COLORADO SPRINGS — Sunday August 23rd, 2020 is a day that Jackie (Jack) V. Anderson will never forget. For Jack it was the day a team of Good Samaritans and medical professionals all worked together to save his life. So how did that day unfold? Jack says he clearly remembers how the day started.
Jack explains, “I was on my way to a job for Handy. I was going to put together some lawn furniture for someone. I was watching my GPS (on my phone), and I dropped my phone and it went under my seat. I had to get out of the car to get it and I didn’t know what was going on. I began driving again and I dropped it (my phone) again...”
As Jack’s reality became shrouded in a fog, he says, “I pulled over in front of the fire station and I was trying to get my phone. Then I thought I put my car in drive and I pushed the gas and nothing was happening and then I thought something’s wrong. I didn’t know I was having a stroke, but I knew something was wrong, so I got out of the car and I stumbled up the hill.” That’s where the details of his day get fuzzy for Jack.
Firefighter Justin Myers with Wescott Fire picks up the story, “When we came down the hill (from the fire station) we found the patient on the side of the road on northbound 83. He was outside of his vehicle and when I got there the lieutenant was protecting his head. When anyone has an altered mental status, obviously there’s a long list of possibilities, and we start with the most extreme and the most dangerous and go from there. There were people (bystanders) on scene saying that maybe it was a diabetic emergency but based on the symptoms I started out with a stroke assessment; that’s more important and went from there.”
The first domino in his stroke treatment had fallen for Jack. Literally, within minutes of his symptoms, he was in the hands of very capable first responders. Justin says, “From the time that I got to him, did the stroke assessment, it was maybe two minutes to the time that we got him into the back of the ambulance, and they took him immediately to the hospital.”
Jack arrived via AMR at UCHealth Memorial Hospital North, where registered nurse Hope Lanning was just coming on duty that morning. Hope says, “I had just got to work and hadn’t quite got my assignment. The department was very busy; I had come into a trauma bay where my charge nurse was. I said, ‘Do you need any help?’ Jack had just arrived and I knew it was a stroke alert but I hadn’t got the whole story yet. It was very upsetting to see, he was not able to follow commands or answer questions. He was completely paralyzed on his right side. Based on his presentation, it appeared to be a very big stroke. Dr. Fouss was in the room, and we quickly evaluated him.”
Dr. Clint Fouss, an emergency medicine physician with UCHealth Memorial says, “I was talking to (neurologist) Dr. Glover on the Telestroke computer, and he was asking me when it (Jack’s stroke) started. I said, ‘I have no idea’.”
Dr. Brandon Glover was one of the neurologists on duty at UCHealth Memorial Central Hospital that’s about 10 miles away from Memorial North. Dr. Glover says when the stroke alert went off that a potential stroke patient was coming into the North emergency department, “They contacted me (from Memorial North) before he arrived, and we had the Telestroke hooked up and ready.”
Hope explains the next step in Jack’s assessment was to get a look at what was actually happening in his brain. “We did not know his ‘last normal.’ ” How a stroke can be treated depends on how long it has been happening. “The neurologist was doing an assessment (over the Telestroke) and I was helping with that, and we got him over to CAT scan and got some imaging of his brain.”
Through the Telestroke, Dr. Glover was able to watch Jack’s CT scans as they happened. Dr. Glover says: “We got the images of his brain in real time. He was brought back to the trauma bay, and we evaluated him again. It was determined he was having a pretty severe clot, and we decided to give him the tPA, also known as the clot-busting medication.,”
tPA, stands for “tissue plasminogen activator” – a medicine used to break down blood clots [en.wikipedia.org]. There is consensus among stroke specialists that tPA is the standard of care for eligible stroke patients, and benefits outweigh the risks of it causing excessive bleeding.
Hope says, “His (Jack’s) outcome would likely be very poor if he did not receive the (tPA), so Dr. Glover made the call to give it to him, and ultimately it saved his life.”
After giving the tPA, Dr. Glover also knew there was more that could be done for Jack. Dr. Glover says after the tPA was given in the emergency room at Memorial North, “That’s when we activated the neuroendovascular team with Dr. Huddle here at Memorial Central.”
When the call was made to give Jack the tPA, and move him to Memorial Central, the next domino fell in Jack’s favor.
The stroke alert also put UCHealth’s LifeLine flight team on alert. Matt Bergland was the flight paramedic on duty. Matt says, “We get all of the stroke alerts here at Memorial North, and we go down to the ED if we can to be there and assist if needed. When I first got to Jack I was very concerned about him. I didn’t think he was going to have a very good outcome. His neurologic status was very poor.”
Dr. Fouss says, “I talked to my charge nurse, and I said he (Jack) needs to get to Central as soon as he can, and he said the helicopter is here.”
Matt says, “With Jack it (the system) worked perfectly because we got the stroke alert, got down to the emergency room, and were closely monitoring the situation.”
Hope explains that as the pharmacist was mixing the tPA, the flight crew was also ready to use their IV equipment, which is different from the IV pumps used in the hospital for the purposes of flight safety on the helicopter.
Matt says, “We were able to start the tPA on our pump, which made it a lot faster to transport him to Memorial Central. Time is very, very valuable. Time is brain (in stroke treatment) and the longer he (Jack) had that clot in there the more damage was being done to his brain.”
Mary Gray is a registered nurse and was the flight nurse on duty with Matt that day. Mary says, “We were able to transition the patient (Jack) quickly. We got him in the helicopter and down to Central in about 5 minutes. The interventional radiology team and Dr. Huddle were waiting for him so that he could get that definitive care - where they could go in and actually retrieve the clot.”
Dr. Daniel Huddle, an Interventional Neuroradiologist with UCHealth Memorial Central, explains the process they use when it comes an ischemic stroke like Jack’s. “We drive our catheter (going through the femoral artery in the leg) all the way up to the level of the clot (in the brain) and try and engage it. It’s like a long hollow tube or straw, and we hook the catheter to a suction device and let it sit there briefly. Hopefully the suction is strong enough to actually engage the clot and pull it into the catheter. If we can get it (the clot) into the catheter, we then remove the catheter with the clot in it and it restores normal blood flow.”
When it comes to the effectiveness of interventional radiology, just like with tPA, success often boils down to time and how quickly a clot can be removed. This has a direct impact on how many starving brain cells can be saved, which has a direct impact on someone’s quality of life, if they survive the stroke.
Matt says that was on his mind as they left Jack in Dr. Huddle’s care. “I have a connection to a lot of my patients in some way. With Jack, I was really worried about him. He is young (for such a big stroke) and I was worried that he was not going to have an outcome that was going to be very good. I talked to Dr. Huddle before we left, and I asked him to give me a call and let me know how things turned out.”
Dr. Huddle says, “In (Jack’s) his case it (the procedure) worked exactly like it’s supposed to and it took only a single pass to open up all the blood vessels .”
As Jack woke up from the anesthesia, that’s when his memory of that day became clear again. Jack says, “I woke up and I saw my daughter beside me; she told me I had a stroke. I knew I had a stroke but I didn’t know how severe it was. I had just woke up and both the doctors were jumping for joy. They were saying, ‘You’re talking right now, you’re alive?’ And I was like, ‘I’m here, I’m not messed up.”
Matt says, when Dr. Huddle called me about an hour and a half later, he told me that Jack was sitting up in bed on his cell phone, and I said, ‘You’re lying. That’s not true, there’s no way that’s true.’ , and he said, ‘I’m serious, I don’t believe it either but it’s true.’ That just did my heart well. At that point we absolutely knew that everything we did worked perfectly. From the very beginning the fire department finding him and recognizing his symptoms and transporting him rapidly to Memorial North to the staff here - the physicians, nurses, everyone working in concert with one another to get (Jackl) the care he needed as quickly as possible - it all worked.”
Hope says, “It’s just the whole team, everyone involved. Things aligned perfectly for an exceptional outcome. You go into nursing because you care about people and that’s why you do it, you want to help others”
Justin, the Wescott firefighter, says, “A lot of things went Jack’s way that day. We joke that he had the stroke right in the parking lot of the fire department, which is actually about 100 yards away. The fact that he was able to get out of his vehicle and draw the attention of bystanders who were the first part of the chain notifying us that something was going on and us being so close we were able to get there in literally seconds to evaluate a stroke, get him in the ambulance and get him to the hospital.”
Matt says, “This is what we train for, this is what we do to try and make sure that we get the best outcome for our patients that we possibly can. The system as a whole worked perfectly for Jack that day.”
Mary adds, “It’s absolutely the best patient outcome you could ask for.”
Dr. Huddle says, “This whole team worked as efficiently as we could ever hope for, and everything worked perfectly. This system (stroke treatment) is a team sport. I can’t do what I do without all these different groups doing what they do. Everything fell into place absolutely perfectly that day.”
Dr. Glover says, “We estimated his time of onset of stroke at 9 a.m. and by the time he had come out of the cath lab and had the clot sucked out and everything else it was probably close to 12:30. I think that's one of the things that was most remarkable about Jack’s case, the time frame - it was all done in about 3 and a half hours. I don't think I've seen the system work more beautifully. The team was remarkable, the nursing staff at North was incredible and it all came together with the flight team there, and that’s why I say I think that the team was important, but also there was something divine going on with him (Jack). He’s supposed to be here for something.”
While Jack says, he is still processing much of what happened to him, there is one thing he knows for sure. “Everything happened in God‘'s plan and basically I’m here today to talk about it.”
Medical experts say, the best thing you can do to help yourself, or a loved one to have the best chance of surviving a stroke, is to know the common warning signs of a stroke and call 9-1-1. Don't drive yourself even if the hospital is across the street.
BE FAST - If you are having trouble with:
Arm weakness on one side of the body,
Speech, slurred speech
Time to call 9-1-1
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