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Joseph S.


A Beautiful Stroke

I had a beautiful stroke 3 years ago.  I was blessed to be conscious throughout the entire event (an extreme rarity) from the first moment a clot traveled to my brain.  The disorientation was perplexing.

I'll miss the stroke.

Really. Don't get me wrong. Sure it was scary afterwards when I understood what the Hell had occurred. The kids, my family, a presentation to give and tomorrow is trash day! But oh how fascinating it was when my mind was co-opt and somewhere between PS (pre-stroke) and afterwards when the "event" was over. But during the stroke which felt like it lasted about 4 hours. There is one (that I can recall) caveat. While the stroke was occurring, linear time does not occur during a left-hemisphere ischemic stroke. There was no past remember and there was not future to consider/worry/think about. There was only the present. And for the only time in my humble adult life I was aware, living in, thinking in solely in the moment and then the following moment and so on. I couldn't consider the next second let alone tomorrow. And as a result of "Being Present" for those hours I was as content and tranquil as I had ever been. And so now when I say I "miss the stroke" perhaps you'll better understand. Other than stress (and who doesn't have it), I was 38 years old, in the best shape of my life. 9% body fat, 158 cholesterol, BP of 120/70, eating right, working out like a freak. Never smoked, only an occasional drink. So, if that doesn't help, maybe I'll start smoking, ravenously wolf down steaks every night, swill martinis before dinner and gulp Scotch at the end of meals.

At some point, a clot moved to my left hemisphere and caused the stroke. In an ischemic stroke blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. 87% of all strokes are classified as "ischemic."

Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-40% of all ischemic strokes. And despite the alien abduction like slew of tests and procedures the reason for my stroke is still a mystery.

What Happened: The Rug pulled out from under

Things started innocently enough. We moved to Colorado from Connecticut 8 months earlier and we had the joy of moving 5 places in those 8 months with two under 5 year old kids in tow. But we had finally settled on the house that was going to become our home. A recent home we bought no more than 3 days and I was heading to our rental home 1.5 miles away. All was left to do was for me to meet to a couple to look at and buy a rug from the rental and then I was heading home for the day. The couple seemed nice enough. Rather non-descript late 30ish/early 40ish. Not gregarious but polite. If I were to guess, they were accountants.

Back and forth they wondered whether it would fit in the room they were planning on them. Not really wanting to keep it any longer, nor did I want to get rid of it, I substantially discounted the asking price as to further incite them to purchase it. "You know, I know it is a little larger than the room you have, but I've done the same. Just fold it under the rug where the couch is going to go. Worked great for us." That sold it.

My Silent Movers

So I rolled up the rug and it started relatively well though we clearly knew this was going to be a heavy job. The husband was in front and I was in the back. It was only slight easier to moving a king mattress. After a little of heavy breathing we collected ourselves for the carry up the stairs and turning the first landing. We cleared the landing and were half-way up and took a moment to catch our breath. On this next push up, with me at the bottom and taking the bulk of weight we gave a big (mighty is an adverb more reserved for heroic efforts) shove. And then something happened. Or more accurately, something stopped happening. I stopped speaking out loud but all of my thoughts and words were in my mind. Though I still not felt that there was anything "wrong." I felt a little floating sense in my head but not light-headed or pain. In fact I stopped thinking about anything but moving that rug. But the husband and wife, made a couple of comments and/or asked me. And I said...nothing. I smiled, I think. Not really a smile, but more of a sense of content. I even fooled myself a couple of times into thinking I may have actually spoken. But in fact I had not spoken a single word had been uttered from me approximately starting at 7:35PM. I learned later that Allison, my lovely wife whom I spoke with the couple the next day, thought I had "just been on drugs."

The couple had left in their truck and was started closing up the rental and this is when I started being more aware of something was up. I went into the home to turn off the lights and to be fair, there were a lot of lights indeed. But I couldn't find all of the lights in the house. After walking around for a few minutes, I gave it up and walked into the garage.

Now in the garage I was simply trying to close the garage with a 4 digit number to shut the garage door closer. I knew it by heart. But I didn't. I tried first. No dice. No problem...it happens. Tried again. Wrong again. Now I just walked around the garage for a few minutes. Not why I was doing that....maybe thinking that it would come back. At this point I knew I was feeling "different" but still hadn't connected the dots yet. But there is also a physiology reason why which I'll come back to later. I tried again, now the 3rd time. Still didn't work. Tried 3 more times getting the number wrong and figured somehow I obviously forgotten a number that I've known for 6 months. Time to call my then wife.

The scene on this chilly early spring night transcended from me alone dimly lit from above near the garage and sat still momentarily becoming aware of the occasional neighborhood dog barking. I didn't contemplate, I didn't think at all and that is the secret that I can recognize in retrospect. I was content.

Complete tranquility. Happy. And this didn't change right away. From a sleepy, non-descriptive suburban development, home, driveway and life was grabbed by a lose thread of a life and unraveled it as if it was pulled unexpectedly torn on a rusty nail while brushing by a fence in disrepair. But I didn't see the mess it created. Despite the cacophony around me I absorbed it, one stimuli at a time...conscious, aware and more curious than disconcerted. One ambulance, 4 EMT first responders, two police cruisers and 4 cops.

One of the EMTs kneeled in front of me. He asked me a number of questions:

-"What is your name?" No response from me.
-"Where are you? No response to me.
-"What is your birthday? No response again.

In each case I tried to answer. I really did but the words wouldn't come out. The EMT stood up to speak with Allison and as quickly as he was in front of me, I forgot he ever existed. And then I saw my neighbor, Sven. Sven and his lovely family are from South Africa and we were lucky enough to have their teenage daughters often come to the house to babysit. Sven and his youngest daughter, Kirsty came across the street and passing the tumult that was impossible to avoid in the quiet Wednesday evening. Kirsty followed closely behind Sven to see us while staying out of the way of the team. And while I was watching Sven's face I was conscious of the fact that the only things I was looking at, hearing and understanding was Sven. Not Allison, the cops, the EMTs or even Sven's daughter who stood right next to him, holding his hand. Sven hadn't uttered a word. He stood maybe 25 feet away but it was like I had a camera lens of a movie that zoomed in on Sven's face. His countenance of concerns, his wispy, thinning front hair, the back angling brow and 1 day's worth of stubble. And I was completely present with Sven without a word from either of us. As focused and locked-in as I was with Sven that moment passed fluidly into looking at Kirtsy. Like while looking at Sven and now again with Kirsty, everything else seemed to lose its fidelity; Sounds, depth, smell, touch, texture and peripheral vision. But what was lost in the moment's context of all five senses was made up by making the subject insanely acute. Like looking through a portal using High Definition and headphones with surround sound. But the screen was not huge like an I-Max.... it was small through the looking glass.

The next scene panned to the EMT again and now I was being helped into a stretcher. I was wrapped in blankets and secured before they rose me up on the stretcher. I was aware I was going into an ambulance. Allison looked at me, kissing me and told me she would meet me at the hospital. "They're going to take care of you. "I'll take care of you." And with that I was put into the back of the ambulance. The doors closed behind.

Inside the ambulance everything was heightened. The lights were brilliantly blinding. The open and closing of cabinets were deafening. The ripped sound of a new IV was heard loudly inside my head, not just outside. One tech began the IV while another wearing latex gloves and looked at me closely. "Mr. Salvati, who is the president?" I focused and I looked deep inside the irises of the eyes of the tech and his over gelled hair and I confidently said to him, "Omama." And I heard it myself too. "Omama." "Why did I say that?" I was thinking to myself. He asked me a couple more questions and I couldn't get another word out of my mouth. In my head "Omama" kept echoing inside the cavern of my head, unable to focus on anything else let alone answer to another question. And then I stopped listen to my mind and came back to listening and focusing on what the EMTs were saying and doing despite how loud it all sounded to me. And next what happened was the precise moment that my calmness was abruptly, rudely ended. The EMT's who were speaking to each were as if the three of us weren't in the same room let alone in the back of a moving ambulance. That was rude enough but I never expected to hear one EMT to say out loudly to another, "This guy must have been doing a lot of drugs." I was enraged but couldn't speak a word and with my right hand I made a fist and hit my thigh. I did it again as if to protest the indictment, implication, possibly endangered me and worst of all he shattered the closest I've ever been to complete tranquility.

IV in place? Check. Rock-hard bed and pillows? Check. Blood draw every four hours? Check. Waking me up in the middle of the night to weigh me? Check. Yup, nothing like a hospital stay to rest and recuperate. I'm starting to wonder if it is part of the insurance companies' conspiracy. If patients complain enough; exhaust enough; sick of the food enough; maybe they will beg to leave earlier than you might otherwise.

That first night I was confused, and very tired but as I mentioned even if you doze off they eventually wake you up for one thing or another. I was up early, around 5 AM. The parade of doctors started around 9AM. Internist, Cardiologist, Neurologist, Infectious Specialist and a speech therapist came in one by one wandering in the room. The business person in me wanted an Agenda.

I. Introduction, Status Internist 15 Minutes 9AM-9:15
II. Heart status Cardiologist 30 Minutes 10AM-10:30
III. Lunch Cafeteria Lady 90 Seconds 12PM -12:02
IV. Neurologist Event Post Mortem 30 Minutes 2PM-2:30
V. Speech Therapy Perky Speech Therapist 30 Minutes 3PM-3:30

For the sake of brevity I am not including the blood draws, medications, etc.
So here is what we knew at this point: I had an ischemic stroke affecting the left temporal hemisphere. Behind my left ear was a constant dull headache that wouldn't go away. That, I would learn later, that this is where brain cells died. Medically they call in an insult to part of the brain. How appropriate.

An ischemic stroke results from restricted blood flow to portions of the brain. The majority of strokes (approximately 80 percent) are ischemic, according to the American Stroke Association. Blood flow to the brain may be restricted by a blood clot (thrombus) or by progressive narrowing of the arteries. People with high cholesterol, diabetes, or heart disease are at increased risk of ischemic stroke. (I had none of those medical conditions.) 'Healthy as a horse' the saying goes. Until of course until they break a leg and then need to be shot.

An ischemic stroke develops quickly. Brain cells begin to die within minutes of the interruption of blood flow to the brain. Prompt medical intervention minimizes cell death and may help restore partial function to damaged areas.

A stroke which occurs in the left hemisphere of the brain can produce one, several or all of the following disabilities, to varying degrees of severity:

Paralysis on the right side of the body
Speech and language problems (known as aphasia- see below)
Cautious behavior
Memory loss

Paralysis may be complete, an inability to move the right limbs, wiggle fingers or toes on the right side, or may be less severe. Many left-hemisphere stroke patients recover all or some of their right-side function, so that they may walk and climb stairs without assistance, although they may retain a numbness on the right side of their body.

Because the left side of the brain contains the "speech center" of the brain, individuals with left-side strokes often have difficulty understanding speech and written language following their stroke, a condition referred to as aphasia. Because this is such a common effect of a stroke, a special section on this page has been devoted to aphasia.

Some left-side stroke patients may exhibit a more cautious behavior than before their stroke, although others may find themselves reacting more spontaneously and/or intensely than before to outside stimuli.

Aphasia was the most obvious and immediate effect of the stroke.

Aphasia (sourced from Wikipedia), from the Greek root word "aphatos", meaning speechless, is an acquired language disorder in which there is an impairment of any language modality. This may include difficulty in producing or comprehending spoken or written language.

Traditionally, aphasia suggests the total impairment of language ability, and dysphasia a degree of impairment less than total. However, the term dysphasia is commonly confused with dysphagia, a swallowing disorder, and thus aphasia has come to mean both partial and total language impairment in common use.

Depending on the area and extent of brain damage, someone suffering from aphasia may be able to speak but not write, or vice versa, or display any of a wide variety of other deficiencies in language comprehension and production, such as being able to sing but not speak. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.

Aphasia can be assessed in a variety of ways, from quick clinical screening at the bedside to several-hour-long batteries of tasks that examine the key components of language and communication. The prognosis of those with aphasia varies widely, and is dependent upon age of the patient, site and size of lesion, and type of aphasia.

Good friends brought me movies, a video player, magazines and books. I also had with me a pad and pen. Unfortunately most if not all of those distractions were not helping. I couldn't read more than a couple of words without getting confused. I was unable to follow the arc of even the most sophomoric sitcoms. Writing was harder than speaking and my speech was significantly compromised. Imagine for a moment that you were working on a file and in haste you saved the file, shut down the computer, went on vacation or on a trip for 3 weeks and then came back. You boot the computer up. And now you try to figure out where you saved that file? Where is it? This is how hard it is for me to find some words. In order to keep a conversation at a reasonable rate I would "dumb" it down rather than looking for the word I wanted or normally would use. This is the same reason which I avoided speaking on the phone.

All of the above was 3 years ago. Today, hours, days, weeks after learning how to speak, read and write (often on the floor with my then 2 year old son) again at the age of 38. After a week in the hospital with resilience and the love of my family and friends, I returned to work. More importantly I have two wonderful boys ages 8 and 5 that will hopefully remember little more than, "Dad had a boo boo on his brain.

Now I say that I had a beautiful stroke.

I had a beautiful stroke 3 years ago. I was blessed to be conscious throughout the entire event (an extreme rarity) from the first moment a clot traveled to my brain. The disorientation was perplexing. The ability to speak escaped me while the arrestment of linear time where both past and future faded but I was oddly at peace. Peace evolved to euphoria of being truly in the moment.

Of course there were obstacles to overcome especially relearning how to speak, reading, writing and not mention following a conversation with others. My first post-hospital grocery trip found me befuddled by the cashier asking me, "Paper or plastic"?

Where is the beauty? It is in the perspective and the gift of my stroke. It was a catalyst for dormant or atrophied priorities and unmasked pretenders.

Thank you to my family and my friends. Today I celebrate my beautiful stroke in your honor.


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