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Dancing on Air


On the morning Irene enjoyed breakfast at Allen's, she'd been planning a big day of shopping downtown. She had gotten into her Buick and turned the key when . . . something happened. She wasn't quite sure what. Her mind suddenly went foggy. Plus, when she looked in the rearview mirror, something seemed to be wrong with her vision. She could see only half of the mirror. Where had the other half gone? And her face was drooping. She also felt very heavy on the left side of her body, almost as though someone were lying on top of her. Panicked, Irene threw the car into reverse and hit the gas. She felt and heard a sudden thud, and then, for some strange reason, the trunk popped open and the car stalled. Once again, she turned the key, this time putting the car in drive and stepping hard on the gas. But suddenly there was a stupid tree growing out of her engine and a smell of burned rubber.

Irene felt certain she needed to get out of the car, but the trouble was she couldn't find her left arm. Maybe it's stuck in the seat belt, she thought. Pushing the door open, she undid the seat belt with her right hand and immediately fell out of the car, her head hitting the pavement while her feet remained caught in the car doorway.

Still conscious, Irene thought how terribly undignified she must look. What would her grandkids think if they could see her?

Just then two men in brightly colored jumpsuits lifted her gently out of the car and onto the pavement. An energetic young man took her vital signs while his partner, a middle-aged man who introduced himself as Bill, smiled at her reassuringly.

"We're with Allentown Ambulance Company and noticed you're having some trouble, ma'am," said Bill. "Can you tell us your name and age?"

"Why, I'm Irene Polosky, and I am 86 years of age," she said, shocked to hear her usually distinct voice coming out as a thick, drunken slur. "It's a real pleasure to meet you boys, but I'm okay, really.

Within minutes, the men had wrapped Irene in blankets, strapped her into the gurney, and fitted her with a breathing mask that delivered 100% oxygen. Once she was inside the ambulance, Jerry worked feverishly to start an intravenous line in Irene's arm.

How'd you get here so fast, anyway?" Irene inquired.

Jerry and Bill exchanged wry grins, conscious of their growling stomachs and the hot food rapidly growing cold at their table.

"Mrs. Polosky, we need to get you to a hospital right away," Bill said. "We think you're having a stroke."

"A stroke, you say?" Irene said dubiously. "Isn't that when you have paralysis of an arm or leg? Boys, I don't have paralysis. I just fell out of my car."

But Jerry had already lifted the expandable gurney off the back of the ambulance and was wheeling it over to Irene. Within minutes, the men had wrapped her in blankets, strapped her in, and fitted her with a breathing mask that delivered 100% oxygen. Once she was inside the vehicle, Jerry worked feverishly to start an intravenous solution of salt and water in Irene's left arm, hoping it would help to flush out the blood clot that was likely blocking one of her arteries.

Meanwhile, Bill took the steering wheel and clicked the switch that set the sirens screaming and strobe lights flashing. Picking up the shortwave as he sped through the streets, he called Lehigh Valley Hospital's Emergency Department. "We're transporting an 86-year-old woman with an acute stroke . . ."

My morning at the hospital had started like any other. "Dr. Castaldo, your 7:00 meeting will be in Dr. Payne's office," my secretary said as I rushed into my office at 6:58, a Starbucks cup in one hand and a bulging briefcase in the other. Following that early meeting with my partners to discuss our cases, I had a full day ahead of me. I was scheduled to see some 20 inpatients—reviewing their radiology films and blood tests, examining them at the bedside, writing up progress notes, and creating an action plan for each one. Then there was the usual bedside teaching of medical students and residents, as well as calls to make to patients' families to give them updates. I was already feeling a bit frazzled but told myself that as long as nothing unexpected occurred, I'd be able to stay on schedule.

I'd made about a third of my rounds when I heard the familiar ring of the red cell phone I carry in my white coat. As I reached for the phone, my beeper went off, too. Snatching it from my belt, I read the "alpha," or urgent, message: "STROKE ALERT ED 15 MIN." My heart sank. I knew that diagnosing and treating a stroke case could take hours, and that by the time I caught up with my other work and got home I'd probably have missed supper with the kids—again.

But I knew the Stroke Alert drill well. I could almost hear pages going off all over the hospital—to the CT technicians, the radiologist on call, the intensive care unit residents, the blood lab technicians, and the stroke team nursing staff.

I flipped my phone open and barked into it, "Castaldo."

"Hey, John, it's Rick in the ER." His voice was far more upbeat than the message I knew he was about to relay. "We have a


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