“It appears your wife has had a massive infarction,” the doctor says, looking at Dad.
I stare at the doctor’s ID badge, which says “Neurologist” below his name. He is a thin man with straight brown hair, carrying a brown leather bag over his shoulder.
“We’re bordering the critical window,” the doctor says. “So it’s now 10:15 pm and you say the last time you saw her functioning normally was between 7:30 and 8:00 pm?”
“Yes,” Dad answers, putting his hand to his forehead, re-running the numbers in his mind.
Ischemic stroke occurs when a blood vessel becomes blocked, prevents the flow of blood to the brain, and thereby creates an infarction, or death, of brain tissue. Within three hours of the onset of a stroke, ischemic strokes are treatable with blood thinners or anti-coagulants such as tissue plasminogen activator (TPA), which restore blood flow. After that timeframe, the risk of fatal complications, such as bleeding in the brain, increases significantly.
The doctor escorts us across the hall, and shows us CT scan images of Mom’s brain.
“I’m going to ask you again,” the doctor says, pointing to a darker spot on the right edge of the brain. “Are you absolutely sure about the timeframe? Because the damage I see here is so advanced that it’s typical of an infarction at least 6-8 hours out.”
We tell him again. We are sure. He ushers us back to the small waiting room.
“Look,” The doctor says. “When an infarct occurs, it’s like stepping on a hose. All blood flow gets shut off. The brain tissues start to break down and die. At this point, if we anti-coagulate her and get the blood flowing again, it would be like running over the hose with a lawn mower and then turning the water back on. The water is going to leak out everywhere.”
I feel like I’m deflating, all my vital air whistling out and the ground about to come up fast beneath me.
“What would you do if she were your wife?” Dad asks.
“I would give her the best possible chance,” the doctor replies. “I know I said before that we might do the TPA, but given the magnitude of the infarct and the critical timeframe, TPA would be contraindicated. Her biggest risk in the next 2–5 days will be cerebral edema.”
Dad crosses his legs, puts his hand over his eyes, and faces the corner of the room.
It’s like I’m watching a foreign film without subtitles. Is he saying there’s nothing he can do? Is he talking about my mother, who just turned 60—a thin, non-smoking vegetarian who exercises every day?
“You should call whoever you need to,” the doctor says. “She may not be conscious in the morning.”
