Sometimes I think the trouble started on Saturday, and sometimes, with yet more chagrin, earlier. I remember noticing on that day before Easter that my mother’s walking had deteriorated. She looked wobbly. But walking has increasingly been, due to neuropathy, hard for her.
“Well,” I thought, “age may finally be catching up.” Last year we had a party for her 95th.
Now I see what seem like the “heuristic reasons” (shortcuts in cognition, or distractions, that lead to ignoring salient factors) that are analyzed after an avalanche accident.
Our holiday was typically chaotic, with relatives and friends coming in and out of the family home in Annapolis, Maryland, from several states.
For Saturday we planned a lunch at the historic Annapolis Yacht Club, and complications started first thing. My nephew Sam was to pick up his mother, my sister Lucy, who, following a severe stroke in 2019, uses a wheelchair and is in care.
He called from the car-rental office, exclaiming, ”All they have is a huge Ram pickup. We’d never get her up into it. I asked for a sedan!”
“I’ll go,” Ryer, a visiting friend, offered, amid a flurry of rejiggering carpool and parking plans.
He arrived in the nursing home parking lot amid screaming fire trucks, because smoke had been seen coming from the roof. No one was allowed in or out, he called to say. Yet Ryer sneaked inside, then tracked down Lucy. They begged and bolted and, amazingly, we all convened at almost the same time.
On Sunday, just before Easter dinner for 11 people, I noticed my mother’s rickety-looking gait anew, and a catch in her voice.
Yet I was setting out dishes, then carrying a plate through the buffet for my sister, while others filled them for my mother and her friend. Lucy, who is paralyzed on one side, requested I cut her ham, my mother simultaneously asking me to turn on music.
As an outdoor writer, I’ve often considered the Swiss Cheese Model of Causation as it applies to disasters in mountaineering; it does in aviation and hospitals as well. I first learned of it in Gene Weingarten’s Pulitzer Prize-winning “Fatal Distraction” (2009), about children accidentally left in cars by otherwise careful parents. The model refers to a string of events, the absence of any one of which could have prevented an ill outcome. Occurrences, happenstance and the lack of barriers align like the holes in Swiss cheese.
A guide’s decision on Everest in 1996 didn’t seem like a great mistake at the time, Jon Krakauer wrote in “Into Thin Air.” “But it would end up being one of many little things — a slow accrual, compounding steadily and imperceptibly toward critical mass.”
Sam later said he, too, noticed my mother slurring, but others at dinner didn’t; it was noisy. Nor did they observe her walking, since Ryer, formerly a professional cook in Aspen, was graciously cooking dinner, and others bustled around helping. (We’d later find my mother could barely write, but that went unseen as well: keyboards.)
The next day Mom was still slurring a little. I offered to take her to a doctor, but she declined, urging my stepsister, Lisa, and me to proceed with a plan to take Lucy to a marina. On our return, my mother’s slurring seemed more pronounced (though that, I admit, is an odd word for it).
We packed her up and, heart now thudding, I drove to the ER. My mother calmly read her book for the two and a half hours we waited.
Nothing showed on a CT scan, which was briefly reassuring, but the hospital kept her in observation, a relief to me. The next day, as a PA from neurology told us, an MRI showed my mother had had a “small” or minor stroke, “a few days ago.”
Acute ischemic infarction.
I was surprised. So was my mother.
The good news, the PA said, is that there was no bleeding, and my mother should recover within a couple of weeks. The stroke was in the coordination center of her brain, affecting walking, speech (which was worse this day; symptoms fluctuate) and fine motor skills, but not personality or reading.
Two years ago my mother had a transient ischemic attack, a ministroke. She spoke off-topic, then lost her words such that we others at dinner knew she was in trouble. It happened suddenly and was clear. This time my mother was herself.
Stricken, I asked, “Should we have brought her in sooner?”
The PA said no. “It was a small stroke, and wouldn’t need any intervention.” She added, “These strokes tend to get better on their own.”
Each day Lisa and I charged around working as a team on the myriad details of care management. On Thursday, Mom was released to rehab for speech and physical therapy. On Monday, Lisa was in a car accident, got sideswiped at 50 mph. Now she was in the ER and hospitalized, with a concussion and myocardial trauma. One of her symptoms was slurring.
“I sound like your mother!” Lisa said, and how could we not laugh?
So my mother and stepsister were both slurring, and my sister slurs since her stroke, and I was visiting all three daily in their respective medical facilities, and feeling like I was on Mars.
Our family is aware that the fact that my sister had her stroke (which followed an ablation procedure) in the middle of the night, in another country, delayed treatment. With most strokes, time is crucial. Every minute the brain lacks oxygen can be damaging.
Here we were spared. My mother’s doctor, too, told us that coming in sooner wouldn’t have made a difference.
“With something like this, it can be hard to know if the person is just having an off day,” he said. “But if the symptoms don’t get better, go to the ER, which you did.”
Still I learned a lesson or two to share, starting with the perpetual life reminder to pay attention, to heed.
Common stroke symptoms are known by the acronym BEFAST: Balance loss, Eyesight changes, Facial drooping, Arm weakness, Speech difficulty — Time to call 911. Yet some strokes come in quietly, with symptoms you could put off to being dehydrated, standing up suddenly or the onset of a UTI. They include lightheadedness, blurry vision, confusion, a headache or intermittent weakness.