Six weeks after suffering a stroke while driving on the Baltimore Beltway, Paul Sargent, 45, is back on his feet, speaking normally and continuing physical therapy. A sprinkler fitter with the United Association of Plumbers, Pipefitters and Steamfitters, Local 536, he often worked on ladders and aerials lifts that put him 100 feet in the air. While he has not yet regained enough balance to work atop a ladder, he is hopeful.
“It’s amazing, considering what I was like that night, that I’ve been able to recover this much,” Sargent says, pictured here with his wife, Tammy Sargent, during a follow-up visit.
By Anne Haddad
During a heavy rainstorm the week between Christmas and New Year, Paul Sargent, 45, was driving his truck on the Baltimore Beltway. He exited onto I-795 toward his home inManchester. Within minutes, a convergence of difficulties forced him to pull over.
For one thing, he had been feeling increasingly sick for the last few miles. For another, the rain was coming down in sheets, making visibility difficult. His cell phone rang, and he could see the call was coming from his son, Curtis. But he was unable to coordinate his hands and fingers to answer the call.
Sargent didn’t realize it, but he was in the early stages of a stroke. He had been experiencing some occasional dizziness for about a month, but now it was disabling him. Somehow, he managed to dial the magic number – 911 – and talk with the dispatcher. Paramedics arrived and took him to a community hospital, where the emergency staff realized he was having a stroke.
Because the University of Maryland Medical Center is a designated primary stroke center, the community hospital called the Maryland ExpressCare offices to consult with physician specialists here — the Brain Attack Team.
As a primary stroke center, UMMC is equipped to deal with the most advanced treatments and the serious risks that are associated with those treatments. The conference call included Marcella Wozniak, MD, PhD, interim medical director of the team and associate professor of neurology, and John W. Cole, MD, MS, associate professor of neurology.
The Brain Attack Team arranged for the local hospital staff to begin the time-sensitive administration of the clot-busting tissue plasminogen activator (t-PA). While that drug, administered intravenously, made its way to the clot that was impeding blood flow in his brain, Sargent was on his way to UMMC via ground ambulance.
On the Neurocare Intensive Care Unit (NCICU), charge nurse John Pfeifer, RN, updated staff nurses who would be waiting to care for Sargent and accompany him to the MRI suite. Staff from Housekeeping Hospitality Services were making sure the room was cleaned and ready for the new patient, while nursing staff reviewed his case to be ready to care for him when he arrived.
Seconds after Sargent arrived, nurses and physicians moved him from the stretcher to his bed, while Ermias Aytenfisu, MD, a neurology fellow at UMMC, introduced himself to Sargent and began asking questions to assess his condition.
“What is your name?”
“How old are you?”
“What month is it?”
“Can you hold your right hand up like this while I count to 10?”
“Where am I touching you now?”
Sargent was able to answer most questions, but with enough impairment that an MRI would be needed to determine whether and where he had a clot impeding blood flow in his brain, and which path of treatment was most appropriate.
“We’re going to do an MRI, so we need to take your jewelry off,” Aytenfisu told him.
Another physician had been standing by since Sargent arrived: Joao Prola Netto, MD, a fellow in neuro-interventional radiology, was following Atyenfisu’s assessment to help determine not just whether they could get an image of the blood clot on the MRI, but whether they could use the latest interventional radiology techniques to remove it, should that become necessary. And when Cole became concerned that Sargent’s condition was becoming worse, he called for anesthesiologist Joshua M. Tobin, MD, assistant professor of anesthesiology, to come quickly to the MRI suite to secure Sargent’s airway with an endotracheal tube.
Nurse practitioner Karen L. Yarbrough, MS, ACNP, acute care nurse practitioner and programs director for the Maryland Stroke andBrainAttackCenter, was observing and making notes to determine whether Sargent qualified for inclusion in any clinical trials, should he choose to participate.
One of the reasons Sargent was transferred was that he received t-PA, the clot-busting drug that must be administered within three hours of the onset of stroke symptoms, or the treatment becomes too risky. Even when administered within that three-hour period, t-PA carries a risk of hemorrhage. But after three hours, the blocked blood vessel is weakened from lack of blood flow. A sudden return of blood flow could cause it to bleed. Because of this risk, the patient must be in a hospital with intensive care nurses and vascular surgeons when t-PA is administered, so they can manage any complications.
After his MRI, Sargent was taken back to the Neurocare Intensive Care Unit, where the nurses specialize in the vigilant care required during a stroke. In fact, several nurses from the NCICU accompanied him to the MRI to care for him before and after the imaging procedure. They included: Betsy Raine, BSN, RN; Olga Pranov, BSN, RN; Ann Adams, RN; and Naomi Crosen, RN.
Once Sargent was out of danger, UMMC rehabilitation staff – occupational, physical and speech therapists – began working with him.
“As soon as someone is stable medically, we want them to start rehab,” says Cole. “The sooner, and more consistent, the better the outcomes.”
After 10 days in the hospital, he was discharged to Kerman Hospital, a rehabilitation hospital that is part of the University of Maryland Medical System, for 14 days of intensive physical, occupational and speech therapy to regain his strength, balance, coordination and ability to speak and swallow. On Jan. 20, he went home with his wife, Tammy, and their son and daughter — Curtis, 19, and Heather, 17.
Today, Sargent continues to improve. His speech betrays none of the impairment of those first few days. He has returned for follow-up visits with the neurologists at UMMC, but has continued physical and occupational therapy closer to home in Carroll County. He has aced speech therapy: He talks animatedly and a mile a minute, just like before the stroke.
“I’m walking by myself, and I can make myself a grilled-cheese sandwich on the stove without burning myself, but I don’t think I can get back up on a ladder yet,” Sargent says.
Whether or not he can go back to his trade, installing fire sprinkler systems in such Baltimore landmarks as the Hippodrome Theatre and airplane hangars that required him to be 100 feet up in the air, he doesn’t know. But he does believe he’s lucky.
“It’s amazing, considering what I was like that night, that I’ve been able to recover this much,” Sargent says.