A Stroke Nearly Sidelined Me, but I Fought Back

Maureen A. O'Reilly, DNP, NNP-BC, MSN

Disclosures

March 12, 2020

Looking back, I should have seen it coming. How many times had I seen a Spot a Stroke FAST poster (Face drooping, Arm weakness, Speech difficulty, Time to call 911)? Why did I think it could never happen to me?

And how, lying on a hard gurney as I was propelled through quiet hospital hallways, staring up at rivers of fluorescent lights and unable to move my entire right side, did this thought even cross my mind: "Dang, I bet I just lost my job"?

Two years before my stroke, I had completed a doctorate at age 59 while still working full-time as a neonatal nurse practitioner (NNP). Anxious to use my degree and accomplish something of note before I retired, I took on writing assignments and teaching. I changed jobs. I also started a large home renovation project. I worked at being a wife, mother, and grandmother. Some euphemistically call this a "full life." For me, it proved near fatal.

On a Wednesday, while jotting notes, my right arm began windmilling, throwing my pen against the wall. I stared at my arm, momentarily bemused, and got back to work. On Thursday, unaccountably tired, I blamed my deep fatigue on work. Friday was a long shift orienting to my new position. My handwriting was a micrographic nightmare—absolutely unreadable. Without time to analyze the cause, I resorted to a laptop for note-taking.

The next morning I woke up at 3 AM, startled. What just happened? A dog barking? A car alarm? No, it was me. I couldn't move my right side. My last clear thought was, I've had a stroke.

The 'Young' Stroke Victim

Chronic hypertension, overweight, overworked, female under age 65—I was joining a growing class of middle-aged stroke survivors.

When I asked the neurologist why this happened to me, he frowned. "I think you probably know. It was stress. I see younger and younger people, especially women, every year, having strokes at age 50, 55, 60. You lead a difficult, too-busy life. This stroke was a warning." Apparently, chronic stress has recently been linked to risk for stroke among middle-aged adults.

My next question was, "Will I ever work again?" He wanted to know what kind of work I did. Haltingly, I described attending high-risk deliveries, resuscitating newborns, and admitting preterm and other sick infants to the neonatal intensive care unit (NICU) and managing their day-to-day care. The procedures, such as intubation and umbilical line insertion, took significant dexterity.

The neurologist's frown deepened. "Very, very few people can go back to that kind of work after a stroke. It's possible. Maybe. It will be very hard."

Luckily, I had no time or energy at that moment to discover that the unemployment rate among young stroke survivors, aged 45-65, is significantly higher than that of the general population. More discouraging is that while young survivors may return to work 3-6 months after a stroke, at least 15% will leave employment within 6 months. Only 50% of people employed before a life-altering event remain on the job 1 year later.

My Motivation to Recover

Four months of recovery followed my stroke, beginning with weeks of hospitalization, stroke "boot camp," and then outpatient therapy. Water exercise, boxing, treadmills, ball bouncing, and printing with a kindergarten-size pencil were mildly fun. But the urgent question always on my mind was, Will this help me go back to work?

In post-stroke therapy, O'Reilly fights her way back to work. Courtesy of Maureen A. O'Reilly

My first independent outing, after regaining my driver's license, began with a trip and fall on my way to the car, leaving me injured and frightened. Scrapes and bruises were my new normal. I blundered on while remaining laser-focused on getting back to work. My bloody knees and elbows were war wounds in the battle. Returning to work would be the pinnacle of my new after-stroke life.

Why was work the driving force for me in recovery? Work meant money, of course. It gave me structure and a schedule. It made me feel vital to patients and coworkers. I was proud of being a neonatal nurse practitioner; it allowed me to positively affect the lives of newborns and their families. Ultimately, work was a source of value and meaning to me.

I found an occupational therapist who was cautiously optimistic about my chances of returning to work, which was both exciting and daunting. Intensive workplace rehabilitation can increase rates of return to work among stroke survivors from 20% to 60%. But the potential for error would be high if I wasn't truly ready to return. Proof of readiness meant perfecting physical skills and demonstrating decision-making ability. We decided to mimic my workplace challenges.

We borrowed equipment from a NICU. I was the clinician, the therapist was my assistant. We stood over a manikin under bright lights, gowned and gloved. Thankfully, I had no audience at this point, because stress and failure brought on autonomic symptoms—face reddening, sweating, and nausea—and I couldn't keep the procedural steps in mind. This gradually cleared as competence returned. Some skills were magically untouched, like starting a peripheral IV or performing an arterial stick. Suturing, however, induced depression and anger which consumed the rest of my day. Trying to write a prescription brought on hyperventilation and that maddening micrographia.

Yet, my determination didn't flag. When a neurophysiologist evaluated me for readiness to return to work, he told me, "You're 94% or 95% back—almost there." He pointed out that I could tie my shoes but I couldn't tie a surgical mask behind my head in a bow. That day, at home, I practiced 71 times in a row until I completed two perfect bows on each masking attempt.

The Final Hurdle

Cognition was the final hurdle. I was given a list of 25 cognitive testing points from the hospital medical board, which I was required to pass before orienting back to the clinical area under supervision.

In the NICU, a colleague arranged these clinical tests for me. I directed a neonatal resuscitation, demonstrated procedures on a manikin, re-took my certification exam, and took "orals" on many topics. I constantly reminded myself that the stress of this ordeal must be controlled or I'd suffer another stroke. Breathe in, breathe out.

I had never been guaranteed that my job would still be open when I returned. I became a frequent caller, begging for my request to be considered. Finally, I was told that I could spend several days working in the NICU and delivery room, observed by a senior colleague. A strict contract was drawn up. My chance at a work life was teetering on this final test.

I successfully navigated this portion of the testing and returned to my job. But I had forgotten about the atmosphere of the NICU. A cacophony of phones, pagers, crying babies, and monitor alarms taxed my ability to separate the noise from important signals.

A near miss with a drug dose was caught and corrected; it shook not only my own confidence but that of the staff nurses, whose trust I would not fully earn back for another year. I was grateful to the nurse who had the courage to question my order. I knew that near-miss events were common—they happen to everyone, and our system of safety checks with drug orders prevents harm to the babies. Still, I couldn't help worrying that my mistake was related to my stroke. I changed my approach to orders, and for a time I stopped giving verbal orders and entered them only by computer so that I could double-check every order myself before transmitting it.

Even after all I had been through to get back to work, I considered "throwing in the towel" many times, and for far less important reasons than a near-miss dosing error. I was much more susceptible to fatigue, for example, than before my stroke. When I was very tired, I would occasionally have trouble recalling a certain word (like hydrocele); and when it was cold outside, I had difficulty moving my right leg, leading to what I called my "Frankenstein" gait. In those days, there were many shifts when I told myself, Just get through this—you can always quit later. Whether from pride or stubbornness, I kept going back. I could see and feel evidence of my recovery every day.

The brain is truly mysterious. Three years later, I still fall down once a month. Six weeks ago, I suddenly found myself able to write a smooth, cursive script. When asked about the stroke experience, I tell other professionals to start work now on protocols for return to work, because there are many more like me, coming very soon.

Maureen O'Reilly is a neonatal nurse practitioner with Ascension St. Francis Hospital in Wisconsin. In the special care nursery, she guides patient care, teaches staff, and initiates evidence-based improvement projects.

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