Tuesday afternoons are usually when Nancy Humphrey golfs. But she was still home a little after 4 p.m. on July 19 because that day’s tournament didn’t start until 5 p.m., and the Clayton Country Club is only about a quarter mile from the home she shares with her husband, Larry Deshaw.
They were watching CNN. She was on the couch. He was in his recliner.
“All of a sudden I was seeing double. The room started spinning,” recalls Deshaw, 78. “I hollered Nancy’s name twice. I knew I had something going on. That was the last I could speak.
“My left side went limp. My right side had contractions in the leg. My right arm was the only thing I could move at the time. I couldn’t talk. My jaw was clamped shut.
“I could hear everything going on around me, but I couldn’t speak. It was the scariest thing I’ve ever been through.”
Humphrey quickly dialed 911.
“His wife is what saved his life,” Upstate interventional neurologist Hesham Masoud, MD, says plainly. “If he was not found in a timely fashion, he would not have survived.”
Masoud is a stroke specialist who received his medical degree in Cairo before completing his internship and residency training at Case Western Reserve School of Medicine in Cleveland. He went on to gain additional stroke therapy expertise with additional fellowship training in endovascular surgical neuroradiology and vascular neurology at Boston University School of Medicine — the precise skills Deshaw needed when a clot the size of a raisin lodged in the basilar artery at the base of his brain.
Deshaw’s wife called for help at 4:15 p.m.
On their drive to the couple’s house, Thousand Islands Emergency Rescue Service paramedics Pamela Jones and Eimile Parker made the important decision to alert LifeNet of New York – and a helicopter based at Watertown International Airport in nearby Dexter was readied for flight, just in case. Patients in rural areas such as Clayton with certain medical emergencies including strokes or diabetic complications have better survival odds the faster they receive definitive medical care.
This story appeared in the Watertown Daily Times
When she laid eyes on Deshaw at 4:22 p.m., Jones remembers he had “that look” of a man suffering a stroke, or a seizure, or both. His face had a subtle droop, he had weakness on his left side, and he was unable to respond. Humphrey told the paramedics how healthy and active her husband was, and Jones made a silent vow to do what she could to bring him back.
The paramedics knew Deshaw urgently needed to get to Central New York’s first and only comprehensive stroke center, some 90 miles away at Upstate University Hospital in Syracuse, and the quickest way was by air. They made sure LifeNet was on the way and radioed the fire department to set up a landing zone for the helicopter.
Jones checked Deshaw’s blood sugar level and connected him to a cardiac monitor while Parker covered his mouth and nose with an oxygen mask and checked his pulse and blood pressure. Then Parker started an intravenous line in his arm. All the while, Jones spoke to Deshaw, explaining what was going on. It felt strange because he never responded, but she kept talking as she was trained to do. A month later when Jones checked on his recovery, Deshaw told her how much her talking had meant to him.
The Thousand Islands ambulance drove Deshaw about a half mile to the fire department parking lot, where the helicopter landed. Flight nurse Rod Kester and flight paramedic Jeff Simons climbed out. Once Deshaw was secured to their stretcher, they opened the door beneath the tail of the helicopter and wheeled him in. Deshaw remembers the feel of the heat rising up from the asphalt.
Driving the patient to Syracuse, even using lights and sirens, would have taken almost an hour and a half. Flying took 25 minutes.
Once LifeNet pilot Scott Talon pointed the helicopter toward Syracuse, the LifeNet crew radioed the emergency physician on duty at Upstate, Brett Cherrington, MD. At 5:17 p.m., he activated the hospital’s stroke team.
Masoud’s pager notified him, and he gathered in the emergency department with the other physicians and nurses who are part of the acute stroke team. They were ready for Deshaw even before his helicopter landed on the helipad at 5:27 p.m.
Deshaw remembers everything.
“They were waiting for me,” he says. “They took me immediately in. I remember them rushing, going fast with me on the gurney.”
Members of the team told Deshaw what was going on as they cared for him. They wheeled him straight to the computerized tomography suite in the emergency department for a CT scan, with the interventional neurologist, Masoud at his side.
Deshaw had symptoms that suggested that he had a seizure or a stroke. “Anyone with these symptoms gets an immediate vessel imaging study. That way, we can identify the blocked artery and plan for immediate therapy,” Masaoud explains.
Nurse Jennifer Schleier is the stroke coordinator. She says the CT scan helps rule out whether a vessel has burst within the brain. Patients with hemorrhagic strokes, in which a vessel bursts, are treated differently than those with ischemic strokes, in which a clot blocks a vessel.
Deshaw received an injection of the clot-busting medication, tPA, or tissue plasminogen activator, at 6:18 p.m. through the intravenous line paramedics inserted at his home. Then he returned to the scanner for a CT angiogram, another set of images that rely on a contrast material so details of the arteries and veins are visible.
There, deep in the basilar artery of Deshaw’s brain, was the clot.
Time is crucial anytime someone suffers a stroke. In many cases, other healthy arteries can temporarily keep the brain alive while we try to reopen the vessel. But for patients with clots lodged at the base of the brain, those other arteries aren’t there to help,” Masoud says. “For those strokes, time is exceedingly important.”
Strokes in the basilar artery are rare, and the outcomes are usually poor. The brain area that can be damaged in this type of stroke controls essential functions such as consciousness, breathing and heart rate, balance and coordination and vision. “In my experience, a majority of these patients die, within a couple days of having the stroke,” Masoud says.
Deshaw experienced what the interventional neurologist considers “a miraculous recovery.”
The emergency physician inserted a breathing tube. Then Deshaw was wheeled to the interventional radiology suite two floors above the emergency department.
At 7:10 p.m., Masoud inserted a small catheter into the artery of Deshaw’s right leg. Guided by an X-ray and contrast dye, the doctor delicately advanced a wire-like stent along the inside of the artery and into the brain. The stent wrapped around the clot, trapping it as if in a cage. Masoud gently backed the device out, removing the clot and restoring blood flow with a single pass of the device.
Deshaw’s wife arranged for her brother from Watertown to drive her to the hospital. By the time they arrived, Deshaw was already in surgery.
Surgery was complete at 7:43 p.m., and around sunset Deshaw was settled into the neurosurgical intensive care unit. The ninth floor hospital unit is staffed by nurses and technicians with specialized training in the care of patients with stroke and other neurological emergencies.
“I didn’t really wake up until the next morning,” Deshaw says, “but when I woke up, everything was working.”
A steady stream of impressed doctors stopped by to see the patient who not only survived “basilar artery thrombosis” but was up and walking the next day.
After a stroke, many patients go through what can be a lengthy rehabilitation program. Deshaw was healthy enough to be discharged to his home three days later. #