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Second Chances: Marcia’s Story

Stroke was not part of Marcia’s plan. Fortunately, it’s always part of ours.

Many months and milestones later, talking about that day isn’t easy. Marcia’s family hasn’t lost the ability to laugh at certain moments of the ordeal. But the fear, the uncertainty–those memories remain sharp. They realize how close they came to losing her.

Marcia realizes it, too. As a physician assistant she knows the stats for a ruptured brain aneurysm.


“I’ve said it a million times. There’s absolutely no earthly reason why I’m still here. I mean, there’s not.”

Marcia | Stroke survivor

Aneurysm

Marcia is living proof that anyone at any age can suffer a stroke–and that immediate treatment is essential to survival and recovery.

There are two main types of stroke–hemorrhagic and ischemic.

Hemorrhagic strokes occur when a weakened blood vessel ruptures, leaking blood into the area around the brain. The most common cause is a cerebral aneurysm, a weakened area of a blood vessel in the brain. Often, there are no symptoms of an aneurysm, but as it slowly enlarges, like a balloon, it becomes weaker.

The effects of a ruptured aneurysm depend on many factors, including size, location and multiple other influences. It can be fatal with no warning sign. Marcia experienced the most common symptom: a “thunderclap headache,” the worst headache of a person’s life. This is what prompted her to seek help immediately at Metro Health.

During Marcia’s treatment, doctors discovered she also suffered an ischemic stroke. This type of stroke accounts for about 87 percent of cases, occurring when a vessel supplying blood to the brain is blocked by a clot. The risk of this type of stroke increases with age. However, in Marcia’s case, it was a response to the initial hemorrhagic stroke.

“We were just lucky to find the aneurysm at her stage, and she was expedited to the emergency room once she had her symptoms,” said Augusto Elias, MD, Director of Metro Health’s Comprehensive Stroke Center.


Chapter 1 – Morning, St. Patrick’s Day, 2018.

It was family tradition. A big group of family and friends would be waiting for her and her husband at the Irish Jig 5K, all decked out in green.

But Marcia and her husband, Dave weren’t going to make it.

“I was getting dressed and I bent over to put on my running tights,” Marcia said. “I just clearly remember this. It was just a sudden, sudden headache and just severe pain and a spasm down the back of my neck.”

It took her breath away and made her want to vomit. She willed herself to keep breathing and not pass out. She cried for help from her husband.
This is one of the parts of the retelling that hits Dave hard, remembering the panicked confusion and pain in her voice.

“I don’t know how to explain, when you know your spouse is in trouble … you hear someone calling your name and you have a feeling it’s not good, but you don’t know what you’re walking into. I went into the bedroom and she was on the bed–you know, head down, hands over her head saying, ‘I don’t know what’s going on.’”

This is what doctors call a “thunderclap” headache. The worst headache of your life. The sign of something bad: a ruptured cerebral aneurysm.

Marcia suspected what it meant. “You need to get me to the ER,” she told Dave. “And take me to Metro.”


Chapter 2 – At the hospital: Worst fears realized.

Her boss, neurosurgeon John Keller, MD, met them in the Emergency Room. As Marcia was admitted, Dave texted her sister Maureen to let her know they wouldn’t make it to the race and to stand by for more news.

Scans revealed a ruptured brain aneurysm resulting in a subarachnoid hemorrhage – a hemorrhagic stroke. This meant there was bleeding into the space surrounding her brain. Without immediate treatment, she faced the likelihood of dying or severe disability. Dr. Keller told her to focus on his next words.

“I need you to stay with me,” he said. “We’re going to get you through this. Positive thoughts. We’ve called the team in. Everybody’s looking at your scans right now, and we’re going to take care of this.”

But back at the race, the news caused its own thunderclap among family and friends who join the race tradition every year. Marcia’s sister Maureen was at about the 1-mile mark of the race when Dave called back.

“His voice was breaking, and I’ve never heard him like that before. He’s our joker, he’s our person that lightens the mood. And he said, ‘I need you to get Reagan and the girls, and you need to come now. You need to come now to the hospital.’”

Maureen sent hurried texts and left voicemails for family and friends and headed to Metro Health.

“It was just a tense, tense, tense drive. And I looked in the back seat of my husband’s truck and they were just holding hands. Looking at each other as we rushed to the unknown.”

Marcia’s first concern was to see her daughters. “I knew the girls were scared, and that just broke my heart. I mean, because as a mom, you’re just, your goal in life is just to take care of your kids and protect them.”

She remembers seeing family in the ICU. She remembers joking that the Metro Health staff had ruined her St. Patrick’s Day. After that, everything fades into a blur.


“It was just a tense, tense, tense drive. And I looked in the back seat of my husband’s truck and they were just holding hands. Looking at each other as we rushed to the unknown.”

Maureen | Marcia’s sister

Chapter 3 – A complicated procedure, a difficult wait.

Marcia’s  procedure was estimated to take three to four hours.

Ravi Shastri, MD, a Neurointerventional Radiologist, explained that doctors would use a catheter to place a stent across the aneurysm to restore blood flow. Even though this was less invasive than surgery, he warned she would need to remain hospitalized 14 to 21 days.

Half of all patients who suffer a brain aneurysm rupture never make it to the emergency room. Of those who do make it,  50 percent have severe disability.

The stent was successful, but Marcia’s body started producing blood clots. She was suffering a second kind of stroke, called ischemic, in which clots cut off oxygen to the brain. The clots needed to be removed, through medication and “aspiration” via a tiny catheter in the artery–painstaking work that had to be repeated every time a clot formed.

After about nine hours, Augusto Elias, MD, Director of Metro Health’s Comprehensive Stroke Center, approached the family.

“The look on his face allowed us to know right away, OK, she’s OK,” Maureen said. “And he said, ‘We are waking her up, she’s OK.’ And that moment is just amazing.”

Once she was out of recovery, immediate family could go in for a brief, visit. This was not the Marcia they were used to seeing, The effects of the strokes were obvious–she had left-side weakness, and she had trouble focusing her left eye. Speaking was difficult because of the breathing tube used during the procedure.

The only thing that mattered at that point was that she had survived. But there was a long struggle ahead. The biggest concern would be the risk of “vasospasm” – when muscles inside blood vessels tighten, risking another stroke. So began another period of waiting.

Others were encouraged by her recovery. But Dave was left with nagging worries – the sort that come with being married to someone who works in medicine.


“In the back of my mind I’m like, she’s doing great–that’s what you see. But I, living with someone like Marcia, know that the storm’s coming.”

Dave | Marcia’s husband

Chapter 4 – “Weather reports” and a long recovery.

Everybody was on the lookout for the storms.

When Marcia was sent for regular ultrasound scans to check her progress, Dr. Shastri would deliver the “weather report”–an analogy to report on her status.
“If you don’t have any history of healthcare, it’s the best way to put it so people that can understand,” Dave said. “He’d say, ‘We see some clouds on the horizon, there’s gonna be a storm coming. It doesn’t look like a bad storm.’

“Sure enough, I think the day he picked ‘thunderstorm’, she had her raging headache.” This happened about a week after Marcia arrived at the hospital. It terrified her. “I mean, all I could think was, ‘Here it is. I’ve been waiting, because I’ve been doing too well. When is the vasospasm going to start, and I’m gonna have that massive stroke and die?’”

When doctors told Marcia she would be in the hospital a minimum of 14 days, that became her deadline–to get out of the hospital, get her life back and return to her family. “I mean that gave me such a purpose,” she said. “My whole purpose was, ‘I’ve got kids to take care of. I’ve got a daughter to raise.’ I was like, ‘We’re going to get better. I’m getting better. I’m going to do this, and I want my life back.’”


Chapter 5 – Determination and hard work

“She worked her butt off,” Dave said. “There’s no one that can take credit for where she came out of that hospital to where she is today, but herself.”

Being able to sit up in bed was a victory. Sitting in a chair felt like freedom. Feeding herself was its own reward – encouraged by snacks like her favorite curly fries from the Metro Health cafeteria. Maureen brought those and insisted she use her left hand to dip them in ketchup for the first few bites.

Some days were harder than others for Marcia and her loved ones. They formed a bond with other families in the ICU, sharing prayers, sharing food. And they got to know the Metro Health staff, growing in their appreciation for them daily.

“There was a day when things hadn’t gone great,” Maureen said, “and I was sitting alone in the ICU family waiting room, and one of the nurses came out to see me. … And she gave me a big hug and she said, ‘You know, everybody has tough days, and this is Marcia’s and she’s going to be great.’

“And she hugged me and made sure I was alright, and then she went back to her work.”

Eventually, Marcia took her first steps with a walker. She underwent physical and occupational therapy, always progressing toward her 14-day goal of being discharged to Mary Free Bed for rehabilitation.


Chapter 6 – Getting her life back.

The joke among Marcia’s family was that the Metro Health staff would celebrate the day she was discharged because they could finally be rid of that big, boisterous group of visitors. When that day finally came – right on day 14 – they did celebrate, but only to applaud her accomplishment.

After all they had been through, Dave couldn’t help but worry. “He really truly would’ve loved to have wrapped her in bubble wrap,” Maureen said.

Dave admits it. Even now, every now and then, something will happen to send his mind racing back to that moment. And yet, there’s no denying how proud he is watching Marcia take back her life. And Marcia admires Dave’s ceaseless dedication and what she calls his “huge capacity to love and take care of me.”

“If you ever doubt somebody’s love for you, an ICU stay will tell you one way or the other how they feel. I mean, he was just there, no question. And I mean, he was pretty much just my rock.”

Marcia made quick progress with her rehabilitation at Mary Free Bed and outpatient therapy. She soon returned, starting out part time. Her biggest struggle was the fatigue that comes after a stroke.

Nearly one year after the aneurysm, Marcia was left with one unfinished piece of business: getting back to the Irish Jig.

She had made a promise to herself: “I will run that race, and it’s gonna be great. And then we’re going to come back to my house and have a big party, and it’s gonna be fantastic.”

It was a miserable day. Barely above freezing, windy. But there among the estimated 4,000 participants was a large group of friends, decked out in green and fulfilling a long tradition – and this time, their group was complete. Dave was there. Maureen, too.

And there was Marcia, dressed in her green shirt, green tutu, a Viking-style hat with green horns, and wearing that big smile.

She and her family had returned, to take back St. Patrick’s Day. It wasn’t her fastest race, a year after she nearly died. But it might have been her best.