Springdale man survives stroke with new system

Twelve years.

That was the time George Berger and John Jones of Springdale, Ark., had shared before that fateful Sunday morning.

Jones, 40, had come inside from the yard and noticed immediately a change in his partner’s manner.

Berger, 55, heard a pop in the back of his neck and then felt the right side of his body go numb. Jones could tell as Berger attempted to stand up from the couch that something serious had happened to his partner. After talking it over with Berger, he called 911 and waited for the ambulance to arrive.

On the drive to the hospital, Berger lost consciousness.

Jones drove quickly, tailgating the ambulance so severely that the driver had to pull over and tell him “not to follow so closely.” Jones obeyed, even as fears grew that the life he’d worked to build with Berger was quickly slipping away.

At the hospital, Jones tried to distract himself with what the doctors were doing. He spoke to one doctor through the telemedicine system, an information technology designed to administer health care at a distance.

He answered questions about Berger’s symptoms and walked through the morning as many times as they asked him — his only hope of keeping his mind off the inevitable. Berger was exhibiting signs of stroke. Both men knew this day was a possibility for almost the entirety of their relationship.

MEDICAL HISTORY
Berger had received a mechanical heart valve in 1999, shortly before meeting Jones, and there was always the underlying chance that a blood clot could break loose and travel to the brain.

But until that morning, neither man had to face that reality.

Now warm memories of their trip to Las Vegas and a shared affection for Celine Dion did little to cushion Jones, who watched helplessly as hospital workers tried to save his partner.

The longer doctors and nurses worked, the more it hit Jones that the outlook was worsening. When he learned Berger would have to be flown by helicopter to Fort Smith, he was sure of it.

He remembered several weeks earlier, how he tried to get Berger to go on a “$50 helicopter ride” — how Berger had refused, his almost comical fear of flying on display.

They had always spoken about “another trip to Vegas” or a stop at the Grand Canyon. Jones remembers Berger joking that he would “let me fly out,” while taking a car himself.

Perhaps another time, Jones would have found the memory amusing. But not today.

FIRST CALL
Upon arrival at Northwest Arkansas Regional Hospital, Berger was in and out of consciousness. Jones waited patiently as doctors tried to save his partner’s life. Dr. Margaret Tremwel, vascular neurologist and a member of the Grace United Methodist Church in Fort Smith, was at the morning worship service when the emergency call came through.

Tremwel left the auditorium, collected her laptop, and ducked in to one of the children’s rooms on the church campus.

Using the telemedicine system, Tremwel was able to “join” Dr. Jacob McClintock in Springdale and determine quickly that Berger had had a stroke.

After interrogating Jones on Berger’s symptoms and studying McClintock’s findings, Tremwel verified the stroke was ischemic (caused by a blood clot) and that the patient was a good candidate for tissue plasminogen activator (t-PA), an intravenously administered drug known as “clot buster therapy.”

The treatment was administered in Springdale, but didn’t work as Tremwel hoped it would. While it did buy Berger time, she knew it wasn’t a long-term solution.

At that point, Berger was loaded onto a helicopter and flown to Sparks Regional Medical Center in Fort Smith.

SECOND CALL
“It was the first day since I’d been here that I’d left town,” said Dr. Clint Wood, an interventional neuro-radiologist at Sparks.

Wood admits he’s an outdoorsman with a love of hunting and golfing. On this particular day, he was out on his boat in Hot Springs, the first time he’d found the time for it since beginning his “first real job (in medicine)” at Sparks in July.

Wood’s considerable height and his confident delivery as he talks about “solitary clot retrieval” devices and left MCA occlusions highlight the contrast between a man, who looks more befitted for beers at the sports bar than the practice of medicine.

Nevertheless, when he received the call that Sunday morning, he left Hot Springs and sped back to Fort Smith, making it to the hospital almost simultaneously with Berger’s arrival.

After assessing the situation, Wood knew the blockage caused by the clot would kill Berger if he didn’t act quickly.

Wood told The City Wire in a recent interview that when he started practicing medicine, “a left MCA (middle cerebral artery) stroke was practically a death sentence, and if not a death sentence, it was a major disability for life.”

Undeterred, Wood made a quarter-inch incision and inserted the clot retrieval device into Berger’s artery, fishing it upward from the groin to the brain, where the clot was broken up and blood flow restored.

In “about twenty minutes,” Wood was able to remove the clot completely.

“In another 20 minutes, he (Berger) was taken to ICU,” Wood added.

LAST CALL
“When he came around, he started to move his leg first,” Jones recalls.

But he stops there. Standing beside Berger, who sits up on a sofa in a patient recovery room at Sparks, Jones is unable to continue.

Responding as best he can to the question of what was going through his mind when he awakened, Berger starts: “I think the main thing was, ‘I’m alive.’” His voice hits a brick wall. His eyes glisten. “Which, I really, didn’t expect to be.”

According to Wood, “five or six years ago,” the recanalization rate, or the rate by which flow is restored to an interrupted channel of a bodily tube, was “15 or 12%” for patients with a left MCA stroke.

“We still thought that was revolutionary. Now we’re up to devices where we have a recanalization rate of 90%,” Wood said. “This is the second patient we’ve had (since July), who came in with the same left MCA occlusion and went home with no deficits. A few years ago, that was unheard of.”

For Tremwel, who has practiced at Sparks for more than 10 years, “this is a dream. It was a dream when I started. I was from Florida, and we were trying to figure out how we could get people from Pensacola down to the University of Florida in Gainesville in enough time because it was a five-hour car drive and at that time helicopters really didn’t have enough gas to get all the way down there.”

Tremwel’s second job was “at UCLA, where honestly, if you want to go down the block, you should probably go by helicopter because the traffic is so horrible.”

“It was just so wonderful to come here because this hospital was the first one I’d spoken to where they talked about wanting a program that would do preventative medicine for our community and actually reduce morbidity and mortality rates due to vascular disease. And they have lived up to it,” Tremwel said.

BACK TO WORK
While how close he came to losing his life is not lost on Berger, on a Wednesday, 11 days removed from the stroke that could have easily killed him, Berger leaves the hospital with Jones.

Besides some facial contortion and slowness in speech, Berger’s recovery is improving quickly. His job as a post-closing specialist at Arvest Mortgage will be waiting for him when he returns, but he hopes to cut the 12-week extended medical leave in half.

Considering where he was a few days prior, odds are in his favor. But for now, work, medical advancements, and operating procedures and efficiencies, mean little compared to the time he has left.

His and Jones’ 12 years will not end in an operating room.

Their last memories won’t be confined to a high-speed ambulance chase or a harrowing helicopter ride.

And for both men, that’s all that matters.