in addition to playing piano, tying flies, and wading trout streams, my stroke robbed me of the ability to do watercolors. The painting above was done in 2003. The painting below was done in 1999. The third picture painting was done when I was a junior in high school.
When last we left off, I had just failed a driving test administered by an instructor under contract to the hospital. My suspicion was that he was incentivized to fail patients the first go around so he could encourage them to go through another round of physical therapy. (money in his pockets, money in the hospital’s pockets). By the same token, however, I could appreciate that many stroke victims or others with cognitive disabilities believe they are perfectly capable of driving.
With this in mind, who was I to think that I wasn’t in the same boat? As I explained to Dr. I, the actual patient remains the one most suited to evaluating his or her condition. Of course, impaired patients can have a warped sense of competency, but isn’t trust a critical component in the doctor-patient relationship? “Trust me,” I urged Dr. I. “Even though my instructor, for whatever reasons, tried to knock me off my game, I still should have passed.”
Needless to say, I did not mention my unwillingness to cough up another $460 out of pocket to repeat the test.
Barely concealing his exasperation, Dr. I made a proposal: “You can take a driving test from a repeatable private instructor, and if you pass the test I will reconsider.”
I cannot recall the name of the instructor with A Adams School of Driving who picked me up three days later for a driving test at a cost of $90, but all the stress and anxiety roiling around this “make-good” test vanished when a jovial, somewhat rumpled man, who looked at least 60, pulled up at the hospital entrance (where I was waiting) and greeted me with, “Are you ready to tear up some road, young fellow?”
I scored 99 out of 100 points ( I apparently forgot to adjust my side view mirror upon entering the car). What a relief! My name would not be on the list of patients that Dr. I periodically forwarded to the Secretary of State, along with his recommendation that their driving licenses be temporarily “pulled” pending further medical review. Thus, I was spared the need to drive without a valid license, always looking over my shoulder for approaching cops, never exceeding the speed limit, because, truth to tell, there was no way I would had completely given up driving.
A Visit from Dr. M
I should note that although I was nearly 10 days into my hospitalization and had managed to reinstate myself as a qualified driver, I had only seen Dr. M once. As you may recall, Dr. M was the neurologist assigned to my case after I had my first stroke. I quickly became enamored of the man, and initially was much reassured by his conviction that my likelihood of getting a second stroke was no greater then the likelihood of any male my age getting a stroke.
On the second day of my hospitalization, Dr. M strolled in my room with a retinue of about eight people, including his nurse, a resident neurologist who he was mentoring, and several medical students. “This is not exactly the place I would want to be seeing you,” said, perhaps a tad too glibly. “So, tell me what happened.” I told him that I had suffered a stroke at the Charleston airport.
” When did that happen?” he asked.
When I told him that it had happened nearly a week earlier, his response was not unexpected. “So, you admitted yourself to the hospital yesterday, five days after the stroke episode.”
“I assumed it was diakaeisis,” I responded.
Now, to put my response into fuller context, please allow me to provide a little background. In the year and a half that intervened between receiving Dr. M’s optimistic prognosis regarding the likelihood that I would suffer another stroke and the onset of my second stroke, I in fact experienced numerous attacks of what certainly seemed to be transient ischemic attacks, or “mini strokes,” When I brought these to the attention of Dr. M, he dismissed them as episodes of what he called “diakaeisis,” a fairly common phenomenon among stroke victims in which the brain, already traumatized by stroke, reacts to fatigue, minor illness, or prolonged stress by replicating the symptoms of a stroke.
Even after a follow-up MIR indicated that my dissection had not fully closed, Dr. M still felt comfortable with his approach to my post-stroke treatment regimen — doing no more than maintaining me on a blood thinner. I had read the literature on dissection strokes, and in most cases, Dr. M’s approach was the recommended one. Dissection strokes do tend to heal spontaneously. However, harking back to my “The patient knows best,” argument, the constant onslaught of stroke like symptoms demanded further intervention. Dr. M had alluded to the insertion of a stent to block the flow of blood in the area of the dissection.
In hindsight, I should have demanded the stent, even given the four-percent odds that it could trigger significant internal bleeding. Instead, I continued to complain about the frequent bouts of diakaeisis. At one point, I even checked herself into the emergency room, convinced that I was having another stroke. I was given a CAT scan (as opposed to more to the more discerning and costly MRI), which revealed no evidence of recent damage in my brain. What the scan did show, however, was that the tear in my carotid artery still had not completely closed.
A couple of months later, I pulled up in front of Evanston Hospital and contacted Dr M’s nurse, telling her that I was about ready to check into the emergency room because earlier in the day I had been in a state of near left-side paralysis. When she asked me how I felt at that time, I said that it had abated to the extent that I could leave work, get into my car, and drive to the hospital.
“The time to be concerned would be if you had a symptom like that and it did not eventually abate,” she responded. Crestfallen and relieved by about equal measure, I drove home.
If I may pick up where I left off, when I told Dr. M that I assumed my symptoms in Charleston were no more than diakaesis, his response, in typical Dr. M fashion, was sort of out in left field. “You know, what’s ironic is that when I got the news of your hospitalization, I was in Rochester at a stroke symposium,” he responded jovially. “Your case was actually on the agenda. “You are what we neurologists call a ‘head scratcher.'”
from what I recall, Dr. M explained that the none of the roughly 60 neurologists at the symposium could recall treating a patient with a dissection stroke who experienced numbness in other stroke like symptoms on almost a daily basis.”
What I wanted to say was, ” for God’s sake, as if though that wasn’t a cascade of yellow flags!” instead, I said something inane, along the lines of, “I guess I’m famous now?
Dr. M chuckled. “Time will tell.” ( In hindsight, what was that supposed to mean?)
if any encouraging news came out of our interview, it was that Dr. M, perhaps observing that the proverbial horse had nearly knocked the barn door off its hinges, decided to take a more aggressive approach to my treatment protocol: he would order the insertion of a stent, forthwith. The procedure will be scheduled for two weeks hence.