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JFK Nurse Chronicles Recovery After Coding Own Stroke

PhillipCastilloContributor

It was Black Friday, 2016. I usually like to request the day off to be with my family and prepare for the holidays. However, I decided to work since it would be my last shift as a stroke/telemetry nurse before transferring to the Operating Room (OR).

Around 5 o’clock, I felt a slight headache — not unusual at the end of a long shift. I took an adult aspirin and drank a cup of coffee.

Soon my headache became unbearable — the worst headache I ever had. Immediately, I had a flashback to my nursing textbook where stroke patients will say the very same thing. However, I didn’t have any other symptoms and I was only 30, healthy, and had no family history. I put an ice pack on my head and just to be safe, checked my vitals, my coordination, motor function and sensation. I convinced myself I was having my first migraine.

Coding

Shortly after 6 p.m., I felt an intense heat and pain tear through my body and I felt unstable. I yelled for my secretary to call a "Code 7." Code 7 alerts the staff that an employee or visitor needs emergency medical care. While waiting for the ER team, other telltale symptoms occurred. At that point, I knew I was having a stroke and handed my phone to my secretary and said, "Call my wife."

Test results showed my diagnosis was not good. The rupture that caused the stroke enabled blood to build up under my skull. By the time I was transferred to the OR, I was showing physical signs that my brain was starting to put pressure on the back of my skull. Back in the waiting room, my wife and parents were being prepared for the possibility I was not going to survive.

Dr. Jeffrey Pan, a surgeon I had just met that day on my unit, performed emergency surgery to relieve the pressure on my brain and remove the hematoma. He also managed to control the bleeding which was complicated by the aspirin I took earlier. In addition, a large portion of the right half of my skull was removed to accommodate the swelling. Even though all signs indicated I would not survive, the JFK team did not give up on me.

After the surgery, I was monitored in JFK’s Neurocritical Care Unit (NCCU). I was taken off sedation on Sunday and when I awoke, I knew exactly where I was and remembered what happened. The concept of being alive and oriented kept me calm though I had practically no function and sensation on my left side. I made an effort to communicate with my wife so she would know I recognized her.

It turns out I had an Arteriovenous Malformation (AVM), which is an abnormal tangle of vessels in the brain. It probably had been there all my life — like a ticking time bomb.

Though the plan was to remove the AVM immediately, the JFK surgeons decided to wait and let me stabilize. JFK neurosurgeon Dr. Thomas Steineke agreed to take my complex case.

In therapy and beyond

I started physical and occupational therapy while still in the ICU. Within a week of the stroke, I was walking with a walker (and a helmet) outside of my room. Every day, a little more motor function came back and I worked at it as much as I could.

The first week of December I was transferred to the Brain Trauma Unit and began my inpatient rehab. While there, I received incredible physical, occupational, speech/cognitive, recreational and psychological therapy and was discharged just in time for the holidays. I requested I be allowed to walk out with my wife beside me instead of being wheeled out. Although my life changed completely, I had already accomplished so much.

There are no words to describe how wonderful it felt to go home. However, I was fearful of surgery for the first time in my life. I was acutely aware that there was a very unstable blood vessel in my brain. I was still missing a considerable portion of my skull and had to wear a helmet almost all the time.

On Jan. 3, a cerebral angiogram and embolization was performed by Dr. Jawad Kirmani in preparation for my surgery. The swelling had gone down considerably and would likely continue to go down with more rest. So, my surgery was postponed, but not my anxiety. People joke "come on, it's not brain surgery" when something is easy. I was about to undergo what people consider one of the most difficult experiences in life.

On Jan. 30, the angiogram, as a result of further embolization, revealed the AVM decreased even more, further reducing the risks related to open surgery. The next day, I was brought into the OR and kissed goodbye to my wife. The nurse manager of the OR came in to give me her support and said, "We are here for you," which meant a lot to me. As the anesthesiologist prepared to give me medications, I moved my left fingers and toes because I was not sure how well they would work when I woke up and I started praying.

When I awoke, Dr. Steineke assured me that he had removed the entire AVM, and I had no deficits. For the first time in 30 years, I did not have a "ticking time bomb" in my head.

This summer, I accomplished a personal goal of running and completing a 5K race. Looking back, I could not have imagined possessing the ability to walk, let alone run. Dr. Steineke and the team of doctors, nurses, therapists — my colleagues — had given me a second chance at life.

And a wonderful life I have again. I successfully returned to the hospital, this time as an employee of the OR and became a proud member of a clinical team that was at my side through my surgery. Now I get to see first-hand that I was not a special case but just one of the hundreds of patients that come through the JFK OR in need of clinical excellence and compassion.

I will be forever grateful to be blessed with a second chance.