Posted on April 29, 2016
Normally I don’t write about or post things like this, but after thinking about it I thought it might be helpful for stroke awareness as well as to those who travel and worry about going through a major medical situation while in another country or away from home.
Sunday was just another day. As usual my day started as they all do: quite benign. I went about my daily activities with no incidents or warnings that things would be drastically different after I went to bed. Almost every day involves some sort of search for temples and today was no different. Searching the internet I found another temple to look for, not really a temple but some artifacts that remain from an Angkorian Temple. The site was not near any roads so the ride on my dirt bike took me across a couple of kilometers of dry, bumpy rice fields and a walk through some think brush. Everything seemed normal to me. A stroke was the furthest thing from my mind.
Bedtime came as always and it didn’t take me long to get to sleep. But tonight was going to be different. Further from the norm than I have ever been before. My recollection of the times may be off a bit but I will try to be as accurate as possible.
About 1:00 AM I woke up feeling numb on my right side. I probably just slept funny on that side were my initial thoughts until I realized that I had no feeling on the entire right side of my body from my shoulder to my feet. I rolled off of my right side and attempted to move my arm. Nada. Then my leg. Nothing. Hmmm, this could be serious I thought.
For so many years of my career I went through the biennial CPR training which over time placed more and more emphasis on strokes and their warning signs. I was fully educated on the signs and symptoms but they were meant for other people, not for me. I lay there with thoughts racing through my head. I am in Cambodia. This is not America. Health care is on a completely different level here. Maybe if I stay still for a few minutes things will start to get better. It was a nice thought but unfortunately not accurate. At this point what could it be other than a stroke?
Lifting my right arm with my left hand felt like I was holding the dead arm of another person. Letting go it dropped down in what seemed like a lifeless thud on the mattress. My lifeless fingers would slide through the fingers of my left hand when I tried to lift my right arm. My leg was nothing more than a fleshy anchor that kept me from moving around my bed. I knew this wasn’t good and I was going to need help. Serious help.
I talked out loud to myself carefully listening to see if there was any effect on my speech. Everything seemed fine there so the effected parts were my arm and leg. Is this a good thing? I have no idea but at this point I will take any positive point I can find.
The first task I had to accomplish was getting out of bed. Every other day of my life this was easy but this night I had to think it through. How am I going to slither a complete body when one half is constantly holding back the other half? Whatever I did I knew I had to be careful. The only option was to ‘fall’ out of bed and if I did it wrong I could hit my head leading to further complications. A stroke followed by an external head injury – probably not a good combination.
I inched toward the edge of the bed on the same side as my lifeless side. I couldn’t feel the edge due to the numbness so in the dark I had to guess where I was in relation to the edge and when I was going to drop like a sack of potatoes. Kind of like hearing a waterfall coming in the dark as you drift down a rushing river waiting for the drop that may or may not kill you. Okay, maybe not that bad but you get the idea.
The drop came and my head didn’t crack. Success number one! But now I was crumpled up on the floor and I needed to get straight on my back. Not the easiest of things to do in my condition but one that I did pretty quickly. Luckily my mind was still in thinking mode and I realized whatever was going to happen I would need my cell phone as well as the charger. They were attached to one another and I was able to coax the phone off the bed with no damage as well as reach and unplug the plug to keep them together. All the while I was thinking is this a stroke or is it a dream?
Now step two. Slide across the floor using a half-useful body to drag the other half. My bedroom door was closed and opening it wasn’t as simple as sliding it open with my good leg. I had to turn my body around in a narrow area between the bed and the wall and go out head first. This is one of the nights I wished I wore a shirt to bed because clammy skin does not slide well on a tile floor.
I made it out of the bedroom and headed towards the front door. Literally. I pointed my head toward the front door and pulled with one arm and pushed with one leg. At that point I realized that I was going to need a few things. I took a little detour all the while my limp arm and leg were bending and twisting in ways that stopped my movement. I had to take the time to remove my twisted arm from underneath my body before I could continue. I knew I would need my passport and some money to take to the hospital. Luckily I just washed my backpack for a trip in two days so everything was on top of the counter. A counter that any other day would not even cause a thought but tonight my things may as well have been on top of a mountain.
I don’t remember exactly how I did it but I was able to use my good side to prop myself on the side of the counter and then reach my good arm over the top of the counter fishing for the things I needed. And then I thought “Oh, I need to put some clothes on” because of course at this point in my life modesty is of utmost importance!
Imagine laying on the floor in a dark room trying to put on a pullover shirt and shorts with the right side of your body basically dead and useless with only the left arm and hand able to move. Had it been on video it might have been quite a sight to see. This gave me a little insight as to how people with permanent disabilities live every day. And that insight turned to wonder as I thought about my future. The shirt and shorts made it on with more effort than ever but when I got to the belt it was too much so it got tossed.
I don’t remember at what point in my monumental trip along the tile floor that I decided it would be a good time to call the ambulance. Luckily I had the number in my phone just in case of a situation like this. At most times this would be a good thing since there were a few obstacles between the initial call and the ambulance picking me up that I had to think about. First – I have no idea if they would speak English or not. Then there is the problem faced by almost no one I know – I have no idea what my address is! In the US you don’t even need an address – 911 knows where you call from and can probably get to you. But here in Cambodia I have no idea what my address is (so please hold off on those Get Well cards!). Addresses are not a common thing here in Cambodia. I suppose I have one but now is not the time to try and figure it out.
Then there is the fact that the front gate is locked every night. Even if I could communicate with them and if I could direct them to my home they wouldn’t be able to get in. I guess we could deal with that when the time comes.
Turns out that these problems were no issue because the ambulance company does not answer its phone! I tried three times over ten minutes as I was slithering along the floor but not once did they answer. In between my internal swearing I was conjuring up other game plans. Plan A, Plan B, Plan C. Okay, what do I do if…….
Of course I thought about calling friends but I know limited people here and most are on Facebook. Who uses phones nowadays? Those that I did have numbers for I just assumed they would have the phones turned off in the middle of the night but if nothing else worked out I would try that option.
At the moment the best option I had was to make it to my front door, get it open and try yelling for help. This is where my previous thinking comes in to play and being fully clothed comes in handy. So again I continue sliding towards the front door. I did the two-turn key lock to lock the door and the worthless little arm lock thing also had to be released – each of these took a couple reaches to make them open.
As I got the door opened I could hear the apartment cleaning lady talking with her friend and watching phone videos at the end of the sidewalk. What a stroke of luck! I pulled my body out far enough so my head was out the door on the top step. I looked towards her, waved my left arm in the air and yelled “Hello!? which was met with a look of bewilderment – for me which was an aside-down look of bewilderment. She got up and came towards me as I said “Help’ and ‘ambulance’ She still did not seem to comprehend (she does not speak much English) but as she got closer her eyes filled with horror as she realized something was seriously wrong.
As calmly as I could I smiled and kept saying “It’s okay, it’s okay” but she was obviously scared. A few times I said “hospital” and “ambulance” but the language barrier was a bit too much to conquer at this time. She went to the apartment next door to wake the Khmer gentleman who spoke English to get his help. He came out, not fully clothed I might add, and started the process of my rescue.
I am not sure how long it took for the ambulance to arrive but I am sure it was less time than I thought. While waiting I slid back inside where it was more comfortable and the housekeeper got a pillow from my bed to put behind my head. As I waited I noticed that I had some very gross movement in my right arm. Some of the movement came back. And my leg could move a bit too. Maybe this will just go away by the time the ambulance arrives. Wishful thinking I guess but on this night that would not be the case.
The ambulance came and together we left. The housekeeper insisted that she come with me even with my objections. I did not want her to worry so I said okay and we all headed to the hospital. On arrival I was taken to the Emergency Department and as I was wheeled into the room looking upside-down above the door I saw the very welcoming sign that said “Code Room”.
All of the movement on my right side was gone as they assessed me and asked question after question. Thought after thought was going through my head. Obviously a stroke – but what will the outcome be? I spent many years in a hospital setting with many of those being in Neuro Intensive Care Units so I knew the short and long term effects that people with stroke face. These thoughts were not comforting in the least and added to the unknown was the fact that I was half way around the world from home in a hospital in a third world country.
I knew they would want money up front even with my insurance which is why I grabbed the money on my way to the front door. They wanted an $800US deposit to continue my care. They stood over me watching as I tried to rip the money I had out of my pocket with my good hand. I handed him the one hundred dollar bills that I grabbed and as he counted them he said “There is only $700 here”. Had I had two good arms the outcome may have been different but all I could do is look at him, maybe with fire in my eyes and say “That’s all I have”. He accepted the deposit, wrote a receipt, handed it to my housekeeper, and left the room. I began to wonder if I did not have money on me if they would have wheeled me out to the street, stroke and all, and said goodbye.
They took me for a CT Scan, did a chest x-ray, drew blood, inserted an IV. All the normal things that are done on admission. I was taken up to my ICU room (which is nothing more than a patient room in an area that says ICU). During my time in the ED, CT and X-ray slight movement would come and go in my right arm and leg. There is no MRI scanner in Siem Reap and the normal meds used for a stroke patient are not available here either. The doctor discussed a transport to Bangkok that would probably be in my future.
The thoughts going through my head covered just about everything. What if this is me for the rest of my life? Where will I go? What will I do? How am I going to hold a camera? Will I have to increase the shutter speed of all of my handheld images to overcome the movement from a weak grip? I wipe my ass with my right hand – and chopsticks!! How the fuck am I going to use chopsticks with my left hand? I had a lot of time to think. Too much time.
After settling in my room just about all movement was back on my right side. I assumed this was a good thing and my negative thoughts quickly changed to more positive ones. Understandably I could not sleep. My arm and leg became weak again and then strong again. I can’t remember how many times.
The people at the hospital in Siem Reap were all very nice but the care was not to the level that I was accustomed to in the hospitals I worked at in the States. They do not have the ability to properly care for a stroke patient. I had a pretty good day as my strength was back all but a few minutes throughout the day. About twenty-four hours after the initial weakness I had an episode where I did not have enough strength to keep my right arm raised. I called for the nurse and asked for the doctor. She had a concerned look on her face when she said the doctor was sleeping. I told her I thought that it was important that he come to see me. She said okay and left the room. After fifteen minutes or so the strength was back but less than an hour later my right arm went numb but I could still move it and the strength was almost normal. Both times my right leg was not affected. The doctor did come to see me – six hours later.
At that point I told him that it was important that I get transported to Bangkok for better stroke care.
It is important to remember that Cambodia is basically a relatively new country. Just forty years ago anyone that was educated, a teacher, an artist or a doctor was murdered by the Khmer Rouge. After the defeat of the Khmer Rouge Cambodia needed to start from square one to rebuild itself as a country including all of the skilled and educated residents. This does not happen overnight. I understand why things are the way they are but I am still going to Bangkok.
Later that evening I was on a medical transport flight on my way to Bangkok. How ironic I thought as the flight took off – I did medical transports for twenty-five years of my career as a respiratory therapist. But now I am the one on the stretcher and I don’t have to lift anything or fill out any paperwork. Still – I would rather be the transporter than the transportee.
On my arrival at Bangkok Hospital I knew things would be better. Just rolling through the lobby I could tell. It reminded me of Strong Hospital in Rochester. The ICU is a real ICU. The care was swift and determined just like I was part of for decades. No effects from the stroke in almost twenty-four hours and feeling good.
The MRI was ordered and just before midnight I was getting my scan. I am not a fan of closed spaces but I sucked it up considering the alternative options. I tried to think of good thoughts to make the time pass faster but the scanner is so damn loud that it actually knocks your thoughts out of your head. It is impossible to think about anything for more than a few seconds. Each time the table would make a big shift I hoped it would be my escape from that little tube. In due time my release was secured and I slid out of the small tube of horror to freedom.
The neurologist told me the scan showed a small stroke and they would do more tests to try to identify the cause in order to lessen the possibility of another stroke in the future. My past life as a respiratory therapist made it easy to understand what all of the doctors were telling me. I have seen enough strokes, head bleeds and traumatic head injury to make my head spin.
The doctor that was in the ambulance from Bangkok airport to the hospital told me my X-ray in Siem Reap showed a nodule in my lung. This is something anybody, especially a respiratory therapist, does not want to hear. I just had an X-ray back home last year and there was no mention of this.
When the ICU doctor told me all of the tests came back with good results I told him about what the transport doctor said. He looked into it and said the type of X-ray at the hospital in Siem Reap may not be the best so he sent me down to have four images done in the X-ray department. Everything is good in my lungs. I am glad I remembered to ask him otherwise I would have those words from the transport doctor weighing heavily on me until I could get it checked out.
I have not had any more episodes since those two short ones my last night in Siem Reap. I am stuck in the ICU longer than necessary because I don’t have a family member to sit with me while I am in a regular room. Hopefully in the morning they will get me a sitter and get me out of ICU. It is too bad the insurance company follows its protocols instead of common sense and pays more per day than needed. Not a bad place here in the ICU – the people are great – professional, nice and smart. The food is good and the Wifi works great. Why would I want to leave?
After the stroke I have no problems walking or using my arm, hand or leg. Considering I was sliding along the floor just a few days ago I am amazed at how I feel now and how there seems to be no ill affects. But I know it happened once and it can happen again – in fact it can happen to anyone.
The IV will be finished with this last bag of fluid and rehab will stop by later to exercise me. I don’t need the rehab for the stroke but just protocol to get me out of bed and moving – something I would do on my own if they would let me. I am not the kind of person to stay in bed or even spend a lot of time at home. I can probably count one or two times a year that I do not leave my apartment for a whole day and here I am four days in to an indoor stay of unknown duration. I don’t like it one bit.
I know just outside the door of the hospital I can probably find some great Thai street food. Inside I wouldn’t be able to tell if I was in Thailand or the United States if it were not for the spoken word and a few signs here and there I couldn’t tell the difference. They even have some of the same posters that hang in 4D at Queen’s Medical Center in Honolulu.
For now things are good and I look forward to leaving and getting back to my life. With any amount of luck this stroke was but a blip on the screen of my existence with more non-health related adventures coming in my future.