“It was like serendipity.”
That’s how Dr. Ron Goodsite described his wife’s stroke, and subsequent response that led to her extraordinary recovery. Serendipity that everything fell into place as it did. “Sandy exhibits what an ideal patient’s response should be,” he said.
It happened April 22, 2014.
Sandy Goodsite, 72, stopped by her medical management company for just a few minutes to get some things done when an employee noticed that she was unable to move, and staring into space. She realized something wasn’t right, and alerted Sandy’s daughter, who was in the next room. Sandy’s right side was beginning to droop. Her daughter immediately called 911. Within minutes, the office was full of firemen, and stunned employees watched as Sandy was loaded into an ambulance.
Longtime Tucson pediatrician Dr. Goodsite is now semi-retired, and works in the imaging department at TMC for Children. He was just finishing up his shift when his phone rang. It was his daughter telling him Mom was on her way in via ambulance. “It was really scary,” he said. “It can happen to any of us at anytime, and it can happen when you least expect it. When you have something like this that affects a loved one, it’s frightening.”
Sandy’s risk factors were well controlled. She had no symptoms. And absolutely no warning signs.
Her miraculous recovery started with the medic’s quick response time and communication to TMC that a suspected stroke patient was coming in. TMC is a designated Primary Stroke Center, and was recently honored with the Gold Plus award status for the fourth year in a row. TMC is also recognized as a recipient of the American Heart Association/American Stroke Association Target: Stroke Honor Roll.
Emergency Department staff triggered a hospital-wide alert called Neuro Red in which a team of people immediately report to the emergency room, including the rapid response nurse, house supervisor, lab technicians, and the neurologist on-call. In Sandy’s case, neurology resident Dr. Muhammad Kahn responded. Radiology was put on alert, and pharmacy was put on stand-by.
As soon as Sandy hit TMC’s emergency department, her blood was drawn and a brain scan was performed. She had suffered an ischemic stroke, in which a blood clot broke off and traveled to the left side of her brain – the portion that controls speech and language. The stroke was significant. CT scans show the clot affected a baseball-sized portion of her brain. The right side of her body was completely weak, as is typical with stroke victims.
TMC Neurologist and Stroke Director Dr. David Teeple administered a drug called tissue plasminogen activator, or tPA. It’s approved by the FDA for treatment of ischemic stroke up to three hours after stroke, and works by dissolving the blood clot.
Ischemic stroke patients should get tPA within 60 minutes of hitting the emergency room. Sandy received it 22 minutes after she arrived at TMC, one of the fastest times in the city.
“With stroke, time really is of the essence,” said Dr. Teeple. “Every minute, a stroke patient loses about 2 million brain cells. Every hour, they lose 120 million brain cells. The sooner you give tPA after the onset of stroke symptoms, the more effective it’s going to be. That first hour is really the golden hour where we can eliminate a lot of the brain damage caused by stroke if we administer tPA quickly. For Mrs. Goodsite to receive tPA 22 minutes after hitting the emergency room door is absolutely incredible.”
Six hours after tPA was administered, Sandy’s motor deficiency had disappeared. Sandy was in TMC’s intensive care unit for two days, followed by two more days in the neurological unit. Initially, she was unable to write. Her words all ran together. She mixed up right, left, up and down – a very common symptom of stroke. Sandy spent the next ten days at HealthSouth where she made big strides with her rehabilitation.
Each day, she started doing a little bit more. It didn’t take long for her ability to write and speak to come back. “My husband used to laugh because of my ability to multitask,” she said. “I’d work on three things at once, and it would drive him batty.” She’s working on being able to multitask once again, and also how to focus. She gets easily distracted, but did not lose any intellect during the stroke.
Dr. Goodsite finds himself wondering what would have happened if anything went differently that day. What if Sandy would have suffered that stroke while driving? What if those firemen were on another call, and it took them longer to respond? What if TMC wasn’t a designated Primary Stroke Center, and didn’t have the Neuro Red team in place? “We have a strong faith in God, and we believe we had help from above. We felt that someone was looking out for us, and especially looking out for Sandy,” said Dr. Goodsite.
Dr. Teeple said Sandy’s remarkable recovery is extremely gratifying from a physician standpoint. “This is the culmination of everything TMC, the city, and EMS have been working so hard on for the past five years. Since TMC is a Primary Stroke Center, we have the foundation in place to be fully prepared for these patients before they even get here. Everyone in every department that was involved – did the right thing, and worked together to get this result.”
“My appreciation of TMC has really gone up 1,000 percent since I’m now a person who has experienced this firsthand,” Dr. Goodsite concurred. “That day, I was at TMC – not as a physician, but as a husband. I am completely amazed at how the brain is able to recover once tPA is administered. But beyond that medication – the Neuro Red team TMC has in place – is incredible. As soon as Sandy hit the doors at TMC, she was immediately taken to the exam room and then her brain was scanned, and the tPA was administered. The response was remarkable.”
Doctors are still trying to find out exactly where the clot came from in Sandy’s body. She’s about 95 percent recovered, and making incredible strides with the occupational and speech therapy she is receiving twice a week. She has what’s known as expressive aphasia – similar to when you have a thought or a word “on the tip of your tongue.” It’s in your head, but you’re just having a hard time retrieving it. Day by day, however, she’s making big improvements.
The Goodsites have plans to formally thank the medics and TMC staff members who did everything right that day, which aided in her quick recovery. Dr. Goodsite said, “I can’t wait for Sandy to walk in, and see these people, and say ‘Thank you.’”