A stroke patient at Spaulding Rehabilitation Hospital
Stroke eventually killed my biological father, But first it turned him from a successful doctor, author and professor into a Job-like figure who lost everything he loved.
He and my mother split up before I was born, and he went on to a second stormy divorce. He had finally found happiness in his third marriage, to a woman seventeen years his junior. But his youthful wife broke under the pressure of caring for him in his diminished, post-stroke form. She slit her own throat with a razor. He found her in the bedroom in a welter of blood and saved her life, pinching her artery closed to stop the spurting until the paramedics arrived. After she recovered, she divorced him, despite all his entreaties. Living on her own, she tried again to bleed to death, and there was no one there to save her.
My father had loved being a doctor. The stroke knocked out just enough of his memory and reasoning faculties to make him clearly unfit to practice. He had loved writing medical novels. The stroke left him unable to spell even the simplest words, and plotting that had once been complex and suspenseful now came out embarrassingly sophomoric, unpublishable. He had enjoyed public speaking and television appearances. Now he slurred his words. He was left, he said often, with nothing that he enjoyed in life except smoking — the very cigarettes that probably led to the stroke in the first place. Death had always been his nemesis, but when it finally came, four years after his stroke, I believe he welcomed it.
Stroke is the second-biggest killer worldwide, and the biggest disabler of American adults. It costs the American economy an estimated $74 billion each year. Among its surviving victims, 70% cannot work as they did before, and about one-third need help with basic self-care. Having seen its damage first-hand, I find myself always watching for word of progress on stroke as I scan the research news, and usually struck by how little there seems to be.
Why is there so very little good news, so few breakthroughs? What is so hard about stroke?
In answer, Dr. Randie M. Black-Schaffer, medical director of the stroke program at Spaulding Rehabilitation Hospital, offered this vivid analogy:
Say it’s wartime, and a bomb is dropped in a field. It’s relatively easy to fix, you just regrade the dirt and sprinkle some grass seed. That’s what happens when you get a skin wound. It’s not hard to get the cut to heal up almost as good as new.
World War Two bombing near Paris
Now say the bomb is dropped not on a field but on a town. A great many things have to happen for that town to start functioning again as a town. You start by clearing out the debris — which is like the inflammatory processes in the brain that clear out the cells killed by the stroke. Then you rebuild the buildings, but buildings alone do not make a town. You have to bring the people back, which is like bringing back the blood cells and the neurons. And then the town has to be connected to other towns, by road and by phone lines. And even then, the pattern of movements of goods and services to and from the town may never quite be the same.
In short, Dr. Black-Schaffer said, “It’s just so complex when you have damage in the brain. There are so many different components and systems involved in each functional area of the brain. They all have to be working right in order for the patient to be able to carry on the function.”
Given that image of a bombed town, it is amazing that researchers have made any progress at all. But they have. Lately there have been a couple of exciting findings, and they come against a longer-term background of growing, hard-won understanding of stroke’s effects in the brain. All in all, enough progress for a round-up of promising steps forward.
Herewith, ten relatively bright spots:
1. Overview: Treatment of stroke has advanced — though not as dramatically as hoped — and lab research has come a long way in recent years. Continue reading