Why more stroke patients don't call 911

Strokes kill someone every four minutes in this country, making them the fourth most common cause of death in the United States.

They’re a true medical emergency — one of those times when every minute counts.

That’s because most strokes are caused by clots in the blood vessels that carry oxygen and nutrients to the brain. Given quickly enough, anti-clotting treatments can help restore the brain’s blood flow and prevent potentially irreversible brain damage.

But most stroke patients don’t reach the hospital in time to receive that treatment.

In fact, only about half arrive at the emergency department by ambulance, a percentage that hasn’t significantly improved since in the mid-1990s, according to an analysis of 11 years of hospital data published this week in the Journal of the American Medical Association.

National Trends in Ambulance Use by Patients With Stroke From 1997 Through 2008.        Kamel H et al, Journal of the American Medical Association.

People don’t always realize they’re having a stroke, so they may delay seeking medical care or call their regular doctor instead of 911, said researchers at NewYork-Presbyterian Hospital and Weill Cornell Medical Center who led the study. At other times, medical staff themselves may not recognize stroke symptoms.

But there’s more to the problem than that: Sometimes patients who suspect they’re having a stroke don’t call right away for help. That’s what happened to brain scientist Jill Bolte Taylor, who was home alone 16 years ago when a blood vessel burst in her brain.

Taylor recounts her experiences in My Stroke of Insight, a fascinating New York Times bestseller I’d recommend to anyone interested in the brain and emotions.

Taylor, then 37 and healthy, awoke alone one morning with a splitting headache that quickly progressed to confusion and difficulty walking.

The Harvard-trained neuroanatomist knew all the signs of stroke. But because the massive bleed affected her brain’s left hemisphere — the side that handles logical thinking and analysis — she struggled for long minutes to understand what was happening to her. And then she spent the better part of an hour figuring out how to call her doctor and ask a friend to take her to the hospital.

Cartoon depicting the “doing” versus “being” roles of the brain’s left                 and right hemispheres. Image from mattovermatter.com

She received excellent care there, but her left hemisphere was so damaged that she was unable to read, comprehend a normal speaking pace or piece together a children’s puzzle.

Researchers have traditionally thought that patients stop improving about six months after they’ve had a stroke. But Taylor writes that she fully recovered over eight years. She attributes this feat to her early and hard work to re-learn how to do things, and to the unwavering support of her mother, friends and doctors.

Taylor’s memoir fascinates me for another reason. She writes that before her stroke, she was an aggressive, reactive “doer” — highly accomplished, but mired in negative thoughts and memories of a difficult past.

But her stroke halted all that. Because it left her brain’s left hemisphere mostly incapacitated, Taylor lost her ego. She no longer compared herself to other people, felt self-conscious or competitive, or succumbed to painful memories. She switched from doing — planning, evaluating and remembering — to being in the present.

As a result, she writes, she felt connected to the universe, immersed in the kind of deep inner peace that mystics talk about.

What’s more, when her left hemisphere rebuilt itself enough for the old emotional baggage to reappear, she made the conscious choice to disengage from it. Instead of indulging old (or new) grievances, she taught herself to handle emotions like anger and worry by sensing them in the body and then letting them pass naturally, as meditators sometimes do.

Taylor now travels widely, teaching audiences to nurture their brains’ right hemispheres to help foster feelings of compassion and joy.

Since reading her book, I’ve started “stepping to the right” (as Taylor calls it) more often — such as by paying attention to how I feel when I snuggle with my cat or practice yoga. And when I notice happiness arising, I try to let it really sink in, as psychologist Rick Hanson recommends. I’ve found doing so cuts straight through the stress-laced stories and memories my left hemisphere likes to churn out.

A stroke of insight, indeed.

Warning Signs of Stroke

According to the National Institute of Neurological Disorders and Stroke, you should call 911 if you experience any of these symptoms.

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

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