97 Minutes. Then death.

97 Minutes.

I want a do-over.  I can remember playing games at recess in elementary school.  When something didn’t go as planned, we always cried out that we wanted a do-over. I want a do-over of August 3rd, 2017.

It was a typical busy day. I had worked during the day, then came home and packed my son up for school as he was leaving the next day for his senior year in college.  As a respite, my husband and I decided to go out for a quick dinner. Within minutes of returning home, my husband’s speech became garbled.  I knew he was having a stroke.  For one brief moment, I thought about putting him in the car and driving him to Barnes Hospital – which is less than 15 miles from our house.  We know and trust Barnes Hospital and its exceptional doctors.  My husband suffered from Congestive Heart Failure years ago.  Following that diagnosis, he had an LVAD (Left Ventricular Assist Device) implanted and a truly successful heart transplant in late 2016.  Both procedures were done at Barnes.  I was conflicted.  The only thing you ever hear about a stroke is to get help as quickly as possible.  I called 9-1-1.  I asked my husband to do everything the 9-1-1 operator asked.  He could lift his arms, smile, and he understood what I was saying. He walked perfectly fine.  The paramedics arrived.  I asked them to take my husband to Barnes.  They said they couldn’t.  With a stroke patient, they ‘needed to go to the nearest hospital.’  That hospital was Missouri Baptist Medical Center.

We arrived at Missouri Baptist Medical Center.  The Emergency Room was very chaotic.  The doctor confirmed that my husband had a stroke.  People were coming in and out of the room.  Several staff members talked about the ‘miracle drug’ t-PA.  The doctor on duty was conferring with others as to if he should administer this ‘miracle drug.’  It was decided they should.  There was a ‘small chance’ that something could go wrong.  A few people on staff had never seen anything ‘go wrong.’ They shared anecdotal instances of patients that were helped from the drug.  Shortly after receiving the drug, something went terribly wrong.  My husband was screaming in pain.  The attending Emergency Room doctor turned to me and said, ‘That was a bad result.’  Completely in shock, I replied, ‘He seems like he is in such pain.’  The doctor replied, ‘Oh, he is.  The pressure in his brain is building significantly.’  I asked what needed to be done… ‘We need to get him to Barnes as quickly as possible.’  I heard that over and over and over again – by multiple staff members. ‘He needs to get to Barnes, they have options for helping your husband.’  Great.  Let’s get him to Barnes.  Truly, that is where I wanted to be anyway.

97 minutes went by before Abbott Ambulance arrived to transport my husband.

97 minutes is a lifetime for someone screaming in pain while the pressure builds in his head.  In St. Louis, I could fly to Chicago in less time.  I could get in my car and drive to Columbia, Missouri – right in the middle of the state.  And yet, to get my husband, screaming in pain, from one hospital to the next took 97 minutes – before help arrived.  The hospitals are approximately 11 miles apart – straight down the interstate.  The 97 minutes was an eternity for me, my children, and my extended family.  We certainly did not understand the delay.  My husband’s brain was bleeding and pressure was building inside.  Help was 11 miles away.  After so much delay, my mom inquired if we could just take him to Barnes ourselves.  ‘That isn’t necessary.  We have the ball rolling,’ we were told.  As we got more anxious, a nurse told us to go ahead and head toward Barnes as my husband would be leaving soon via ambulance.  If we left at that time, we would get there at the same time.  We left.  I never saw my husband conscious again.

We got to Barnes and waited. And waited.  And waited.  My husband did not arrive.  We called back to Missouri Baptist.  My husband had not left.  I felt helpless.  My God…my husband was screaming in pain and now alone.  Should we drive back to Missouri Baptist?  I could see the angst in the eyes of our children.

Over the next few days, we heard repeatedly that little could be done for my husband.  ‘After blood sits for an extended period of time on the soft tissue in the brain, the damage is done.’  I know the blood sat for an extended period of time as we waited for help at Missouri Baptist Hospital.  My husband passed away on August 8th, 2017.  Since that time, I have spent many nights lying in bed watching the clock tick away for 97 minutes and wondering what went wrong? What could have been different?  Why was there no apparent Plan B? Was t-PA the best option?  Should a heart transplant and LVAD recipient receive t-PA? We were never told of any other options.  If only I could have a do-over.

In my opinion, there was no Plan B.  By total default, Plan B seemed to be to ‘get him to Barnes as quickly as possible.’  Yet, 97 minutes went by before a transport arrived.  It must be extremely rare for something to go wrong with the t-PA drug; however for us, something did go wrong.  Everyone seemed stymied. Doctors, nurses, the pharmacist…everyone just seemed completely baffled to me.  If you are going to administer this powerful drug, there must be a Plan B.  

With regard to the paramedics that came to our house that evening, they noted they are required to take stroke patients to the nearest hospital.  If within a reasonable distance, why are they not required to transport stroke patients to the nearest Level One Stroke Center?  We have five Level One Stroke Centers within 15 miles of our house.  Missouri Baptist Hospital is not one of them.

As I have thought about this continuously since August 3rd, I would understand not having a Plan B if you lived by a rural hospital.  Staff would be giving the patient what they believed to be the best option at that time. But, if you live in a suburban or urban setting, you should go to the hospital that quickly can implement a Plan B should something go wrong.  What if we had gone to Barnes on that fateful night right from the beginning?  IF something went wrong with the t-PA, a drain could have been put in my husband’s head almost instantly to release the pressure in his brain.  Would that have changed the outcome?  We will never know.

I had the opportunity to talk to a doctor at Missouri Baptist following my husband’s stroke. He said that the damage was done as soon as the t-PA drug was administered.  But, the doctors and nurses on duty that night believed Barnes could help my husband.  They told us that often.  Why else would they have initiated the transfer?  Why couldn’t my husband get to Barnes?

If I could have a do-over, I would have driven my husband to Barnes right from the beginning.  I did not realize the window for helping a stroke victim is within the first few hours of symptoms.  I could have made it to Barnes.  I did not realize that Missouri Baptist Medical Center was not a Level One Stroke Center.  “IF” something goes wrong at Missouri Baptist, Barnes is the go-to facility. Yet, we had to wait for 97 minutes for help to even arrive at Missouri Baptist to transport my husband. Had anyone said to me on August 3rd, ‘We would like to give your husband this drug.  If something goes wrong, we will not be able to help him. We would need to transfer him to Barnes and you will have to wait 97 minutes before a transport arrives.  BUT, you are within the window of getting help, if you would like to drive to Barnes, and they give him this drug, and something goes wrong, they can help him immediately.’  I can say with 100% confidence, I would have driven to Barnes.

Sometimes we did get do-overs at elementary school recess.  It was just fun and games.  I can’t have a do-over on August 3rd.  A life I loved was lost.

#stroke #tPAdrug #lifelost #sireninthedistance