Stroke

This story about a stroke tells of my brush with fate.

Let us be honest; it is a chiropractor's nightmare. If a patient has a stroke, and he had consulted a DC in the last month, manipulation is always blamed, no matter what.

There was even a case in which a patient with a sprained ankle, and the only treatment was to the lower limb, yet chiropractic was vilified in the medical and popular press.

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A good scare is worth much more to a man than sound advice.

- Edgar Watson Howe

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Bats in my Belfry

This page was last updated by Bernard Preston on 9th January, 2019.

by Bernard Preston DC

It’s always irritating when a patient misses an appointment. When it is the first appointment on Monday morning, it is doubly irritating. Sally, my secretary, has a superstition that, when the first patient does not arrive, then the rest of the day will be chaotic.

I have to admit that she has a point, but we are all allowed to be found wanting occasionally. It is part of life to be forgetful, or have the car not start on a winter’s morning. It is not often though, that a patient misses the first appointment on a Monday morning because his wife was struck by lightning over the weekend. Golf clubs make good conductors.

Sally brought me the news a few hours later, and I went over to Jerry’s place after work. His kids had started arriving and I felt a bit awkward, said my piece and left. His daughter was talking about "an act of God" and their sons were just shaking their heads and saying things like "shit happens." So it does. They were a golfing family and all three children, now young adults, were scratch players which is no mean feat. I wondered is golf a dangerous game? What are the statistics?

Jerry finally made the missed appointment about ten days later. Sally had booked some extra time knowing we would talk. It was not easy comforting him after such a meaningless death. A stroke of fate. On his way out, he said, "One of the kids looked it up on the web; there’s about a one in a million chance of being struck by lightning while playing a game of golf. Why did it have to be Sonia?" Why indeed?

I sat pondering those statistics that evening with Helen. ‘One in a million. Just how dangerous is that?’ I asked her.

‘Do you mean: If you were a golfer what would the chance be of you being struck on the golf course this weekend? Struck by lightning, that is.’ Helen, the mathematician, didn’t need a calculator though she reached for a piece of paper and a pen.

"Yes, let’s assume that the average player plays golf, say 25 times a year."

‘You go soaring far more than that!’ she exclaimed.

‘Nonsense! Once you add up rainy weekends, holidays and congresses then I bet it’s no more than 25 times a year. I’ll get out my gliding log book if you like.’

‘Okay,’ she tried to placate me. ‘Then if we work on forty years, probably a bit on the high side but nice for the figures, that comes to 1000 golf-days in a lifetime.’

‘That means that, on average, one in a thousand regular golfers would be struck down by lightening on the golf course during their whole lifetime. A good deal safer than soaring or motorcycling don’t you think?’

I made a phone call. ‘Shafton Golf club has about 500 members.’

‘That means that, in eighty years, one person would be struck by lightning on the Shafton golf course, on average. I think I’ll take it up. It sounds like a pretty safe sport.’

Helen was enjoying teasing me, knowing that she knew that I knew, that all she needed for peace of mind was a patch of earth. Her favourite saying was: ‘When the world wearies, and Bernie ceases to satisfy, there’s always the garden.’

‘Of course, a second person could be struck next weekend.’ I had to have the last word.

On average. So why Sonia? No one ever remembered another player being struck down at Shafton’s golf club. Statistics. They can be useful. Lies, damn lies and statistics, my aunt used to quote, knowing how figures can be manipulated to prove a point. Still, I decided that one death in a million made golf indeed a very safe sport as far as lightning is concerned.

‘One would probably more likely be hit on the head and killed by a mis-cued ball,’ said Helen thoughtfully.

I agreed. No doubt, though, there would be less angry shaking of clubs at passing clouds, after a wicked hook shot dragged the ball into the thick rough.

Bats in my belfry

Stroke

It was not many weeks later that I was taking the history of a middle-aged woman during an initial consultation. She was a pleasant enough looking woman, and she shared with me the absolute misery of her headaches, ever since a fall off a horse in her childhood. Horses are dangerous animals, a lot more dangerous than lightning on a golf course, especially when crazy parents encourage their children to climb on some wild nag at a guest farm. She went on to tell me how at least once every six weeks she would go out of circulation for three days with the most awful pounding headache.

‘Do you ever get nauseous, Mrs Anderson? Does it affect your vision?’

She nodded, confirming many of the classic migraine signs including nausea and occasional vomiting and, on occasion, all the stars and stripes, though jagged, of the American flag. Two or three days would be spent on her bed with the curtains pulled, in a drugged sleep. Could I help her?

‘Well, I may be able to help you, Mrs Anderson. Chiropractic does help many people with migraines, but first I must examine you and find out if you have any signs of subluxations in your neck, whether you have active trigger points in spinal muscles or even perhaps a problem in your jaw joint. Is there anything else that may be important, which I haven’t asked you about? Are you in good health, as far as you know?’

‘Yes, I am in good health, other than these headaches. Once or twice when I have the headache, I find I can’t think straight; a sort of muddled thinking,’ she tried to explain. ‘Once it was so bad I could barely speak intelligibly for an hour, but then it passed.’

‘When was that?’

She thought for a few moments. ‘Perhaps three months ago, maybe longer.’

‘Did you consult your doctor?’

‘Yes, he was quite concerned, and said if it happened again I would have to have some tests.’

I nodded. ‘Would you please go and change in that cubicle, strip down to your underwear and put on the gown, with the opening at the back.’

She came back in a few moments. ‘I’m afraid I don’t feel too well. I think I am going to be sick…’ Her voice became a croak as she tried to force the words out. I sat watching, bewildered. What was happening? She tried to sit, missing the chair and fell to the floor, slumping to the side. As I watched her, the right side of her face started to sag and she grunted out a few inaudible sounds before collapsing to the floor, unconscious, all before I had laid a finger on her. I rushed to the phone, and called the hospital. ‘Please send an ambulance immediately to the Back and Headache Clinic in Chapel Street. This is an emergency!’ I turned back to Mrs Anderson who was now lying on the floor. I took her pulse which was thready, but she was breathing, her eyes closed and her face now completely twisted in a grim mask on the right side. Suddenly her left arm gave a tremor, and she groaned, and I knew she was dying. There was absolutely no need to follow the three point test for a stroke. Could the patient:

1. speak intelligibly?
2. smile?
3. raise their arm?

Even a layperson could easily see all three were affected. I wondered whether I would have to start CPR and checked her pulse again. I could just feel the pulse in her neck, and leant down to hear if she was breathing. She was, though she was gasping and struggling for air. I loosened the gown from around her neck, relieved to hear the siren outside.

Moments later Sally burst in: ‘What’s happening?’

I shouted: ‘Bring in the paramedics. Quickly!’ Mrs Anderson gave a little gasp and, when I felt again, there was no pulse, and nor was she breathing. I had never done mouth-to-mouth before on a real patient, and my mind raced. One, one thousand, two one thousand, three one thousand, was that it? I made a reluctant start, extending her neck and blocking her nose. Two burly men came rushing in, I could have kissed them but my lips were otherwise engaged at that moment. One quickly set up a drip and the other pulled out the cardiac massage machine while I went on for a moment longer, losing my rhythm. They took over very professionally, injecting her with something.

Mrs Anderson had died in front of me, before I had laid a finger on her. They managed to get her breathing again, and it wasn’t more than a few moments, though it seemed like interminable hours, before they had loaded her onto a stretcher and carried her out to the waiting ambulance, still standing outside my office with lights flashing and a siren going. It wasn’t the kind of advertising that a chiropractor would want outside his office.

That night I realized there were difficulties ahead. There would be those who said that I had manipulated her neck – which is what I was going to do, most likely, if I found subluxations and there were no contra-indicatory signs – and caused her stroke. There would be others who would accuse me of having treated a patient without having first examined her: my examination pad had only a detailed history, and nothing else.

I went early next morning to the hospital. Mrs Anderson was in a coma. Her daughter was sitting there, holding her hand and the doctor was doing his rounds. He was also my GP so I knew him quite well, not that I had the need to consult him too often, but Helen and the kids had certainly had their share of mumps and measles.

‘Well, what happened, Bernie?’ He wasn’t his usual friendly self and Mrs Anderson’s daughter scowled at me. I told him. He raised an eyebrow. I could read it all: I’ll believe you but thousands wouldn’t. He never said another word.

Mrs Anderson came out of the coma later that day, but she was horribly confused, and couldn’t speak a word. After a week she went home, to the care of her daughter. I visited every few days. It was quite odd – Mrs Anderson was able to sing beautifully, songs that she obviously knew by heart but she couldn’t utter an intelligible word. Five days later I arrived, and it was obvious that something had happened. There were several cars parked outside. The front door was open, so I slipped in quietly. Mrs Anderson’s daughter was saying: ‘I was holding her hand and telling her that John had got a hundred per cent for his mathematics test. Her eyes were alive and I could see she understood. She gave my hand a little squeeze, and then suddenly her eyes just went blank… and her hand went…’ She gave a sob and wasn’t able to finish, looking up for the first time, and seeing me. Her eyes hardened but she didn’t say anything.( Stroke )

Next morning a burly policeman arrived a little after nine o’clock. I was busy with patients but he demanded to see me. ‘Could you come back at ten o’clock, detective? Doctor Preston is busy with patients.’

‘No, I cannot do that. I have my orders. I must speak to him now. Someone is dead.’

Other patients sitting in our reception rooms looked at each other. One leaned over and said: ‘I heard that one of Doctor Preston’s patients died here last week.’

‘No!’ the other man exclaimed. ‘I wonder what happened?’ he mused, looking at the officious policeman. The first stood up. ‘I can come back later,’ he said. ‘In fact, I’ll just phone next week.’ He left and the other man trooped out after him.

Just then I came through to collect my next patient. ‘This man is a detective, Dr Preston. He needs to see you,’ Sally said. ‘Now,’ she added rather ominously.

‘Come through to my office, detective,’ I said shaking hands with him and ushering him into the office where I did my initial consultations. It was in fact the same room where Mrs Anderson had died a few days previously, only to be resuscitated.

‘There will be an inquest, Doctor, concerning the death of Mrs Anderson. I have come to subpoena her file. Then you must make a statement and sign it.’

‘May I make a copy of the file before you take it?’

‘Yes, I suppose so. Would you make the copies now, please?’ I called Sally. ‘Please will you bring Mrs Anderson’s file. Make a copy of everything first,’ I added.

After she brought the documents I put the copy in my drawer and gave the original to the policeman.

‘Now will you please make a statement?’ He passed me a sheet of paper.

I took my time. I knew my career hung in the balance. A woman was dead, and it was not entirely unreasonable to assume she had died because of something I had done to her. I was after all the last person to see her alive and normal.

I wrote:

Mrs Anderson consulted me at 10am on Monday, 9th February, 2004. She told me of a long history of headaches since she had a fall off a horse as a child. She spoke of the severity of the symptoms, typical migraine signs that she had experienced, the previous treatment that she had had, and the medication she was taking, which included Migril and medication to prevent pregnancy. She was also a smoker of some 20 years and had controlled hypertension, so she said. She stated that it was 152/96 on her last consultation with her doctor. She reported that she had no serious illnesses, or injuries other than the fall off the horse. She described some typical symptoms of a so-called TIA (Temporary Ischemic Attack) some three months ago. I instructed her to disrobe and put on a gown for the physical examination. On returning she declared that she felt unwell and nauseous and collapsed onto the floor. I had just started CPR when the paramedics arrived. I had not even begun the usual Chiropractic examination.

I did not treat Mrs Anderson in any way. Our only physical contact was a handshake whilst still in the waiting room and, of course, the CPR.

Had fate ordained that Mrs Anderson had her stroke an hour later…

Ebook

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Stroke is chapter 4 from Bats in my Belfry by Bernard Preston.

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