Darlene Smitter has always had a healthy respect for time.
As a little girl, watching her grandpa repair broken clocks, she became fascinated with the mechanisms that measure the seconds and hours of each day.
The tick-tocks, chimes and cuckoos seemed to sing: Here’s another second. Make it count.
And oh, how those seconds counted when Smitter suffered a stroke.
Her fate hinged on getting the right medication and the right surgical procedure to remove the clot. And the quicker she got them, the better the chance she would survive without a crippling brain injury. Or survive at all.
As it happened, everything aligned to produce an outcome that her daughter, Susan, described as “a miracle.”
“The grace of God,” Smitter agreed. It’s hard for her to comprehend what could have happened. “It’s mind-boggling,” she said.
Her stroke specialists at Spectrum Health hope others will learn from Smitter’s experience. Dramatic advancements have taken place in the past few years in stroke treatment, particularly for severe strokes. But quick action by patients and families remains crucial.
“We have things that help people, but they need to get to us soon enough to do it,” said neurosurgeon Justin Singer, MD.
If we didn’t open the blood vessel, she was going to end up with a major, major stroke.
Smitter, a 70-year-old woman from Grand Rapids, Michigan, couldn’t comprehend all that when the blood clot blocked a major vessel in her brain.
‘Mom, you’re having a stroke’
It was the day before Thanksgiving, and she had holiday plans on her mind. She looked forward to cooking a turkey dinner for her husband, Bob, their grandson and his fianceé.
She rose that morning, reached to shut off the alarm clock, and then dropped to the floor.
Bob heard her call out to him, so he hurried into the room.
“I tried to help pick her up,” he said. “But I noticed that her left arm wouldn’t do anything. So I thought there’s something more wrong here than just a fall.”
He called their daughter, who lives a mile away. Susan and her husband, Patrick, arrived in minutes.
“I’m fine,” Smitter told them. “I’ll be all right.”
She didn’t realize her speech was garbled. But her family members did. They saw that the left side of her face drooped, and she couldn’t raise her left arm.
“Mom, you’re having a stroke,” Patrick said.
Susan called 911.
Paramedics arrived promptly and whisked her to the emergency department at Spectrum Health Butterworth Hospital.
Muhib Khan, MD, a vascular neurologist and the director of the Spectrum Health Stroke Center, ordered CT scans, including a specialized scan to identify blockages in the brain’s blood vessels. He found a clot in the major artery that feeds the right side of the brain.
“It showed she had a small stroke already in place, but a bigger area of the brain was at threat,” Dr. Khan said. “If we didn’t open the blood vessel, she was going to end up with a major, major stroke.”
He turned to Dr. Singer, the director of vascular neurosurgery, for the next step. In recent years, a new surgical tool, called a stent retriever, has become available to pull large clots from the brain.
Dr. Singer fed a catheter into the artery in Smitter’s leg. Through it, he sent a smaller catheter up into the artery, following it through her body and right into the brain. Using the wire mesh device on the end of the catheter, he attempted to pull out the clot.
“Her case was actually a little bit complicated,” he said. “(The clot) didn’t want to come out so easily.”
That’s not unusual. Although some clots come out on the first try, others require multiple attempts. With so much brain tissue at stake, it made sense to keep working at it.
Three times Dr. Singer went into the brain artery, each time pulling out part of the clot.
“We were able to achieve a complete re-canalization of the artery and restore blood flow to virtually normal in that area,” he said.
As they worked together to treat Smitter’s stroke, the specialists felt a special sense of urgency. It was the day before Thanksgiving, the beginning of a holiday season filled with family gatherings.
“It’s tough for everybody,” Dr. Singer said. “Nobody wants to ruin somebody’s holiday. We want to do as much as we can for patients all the time, but especially around this time of year.”
They didn’t have to wait long to see the impact of the treatment.
When she arrived at the hospital, Smitter could not move her left hand at all. Within an hour of the procedure, she could already move it. Her confusion and cognitive impairment also improved dramatically.
“That makes it very gratifying, and especially emotional for the family,” Dr. Singer said. “The outcome could have been horrendous. They could have been dealing with somebody who had a severe disability or possibly passed from the stroke.”
Ready for rehab
Five days after her stroke, Smitter transferred to the Spectrum Health Inpatient Rehabilitation Center at Blodgett Hospital for rehab.
We will get through this. It’s just another challenge.
She began therapy at a high level of functioning for a stroke patient, said physical therapist Linda Rusiecki, DPT.
When her therapists assessed her ability with a balance test, she scored 25 out of 28—the highest score a patient could receive using a cane. And she used the cane, in part, because she was still recovering from knee replacement surgery five weeks earlier.
She did need physical and occupational therapy―to improve her balance, the use of her left arm and cognitive functioning. But given the size of the blood clot in her brain, her abilities impressed her therapists.
“The fact that they were able to do this procedure and have a really good rehab outcome is really remarkable,” Rusiecki said. “That’s not typical. But with thrombectomies and (the clot-busting drug) tPA, we are seeing these kinds of outcomes more and more.”
‘Time is brain’
The medical team praised Smitter’s family for their quick response when they saw her stroke symptoms.
“They did everything right,” Dr. Singer said.
Smitter stayed at the Inpatient Rehabilitation Center four days for treatment.
“We will get through this,” she said, as she rested after a therapy session. “It’s just another challenge.”
The stroke was not the first medical hurdle she has faced. She survived breast cancer in 1999. She has undergone surgery on her wrists.
I have to give you a hug. You saved my life.
And she had both knees replaced, one in July and one in September. Through it all, she learned to tackle therapy with determination and humor.
“If they tell you to do 10 reps, you do 15,” she said. “If you want to get your function back, you have to be positive and work at it.”
“She’s a hard worker,” said her daughter, Susan. “She knows how to put her big-girl pants on and go to work.”
Her rapid progress lifted her family’s spirits.
“Every day was a treat because I could tell she was getting better,” Bob said.
A hug for her doctors
Seven weeks after her stroke, Smitter walked down a hall at the neurology office, her steps smooth and sure.
“It doesn’t look like you had a stroke,” Dr. Khan said.
Dr. Singer, the surgeon who performed the thrombectomy, introduced himself. Smitter didn’t remember meeting him in the intensive care unit after her surgery.
“I have to give you a hug,” she said. She reached out to embrace him, and then Dr. Khan. “You saved my life.”
The follow-up visit showed Smitter was almost back to pre-stroke functioning. Knitting still was a bit tricky, but it got easier every day. She hoped to be cleared to drive a car again soon.
To see her doing so well “is very gratifying,” Dr. Singer said. “It’s very rewarding.”
“It’s good feedback for us,” Dr. Khan said.
At home with her husband, Smitter sat in a recliner knitting a washcloth. A favorite clock hung behind her. “Time is of the essence,” it read.
Clocks must run in her blood. Like her grandpa, she enjoys tinkering with them and bringing broken timepieces back to life.
The stroke gave her new perspective on time―and life.
“I always valued life,” she said. “It’s just that sometimes I think you take things for granted. You should never do that. Life is much too precious.”