A Stroke of Bad Luck.

Last Tuesday, July 29th I was informed that my father, Peter Grundy, suffered a brain stroke and was in the hospital. I was aware that he was going through some stressful times at home with his girlfriend but I never imagined it could escalate to this. I immediately sought to travel to Chile -where he lives- to help him recover. My younger brother, Alan, had enough American Airline Miles (60,000) to get me a flight on Thursday, August 1st. I arrived Friday morning in Santiago and went straight to Clinica Santa Maria where he was in the critical care unit.

He's lost motion in his right arm, has some blind spots in his right eye, and has difficulty verbalizing ideas. The last is the most important to me, although the first two will likely prevent him from driving which translates to him being unable to take care of himself.  His ability to verbalize ideas that he has is not only incapacitating from a work/life perspective but is affecting his psychology. He's frustrated, afraid, and overall feels/looks/acts powerless. Let me elaborate on this point. During the times I had alone with him, I can speak intelligently in either language and his facial expressions, body language, reactions are from the man I've always known.  "Chincol", "no te vaya dar un surmenage", "dejate de hueviar"... all the same quips he would tell me growing up. It's when he wants to express a complex thought or discuss a topic as intertwined as the drama that likely triggered his condition. He will "ummm" and "ahhh" for as long as 45secs at a time and culminate with a deep breadth and a wipe of his face.  In one occasion he muttered a "damn it" as if to release the frustration of not being able to communicate as he once did.

Video of CatScan and Ultrasound

One thing is clear. He needs help. He knows it and is willing to do what's necessary to recover. That includes moving from the remote village where he lives, Pirque, to the city, Santiago, where friends and family can help him. Moving to the USA isn't out of the question but as he sees it "it's impractical and generally an unpleasant place for me".  So the plan for the next 6 months is starting to take form. Once he's released form the hospital on Wednesday, August 6th we'll head to Pirque to work on getting his mobility back. Meanwhile, we'll work on a move to Santiago to allow him easier access to friends and family that can help him get his mind back. That's what he told me today: "where you can help me is to work me through completing my thoughts until I can do so for myself again".   

Medically there are a couple decisions to make. Most pressing is a recommendation to surgically implant a pacemaker. The argument is as follows. Neurologist Dr. Gonzalo Bustamante (head doctor in charge of my father's case) reviewed the scans attached above and hypothesizes that a blockage to the Arteria Central Media caused the stroke.  Limited flow prevented enough blood from reaching the left center and back areas of the brain. They are prescribing blood thinners to try and free up this blockage and avoid more from potentially forming. Dr. Bustamante also requested a cardiologist study to understand what might have pushed a clot up into the brain. Dr. Rubio, the cardiologist, carried out a Holter Exam over a period of 24hrs on Wednesday, July 31st which studies the performance of the heart. He found that there was an arrhythmia which means the heart rate tends to spike and drop. The lowest he recorded was 34 beats/min at one point. Based on this, their recommending implanting a pacemaker. This procedure is only mildly invasive since the device sits just below the skin and electrically triggers the heart to maintain a minimal rate. This is meant to prevent fainting. At my father's age and physical state, his heart rate should be in the 65beats/min zone. The pacemaker would keep the low end from ever dropping below a safe threshold but do nothing for the high end which is believed to have caused the blood clot in the brain. In other words, the high heart frequency can cause moments of blood turbulence that can form clots in the blood pathways.  In my father's case this happened in the pathways to the brain.

My father is not ok with the pacemaker. He's never needed one before and finds that it won't help with preventing further strokes, only from fainting. He thinks the chance of him fainting is too small to warrant something as invasive as a pacemaker. The decision will come to a head on Monday, August 4th when the doctor expects us to have a decision. Maggi is leaning toward putting it in, since it's the doctors recommendation. I'm leaning towards my father's argument but don't want him fainting and possibly hurting himself in the process.  Tough call.