Papa John had a stroke

At some point this week, my dad had a stroke at home. We don't know exactly when it happened, but on Thursday, cousin Debbie texted because Dad hadn't replied to texts or phone messages for a couple of days. Not his MO. After he didn't respond to my text or call, I got in touch with his friend in town, Marty. Marty went by the house to find Dad sitting in his chair, but not responding to Marty or EMTs pounding on the window, shouting his name. Once they got in the house, Dad evidently greeted Marty right away, but he clearly needed to go to the ER.

His was an ischemic (clot) stroke in the right anterior cranial artery. If you're going to mitigate a stroke by dissolving or removing the clot, you have to act within a couple of hours. That window had passed for Dad. CT and MRI show a large, damaged section of his right frontal lobe: to my untrained eye, a strip about an inch wide in the front half and upper two-thirds of his brain.

Dad went to the ER around 6pm on Thursday. I got there around 11:30 that night. Despite the events of the day(s), he recognized and greeted me right away (as he's done with every visitor or caller since). Friday was a full day of tests and visits from internal medicine, neurology, physical therapy, occupational therapy, and speech pathology. He was moved from the emergency department to a stroke service in the hospital.

So the immediate impact of the stroke: Being on the right side of his brain, the left side of Dad's body has been most affected. His left arm has scarcely moved; one nurse and doctor have discerned some reflexive movements in the fingers, but they are very subtle. His left leg has shown only uncontrolled or reflexive movement. (It has a superb tickle reflex; more on that later.) There's a droop on the left side of his face, which is more pronounced when he's tired. And it seems that his brain may be "neglecting" the left of his field of vision. He appears to have normal sensation all over his body. He can control the right side of his body, but movements are slow, and he's quite weak. When the PT and OT jointly got him to a sitting position on Friday, there was no sign he could maintain it.

He seems to be fully aware of his surroundings. As indicated above, he greets whoever enters, and he's aced every question about his name, birthday, location, month, year, etc. His speech is mumbled, with a very flat affect, and there is a noticeable delay for him to respond. He's been cleared to eat since late Friday morning, and has polished off every hospital meal since (being fed, of course). He is most talkative towards the ends of meals or on the phone.

His spirits are the hardest thing to gauge. Though he is not talking much, his speech is full of his typical, dry quips. (Extremely dry, given his current voice.) He's made a few comments about being home "tomorrow", and called the plumber to try to schedule a repair at the house. It's hard to know how much this is undue optimism, cynicism about the ability of the medical staff to help him, or complete unawareness of his own condition. (On Friday, he claimed to be able to move his left arm, but that didn't come up today.) He tends to clam up when he is being asked to perform various tasks ("raise your arm", "follow my finger with your eyes"). Again, it's hard to say why. Fatigue, because these tasks are very challenging at this point? Frustration, because he can't do them? Confusion? Pissed-off resignation? I don't know.

This afternoon, I did see his first grin, and maybe even heard a chuckle, while I was clipping his nails. I went to his left foot, forgetting its aforementioned tickle reflex, and was dramatically startled when it flew up at me. It made me laugh, and when I looked at Dad's face, he was clearly amused, too. That was the highlight of my day.

After a very busy Friday, I've been told that we're just hanging out at the hospital this weekend. For a few days after a stroke, there is an elevated risk of a second stroke. Preventing that is the top priority. Dad has high blood pressure - he'd just started a medication to bring it down - which is the top risk factor for a stroke, but there has been no clear, "aha, here's where your stroke came from" found. On Monday, we'll start talking with the case manager about the next step. That's likely to be an in-patient rehab facility, a place with hospital-level care plus three hours of rehab, five days per week. In extremely notional terms, he might be moved to such a facility mid-week, for a 2-3 week stay.

I want to thank all of the family and friends who have visited or called Dad and who have sent love, prayers, and offers of help. (This goes for all those back in Dallas who are helping Kerry, Owen, and Katherine fill in the gaps while I'm in Tulsa. I don't know exactly who's doing what, but I know that you have our family's back.) It means so very, very much; I can't imagine what this process would look like without you.

I will do my best to provide news here, or at least more funny stories of Dad trying to kick me in the face.