All The Right Moves

A stroke changes the lives of an Ames couple, and their feelings about a hospital.

By Steve Sullivan

Tony Ellis’ wife was having a stroke. He raced to her place of work and got her in the car.
Worried and anxious, the Ames man, a physician himself, then had a choice to make. Turn left and head south to a big hospital in Des Moines? Turn right and in minutes be at Mary Greeley Medical Center?

His wife was having a stroke and time was of the essence, but could a community hospital deliver the care she needed?

He made a fast decision, and, as he and his wife, Rebecca, quickly learned, it was the right one.

Shock

Rebecca Ellis, a nurse at ChildServe in Ames, was working with children who have special healthcare needs when she felt something like an electric shock in her neck. Her left side went flaccid and she couldn’t lift her arm.

“I didn’t have the face droop or slurred speech, but when my nursing supervisor came in, I said, ‘I think I’m having a stroke,’” she remembered.

Rebecca called her husband, Tony, who works on contract at hospital emergency rooms in Iowa and Los Angeles. He’s often out of town, but was fortunately nearby that morning. He rushed to his wife.

“He immediately hugged me, and I said, ‘Tony, is my face OK? Is my smile OK? I was walking through all the FAST stuff,’” she said, referring to the acronym used to spot stroke symptoms.

What's FAST?

FAST is an acronym to help remind people of the signs of stroke. The familiar formula has recently been modified by Intermountain Healthcare as BEFAST:

• BALANCE: Loss of balance with sudden onset.
• EYES: Sudden change or loss of vision, particularly in part of the visual field.
• FACE (facial droop): Have the person smile to see if one side droops.
• ARMS: Have the person hold their arms up like carrying a pizza box; watch for one arm to drift downward.
• SPEECH: Have the person say a simple sentence such as “no ifs, ands, or buts about it.” Listen for slurring of speech.
• TIME to call 911. Stroke is an emergency and the EMS providers are trained to recognize and care for stroke patients. They also can alert the ED to prepare to evaluate and care for the person experiencing stroke symptoms.

A health scare like this is obviously a shock, and even more so in Rebecca’s case. She is in her mid-50s and over the past year had lost 70 pounds thanks to diet and exercise.

“I’m in the best shape I’ve ever been in,” she said.

Tony wasn’t sure a local community hospital would have the skills and resources his professional experience told him his wife would need. His work primarily involved large hospital systems and urban medical centers. His hesitation about Mary Greeley was also personal. Yes, he had volunteered here to cover prerequisites for medical school. Yes, one of his and Rebecca’s children had been born here. Yes, they lived just a few blocks away. But a dear friend—the man who had introduced Tony and Rebecca and was the same age as Tony—had recently died at Mary Greeley following a serious illness. Tony felt the pain of that loss every time he drove by the medical center.

“I knew this was serious, something potentially devastating,” he said. “I was thinking, do I stop at the house and get aspirin? Do I go to Des Moines, where she will mostly likely be transferred?”

Deep Bond

Rebecca and Tony have been married for 36 years. They met as teenagers when she traveled to Iowa from Minnesota to work as a summer volunteer at a facility near Tony’s
central Iowa home. Their connection was intense and immediate. Rebecca went home to Minnesota, but eventually returned to Iowa to reunite with Tony. They ultimately married, though before either had reached the age of 20.

“We basically grew up together,” Tony joked.

He was farming when they got married. When that career path didn’t work out, Tony decided to become a doctor. Because, why not?

Rebecca went on to earn her nursing degree. They have three grown children and five grandchildren.

Their bond is deep and they are devoted to each other. Tony and Rebecca are the first to admit that their lives together have been blessed and eventful, which made the events
of that Friday the 13th in April all the more distressing.

ER Response

When they arrived at Mary Greeley’s Emergency Department (ED), all Tony had to do was announce, “My wife is having a stroke.”

When a possible stroke patient arrives in the ED, the front desk immediately alerts the care team. Rebecca was taken to a treatment room where Dr. Sherri Flugrad, McFarland Clinic, began her examination. Ashley Jones, BSN, RN, told Rebecca, “we don’t yet know if you’re having a stroke, but we are going to treat you as if you are.” ED staff go through stroke care training, learning the National Institutes of Health’s stroke scale that is used to assess stroke patients.

“We call a stroke code to ensure that Radiology has a CT (computed tomography) scanner ready so a scan of the patient’s head can be done as soon as possible,” said Jones.

“Rebecca’s symptoms had started less than an hour ago, so we had time, and you don’t want to waste any time with a stroke because time is brain.”

There’s also a four-hour window to administer tPA, a clot buster medication. That’s where Sharon Ellrich, MSN, RN, Mary Greeley stroke program coordinator, comes into the Ellis story. Rebecca’s symptoms were mild, she said, but “even mild symptoms may be life changing.”

“A stroke can happen to anyone at any age, and the trend in the United States has been that the age of onset of stroke has gotten younger,” said Ellrich. “Early recognition and early treatment is incredibly important. Many people wait to come to the hospital; Rebecca, fortunately, did not.”

Ellrich responds whenever there is a stroke call. She assists ED nurses in assessment, helps educate family, assists in the administration of tPA, and monitors the patients for the first 24 hours.

“tPA is a medication that we give that helps break up an existing clot. About 87 percent of all strokes are caused by blocked blood vessels in the brain,” Ellrich explained. “The sooner we can treat a stroke, the better a person’s chance to recover function.”

Tony, in full husband mode despite his extensive experiences in emergency medicine, was on hand to observe everything.

“I didn’t know he was a doctor until halfway through the process,” Jones said. “It wouldn’t have changed how I cared for her.”

Dr. Selden Spencer, a McFarland neurologist, also arrived. He was a friend of the Ellises and a welcome site to the stressed couple.

“It was comforting that the hospital has a neurologist available, just across the street, and that we knew each other,” Tony said.

Comfort

Scans indicated that Rebecca had suffered an ischemic stroke. It results from an obstruction within a blood vessel providing blood to the brain.

Rebecca was taken to the Intensive Care and Cardiac Unit. By that time the tPA was doing its work and her condition was stabilizing, though she still felt the stroke’s effect on her left side.

The next day she was transferred to a room in Mary Greeley’s west patient tower. Dr. Cari Low, a McFarland hospitalist, became part of Rebecca’s care team.

“We knew from the moment we met that Dr. Low has something special,” Tony said. “It was most apparent on Saturday morning. We had such improvement in Rebecca’s legs and
anticipated that the arm would improve just as fast.”

That was not to be the case, though.

“I was very tearful and telling her ‘my arm, my arm isn’t back.’ Dr. Low sat on the edge of my bed and looked me in the eyes and went through everything that they’d seen in the ED and then detailed what all the improvements were,” said Rebecca. “She was so gentle. She became our cheerleader. She was there every day.”

The first few nights in the hospital were scary for Rebecca, but she found comfort in the presence of her family. Then came an improvement.

“One night I woke up at 3 a.m. and looked over to see my daughter and grandson asleep in my room, and I suddenly realized that my arm was back,” she said. “I had no numbness,
no tingling. It was an emotional moment for me. I was at peace, and I laid there for another hour watching my daughter and grandson sleep.”

The Ellises continue to seek medical advice on what may have caused Rebecca’s stroke and how to avoid another one. (Statistically, about 25 percent of people who experience strokes will have another.)

Rebecca participated in Ellrich’s stroke support group. She also did hand therapy with Linda Power, MS, OTR/L, a certified hand therapist with Mary Greeley’s Rehab & Wellness.

“We knew so many people all the way. We had connections through work, church, and our family,” said Tony. “There was a close feeling, a feeling of safety. The whole experience changed our image of Mary Greeley and how fortunate we are to have this place.”
When Tony drives by Mary Greeley, he still remembers his late friend. He also now remembers the experience his wife had here after her stroke. He knew she got the care she needed. He knew they made the right turn that day.