Recovery continues

I wish I could say everything is wonderful on the recovery front. It isn’t. We are not back where we were. We are in a holding pattern with very slight increments of improvement.

That being said, I do have a lot of positives to report. The most important is my husband has learned to pace himself with the carotid artery dissection fatigue. We have accepted it as a real thing and we have adjusted to account for it. For example, Tuesday evening is my husband’s pool night with some buddies. In preparation for the evening yesterday he rested a lot during the afternoon, deliberately taking a long nap and spending a lot of time lying in bed with his laptop doing things that require little or no mental energy. The result was he was able to enjoy the evening with the fatigue only starting near the end of the last game. Now I realize that we are very lucky that he can even walk over to the senior’s centre by himself and play pool. Many people after a carotid artery dissection simply could not. So I am grateful for that. However, if my husband has to miss his pool game because of post carotid artery fatigue or miss pool because he can not walk over there, he is still missing his pool game due to the dissection. So this adjustment is a major and extremely important one though it might seem very small.

It is the same thing with his work. He is retired but he loves continuing to do science to and mentor people.  We recently finished a paper linking code biology and our differentiation waves. He did all the final editing of adding the references and numbering the figures and the process of submitting it. He did it at a much slower pace than he would have before but it did get finished. He did not stay up all night and push hard to get it in on time at the last minute. That would have been the old pattern. This time he deliberately got it done well ahead of the deadline so there would be no last minute crush. Other things were neglected in the meantime but it got done.

I am happy to report he is taking this recovery and rehab thing very seriously. He has been using his treadmill desk faithfully and dropped two inches from his waistline. That is the only risk factor he has for stroke that he has any control over. He doesn’t drink or smoke. He can’t control genetics or his age. He can control his weight and fitness. Plus he has started a ping pong club with his friend Frank Chen for Thursday evenings at the community centre. Ping pong is very good for working on hand eye coordination and forcing the body to use the slightly weaker left side. He was exhausted after the first session but it was a good kind of exhaustion. We even had a good turnout with seven people showing up.

Our friends the Chens have a new dog and they have been bringing the dog over for play time with our Misty. Both dogs have great fun and it’s good for us when they wear each other out.

We have both suffered a blow to our sense of invulnerability and immortality. He could have died. The feeling of shock is wearing off but we are still both looking over our shoulders watching for the grim reaper. We went out to view some property with a friend and his family that they are considering purchasing. We were having such a nice time on this rural property that we did not keep track of time and we did not hydrate. We abruptly had to leave because my husband had a dizzy spell. The drive home took forever and I was panicking while pretending I was not. I knew rationally that this was likely a side effect of the meds. We had been warned about that. It was most likely not a stroke from the dissection. We got him home. The blood pressure monitor confirmed he had dropped too low, and we got fluids into him and he had a chance to rest and recover. I had my heart in my throat until he woke up feeling fine.

Afterward, everyone said how wonderfully calm I am in an emergency. I am faking it. Inside I was coming apart at the seams and I’m sure if I had used his machine to take my own blood pressure, I would have blown the thing up. Once it was all over, I had to go and vent to my good friend who is marvellous about listening and nodding sympathetically and just being supportive. Another lesson learned. No long hikes without hydration before, during and after. Hopefully, at the three months post carotid artery dissection check up we will be told the artery is healed and we can begin cutting back on some of the more powerful meds or reduce the dosage.

We got a bunch of money back from our insurance plan for the drugs he’s on. To our disappointment we only got about half back. It turns out that in Manitoba pharmacists can charge all kinds of extra things like dispensing and counselling fees and there is no regulation on these. It is a free market. We found out our local pharmacy is among those who double the cost of drugs with those additional fees. Who knew? Next month, Manitoba will finally join the rest of Canada in regulating those extra charges. Meanwhile, we are looking for a different pharmacy. We will now be shopping around for the lowest additional fees instead of going where it is convenient and the pharmacist tells a good joke or two. Another lesson learned.

Now those slight increments I mentioned. Before the dissection my husband would typically join me at bedtime around 11:00 am and then get up about 1:00 am and work until about 5:00 am and then wake up with me about 7:00 am. When we first got home from the hospital, my husband needed a good sleep with no working at night and about eight naps, some of them two to three hours during the day. In other words, he was sleeping pretty much all the time. He is now down to about four naps a day and most are only about forty five minutes though there is usually one that is over an hour. He is working at night for thirty minutes to one hour. Part of the improvement is simply he needs less sleeping which is real recovery and part of it he is getting the knack of pacing himself and resting before he needs to sleep. That is our small incremental improvement.

In the meantime, our world remains much smaller. A trip to town for groceries we can’t get from Frank’s little store in town and a short visit, left him worn out the next day and unable to accomplish much even though he slept during the one hour drive there and back. We have a regular dental check up coming up in a couple of weeks. That is also a one hour drive. We have our son, his wife and three grandsons coming for an overnight visit. I am a bit concerned about managing. Trips into Winnipeg are basically out of the question. Our world is going to be centred as much as possible around Alonsa for a while yet. Given all the support and friendship we have been enjoying, I can think of no better place for us to be stuck.

Advertisement

Yesterday Felt Normal.

Yesterday felt normal. That seems like a strange thing to say but all day yesterday I felt like life was as it should be and had been before the stroke. In fact, I didn’t think about the stroke even once during the day. I realized it as I fell asleep and I awoke contemplating how that happened. There are two main reasons. First it was cool and it rained off and on all day. It was also the Sabbath. A slow sleepy day of doing very little and relaxing and taking a long nap on such a day was entirely normal before the stroke and so the slow pace felt entirely normal yesterday.

The second reason is our new doctor told us to only do the blood pressure thing with the new monitor three days a week. We are to measure blood pressure morning and evening Monday, Wednesday and Friday. The blood pressure thing was what the doctors fussed so much about during and after the stroke. During the stroke his blood pressure had soared up to 220/180. The first twenty four hours after we got to the hospital he was hooked up to a monitor that sent telemetry to the ICU because whenever his blood pressure went over 180 on the top number they added drugs to his IV to bring it it down. For the first night they were giving him so much they were worried about accidentally stopping his heart. The blood pressure was the thing they continued to fuss over until he was released. It was such a relief when he got home that it went from 180ish to 140ish in 24 hours. (Hospitals are stressful places.) After the first two weeks and a change of one of the three blood pressure medications back to his old one, the one we knew worked, it dropped again to the 120ish range. Each time we take out the monitor it is a reminder of the events. When it reads as normal we have a sense of relief but there is still that reminder. Saturday we had no such reminder.

My husband is now back at his regular work although at half the pace. He has several collaborators from around the world. Many of them are students or junior professor types and some of them are from countries where the education is spotty or English is not the first language. Much of his time with them is spent doing things like explaining why you need a scale bar on a micrograph or how to better word an abstract for publication or how to write a grant. He also spends a lot of time converting the universal language of science, bad English, into native English (albeit American English.) It is not just junior people. He translates for scientists who are senior in ability and expertise to him in their fields with whom he collaborates. He does all this via Skype and Google Hang Outs and similar communication methods. Prior to the carotid artery dissection, he dedicated Mondays to collaborations and he would literally spend 12 hours giving each person one hour of undivided time. He has been having on line meetings with a few people this week where projects are urgent and his presence cannot wait and that has been going well, even at the slower pace. Tomorrow he begins his regular mentoring day once again. He has switched from one day of twelve, hour-long blocks, for two days of hour-long blocks interspersed all through Monday and Tuesday with down time in between. He will not get as much done of his own writing on Tuesday but he thinks he can handle the mentoring/collaboration this way even with the fatigue. He has warned everyone that if he gets too tired they will have reschedule. They are all being so supportive it is heartening.

We missed the wild Saskatoon berry picking season we always took in during previous years because of the stroke. To our delight and gratitude a group of young people in the community picked pails and pails of a bumper crop and shared with us. I made Saskatoon pie and it was heavenly. Even if there wasn’t enough to make jam it still felt so normal to eat Saskatoon pie in summer. Bless those kids. I’ll bet they have no idea how much they brightened up my special normal day with their small gesture of kindness.

On the home front we have always split the household chores. He makes breakfast and I make supper. He does the laundry, I do the dishes. We share the lawn mowing. He has been too tired to do his share since we got home. Because it was raining and it was a slow sleepy day, it didn’t matter. He was able to do things indoor as he normally did before. He took a mere four naps/rests instead of the typical eight to ten he was doing. And we even managed to get a nice long walk with the dog in-between rain showers. I am hopeful this indicates an upward recovery trend. It felt so good to feel normal.

 

 

 

Rodent Wars

I have pocket gophers. This year we had hardly any of the iconic yellow prairie garter snakes but we have had a veritable infestation of field mice and pocket gophers. The field mice I am less concerned about. They do very little damage as long as they stay outside the house. Also between my cat and neighbours’ cats and the semi-feral bunch of cats we have in town, the mice seem to be caught as quickly as they multiply. I say that because my cat, who is elderly and cranky and prefers sunning himself to hunting, has been bringing home at least one mouse a day. And then there are the gophers. The young ones are apparently an easy mark. Klinger brought home three little ones over the course of a few days. The adults are another matter.

The first mound appeared in my strawberry patch. By inserting a hose and letting it run a couple of hours I eventually got that one to move. The gopher moved into my herb garden. More attempts at drowning and the [expletive] critter moved into my potato patch. The potatoes apparently loved the water. I will have a fine lot this year judging by the lush growth and heavy blooms. Persistent attempts at drowning finally got the little creature to move across the yard to my tomato plants bed. This gopher move apparently required going above ground because Klinger brought home a fat adult female as a present for me. Good cat. (Yuck!) Thank you kitty for the fine present. (Gag!) I am reminded why we domesticated you little bossy arrogant savages who think you own the bed.

I bought two kinds of traps I was assured would work. They didn’t. I tried the juicy fruit gum trick. The rodents were unimpressed. Nor were they caught. They do seem to dislike the mothballs down the gopher hole trick. The mothballs ended up in the mounds. Mothballs apparently do not encourage moving on, just house cleaning. I refuse to try poison. The cats are too important to risk with second hand poison.

The rodent has now retreated to beside my garage. I am on my second day of flooding.  I thought I was done yesterday. I was flooding the mound and got a strong whiff of rodent nest as the water started gushing in. A rodent exited another hole and made a mad dash under the fence and towards the neighbour’s yard. The rodent didn’t get very far because a red tailed hawk swooped down from the sky and carried off lunch. I need to wear a go pro when I am in my yard because no one believes me and I have no proof. I now know why I am being followed by a hawk.

Apparently there was more than one gopher down there even though Wikipedia says they are solitary and territorial. This morning the mounds were renewed. I came out this morning to find wet mud in all the freshened mounds. Usually the gopher moves once it has to excavate mud and I flood them again. Hopefully that means they will move next door where they aren’t my problem anymore. My neighbour said she prefers the mice and gophers to garter snakes. We’ll see how she feels when they are filling her yard with mounds. I hope my garage does not collapse once the water drains away.

On the bright side, as I went out to check the rodent mound, I found a flower. It’s a native wildflower I have been trying to get to grow forever by collecting seed and spreading in my yard. It’s right there, blooming it’s pretty red head off. If not for the gopher I might have missed it. That doesn’t mean I have forgiven the mound making invader though.

If you know any better tricks for driving off northern pocket gophers, I’m more than ready to hear them.

Lover to Caregiver and back again.

I can’t really claim I have been transitioning between the two states very well. Yesterday we went for lunch to Riding Mountain National Park. The park is only forty kilometres away but once we get to East Gate, we have another thirty five kilometres of extremely challenging roads to get to the town of Wasagaming. In the past, we have loved this road because we always see some wild life and often it’s a bear. The road goes up several switchbacks and then continues through beautiful wild country with small rivers and wildflowers, little lakes and wide marshes. When the rain is heavy, the road can get washed out. It was raining heavily. Plus in the back of my mind was the fear. It was a seatbelt accident that caused the carotid artery dissection so I worried the whole way even with the new seatbelt cushion and head rest. When a deer ran out in front of us crossing the road I didn’t gasp at the beauty and grace as I have in the past. I cursed the need for a sudden stop. He slept through it all.

We had a lovely time visiting friends and eating lunch. I watched to see if he got the fatigued look. He did, but when I asked if we should leave early he assured me he felt fine. We ran into our son, daughter-in-law and youngest of our two grandsons and had a happy reunion at the art gallery where our luncheon host had her work on display. What a bright spot of joy that was! We stopped for gelato. He was the charming host insisting on paying for everyone in our group. It was good to see my lover back. We left and started the drive back. He fell asleep slumping over the seatbelt and I woke him immediately and insisted he put down his head rests and not droop over the seatbelt. He didn’t listen. I had to tell him twice. I don’t like that. He is an adult. His wife should not nag him. His wife should not have to remind him how to behave. Lover to caregiver again.

He perked up on the drive through the park after a short nap. My lover was back. We enjoyed the drive through the park back to east gate together talking like the damned dissection had never happened. We stopped at the overlook to take a selfie like the damned dissection had never happened. This spot has many fond memories of many fine trips with friends and family. It’s sort of a tradition to stop here and look towards home. It was just like the damned dissection never happened. Once we were out of the park, he slept all the way home, not even waking completely when I stopped to fill up on gas. Once home, he was cranky and out of sorts. His computer wouldn’t start properly and he was angry and ready to spend hours on the phone with Apple support even though he was still exhausted. I stopped him. I fixed the problem. It was trivial. He should have known that fix but he was too tired to think straight. Afterward he apologized for being cranky.

Today he complained he is too tired to do much of anything. We go out for a six hour spell for an easy lunch with friends and a short stop at an art gallery and a nice drive and he needs the next day to recover. I tell him it’s okay. I tell him this is normal. I am patient and kind. I remind him this three day camping trip he hopes to make with friends in a couple of weeks is likely not a good idea. He’s not recovered yet. He agrees. Again I am left feeling like his caregiver not his lover.

This is normal after a carotid artery dissection they say. This is the way it will be until he recovers. This may be the new normal. I may have to live with these odd moments of caregiving in order to have the sweet moments remaining with my lover. It is a price I am willing to pay even if I would prefer not to. How many widows would pay far more for far less? Still it would have been better to not have to pay this price at all. it would be better if the damned  dissection had never happened.

 

“He Took Aspirin.” Stroke and Aspirin

June 24th, 2019 my husband had a stroke. It started with a funny headache around his left eye. He also had ringing in the ears and pain in his upper molar. He decided it was eye strain and took a nap to try to shake it. When he awoke an hour or so later, he was having trouble with his arm and he felt “funny”. The headache, while not bad, was different from anything he had experienced before.

Normally I recommend ibuprofen for a headache. I get periodic headaches with aura that last about three days. Aspirin and Tylenol don’t do a thing for those but 200mg of ibuprofen works like magic. For some reason, a little alarm bell went off in my head and I told him to take two regular aspirin. (325mg each meaning 650mg total.) It was while he was pouring the water to swallow the aspirin that I could clearly see his arm wasn’t working properly. He was overshooting and knocking stuff over. As he swallowed the aspirin I first began thinking maybe we should go to the hospital because it might be a stroke.

The drive to our nearest local hospital is typically one hour and fifteen minutes. I made it in under fifty. I was speeding. At the hospital, they said I should have called 911 and waited for an ambulance. If I had done that, the paramedics could have started the stroke protocol immediately and my husband could have been in a CT machine about an hour and fifteen minutes after paramedics arrived on scene. I felt horrible. I felt crushed. However, talking to the local folks here since we got home, many have told me that paramedics take at minimum forty minutes to arrive at our small rural town. And that forty minutes is on a good day with nice weather and only if the nearest ambulance is not busy with another call. Sometimes in an urgent emergency like a stroke of heart attack, it can take an hour and half to two hours for the nearest ambulance to arrive. They would also have had to then make the same drive I did.

It is possible we would not have had to go through the one hour delay to CT involved in a transfer from the small hospital I went to first. That hospital had no CT machine. They had to arrange the transfer to the large teaching hospital for the CT. There are two local smaller community hospitals that have CTs. They are slightly further than the one I went to in different directions. They usually have staff on hand to do a CT. However neither one are equipped for acute care beyond contacting a neurologist at the major centre, administering clot busting drugs and then transferring to the large teaching hospital we ended up at anyway.

The neurologist told me to stop fretting about it. It does no good to blame myself. I did the right thing and the outcome was excellent. He told us that since my husband’s symptoms were resolving on their own and had largely resolved by the time he had the CT and the symptoms were so very mild, he would not have been eligible for the clot buster drug anyway. The clot busting drug is high risk resulting in 6% of patients dying. Compared to a catastrophic brain injury its well worth the risk but that was not what we were dealing with. His kind words took a huge load off my mind and eased my conscious considerably. Analysis of events to improve future response is one thing. Second guessing and regret is another and it is a waste.

In retrospect, I should have called 911 and then took off and met an ambulance somewhere on the trip in to one of the hospitals. The 911 people would have known where the nearest hospital open to do a CT was. Also when we arrived at the local hospital, my husband’s systolic blood pressure was over 220. They treated that while arranging the CT and transfer. The paramedics could have started that treatment sooner. Given their travel time, however, that meant only ten minutes sooner. I risked him having a major medical crash after a catastrophic stroke affecting his breathing and heart during those extra ten minutes. They would have been better equipped to handle that event.

The symptoms of arm weakness and headache my husband was experiencing dropped to about half by the time we hit the first town near us, a 38km (23miles) drive away. It was twenty minutes after he took the aspirin. While he was in the CT machine, the last of the symptoms went away. His arm was still a bit weak but it was working properly and the head ache was gone. The diagnosis was inner carotid artery dissection clearly visible on CT. At that point they weren’t sure if he’d had a full stroke or a transient ischaemic attack (TIA) or transient symptoms due to the carotid artery dissection. They had not yet determined if he had thrown a clot that had traveled and lodged somewhere deeper in the brain or if the relatively small area of carotid artery had partial closed due to the dissection and reopened. Later, the neurologist would tell us he suspected it was a mild but full stroke and a clot had traveled and lodged in the area of the brain that controls arm movement and it has done a small amount of damage. (That damage will remain but the slight weakness should disappear as the brain heals and rewires itself around the stroke site.) Only an MRI will tell for sure if there is damage and it was a full stroke or a transient ischemic attack related to the carotid artery dissection.

We went through four days in hospital of careful monitoring, 24 hour heparin drip, a barrage of drugs and lots of fighting his blood pressure. (It needs to be up to get blood into compromised areas but not high enough to encourage another clot of break off and travel. The doctors fretted and administered drugs every time the systolic number went over 180.) Students came and went along with the many doctors and one thing I kept hearing over and over again was how lucky my husband was and how mild the event was. This was invariably followed by a lowering of the voice, heads coming closer and then in a near awe-struck tone someone would say, “He took aspirin.” This would be followed by knowledgable head nods and as if that explained it all. At the time it made no sense to me. I fretted that maybe I had made things worse by telling him to take two aspirin instead of an ibuprofen. I even asked if the aspirin made it worse. “Oh no, not at all,” everyone assured me. No one mentioned it might have been absolutely best thing to do.

I have since put things together in my mind. In ScienceDaily, 18 May 2016, there was commentary on how taking aspirin as soon as you have symptoms of a stroke, especially if you are far from medical help, reduced the chances of a major stroke by 70-80%.

The authors concluded ‘Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke — and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations.’

Furthermore: ‘The findings suggest that anyone who has stroke symptoms, which are improving while they are awaiting urgent medical attention can, if they are able, take one dose of 300 mg aspirin.’ [Note I gave him 625mg which may have been too much but then again….]

I am an avid follower and reader of science news consolidators such as Science Daily. I often then go back and read the entire article they reference. In retrospect, I think I must have read that article about stroke and aspirin and it sat in my subconscious. I now also think the dramatic improvement we saw in twenty minutes was due to the aspirin starting to dissolve the clot. The fact that the symptoms pretty much vanished even as he had the CT was when the clot was fully dissolved. All the other stuff the doctors did, like keeping his blood pressure in a range that allowed more blood to get to the brain but not so much as to cause the delicate healing process of the carotid artery dissection to break open, those anti-inflammatory drugs to stop the brain from overreacting to the damage, and the blood thinners, all prevented something much worse from coming afterward.

Am I recommending taking an aspirin if you have symptoms of stroke? I can’t do that. I am not a doctor. (Okay, I am a doctor but the PhD kind not the medical kind.) There are two kinds of stroke. One kind (about 30%) is caused by blood vessels rupturing and bleeding into the brain causing damage. The other kind, the 70% kind like the one my husband had, is due to a blockage, usually but not always by a clot. Aspirin could make the bleeding kind worse. That’s why doctors don’t just give you clot busters if they think you are having a stroke. They do the CT first to make sure they don’t make a bleeder worse. I also don’t know if it will help all kinds of blockage. There are also people who should not take aspirin because of other reasons. So no, I can’t recommend you take aspirin if you are having stroke symptoms.

I recommend instead that everyone read up on the symptoms of stroke so you know if it happens to you or someone you love. Understand your best options for getting to medical care quickly before you need it. Talk to your own doctor about it and read up on taking aspirin. Weigh the risks. Make your own decision once you are fully informed and do it before you need to deal with an emergency. If you live next door to a major teaching hospital you can afford to wait to treat. If you live 250km from the nearest hospital, like we do, you have to play different odds. Aspirin might be your answer. Maybe.

We got lucky. As Louis Pasteur said, “Luck favours the prepared mind.” We were also prepared with knowledge even though I did not recall from where during the emergency. We had aspirin on hand. I distinctly remember buying that aspirin even though we never use it, in order to have it in the house, just in case. [My husband has been on the low dose aspirin for decades which he takes with a multivitamin which is why we don’t use it randomly for other things.] I don’t recall just in case of what. The aspirin bottle has an expiration date of this year. That means I likely bought it around the time I read that article in 2016. It doesn’t have the vinegar smell of spoiled aspirin and aspirin lasts a lot longer than the three years or so written on the bottle. Even so, I will be buying a new bottle next trip to town. I might even buy a half dozen or so and keep aspirin in my truck, my RV and a couple in my purse.

We got lucky. Luck favours the prepared mind. Be prepared.

 

Two weeks post carotid artery dissection and counting

Hubby dearest had his two week post hospital release check up. We saw our new family doctor. This is a point of loss for us because I really liked our previous doctor but her practice is not geared to his needs right now. Fortunately, the new guy turned out to be a nice young man, personable, and knowledgeable and he works closely with the neurologist on other issues with other people. We left feeling confident about him.

I knew on a rational level that we were in for a long recovery but emotionally I was not ready for what this new doctor said. One thing that added to my hope was the slight weakness of the left leg and the occasional tremble of the left hand seemed to have pretty much gone away within the first two days home. I was hoping to get a “Yes, your life can go back to normal now”. I did not get it. Instead I got a reality check. The neurological exam showed the weakness on one side is still there. Life is not going to return to normal anytime soon. In three months we go for the update CT and a neurology consult. Then we see the new doctor again one week later. Meantime, we do nothing unless something changes. If something changes we are to come in right away no matter the time of day or the day of the week. Otherwise we carry on as is.

Because of how mild the possible stroke was we have no instructions for rehab. Basically he is to simply go back to life and ignore the tiny tremor and slight weakness on one side. They will go away or they will not. For the strange fatigue that hits like running into a wall, same thing. Rest when tired. Stop when you don’t feel like working and then work and live when you do. It too might go away in time (but not anytime soon) or it might not. This might be the new normal.

We brought up all the meds and some side effects, and got kind of a shock. Maybe in three months we can talk about changing or lowering meds but most likely not.  All he is allowed to do is change the time of day to a better time. On this new doctor’s advice we ordered our own blood pressure monitor. We got home and filled out forms for all those new meds and filed it with our insurance company and promptly got audited. Their computer noticed something new and now we have to prove this change is real. All the money we spent on drugs must now wait for fourteen extra days for the audit to be processed and then up to ten more working days for the refund. For the first time in years, we have blown through our deductible. And to think I was ready to cancel that supplementary insurance because of the cost of it. Thank goodness I did not!

We are in for a long winter in our little house because we won’t be able to travel south for at least one year. No travel insurance will cover him. Among our recent investments was a desk treadmill combination. In the past, cold weather meant we just didn’t venture out and we got fat and grumpy. That was the main reason we went south, to be healthier. This will simply not do in our new normal. The combination of desk treadmill should mean we can keep up with our walks in winter. Of course another friend told us he purchased a treadmill post heart attack and it is now a very expensive clothes hanger. His good intentions went nowhere. You get used to limitations, he says. Can I live with that? Right now today we are determined we won’t. I alternate between wanting to start blowing some of our savings to purchase everything we need to make the house perfect for winter right now, and trying to remain within a budget just in case we both live another thirty years. There must be a happy medium in there somewhere.

And then there is the fear. Every cough, every yawn, every bout of fatigue and I am watching him. If he naps for too long I go and check he’s still breathing. If he complains of being tired and goes to rest I calculate in my mind how long since the last nap. Is this worse? Is this a change? He grumbled about something ordinary and I found myself wondering, is this a personality change? He got impatient and overreacted to some normal family drama. I worried about what the stress was doing. Could this bit of drama, which forced his systolic blood pressure up 40 points for a few minutes on the damned machine, cause another episode? Please calm down. Don’t respond. Leave it. I didn’t want to nag him so instead I told the dog to leave it and she looked me all puzzled and hurt. Leave what? I was sleeping. Fortunately dogs are forgiving. A bit of cheese and all was forgotten.

It has affected our children. I got so angry at the grown son involved in the drama for that rise in blood pressure and then I was shocked to discover he has his own anger. Mortality and aging has come up and smacked him in the face from both his father’s near miss with death and his now adult son who is going his own way and doing something contrary to what Dad wants for him. The son is entitled to his anger too. The strong adult reaction and support we have received from the grown grandson during this drama simply illustrates what a very fine job of parenting the son has done but he isn’t in a place to realize that just yet. Children grow up and do not fulfill your dreams for them. Instead they pursue their own dreams. It is easier to understand when you have already been through that life phase yourself. For some reason it is also easier for grandchildren to accept aging of grandparents. I suspect it is because the young are still young enough to think they are immortal.

Our daughter and another son came to visit and I was surprised to see how long they held on and hugged their father. They too have had their world rearranged. Yes, their father got lucky this time but what if next time it doesn’t go so well? What has felt best for me from the family support? What has comforted me the most? The long generous warm hug from one of my daughters-in-laws whose eyes say she understands mortality with her soul of great compassion. Being one step removed, she can stay detached. I have no need to comfort and reassure her. She comforts and reassures me instead.

We are so much more tender and caring of each other as husband and wife. There are many more “I love you”s and little pats and moments of pausing for a hug and more loving looks. Today, he actually put up that hook I had been waiting for since we moved into the house four years ago. It doesn’t make up for the fear. It serves to emphasize how much we have to lose. I keep feeling like I need to have a good cry but there are no tears.

I did get a bit of good advice from another friend who had a far worse stroke though she has made a really remarkable recovery. I mentioned again how the doctor had said how fortunate we were. She said, yes, she knew that feeling too. While she was in rehab she saw lots of examples of how much worse it could have been for her. However, she advises that it is important to let yourself get angry. Yes, you are lucky it wasn’t worse but it would have been even luckier to not have a carotid artery dissection at all. You have to go through all the steps of mourning to get to finally accepting loss. It was strange to be told I had a right to be angry and feel loss but it certainly made me feel better. Our world has shrunk. So what if others have had it worse? We have still had a loss and we are entitled to mourn.