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Stroke

Trauma and emergency vehicles only sign
Under normal circumstances, Jim White, 56, would have been alone at 6am on a Saturday morning. But Jim’s life, like most others, looked a little different on April 18, 2020, one month into stay-at-home orders stemming from COVID-19.

“My daughter and her family live in South Philly, but were staying with me in Downingtown for the quarantine,” Jim says. “So I had a full house. Little did I know that that full house would save my life.” 

Jim had taken a shower and gotten dressed that morning but wasn’t feeling himself. When his daughter came downstairs and started talking to him, more extreme symptoms began presenting – and fast.

“All of a sudden I went deaf,” Jim remembers. “I was panicked, saying, ‘Baby, I can’t hear a word you’re saying.’”

Jim’s son-in-law ran into the room, at which point Jim’s symptoms reversed: He got his hearing back but lost his ability to speak.

“They’re asking me questions and all I can do is shake my head yes or no. I heard my son-in-law say that it might be a stroke.” 

By the time paramedics arrived, Jim was paralyzed from head to toe but entirely conscious. Now that COVID-19 was a fully-fledged outbreak, having to go to a hospital or emergency room was daunting for many. For Jim and his family, they knew that COVID was no reason to hesitate. Jim had to get to the hospital.

“Honestly, at that moment COVID wasn’t even a thought until the paramedics told my son-in-law and daughter that they weren’t allowed to ride in the ambulance with me,” Jim remembers. “That’s when I remembered what was going on in the world.”

The no-companion policy was the first of many new protocols that would shape Jim’s experience at Penn Medicine – an experience that ultimately saved his life and kept him safe from COVID-19.

A Race Against Time

As the ambulance rushed a paralyzed Jim to Penn Medicine’s Chester County Hospital, COVID-19 was still the last thing on his racing mind. But COVID was top of mind for Penn Medicine. Extreme protocols had been put into place weeks prior to protect patients (as well as families, caregivers, and hospital staff) from contracting the virus.

From medical staff to environmental services to food services, any Penn Medicine employee who comes into contact with patients like Jim wears a mask, and has undergone a complete health screening to ensure they aren’t carrying the virus.

No visitors are allowed in patient rooms and treatment areas. All areas of the hospital are rigorously cleaned and disinfected several times per day. In addition, physical distancing is enforced in waiting rooms and patient care areas. Patients scheduled for surgery, or emergency cases like Jim’s, bypass waiting rooms entirely.

“Rigorous protocols that ensure safety and cleanliness have been merged with clinical practice in order to provide time-sensitive medical care,” said Christopher Favilla, MD.

Amidst all of the new protocols, Penn Medicine staff is still working as efficiently and effectively as they were pre-COVID to save lives. “In the case of a stroke evaluation, every minute is critical. With precautions in place, we can seamlessly perform a clinical evaluation and obtain emergent neuroimaging studies in order to make a quick treatment decision.”

Jim underwent a CT angiogram as soon as he arrived at Chester County Hospital.

“One of the things that will always stand out in my memory is the fact that the nurses and doctors kept talking to me. The whole time I was being examined and scanned, they kept me informed, telling me what was going on even though I couldn’t acknowledge them or respond.”

The scan showed an occlusion of the basilar artery – a blood clot was causing a devastating stroke in the brainstem. Injury to this critical portion of the brain is often fatal without treatment. Due to the severity of the stroke, Jim would need to be airlifted to the Comprehensive Stroke Center at the Hospital of the University of Pennsylvania, which offers the most advanced stroke treatments available.

It was around this time that Jim became unresponsive.

One Challenge Down

Jim was rushed to the neuro-interventional radiology suite when he arrived at the Hospital of the University of Pennsylvania. There, Bryan Pukenas, MD, a specially trained neuro-radiologist, used a minimally invasive technique to quickly remove the clot and restore blood flow to Jim's brain.

When Jim woke up later that day, it was 4 pm – 10 hours after his symptoms had begun. He was in Penn’s specialized neuro-intensive care unit recovering from his emergency thrombectomy. His neurologists, Christopher Favilla, MD, and Scott Kasner, MD, tested his strength and coordination and determined that the procedure on his brain had been a success.

The very next day – Sunday – Jim was moved from the ICU to the stroke unit. Hospital staff continued to provide state-of-the-art, disease-specific care, while implementing Penn Medicine’s protocol’s to reduce the risk of COVID exposure. What could have been a devastating, even fatal, stroke was treated so quickly and successfully that by Monday he was discharged home to his daughter and his family.

And Jim remained COVID-free through it all.

Recovery Begins

It will be six months to a year before Jim fully regains his balance, coordination and speech, but he is expected to make an excellent recovery from his stroke.

“My doctors have been very honest about the time it’s going to take to regain everything I lost, and what it will take. I appreciate that.”

Immediately following his discharge, he had home visits from a physical therapist twice a day through Penn Medicine at Home, a service that’s become particularly valuable in this age of COVID.

“My physical therapist showed me all of the exercises I have to do, and now I do them on my own and check in with her,” he says.

All of Jim’s follow-up appointments with doctors have been over the phone or through telemedicine, another measure Penn Medicine has taken to prevent patients and their families from having to travel to a healthcare facility during COVID-19. With services like telemedicine and at home therapy, patients can experience the same level of outstanding care from the comfort of their own home.

“The video appointments are easy. I call in from my smartphone using the dial-in information that Penn Medicine sends me in an email. We talk, and then the doctor checks my coordination and responses by having me do things like touch my nose with my hand and close my eyes when he tells me to. It’s like a normal appointment. I had an appointment last week that was over an hour because of all of the questions I asked the doctor. He spent a lot of time answering them.”

Jim’s doctors say he probably wouldn’t have survived the massive stroke if he had avoided coming to the hospital due to concerns about COVID-19. “Patients are understandably trying to avoid emergency rooms, but when it comes to a time-sensitive medical emergency, it is important to understand that precautions allow us to keep our patients safe while delivering life-saving treatment,” said Dr. Favilla. And while COVID was the last thing on Jim’s mind on April 18, he now realizes how fortunate he was that Penn Medicine had all of these protocols in place to prevent him from contracting the virus while at the hospital for three days during the peak of the outbreak.

“An experience like this changes your perspective. I’m lucky to be alive and healthy. The stuff that mattered before doesn’t matter now. I’m happy to be on the road to recovery.”

 

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