Stroke of Fate
By Maureen Dowd for the New York Times ( 5.3.2015 )
–EDGEWATER, Md. — THE thing that’s easy to miss about Tara is how competitive she is.
In a big Irish family of gabby, argumentative people, my niece is a lovely, willowy brunette with an easy laugh and quiet manner.
Her parents had a love match on the tennis courts at Catholic University, when my brother Martin was coach of the men’s team and his future wife, Jone, was coach of the women’s team.
They are not the overindulging side of the family. Tara never smoked or did drugs, and two glasses of wine on a weekend is a bacchanal.
Tara constantly challenges herself. She played on her mom’s tennis team at Catholic, helping it earn a Division III national ranking, and, at 25, joined the California National Guard, winning the top women’s fitness award.
Tara had already done several triathlons, but approaching her 40th birthday two years ago, she began training two hours a day to compete in a Half Ironman, cheered on by her husband, Chris O’Kieffe, who runs a successful Kona Ice franchise in their Chesapeake Bay town. After 16 years teaching kids with disabilities, Tara — mother to a pretty 9-year-old, Kasey — now helps Chris with the business.
Last spring, she also decided to start playing tennis again. She was nervous that, because of her tennis family, her friends would have high expectations.
Her shoulders tensed up through her entire first match, but she was elated when she won. By the time she drove home and got in the shower, however, she had a throbbing pain in the back of her head above her neck.
She took some Advil and got into bed. She looked at her phone, but the letters were moving. She tried to watch TV with Chris, but it was “like looking through a really thin layer of water, rippling and sparkling.”
She assumed that she was having her first migraine, a letdown after being so amped up.
The headache was still there in the morning, and the morning after that. Her husband teased her about being “a big baby” and held up his fingers to the right of her face to test her vision.
“I can’t see your hand at all,” she told him.
“We need to go to the emergency room,” Chris said.
She had some tests. “The doctor came in and said, ‘Well, it turns out you had a stroke,’ ” she recalled. “I don’t know if the doctor’s words or Chris’s expression scared me more.”
The next months were the worst of her life. “I didn’t go through a day without crying,” she said. She was afraid to exercise or even turn her head.
“At some point,” she said, “I got really angry about, why the hell do I do everything right and then almost die? From playing tennis? The thought of not being able to do anything more than what I’d already done was so sad to me.”
Tara was part of a disturbing health trend, according to a Washington Post piece that ran a month after she had the stroke. After years of declining in the elderly, the paper reported, strokes are rising among younger adults.
Because they are accustomed to being healthy, younger stroke victims often deny or ignore the symptoms, leading them to miss treatment in the critical hours and days afterward. And, because they look young and healthy, doctors often don’t consider stroke as a cause.
Tara lost 30 percent of her peripheral vision. Doctors told her to cut back on physical activity.
“So I was going to walk gingerly and turn my head slowly and do what I needed to do to see Kasey grow up, and that was my battle,” she said. “I was living like I was made of glass.”
I urged her to get another opinion, and she booked an appointment with a national stroke expert, Dr. Louis Caplan, a Harvard professor of neurology who works at Beth Israel Deaconess Medical Center.
When I met Tara at the airport to fly up to Boston, I walked past her. In four months, she had lost 15 pounds, and her spark was gone.
At 78, Dr. Caplan is gruffly angelic, like a Frank Capra character. He showed Tara picture cards to test her memory and speech, checked her visual abilities and looked at her brain and vascular images. They had been misinterpreted by the Maryland doctors, who thought that Tara’s vertebral artery had closed when it had just narrowed, meaning it could open and heal.
Some younger people have strokes from recreational drugs. But others — even children and teenagers — have strokes after dissections, a tear in the wall of an artery that unleashes a clot.
“It can happen with a sudden everyday movement that stretches the artery,” said Dr. Caplan, who sees dissections on a regular basis. “The arteries are more elastic with younger people.”
He has treated a doctor who lurched when he thought his kid was falling from a tree, a basketball coach who was running up and down the court looking back and forth, and a pregnant woman who swerved her head to check traffic before crossing the street. Dissections can be caused by sneezing, coughing, vomiting, sex, or even leaning back to get your hair washed at a salon. And sometimes the only symptom is a headache or neck ache.
Dr. Caplan is not sure if strokes are increasing among younger people or if doctors are just getting better at realizing “it’s not just old folks.”
He said stroke experts have had a hard time getting the message across to E.R. personnel that if a stroke is suspected, a vascular image must be taken as well as a brain image, because it shows up first in the vessels that supply and drain the brain.
“You have to be pushy,” he explained to me later. “There are a lot of organs E.R. people have to deal with quickly, but they get little neurology training. The brain is the Rolls-Royce of the system. Would you run your Rolls-Royce into the local gas station? If you have problems with the brain, ask for a neurologist. If you live in a big city, find an academic medical center that has a specialization in stroke.
“I’m afraid to go to the emergency room,” he added. “I think it’s dangerous.”
Dr. Caplan dryly admitted that it’s a contradiction: You have to worry about getting to the E.R. fast and then worry about the quality of treatment once you’re there.
He assured Tara that her stroke was not caused by nerves or a weakness in her arteries and said that there was only a 1 percent chance of recurrence for this kind of stroke after the first month. He told her he was going to play tennis and advised her to do the same.
“Unfortunately, doctors and patients put too many restrictions on themselves,” he said later. “They’re told, ‘Don’t lift your baby,’ ‘Don’t have intercourse.’ Because movement brought this on, they think they cannot have any movement. That overprotectiveness can be worse than the dissection itself.”
When Tara got home, she ran a mile and a half, crying all the way.
“It was like I realized I don’t have to throw me away and try to develop this new person,” she said.
On April 2, the first anniversary of her stroke, she ventured back onto the court for a cardio tennis class. She was terrified, and her friends were jittery, picking up balls for her.
“I was nervous for a few hours afterwards,” she said. “I would look in the mirror and smile and make sure I wasn’t drooling.”
As we drove in her neighborhood one recent afternoon, she marveled at how wonderful it was to see the spring. “I missed the last one,” she said.