Early one morning last December, Susan Smith of Rockwell, North Carolina, awoke to find her husband kicking at the covers beside her. But Robert, 56, wasn’t having a bad dream. Instead, he had lost the ability to speak, his face had started to droop, and he was experiencing paralysis in his right arm and leg.

Susan knew instantly that her husband was having a stroke.

This was a surprise because Robert didn’t have any of the classic stroke risk factors. A 20-year veteran of the U.S. Navy who served on submarines, he was in great shape. He didn’t drink or smoke, followed a healthy diet and walked five miles every day.

“I was shocked,” Susan recalled. “I would have never expected this to happen.”

‘Everything lined up perfectly’

Susan called 911, and EMS arrived quickly. Robert was taken to Novant Health Rowan Medical Center in Salisbury, where he was promptly evaluated. Because his stroke was already severe, doctors decided to transfer him to Novant Health Forsyth Medical Center in Winston-Salem, a certified comprehensive stroke center with access to expert neurologists, neurosurgeons and other specialists providing advanced stroke care.

Winston-Salem is a 45-minute drive away, but luckily, the Novant Health Med Flight helicopter was on the pad at Rowan Medical Center that night, ready to go with its three-person crew of pilot, flight nurse and flight paramedic. Just 12 minutes later, the Smiths were at Forsyth Medical Center.

“Everything lined up perfectly,” Susan said. “From EMS arriving so quickly, to the helicopter being available and ready to go, to the expert care Robert received every step along the path at both Rowan and Forsyth. It felt like it was more than a coincidence.”

It takes a team effort

Once at Forsyth Medical Center, admitting neurologist Dr. Yuriy Zeylikman assessed Robert’s situation and ordered a CT scan, which revealed a clot on the left side of the brain. Robert was having an ischemic stroke, in which a blood clot blocks an artery leading to the brain, cutting off blood flow and causing brain cells to die. Unfortunately, he was outside the time window to receive the clot-busting drug TPA.

That’s when interventional neuroradiologist Dr. Morry Brown was consulted. Brown reviewed the brain images and made the decision to remove the clot with a procedure called an intra-arterial thrombectomy.

“In Mr. Smith’s case, it was more than your standard stroke,” Brown said. “It was a blockage in a major artery of the brain … We needed to get in there and remove the obstruction quickly, because every minute the brain isn’t receiving blood flow, millions of brain cells are dying.”

“The quick helicopter transport from Rowan to Forsyth was very helpful in this instance, because time is of the essence with the brain,” Brown added.

Brown removed as much of the clot as possible, but Robert wasn’t out of the woods yet. While in the critical care unit, his brain continued to swell. Brain swelling, also known as brain edema or cerebral edema, is a dangerous condition that can impair cognitive and behavioral function, and in some cases, put the patient at risk for death.

Robert was given medication and placed on an IV of heavy salts to reduce the swelling, but neither approach seemed to work.

“The medical team was doing all they could, they exhausted all the possibilities,” Susan explained. “It was time for a difficult decision.”

That’s when Robert’s care team brought in a neurosurgeon to perform a surgical procedure in which a portion of the skull is removed to relieve pressure, allowing part of the brain to swell. This surgery, known as a hemicraniectomy, was critical in Robert’s case, because the skull is rigid, and swelling — if contained inside the skull — can lead to intracranial pressure that interferes with blood flow and causes brain damage.

It was a decision that paid off. One week after the surgery, Robert was awake, alert and following commands.

Brown and other members of Robert’s care team stressed how much of a team effort is required to achieve a positive outcome like this. “Everyone has a part to play,” Brown said. “EMS, air transport, the admitting neurologist, the interventional radiology unit, the neurosurgeon, and everyone else involved. All the roles are important.”

Many steps on the path to recovery

While the hemicraniectomy was successful, Robert still had obstacles to face and challenges to overcome. And they were more than the normal difficulties of recovering from a stroke.

During his time in rehab, he developed a serious infection. After receiving a powerful antibiotic to resolve that issue, he then contracted the norovirus, a condition that causes vomiting and diarrhea.

Shortly thereafter, things finally started to look up.

On Feb. 9, 2018, Robert came home. He received physical therapy and occupational therapy at home twice per week for a few weeks, then began outpatient therapy at the Veterans Health Administration.

He’s now able to move his right leg some, feed himself and sit up for a couple of hours. He can watch television and have short conversations, and though he’s still working on his speech, he’s making progress.

“Cognitively, his recovery has been miraculous, because a left-side stroke like the one he had usually takes your speech,” Susan said. “But despite what he’s been through, he’s been very good at comforting me during all this.”

Even with all he’s been through, Robert never doubted he would recover.

“I always believed I was going to get better,” he said. None of the ups and downs had him concerned, “because I knew I was in good hands the whole time. The care at Novant Health was the best I could have gotten.”

Robert went in for a follow-up visit on May 1, 2018. His care team noted the improvement in his speech and movement in his right leg, and predicted a good functional outcome. His neurosurgeon pointed out that while the extent of his recovery is yet to be determined, he’ll have a good chance of being ambulatory, which means he’ll be independent.

“The collaborative nature of the stroke program at Novant Health, and everyone working together seamlessly as a team, is what helps us create results like this for our patients,” Brown said.

Robert and Susan agreed, pointing out how everyone seemed to be at the right place at the right time on that night in December — EMS, the medical helicopter, the admitting neurologist, Brown, and the other doctors, nurses and staff at Rowan and Forsyth medical centers.

“We were so lucky,” Susan said. “We worked with the very best people, all the right people at the right time, and everything worked out.” At the same time, she said, “I don’t believe in coincidence.” She believes her faith, the prayers of family and friends also played a role in Robert’s survival. “He has yet more to offer the world,” she said. “He is not done yet.”

To learn more about our stroke treatment, or to schedule an appointment with one of our experts, find a Novant Health stroke expert near you .