AANS Neurosurgeon | Volume 28, Number 4, 2019


A Neurosurgeon’s Stroke Recovery Story

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At 44, I was the picture of health. I played soccer, tennis, golf and ran marathons. I did not smoke, and I rarely had an alcoholic beverage. I was in a seven-person neurosurgical practice I had joined the previous year, after a 20-year career in the Navy. My life changed one weekend when I was on call for our group. My wife and kids had gone to visit relatives for the weekend, since I was usually busy during my weekend call. I came home in the evening after taking care of a patient with an acute ruptured aneurysm. I read for a while, then went to bed. I woke up in the middle of the night, and noticed the right side of my face was tingling. I tried to get out of bed, but discovered that I had a right hemiplegia. I remember sitting on the floor muttering to myself, “I think I had a stroke”. I picked up the phone to call for help, but could not remember 9-1-1. I finally was able to hit the operator button, but when the operator came on the line, I had a dense expressive aphasia and could not give her any information. Fortunately, she traced the phone call and sent help. I was still sitting on the floor in the bedroom, holding the phone, when the police, EMTs and firefighters all came in my room.

My brain MRI revealed a non-hemorrhagic left thalamic infarct. My medical workup was comprehensive and included carotid Doppler’s, echocardiogram, a bubble test and lab studies looking for a hypercoagulability disorder. All studies were normal. Fortunately, my strength and speech began to improve over the next three days. By discharge from the hospital, I was ambulating with a walker and my speech was understandable. 

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After discharge, I had extensive speech, occupational and physical therapy. It began with simple tasks, such as writing the alphabet and using a pegboard. Initially, I despaired that I would ever return to my practice and wondered how I was going to support my family. I am blessed to have a great wife, who was my rock throughout this ordeal. I had great partners, who stood by me during my recovery, and I drew strength from their unwavering support.

My recovery progressed fairly rapidly over the next 3-4 months. My improvement was so dramatic that I began to think that I might be able to return to my practice. I had many discussions with my partners, but we were all concerned regarding what criteria to use in order to determine whether I could safely return to clinical neurosurgery. My partners contacted neurosurgical colleagues around the country, to determine if anyone had ever gone back to practice neurosurgery after having suffered a cerebral stroke. We could not locate anyone who successfully returned to work. We were left with having to come up with a process and criteria that would satisfy my partners, the hospitals where I was on staff and our liability carrier.

My process involved several steps. First, I had extensive testing by the physical and occupational therapists. I also underwent thorough neuropsychological testing and was examined by the chair of a top academic neurosurgical program. I then returned to work in stages, first just seeing patients in the office. This was followed by a gradual return to the operating room, initially in an assistant capacity and then as a primary surgeon, with one of my partners acting as my assistant. When my partners and I felt confident in my abilities, I returned to independent practice.

I had a successful and rewarding neurosurgical career for another 16 years, retiring last year secondary to health issues unrelated to my stroke. My life changed after my stroke. I was forced to accept my mortality and I developed a true appreciation of what my brain-injured patients and their families endure. To this day, I feel incredibly thankful for my family, partners and friends who supported me during my recovery. While there can be just one right path, by sharing my personal experience of returning to neurosurgery practice after a devastating medical event, perhaps the advice will prove useful for others.

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Edward J. Zampella, M.D., FAANS, FACS | September 11, 2018 at 9:53 am

Your experience was similar to mine (in 2012) but different. I was 52, a former athlete gone soft. At the end of a stressful day, just prior to my last case of the day, I had a “heated discussion” with one of my partners. Shortly thereafter, I passed out (after positioning the fluoro viewer, placing a localizing needle and confirming the location – none of which I remember). That same partner was standing outside my OR door when I was whisked out on a stretcher. He took me to CT scan, then to the IR suite. I received my IV tPA in CT, 14 minutes after onset of symptoms, had the R MCA clot removed using a Penumbra device shortly thereafter. When I awoke from my induced coma after my F/U MRI the next morning (small non-hemorrhagic R thalamic infarct) my only motor deficit was L leg weakness, which resolved by midday. I was discharged after 48 hrs in the hospital. My lumbar lami patient was operated on by another partner a few days later. I FELT ready to return to work that same week. Cooler heads prevailed and I,too,underwent neuropsych testing which revealed spacial perceptive/localization problems. My neuropsychologist admitted that there was no normal data for neurosurgeons so they baselined me against the data they had for flight controllers. Within 3 months, I tested normal and returned to the OR, under supervision of another neurosurgeon until ALL were satisfied (partners, administrators and Chief of Surgery) that I was back to my pre-stroke self. It sounds like a success story, but it was a FIGHT the entire way; everyone (and I mean everyone) encouraged me to take the opportunity to retire and take advantage of my disability insurance.I know they all meant well, but I wasn’t having any of it. I LOVED my career, and fought tooth and nail to return to practice. I was glad I did. I had a few truly wonderful years before complications associated with my own fifth spine surgery forced me to hang up the towel.I’m working now to develop a neuroscience program for a large multi-specialty physician owned group. To this day,I regret loosing the opportunity to operate with my daughter when she graduates her neurosurgery residency. Being immensely proud of her achievement will have to do.

Dante Calvo (SCPO, USN, Ret) | August 30, 2019 at 5:25 pm

Dr. Heim,
I decided to search for you and this article came up, wow whata story and I’m definitely glad you recovered well enough to continue your practice. I have mentioned your name to countless people when I comes to neurosurgery, you see, thanks to you I was able to serve on active duty in the Navy for 19 years and 4 months after diskectomy/laminectomy on December 15th 199 at NNMC Bethesda. I was discharged from a local hospital in northern Virginia today and have a nerve being pinged inthe same levels as those you operated on, but the left side this time. I wish I could contact you for your expert opinion on what course of action I should take. I can tell you that retired medical treatment is different than active duty. I will forever be thankful you were the one who provided me with a new beginning when the Navy may not have had a choice but to medically discharge me almost 20 years ago.