With stroke, fast treatment can be the difference between recovery and permanent brain damage.
Good communication, thorough training and impeccable timing led to Bob Curry’s full recovery after a stroke. Curry, 74, a New York transplant to North Carolina, was rushed by ambulance to Novant Health Presbyterian Medical Centerl – a comprehensive stroke center – had surgery and walked out two days later with no long-term effects. (Forsyth Medical Center in Winston-Salem also has the designation.)
Here’s his story, told by him, his son, and a few of the Novant Health team members who played a part in saving his life and preventing permanent disability. One key component: a team member who found a way to speed hospital admission and treatment.
Every morning, I walk the two dogs for about a mile and a half. On Aug. 4, I was returning to our Myers Park apartment building from our walk – I remember this so clearly – and collapsed at the gate. My right side was frozen. I started to go down and held on to the gate with my left hand. I looked at my watch and could see it was a little before 8 a.m. The place where I went down is behind tall bushes. No one from the street could’ve seen me.
We have a routine, so when dad wasn’t back at 8, I started to worry. I texted him at 8:05 and didn’t hear back, which was unusual. I came downstairs with my young daughter, looked to my right and saw my dad on the ground. He was still holding on to the two dogs. I called 911. They asked me questions to try to determine what had happened. I had figured it was a stroke, and the questions they asked let me know that was their thinking, too.
Fortunately, my dad had been to the doctor the day before and had the paperwork in our house. I was able to tell Medic EMS what dad’s blood pressure had been the day before and give them his entire list of medications. They arrived within six or seven minutes, and they radioed ahead to the emergency room. They let me get in the ambulance. I already had my mask and gloves on. It took us 10, maybe 12 minutes to get to the ER.
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We were asked what hospital we wanted to go to, and Rob told them Novant Health, where I had recently seen an internist, Dr. John Holevas.
When we got there, the doctors were waiting on us.
Dr. Swaroop “Roop” Pawar, vascular neurologist
The good thing for Mr. Curry is he has a doting son. When Mr. Curry wasn’t home by the time his son was expecting him, he went looking. EMS was called, and then EMS called us. By 8:57, we were ready and waiting.
One million pieces of a puzzle have to line up on stroke treatment. And they did that day.
Stacey Godwin, assistant nurse manager in the Presbyterian ER. In 2019, Godwin had the idea to streamline pre-registration for stroke patients so they get care even faster.
Mr. Curry’s right side was weak, and he wasn’t able to speak when he came in. His CT scan, the first step in diagnosing and treating stroke, was completed by 8:58 a.m. It showed a clot in a blood vessel.
It used to be that we registered patients when they arrived – got their name, date of birth, found out what medications they were on. And in a lot of cases, their speech was slurred because of the stroke. Or they were confused and gave us wrong information. They might tell us they weren’t on blood thinners when, in fact, they are. And that makes a big difference in what we use to treat them.
Elizabeth Mills, nurse and stroke coordinator at Presbyterian
I was in the hospital when Mr. Curry arrived but not with him until later. But I have the full chronology of events. Shortly after 8:58, the benefits and risks of TPA (tissue plasminogen activator), a life-saving drug that can break up blood clots and restore blood flow to the brain, had been discussed with the patient’s son.
By 9:01, we administered TPA. The sooner you give it, the better your chances of opening the blood vessel. Timing is everything in stroke treatment to preserve brain function. We have 60 minutes – the ideal time frame – and we did it in four. That’s a record for us.
We go immediately from CT scan into surgery if the scan shows the patient is a candidate for surgery. Not everyone is.
Mr. Curry had a large blockage in his brain. After the TPA was given, he needed a thrombectomy. That’s similar to a heart catheterization. We go up through the groin to remove the clot and restore blood flow.
At 9:22, he arrived at radiology for us to try and have the clot removed from his brain. The procedure was done by Dr. Greg Imbarrato, who successfully removed the clot at 9:54.
Getting TPA administered to a stroke patient as soon as possible is key. But they can’t get the drug until they have a CT scan and take a quick assessment test – the NIHSS test – where they have to raise their arm, push down with their feet, grab a hand and squeeze, look at simple drawings and be able to tell us what’s going on in the picture. That’s done to see how coherent they are.
The NIHSS test, which measures the severity of the potential deficits from the stroke, is scored from 0 to 42. Mr. Curry’s score was a 23, which falls into "severe" territory. By that afternoon, his score had gone down to 0.
There is no history of stroke in our family. None. So, this came as a complete surprise.
They told me they cleared the first blockage, but then discovered another blockage of the carotid artery. They put a stent in to be sure it stayed open. The nursing staff and the doctors – everyone was super capable and very professional.
My late wife was in hospitals – a lot – when we lived in New York. We’ve been in hospitals over the Fourth of July and Christmas. We know good doctors and staff when we see them, and that’s exactly what we saw at Novant Health.
I remember everything up until I got to the ER, and then I remember being in the neuroscience ICU. The surgery is something I don’t remember.
But immediately after surgery, he was talking, according to the doctors, and I saw him two hours after surgery. My dad was able to recount everything that had happened to him, and the staff in the ICU was extremely professional and attentive.
On Wednesday morning, they came to get me for occupational therapy. They walked me through everything and said I was OK. An hour or two later, a physical therapist came and got me. We walked around, and she said I was OK. They kept me for another night.
‘There has to be a way…’
Last year, we spoke to every medic in the county in person. We did 11 days of teaching – probably 40 to 45 classes.
Medic is our eyes and ears. We have to trust and empower them. When they pick up the patient and call us, it sets up a chain, a cascade. If I’m in the ICU or rounding on patients in the hospital, and I get a notification of a stroke alert, I go immediately to the emergency department (ED). The pre-arrival notification helps tremendously. There are 100 checkpoints we go through before the patient even arrives.
Those checkpoints are working. A patient who came in paralyzed walked out of the hospital two days later.
While the patient is being checked in, the charge nurse is waiting to take them back for a CT scan. That’s the first thing that has to happen. As we say in stroke treatment: Time is brain. When we cut minutes, we save brain cells. That’s why looking for ways to cut check-in time is critical.
I thought: There has to be a way to speed this up. I asked if, when Medic calls to say they’re headed for the ED, they could spell the patient’s name and give us the date of birth. They were readily able to do that.
Now, we register patients in advance. When they arrive, we just make one click to indicate they’re here. The orders are already in; they can go straight for the CT. We have shaved valuable minutes off the process.
As the stroke coordinator, I follow and track patients in the hospital and after they’re discharged. I look at times, data and outcomes. I make sure patients have gotten their prescriptions filled and that they’re taking their medication. We make sure a patient gets a neurology follow-up at our stroke clinic within seven days of discharge.
Most of the time, stroke patients need ongoing therapy. But Mr. Curry walked out of the hospital after having a major stroke – needing no further care.
The entire process starts outside the hospital. It starts with family members and members of the community who know to call 911 and activate EMS. It starts with EMS education; the paramedics are essential in this process. It starts with great providers.
When the process works as it should, everyone – pharmacy, nursing, CT – is assembled and waiting on the patient’s arrival. If everything hadn’t aligned as it did, Mr. Curry could’ve had significant disability or even died.
It’s always interesting to meet with patients the day after they’ve had a stroke. Mr. Curry said he didn’t realize what was wrong, but that he had a sense everyone was working fast – and that there was a sense of teamwork and efficiency.
I am working my way back to full strength. I still get fatigued easily, but that’s the only aftereffect. This was a miracle. There’s no other way to describe it.
Top photo caption: Dr. Sawroop "Roop" Pawar works closely with ER and stroke care team members to constantly find ways to speed stroke treatment that can mean the difference between permanent disability and walking out of the hospital to return to a full and happy life.