Stroke: “Send Me”

We had eaten a delightful dinner.  We had shared laughs, updates on families and careers. And Zulma and Mario Maciel’s son Leo bewitched us with his latest rap poetry.  It was the day before Valentine’s Day.

It had been a busy week with back-to-back meetings, including breakfast and dinner meetings in Sacramento followed by much the same in Oakland before the trip down to San Jose and then a drive further south to Gilroy to the Maciel home.  “Jack, you always put my wife and family up when they’re in DC,” chided Mario, San Jose’s director of the Mayor’s Gang Prevention Task Force, a national and international leader in this work and a dear friend and colleague since our first meeting in 2007. “Come on, man, let us open our home to you.”  His wife, Zulma, she also a key figure in the public service field, leader of immigration policy and programs in San Jose, Santa Clara County and well beyond, prepared an exquisite meal.  We lingered at the table.

A wonderful evening.  A normal rhythm to the day.  Time for bed.  Getting up from the couch, I found my arm swinging independently by my side.  It was as if I had an empty sleeve.  Odd.  Perhaps it is asleep: one’s foot often falls asleep when sitting too long.  I went to the bathroom and returned, “looking strange” both reported.  Zulma put both hands on my shoulders, put her face close to mine and asked firmly, “What is your name?”  I do not remember this.  I could not speak.  Zulma and Mario reacted instantly to these classic signs of a stroke.  Within minutes I was packed into an ambulance wailing through almost flooded streets to the St. Louis hospital in Gilroy.

Lying there in the back of the ambulance, bouncing around on a gurney, hearing the constant splash of rain, I felt, for some odd reason, completely relaxed.  I tried to make conversation with one of the paramedics sitting with me, who, I found out through garble and gesture, lived in Monterey, was a father of two sons, 9 and 11, both of whom he coached in baseball.

The next memory, also etched clearly: I am now in the ER under the lights awaiting something.  I didn’t know what.  Later I found out that the medical personnel, shadowy in the background, were awaiting permission from my wife Ottilia, she across the county in Falls Church, Virginia, to administer the powerful drug TPA, gently known as the stroke’s “clot buster.”  TPA, to be effective had to be administered within three hours.  The window was closing.  Ottilia, awakened at 1:00 am, thought it was a crank call and almost hung up until Zulma kept repeating, “Zulma. It’s Zulma and Mario…a doctor needs to talk to you.”  It clicked.  The doctor, indicating that the three-hour window was closing, said there was only time for “Yes” or “No” questions – allergies, current meds taken, medical issues, etc.  Then he asked Ottilia’s permission to administer TPA, a drug “with a 3% fatality rate.” Ottilia brilliantly asked, “Would you give it to your father?”  “Yes, I would.”  They prepared me to administer the drug.

While this was going on, I lay on the gurney under the bright lights.  Mario was leaning over the bars of my gurney along with Angel Rios, San Jose’s Deputy City Manager. Another dear colleague and friend who, with Mario, had helped me start the California Cities Violence Prevention Network in 2007.

With Zulma on one side, Mario and Angel leaning over the bars of my gurney, the three of us linking forearms, a tight almost wrestling grip (though my right arm was pretty flaccid), Angel then gave an amazing, resonant prayer that I felt deeply and vividly recalled: “Father God…your servant Jack…watch over him…we need him…his work is not yet done…protect him…strengthen him.”  A warmth, a strength, a confidence flooded my whole body.

Then two words came to me, “Send me.”  I recall in my garbled speech trying to communicate that this – “send me” – lay at the heart of faith, namely showing up and showing up with love and staying there, that the three of them embodied this core. I recall trying to say that if it had been Mario on the gurney, I would have been on the other side, for I would have said, “send me.”  Is this not the very heart of our work, “send me?” This is what I was desperately trying to communicate to them.

The words that came to me on the gurney were from Isaiah 6:8, “And I heard the voice of the Lord saying, ‘Whom shall I send, and who will go for us?”  Then I said, ‘Here I am! Send me.”

 

I wrote my friends two weeks later, asking, “While all of this was crystal clear for me, was I dreaming?  Please help me with this!”

On March 2, Angel responded, “Beloved Jack: That was not a dream.  That is your miracle you are recalling.  The very fact that you can remember with such vivid detail is an indication of that miracle…you remain daily in my prayers, my friend…I’m glad to hear you are doing well as we have a lot of work to do to get this country moving back in the right direction…”

The very next day, ten hours after my stroke, in ER Recovery, I, much to the concern and disbelief of the nurse in charge asked for permission to get up to go to the bathroom, she, watching me like a hawk. As the wounded brain was “already regenerating itself…” it needed guidance and help, and within the hour nurses came to start, Speech, Occupational and Physical therapies (though all from bed).  Strength had returned fully, my right arm grip firm.  Conceptualization, summoning words and constructs posed no problem, though forming and transmitting words proved difficult. I hesitated calling my wife for fear of scaring her, but I did.  Ever upbeat and positive her embrace flooded through the phone, although she admitted later that I was about 40% intelligible. My first language “Moderate Early Drool” took about two days to end. It took me two weeks to say “neural plasticity,” yet the “br” in “Atrial Fibrillation” still trips me. I now have a real affinity for Italian, “amore…Roma…ecco…adagio…” the ripple and easy sliding of vowels. 

After two days, I was released from the Critical Care Unit, and after two days in the main hospital, released to the rehab hospital.  I am convinced I was released (or ejected) early because of my endless walks throughout the hospital halls in a thin, paisley gown with a breezy back.

I got another advanced degree for my den’s wall within two days, this one on “Swallowing.”  (They fear choking).  I began to appreciate and feel awe for the miracle of language.  Consider the simple word, a monosyllabic one, “thanks:” tongue forward for the “th,” back to close the “k,” and roof of mouth for the final “s.”  All in less than one second.  One simple word.

Miracles of speech.  Talk about miracles.  There were many, at least four. “Thanks” courses through my body.  First, that I was with friends when the first signs of stroke appeared, not alone in a hotel room in Sacramento where I had spent two nights three days before, and where, according to the doctors, “…you probably would have shrugged it off, gone to bed, and awakened, if at all, totally paralyzed…”  Second, Mario and Zulma’s swift response, proximity to the hospital and eventual transfer to Good Samaritan Hospital in San Jose and then to Good Samaritan Mission Oaks, an award-winning rehab center where I received a week of intense PT, OT, and Speech therapy.  Third, Angel’s prayer that jolted through my body, and fourth, proximity to my beloved sister and brother-in-law in Berkeley, who after rehab found a house for me in which to heal, practice speech and exercise before being given permission to fly home.  Fourth that my wife was found that night, that she responded so beautifully, and that the day following my arrival at the intensive care unit, she arrived from Virginia, never leaving my side until we flew home together.

Laughter.  There was a great deal.  According to research and the various staff who attended to me, the old adage is right: he/she who laughs longer, lives longer. The big intake of breath, release of spirit and the body bathed in life-giving oxygen.  My wonderful, smartass sister Deane abetted this.  Much of my OT work related simply to aging, namely that gravity pulls us down, into a slouch, causing us to breathe shallowly from the chest, not deeply from the diaphragm, thus affecting both speech and general health.  As I was doing my daily “laps” at the rehab center, I heard my sister’s loud voice from far down the hall shouting “Nipples up, Jack!”

Loving presence: the daily calls from family, friends, colleagues, my faith community bathed me in love and encouragement, and yes, humor.  Our wonderful neighbors, here in Virginia, sent me a short video of their five-year-old daughter, my buddy Vivienne.  It had snowed while I was gone.  Vivienne stood in our driveway holding a shovel almost twice her height saying, “Mr. Jack, I’m shoveling your driveway so you won’t have to when you get back.  Please come home soon.  I love you.” 

I will be reflecting on this powerful incident in future blogs.  But for now, this, the overwhelming feeling of gratitude: the sun on rough dimples of a stone wall, light-filled droplets of rain sagging from tree branches, a “tree walk,” not a timed, puffing power walk, but a “tree walk,” a walk of witness, of awe – and the objective fact that I was there to witness it.

And my wife, while holding hands, starting the day with this: “I love you.  I’m grateful for you and the gift of the day before us.”