Inside a Transient Ischemic Attack (TIA): A Personal Journey

Out to Pastoral

by John Idol

BURLINGTON North Carolina—Weekly Hubris)—1/9/12—Why a non-smoker, light drinker, and only slightly overweight man with low blood pressure and non-elevated cholesterol should be hit with five TIAs in just over a year is something of a puzzle to me. Puzzle or not, I have to deal with them, driven by the fear—supported by the medical community—that these TIAs are often a prelude to The Big One, the stroke capable of disabling or killing me.

My first TIA, experienced in late December of 2010, was the subject of an earlier essay (https://weeklyhubris.com/2011/01/03/knocked-flat-by-a-t-i-a/). Though scary, it was mild, lasting less than an hour and leading to a regimen of Plavix and Zocar. It brought on slurred speech, temporary paralysis of my right side, and problems, long range, with balance. I was told that if The Big One were coming, it would likely strike me within three months.

That time came and went and with it no sign of even A Little One. “Great,” I thought. “Plavix is doing everything the TV commercial claims.” I put in a summer and early fall of normal activity, including some sweaty labor in my small garden. But bodily forces were building, silently, to bring me down.

My second TIA sneaked in (on October 18) as I sat on a couch near my wife, with whom I’d been watching the evening news on the local CBS affiliate in Greensboro. No blood-pressure-raising news, such as Newt Gingrich’s announcing a run for the White House. Just an ordinary day with nothing really exciting going on. Suddenly, my right arm and leg grew stiff, immovable, dead to the touch; my tongue seemed to coil into a wad of rubber, rendering me incapable of producing any comprehensible sound; and my vision turned cloudy.

I later learned that the double vision I’d experienced during the day was an early warning of a TIA’s advent.

My wife and I live in a retirement center equipped to respond quickly to alerts, and soon members of three response teams, EMS, the Burlington Fire Department, and on-site nursing staff rushed to our apartment. A quick exam of my state led to a decision to get me post haste to Moses Cone Hospital in nearby Greensboro, with its widely recognized success in treating strokes. With the siren screaming the whole time and speed limits apparently disregarded, the ambulance transporting me got me there well within the three-hour window for treatment with tissue plasminogen activator (tPA). Lucky thing, too, for I was not coming out of this attack on my own.

The attending doctor later told me, “You were in terrible shape when they brought you in here.” Indeed I was, and this second one will be the focus of my current essay; only the fourth one, occurring on December 28, being as vivid in my memory—due to its being equally traumatic.

The inside story of a TIA yields a narrative captured by a reeling brain, a brain despairing, fearful, inquisitive, confused, hopeful, and committed. What if I don’t recover and leave my semi-invalid wife unable to carry on? What if I become paralyzed on the left side as well? What measures can be taken to prevent more episodes like this? What in my life-style brought this on, especially since from around the age of 35, I have followed a diet that would normally not engender clots? Oh, this too will pass and I’ll get on with books and essays I have planned to write. I’m determined to beat this thing and live to be 95, at which point I’ll collect the last check of my annuity and take my place in the family graveyard on Idol Mountain. That’s really something I mean to do and no TIA will keep me from it!

Such thoughts as these flooded my mind as the ambulance sped to Moses Cone Hospital. Once in the emergency room there, I had no leisure for musing. Transferred to a hospital gurney, I was rushed down halls and around corners; brought to rooms for a CT scan and MRI. The quick turns and jolts in the seeming maze that led to those machines stirred up an ancient problem, motion sickness, and resulted in my retching onto my shirt and the hands of the nurses pushing the gurney. What an embarrassment! Nausea! Something I’d not experienced since boyhood days on the curvy roads of the Great Blue Ridge Mountains!

My emissions scrubbed from me, I underwent tests by those wondrous machines, one almost whisper-quiet; the other sounding off with whirrs, pecks, knocks, hammerings, and other noises unique to itself.

They yielded vital information: no bleeding in my brain. Thus, it was OK to shoot me up with a round of tPA.

Wheeled off to intensive care, I awaited recovery as my niece, Sonya, and my wife stood by my bed. Still tongue-tied, I spoke mostly garbled words, a few of which Sonya understood. Trained in phonetics, I knew how explosives, bi-labial consonants, fricatives, and sibilants were produced, but my rubber ball of a tongue and partially paralyzed lips yielded only heavily slurred speech, despite my desperate efforts to make myself understood. Is it my fate, I wondered, never again to speak intelligible words or once more sing a song? The thought was depressing. Deeply so.

How much more depressing must it be for stroke victims who never regain the ability to speak? If their brains, like mine at the moment, heard and understood everything said to them, how utterly frustrating must it be not to reply?

As I pondered these possibilities, I sensed that my right arm and leg could move. To the delight of my niece and wife, I wiggled my fingers slowly and pumped my right foot forward and backwards. I was decidedly coming around.

The attending neurologist now entered the room and proceeded to test my responses to his commands: “Smile, open your eyes wide, squeeze my fingers with both hands, raise your right leg and don’t let me push it down, count the number of fingers I’m showing you, follow the movement of this finger with your eyes only, tell me your birthday and where you are,” he rattled off.

I answered him with slurred speech, like that of drunk, but understandable enough to give me hope that I could speak comforting words to my wife and niece before, at two  in the morning, they headed back to Burlington. Those words came. Their homeward journey left me free to contemplate, and marvel at, how fortunate I was to have received the tPA in time. The realm of incommunicability and immobility I might have entered, never to emerge,had been avoided. At least for the time being.

The TIA of 28 December came too soon for help from a tPA, since at least three months must pass between injections of this wonder-working drug. My body’s inherent clot-busting talents had to bring me around this time. Nearly six, long, angst-filled hours passed as my body’s housekeeping abilities advanced far enough along to produce for Sonya and my wife wiggling fingers and toes and responses to the commands of the neurologist. Now, after a shift from Plavix to Aggrenox (a more potent blood thinner), I hope to be ever free of TIAs. But somehow, I feel that that hope is hollow . . .

Editor’s Note: Some online resources providing further information on TIAs and strokes: http://usgovinfo.about.com/od/medicalnews/a/strokewarn.htm; http://www.strokeassociation.org/STROKEORG/WarningSigns/Warning-Signs_UCM_308528_SubHomePage.jsp; http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/stroke_signs_and_symptoms?open.

Also: A video by Dr. Jill Bolte Taylor, describing, vividly, and from a scientist’s point of view, her own stroke: http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html.