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Patient Essay: Kim Steele-McNeal

Unable to form words and feeling the left-side of her face start to droop, Kim Steele-McNeal realized she was having a stroke.

Kim Steele McNeal
Kim Steele McNeal

I am fully recovered. ... I want to tell everyone: You can make it through the worst of times.

Kim Steele-McNeal: Stroke survivor

One day last June, as I cooked my mouth-watering, lightly golden salmon patties with caramelized onions and golden crisp-edged potatoes, I remember turning to my husband and saying, “I’m not feeling like myself.”

I knew what was going on around me, but I felt this unexplained cloudiness. It felt like I was high. 

Later that week, I woke up with a sharp pain behind my eyes that radiated through the top half of my head. It was so piercing that I couldn’t stand on my first attempt to get out of bed. I thought it was the beginning of a sinus infection. I had a headache, slight dizziness, pressure behind my eyes, and a dull right-side jaw ache with some left-eye twitching. I rarely got headaches. Reluctantly, I called in sick this day and didn’t go to work. I’m a supervisor and echo specialist in cardiovascular testing at Johnson Memorial Hospital in Franklin, Ind.     

The next day, I returned to work with the same headache, but I was determined not to miss another day because soon I’d be on vacation and basking on the sun-kissed beaches of Florida with 11 members of my family. I took some ibuprofen, and my headache seemed to subside.


June 11, 2018: The First Stroke

By the time Monday (June 11, 2018) arrived, I was exhausted but couldn’t tell if I still had symptoms because I was pumped up for our family road trip to Florida. 
Signs of Stroke
I decided to go to the cafeteria. Our employee bathroom was right across from my office, so it was easy to wash my hands on the way down. Using my right hand to turn off the cold-water faucet, I then tried to use my left hand to turn off the hot water. But my entire left arm swung toward the faucet handle. It missed! My arm felt detached from my body. I heard what seemed to be a loud echo, like I could hear myself talking. I was 42 years old and had worked in health care for more than 25 years — starting as a transportation aid when I was 17. I thought, “I’m having a stroke?” 

Once I left the bathroom, I had made up my mind to be inconspicuous so no one would notice I was experiencing a stroke. I walked around the nurse’s station and asked a student who had just finished her lunch if the cafeteria had anything good to eat. Only baby gibberish came out of my mouth. The student gave me a confused look, and I quickly went into one of our treadmill testing rooms.

A cardiovascular technician took my blood pressure. My blood pressure had spiked to 138 over 90. It usually runs 110 over 70. The technician asked me if I felt OK. As I shook my head no, the left side of my face started to droop, and my left leg began to droop. I couldn’t form complete words. The supervising cardiologist, Abhishek Khemka, MD, FACC, came in asking questions, and I could answer only by shaking my head.

“You could be experiencing two things: Bell’s palsy or a stroke,” he said. “Kim, I think we need to get you to the ER because I believe you’re having a stroke.” 

As the ER nurses frantically placed orders from the ER physician, I answered every question by shaking my head and attempting to speak from the right side of my mouth. I listened to them repeatedly ask me to straighten my left arm, which was twisted and drawn up toward my left chest. By the time I returned from having a CT, they had a neurologist pulled up on a teleprompter supported by a robotic arm.
  
I wasn’t sure how I felt about the new age of telemedicine, but the physician working remotely was very kind.  She informed me that when someone is experiencing a stroke, they administer a medication called tissue plasminogen activator, known as TPA. This drug was very familiar to me. As a former cardiac catheterization lab specialist, I saw TPA used often. It helps dissolve a blood clot to improve the flow of blood to the brain in people who are having a stroke. 

In a state of panic, I asked to wait until my husband arrived before giving the medicine, so I could tell him goodbye or maybe even sorry. After 26 years together, sometimes we don’t remember if we are mad or unpleasantly abrupt with one another.  

The ER continued to wait for me to decide whether to accept TPA. I shook as I stared at the TPA vial in the right hand of the nurse. Then someone said to get an MRI.


Carotid Artery Dissection

After the MRI, I returned to my triage room and gasped in relief to find my husband with a blank stare of confusion, my big sister wiping the tears from his eyes and my mom! My mom’s faith is strong. She is my praying partner. The look on her face was one of confidence and said everything would be all right. Shortly after my MRI, the ER physician came running into the room saying they needed to get me to Indiana University Health Methodist Hospital because I had a right carotid artery dissection. I had a tear in the artery that supplies blood to my head and brain. When this happens, blood flow is blocked or slowed.

The ER physician yelled, “Don’t give TPA!” TPA could have caused me to bleed out. 

During my seven-minute flight on the helicopter, I felt so much peace. Indiana University Health Methodist had always been a place where I felt safe. I had worked at the hospital as a cardiac sonographer, learned to follow and learned to lead there. It had the very best physicians in the country, and it was where I was born. 

I landed onto the helipad of my hospital and was wheeled into the ER. Young physicians who looked young enough to be my sons surrounded me. I felt old but reassured. They looked me over and asked me so many questions. Do you remember hitting your head? Have you visited a chiropractor? Have you been on any roller-coaster? Have you been in any car accidents? Have you injured your neck? Have you been jerked around? I looked the doctor in the eyes as if to say, “Doctor, I’m a woman, 5’2”, and I’m black. I’ve been jerked around all my life!” 

The physicians and fellows were kind and gentle. They went on to say in these cases if you’re conscious and stable, we’ve found it would do more harm than good if we did surgery. For treatment, my health care team gave me the clot-fighting drug clopidogrel (Plavix) and midodrine. I was stunned and relieved. 

My favorite cardiologist, Richard Kovacs, MD, FACC, was there at the hospital. He made sure I had the best IU team on staff. I knew I was in good hands. 

I felt physically horrible. I felt as though someone was slamming my head against a wall. I was nauseous, had a nagging pain in my right jaw, and I felt like I was going to pass out. I couldn’t walk on my own. 

Physicians visited me each day. They sent me for another CT and MRI. The heart is amazing, but I experienced how amazing my carotid arteries are, too. I had grown a collateral off the dissected artery. That means another artery had grown to reroute the blood flow to my brain. That was the coolest! My neurologist told me that I had a clot about the size of a ballpoint pen lodged in a small artery in my brain. I stayed in the hospital for three days.


Another Stroke

I was sent home on a baby aspirin. Two days later, while my mom and family took turns spending the night at my house, I suffered another stroke. My speech slowed down, my left arm went out, but I was able to walk to my mom’s car so she could rush me back to the hospital. 

During my second hospital stay, I passed my hospital physical therapy and speech assessment. I convinced the staff I was strong enough to walk the halls. After a short stroll, I sat down in my room on a chair and started slipping toward the floor. I tried to signal for help. My blood pressure dropped, and the medical emergency team was called. The next thing I remember, I was being placed back in my bed. I recovered after three more days in the hospital. 

I stayed home for three months. During that time, I experienced moments of depression and feared that I would never have my old life again. Would I return to supervising a cardiovascular lab and bonding with my patients but with a greater empathy and skill to care for others?  

Many nights, I lay awake and could hear the turbulent flow of blood through my right carotid artery. It sounded like I had a seashell up to my ear. That was the closest I got to a beach last year. Occasionally, I can still hear the sound! It’s an amazing reminder of what I’ve experienced. 

We attributed my dissection to my newfound weightlifting and kettle bell lifting that I had done to get ready for the Florida vacation. I had increased my weights to become bikini ready. 


Recovery

I had the best care, supportive family and — most of all — I had the faith that God would get me through this as a caregiver to offer compassion and love. 

Nearly a year later, I am excited to say that I am fully recovered. I have full use of my body. With just a baby aspirin each day and a headache at stressful times, I feel amazing. I want to tell everyone: You can make it through the worst of times. 

Thank you to everyone — the Johnson Memorial Health team and to the Indiana University Health team! I wouldn’t take anything for my life’s journey.

If you notice someone shows signs of stroke — sudden loss of movement in face, leg or arm, or has trouble speaking — call 911 at once. Go to CardioSmart.org/Stroke to learn more.


Published: May 10, 2019

Infographic: Stroke

Infographic: Shared Decision-Making