Swallowing hard against the bitter taste of worry and fear now in every corner of her mouth, Nikki read on. “A blood clot travels through the arteries and gets stuck–Some individuals with heart problems may develop clots in the heart. A clot might break loose and travel through the arteries. If it travels to the brain, it can get stuck in a small artery. This would block blood flow and damage would result. This is called an ischemic stroke.” Still a little confused, Nikki looked up at Casey.
“You’re doing fine.”
“I’m not even sure how to pronounce half of these words, let alone what any of them really mean.” Nikki admitted with a little smile.
“You’re doing well so far. Remeber, I’m here if you want to ask me anything.”
Nodding, Nikki continued. “One of the arteries bursts–When an artery in the brain bursts, blood leaks out and damages that part of the brain. High blood pressure can cause this, so can a defective artery at birth. This kind of stroke may happen in younger individuals. It’s called a haemorrhagic stroke.”
As angry tears burned her eyes, Nikki whispered, a bitter, furious edge to her voice, “Damn it, Victor knew he needed to stay in town, he knew his blood pressure wasn’t where it should have been, why didn’t he listen to any of us?” Seething, she slammed the binder shut and paced to the window.
“Nikki, come on. Let’s go for a walk. It’ll do you some good.”
“I’m staying put Casey.”
“Damn it Nikki! Why do you always have to be so stubborn?”
“Up until now, it’s worked pretty well for me-I stick with what works!” Nikki shot back sarcastically, angrily.
Shaking her head, Casey folded her arms and resigned herself to the situation, ‘I swear, sometimes Nikki has the hardest head of anybody I know, except for Victor!’ She thought to herself shaking her head.
“What do you expect me to do, sit here knitting?”
“No, but driving yourself crazy worrying about a situation we have no details on isn’t going to do you a damn bit of good! Neither will reading all the medical research you can get your hands on! It’s not going to do any good, not until we know what’s going on!”
“It’s better than sitting here doing nothing while my husband is in there fighting for his life! If you don’t understand that, if you can’t understand that, then leave!”
“Not a chance, sweetheart! I’m not going to leave you all alone and have you self destruct!”
“I’m stronger than you think!”
“Nikki I’m on your side! When are you going to get that?”
“Then help me understand all this research!”
“Okay. Apparently I have not other choice!”
“That’s not true.” Nikki told her pointedly. Then, rethinking her position a little bit, she said, “Casey, I’m not trying to make this any harder on you, believe me, I’m not. All I’m trying to do is the best I can, whatever I can to help Victor; to make sure he can come out of this and come home!”
“And I’m not disagreeing with you on that. I just wish you’d cut yourself a little more slack, that’s all.”
“At this point, I can’t afford to do that.”
Letting out a somewhat tired, somewhat frustrated sigh, Casey begrudgingly relented. “Fine, for now.”
Satisfied Casey wouldn’t try to dissuade her from doing what she felt she had to do, what she knew she had to do, Nikki continued. “Outside pressure on a brain artery–A tumor, infection or brain swelling may cause pressure on a brain artery and cut off blood supply to that area. Each stroke is different. Stroke recovery depends on which part of the brain was affected and how much was damaged. Some individuals suffer a mild stroke, meaning there is very little injury to the brain. These individuals usually recover fully or with few challenges. Others might have a severe stroke in which a lot of damage is done. In these cases, it might take a long time for stroke survivors to regain even partial use of their arms, legs, speech or whatever has been affected. The individual’s general health, personality and emotional state, the support of family and loved ones, and rehabilitation are all significant factors in the recovery process.”
Turning to Casey, she asked, “So, even if Victor did have a stroke, there’s no telling how long it’ll take him to recover, or how bad it was?”
“Nikki, we don’t even know if that’s the case.”
“Just answer me, please, Casey I need to know!”
“No, there’s no telling how long it will take him to recover, not with out us knowing for sure if that’s what really happened.”
“If it is?” Nikki asked fearfully.
“If it is, the doctors will want to run some tests to find out what areas were affected and how severe the effects were/are.” Casey answered honestly, without trying to give her too much information ‘The less she knows the better, this is taking a huge tole on her!’
“As for how bad the stroke-if Victor even had one-was and how severe it was, how it affected him, they won’t know that for sure until he wakes up. I’m sorry, sis.”
“Don’t be. None of this is your fault,” Nikki answered before she continued on her quest to find out as much information as she could in an effort to somehow help the man she loved.
“Definition/explanation of TIAs: A TIA (short for Transient ischemic Attack) is a mini stroke caused by a temporarily blocked blood vessel. It leaves no permanent brain damage. In approximately ten percent of cases, a TIA occurs before a stroke. TIAs are a crucial warning that an individual may be about to have a stroke and should not be ignored. By getting prompt medical treatment, individuals who’ve had a TIA can possibly reduce the risk of a full-blown stroke.
Causes of TIAs: TIAs can happen when an artery supplying oxygen and nutrients to the brian gets blocked. The part of the brain supplied by that artery doesn’t get the blood it needs. If the brain cells don’t receive sufficient oxygen and nutrients, they begin to die. Brain cells die very fast, in approximately four to six minutes. Several conditions can bring about TIAs. The primary cause is atherosclerosis, or hardening of the arteries. Other possible causes for TIAs include: spasms in the arteries of the brain, abnormalities in the shape of blood vessels, certain blood disorders that can cause inflamation of the arteries in the brain, abnormal blood pressure changes, uncontrolled bleeding (haemorrhage) in the brain caused by structural challenge with blood vessels in the brain. These structural challenges include aneurysms and arterio…..” Nikki’s voice faded away, unable believe what she was reading.
“Arteriovenous malformations or AVM for short.” Casey finished as she sat beside her sister, silently taking her hand and giving it a little squeeze before asking, “Are you sure you want to keep going?”
Silently, Nikki nodded and, trying to ignore the fear bubbling up inside her continued. “These could all cause problems with blood supply to the brain. In some cases doctors are unable to determine the cause of a TIA.”
Turning to her sister, she asked fearfully, “What if they can’t find the cause? What happens then?”
“I don’t know. I’ve never had it happen or heard about it happening.” Casey answered honestly, wishing she could be more helpful for her sister at a time when she needed it more than anything.
Undeterred, Nikki trudged on with her research. “Brain damage may affect the way individuals move, feel, behave, talk and think. Some areas of the brain will function normally and some will not. How a stroke affects an individual depends on the location of the stroke; how serious the stroke was; and the person’s age, health and personality prior to the stroke.”
“Effects of Stroke: Although strokes don’t ruin people’s lives, they do change them. Although some individuals will be severely disabled many stroke survivors can and do recover to lead meaningful lives. They do this through their own natural body healing and/or through stroke rehabilitation programs. In addition to this, families, friends and relatives can provide valuable support. Each stroke is different. Despite the fact that a stroke doesn’t affect any two individuals in precisely the same way, it often brings similar challenges. Common stroke effects include: Paralysis or weakness of one side of the body–This is one of the most common effects of stroke. The weakness usually happens on the side of the body opposite the side of the brain where the injury took place. As an example, if the injury took place on the left side of the brain, the right side of the body may be weakened or paralysed. (Strokes that happen in the brainstem do not follow this pattern.)”
Turning to Casey, she asked, “Why not? Why do those kind of strokes follow a different pattern?”
“That’s not really clear yet, my guess is because different parts of the brain work differently and strokes can be very minor or very severe, depending on where they happen.” Casey answered honestly.
“When they say weakness, does that mean paralysis? Is it permanent? What’s the treatment?”
“Nikki, We don’t even know if there’s been paralysis or anything else about how the stroke affected him, we’re guessing at this point, dealing in suppositions!” Hesitating only a moment, she said, “I’m sorry, I’m not being very helpful am I? I guess-“
“Casey, you are. If it weren’t for you, I probably would’ve been thrown out already for harassing the staff.” Nikki told her with a half smile.
Sobering, she continued. “The pattern and time needed to recover varies from individual to individual. Paralysis or weakness on one side may result in stroke survivors neglecting the weak side of their bodies. Other changes stemming from paralysis include challenges walking, or bumping into things.
Challenges with vision are fairly common following a stroke. Some survivors lose part of their vision in one or both eyes. This condition is called a visual field deficit. Individuals with a visual field deficit may only see food on one side of their plates, or be able to read only one side of a written page.”
“How do I help Victor if that happens?”
“If that happens, and that’s a big if, put things on his good side. The side he doesn’t have trouble seeing on. That’ll make it easier for him to see what’s in front of him. For some people, turning their heads also helps them see more on the side with the deficit. “
“Good to know,” Nikki said before continuing with her research.
“Individuals who have had a stroke in the brainstem may have double vision. In this case, a stroke rehabilitation team may prescribe special glasses or patients may wear eye patches to help counteract double vision.”
Strangely enough, as she read on about all the treatments and information that surrounded strokes, Nikki began to relax a little.
A little more relaxed than she was when she first started, Nikki continued. “A…A…”
“Aphasia. It’s a tongue twister, it’s actually pronounced ah-faz-ee-ah.”
“Thanks. You always were the one who was good with big words.”
“Yeah, mostly, I just did it to drive you crazy.”
“Any time.” Casey’s smirk made Nikki chuckle in spite of herself.
“Casey, what is that?”
“It’s a challenge in using or understanding language. Strokes can affect people’s ability to talk, read and write, or understand other people’s speech. Other individuals might have trouble understanding what a stroke survivor suffering from aphasia is saying. Another challenge brought on by a stroke may be dysarthria pronounced dis-ar-three-ah or slurred speech. ” Casey put in helpfully before continuing. “People who’ve had strokes often feel really tired. It often takes more energy to do things after a stroke. Not getting enough exercise, not eating right or depression can also cause a stroke survivor to feel tired.
Up to half of all survivors might become depressed for up to two years following a stroke. This can be directly because of the brain damage, but it’s also a common reaction to any severe illness. Survivors get depressed because they don’t feel they’re healthy, productive people anymore. They need to be encouraged to share these feelings during this challenging period.”
Nikki had been sitting quietly, listening intently to the explanations her sister had given for the more difficult terms before she continued. “Emotional expression and la…la…”
“Lability, pronounced LAH-bill-ity.”
“Thanks, what is it?”
“It’s a term used to describe emotional responses that are exaggerated or aren’t suited to a particular situation. For example, outbursts of anger, moaning, laughing uncontrollably for little or no reason are common results of this condition. What caregivers need to understand is that this is because of the stroke and the survivor can’t control it. A lot of times, people who’ve had strokes can’t make sense of their emotions either and may be embarrassed by them. They need reassurance that these are common changes after a stroke and they’re not ‘going crazy.’”
Thinking it was better to ask than assume anything, Casey asked, “We’ve been at this for quite awhile. Do you want to take a break or keep going?”
“Okay, if you’re sure.”
“I’m sure. For the first time since I found Victor in his office, I finally feel like I have a way I might be able to help him. The more I read, the more I learn, the stronger that feeling gets. I need to keep going Casey.”
“Okay, it’s your call.”
“I’m not doing much, but you’re welcome.”
With a little smile and a small shake of her head, Nikki told her, “You’re wrong. You being here’s doing more than you know.”
Without waiting for an answer, Nikki trudged on. “Survivors may also have memory challenges or challenges learning and remembering new information.”
“Damage to the brain can result in survivors having less control over their positive or negative emotions. This can change how they behave or interact with others. For example, they can become impulsive, have extreme mood swings or be stubborn, selfish or demanding. They can become indifferent or uninterested in everything around them. This behaviour may be upsetting to caregivers and family.–No kidding, I wonder why?–” Nikki ended on a very sarcastic, bitter note before continuing. “Survivors may have no idea what they’re doing to the people around them. All survivors are struggling to cope with a significant threat to their self-esteem. Learning to live with these changes takes time. Luckily, most survivors recover from these personality changes.” As she stopped to consider what she just read, she thought to herself aloud, “That’s good, at least some of the effects may be temporary.”
“That’s right. They’re not all permanent.” Casey agreed reassuringly before saying, “I’m going to get some coffee. Do you want anything?”
“You sure? You need to eat, and so do they,” Casey added putting a gentle hand over her sisters rounded stomach.
“Trust me, Casey, they eat well, really well. Remember Miguel?”
“Not good enough. I’m bringing you back something. Hush up and don’t argue. You won’t win.”
“Fine. I’ll see you later.” Nikki couldn’t help but smile as she watched Casey walk out of the waiting room and towards the elevator. “She always did fuss over me way too much.”
Sobering, she continued. “Following a stroke, how an individual sees everyday things may change. Survivors may not recognize familiar things or know how to use them. They might also find things such as telling time difficult to understand. For this reason, planning and carrying out simple activities can be challenging. This may be frustrating to accept, so patience and understanding are necessary.”
In the ICU, nurses and doctors had been in and out of Victor’s room since he’d come out of surgery.
It had been hours and the doctors were finally considering letting Nikki see him when the very thing they were dreading happened. The nurse ran as fast as she could to the front desk.
“Page Dr. Cornwell and Dr. Thorton stat! Find Dr. Hoffman as well! Get them here as soon as you can! We don’t have a second to lose!”
“Why? What happened?” The nurse at the front desk asked alarmed.
“Just get them!”
Unaware of the turmoil brewing in Victor’s room, Nikki stood at the window in the waiting room and wondered, ‘How much longer are they going to take? Why haven’t I seen anybody yet? Why hasn’t anybody told me anything?! They must know something by now!” Angry and frustrated, she began pacing the small room.
“Nikki, as soon as they know something for sure, they’ll come talk to us. Come and sit down.” Casey tried to reassure her as she lead her back to the couch to sit and talk.
Nikki said nothing as she stared straight ahead blankly.
Taking her sister’s ice cold hands in hers and rubbing them, Casey told her softly, “I know this is difficult for you. It’s probably the hardest thing you’ve ever had to deal with, but you have to stay strong. Victor needs you to stay strong.”
“What if he doesn’t make it Casey? What if he doesn’t make it? What am I supposed to do then? Casey, I can’t lose him! I can’t!”
Wordlessly, her heart breaking for her sister, Casey wrapped her arms around her and rocked her back and forth. Pulling back, and drying her tears, Nikki whispered, “I’m sorry. I know I shouldn’t be this upset. We don’t even know what’s going on, I’m being ridiculous.”
“You’re not. You’re being a woman in love with her husband who wants to know what’s going on. It’s me Nikki. Don’t worry. I understand.”
After taking a few minutes to pull herself together, Nikki continued with the information Casey had given her. “There are two types of aphasia-expressive and receptive. Some stroke survivors might have both. When individuals have expressive aphasia, they know what they want to say but can’t make the words come out right. Individuals with receptive aphasia might not understand what others are saying to them, but it might look like they do. Aphasia can also make it hard to read, write or do math. As a caregiver, it can be frustrating to communicate with someone with aphasia. Survivors haven’t lost intelligence or common sense. Instead, the challenge for them is saying what they’re thinking. It is equally frustrating for survivors not to be able to communicate effectively. Some individuals with aphasia can improve their use of language within a few months. Others will have permanent language challenges. Even if individuals don’t get the full use of language back, they might be able to learn to communicate effectively despite their aphasia.”
Feeling a sick sense of worry growing in the pit of her stomach, Nikki asked, “How do they know whether the problems with language are permanent and what do they do if they are?”
“That all depends on the individual patient, their health before the stroke, the treatment they receive and support from family and friends, to name a few things.” Now back with tea and coffee and something for both of them to eat, Casey told her honestly, regretfully, “I wish I could give you more to work with here.”
“You’re being honest with me. That’s what I need right now more than anything.”
With her hands shaking and her eyes beginning to itch, Nikki went on with the research.”When talking to someone with aphasia, use short, simple sentences. In addition, use gestures to help describe what you’re saying. Pictures can help. Stand where the person can see you and read your lips or facial expression. If the survivors speech is restricted, ask questions that he or she can answer ‘yes’ or ‘no’ to. Make sure to allow the survivor enough time to answer. Keep in mind that it’s easier for individuals with aphasia to understand if there’s only one person talking at a time. Try to keep background noise e.g. tv and radio to a minimum. Don’t pretend to understand the stroke survivor. Be honest and tell them, ‘I’m sorry. I don’t understand. Let’s try again later.’ Encourage the survivor to be as independent as possible and to keep enjoying favourite activities. While some activities may be challenging (e.g. reading), substitutions can be made (e.g. listening to books on tape). Work closely with the speech/language pathologist to improve and keep up communication skills. Be fully aware that survivors may not want to see friends and relatives until they’ve improved their communication skills. Respect this wish, but slowly try to increase their chances to meet with other people. Most of all, keep in mind that individuals with aphasia are as smart as they used to be. Keep treating them like adults. Don’t talk about them in their presence, even if they don’t seem to be able to understand what’s being said. Always assume that an individual with aphasia will understand and want to be part of the discussion.”
“In addition to challenges with reading, talking, thinking or doing math, a stroke survivor’s behaviour may become more slow and cautious than usual. He or she may have difficulty learning or remembering new information. To finish tasks, he or she may need frequent instructions and feedback. The survivor may have difficulty dealing with general concepts.
If the stroke happened on the right side of the brain, possible effects include: weakness on the left side of the body. Vision challenges (i.e. challenges telling distance, depth, difference between up and down or between front and back) can make it difficult to pick up objects, button shirts or tie shoes. It can cause challenges understanding maps as well.
Individuals may also have trouble with short-term memory. They may be able to remember something that took place years ago, but not something they did a few minutes ago. Individuals with paralysis or weakness on one side of the body may ignore body parts i.e. arms or legs on that side.”
“Brain stem strokes are an uncommon form of stroke. The brain stem is the area at the very base of the brain, right above the spinal cord. If an individual has a stroke in the brain stem, he or she can have difficulty with: breathing and heart function, body temperature control, balance and coordination, weakness or paralysis of the arms and legs on both sides of the body, chewing, swallowing and speaking.” Parchment white, Nikki sat stone still and tried to take in all she’d just read. Silently, she prayed, ‘Please God, don’t let him die! He has to be okay, he has to be!’