heparin (a medication that’s administered by injection in the hospital) and warfarin, which comes in a pill If you’re taking warfarin, you may need to have your blood tested regularly to make sure you have the right level of medicine in your blood. Antiplatelet medications (Platelet Aggregation Inhibitors) keep small blood cells called platelets from sticking together and making blood clots form. There are many types antiplatelet medicines. If you’re taking an anticoagulant or antiplatelet medicine, you might bleed more than usual, so try and avoid injuries and falls. When you go to the dentist, another doctor or have a medical treatment or surgery, make sure to tell him or her that you’re taking a blood thinner.”
“It would probably take longer to heal too,” Nikki murmured thoughtfully before continuing.
“Cholesterol-lowering medications–If your blood cholesterol level’s too high, your doctor will recommend that you change your diet, lose weight, or get more physically active. If your cholesterol doesn’t get back to a healthy level, medicines might also be prescribed. There are lots of types or classes of cholesterol-lowering medicines.
Medicines for high cholesterol–Medication therapy is an option for those who can’t lower their cholesterol with lifestyle changes alone. Statins are the group of medicine that’s usually the first choice of medication used for lowering high cholesterol. They might be used if someone’s considered a high risk for a heart attack or stroke, regardless of his or her cholesterol level. No matter what medicines you’re given, it’s critical to know what medicine and what dose you’re taking, and any potential side-effects to watch for. It’s extremely important that you take your medicines. Consult your doctor regarding alternatives if you feel any unpleasant side-effects, or talk to your pharmacist for further information regarding your medicines.”
Medication Types– Statins–These medications block a liver enzyme that’s needed to make cholesterol. Because of this, your liver produces less cholesterol and picks up LDL ‘bad’ cholesterol from your blood stream. These medicines are very effective and lower LDL-cholesterol by up to fifty-five percent. They’re the most widely prescribed cholesterol lowering medication. Despite the frequency of side-effects with these medicines generally being very low, headache, muscle pain and weakness, and high liver enzymes might happen. Your doctor might do a simple blood test after beginning statin therapy to rule out any serious side-effects.”
“With all these medicines, you’d think there would be something Victor could have taken! That’s if he was willing to follow doctor’s orders; and I know better than anybody what the chances of that were!” Nikki snapped as she thought of just how much disdain Victor had for following anybody’s advice, let alone their orders!
“Cholesterol absorption inhibitors–Right now, there’s only one cholesterol absorption inhibitor you can get in Canada. It works by stopping your body from absorbing and storing cholesterol in your liver and improving how cholesterol’s cleared from your blood. This medication aids in lowering the levels of total and LDL-cholesterol in your blood. It’s only prescribed when your cholesterol can’t be controlled with proper diet and exercise. This should always be used as part of a healthy living plan, which includes eating a lower-fat, low-cholesterol diet and exercising regularly.”
“Bile acid sequestrants/resins– The body uses cholesterol used to make bile; an acid used in digestion. Bile acid sequestrants bind to bile–keeping ti from being used during digestion. Because of this, the liver produces more bile and the more it produces, the more LDL ‘bad cholesterol it needs–meaning there’s less LDL-cholesterol flowing through the blood. These medications can cut cholesterol by twenty percent.”
“I really hope Victor will realize just what I’m doing for him here. I just killed my appetite! Yuck! I need to read this when I’m going to eat junk food I now I shouldn’t eat!” Nikki exclaimed disgusted.
Putting aside her sandwich, she continued. “Fibric acids/fibrates–These medicines break down triglycerides and are used to treat very high triglycerides. They may bring about muscle discomfort or fatigue. They’re occasionally used in conjunction with other cholesterol lowering medicines.
Niacin–This works by slowing the liver’s production of the chemicals that help produce LDL ‘bad’ cholesterol. It considerably raises HDL ‘good’ cholesterol. It’s a form of vitamin B that should only be taken as a cholesterol lowering medicine when prescribed by your doctor. Side-effects can include flushing in the upper body and face.”
Though she’d been fighting it for hours now, Nikki finally gave in to the fog of sleep quickly overwhelming her as she leaned her head against her daughter’s and fell asleep.