Christopher Freer, D.O., Chairman of the Department of Emergency Medicine.

Joanne Gavin and her husband had just settled down to eat snacks and watch a movie during a terrible snowstorm on January 22, 2005. Then the phone rang and she answered a call from her 87-year old father, who said that her mother, Mary Maher, had stopped speaking to him. He put his wife on the phone, saying that maybe Joanne could get some response from her silent 83-year-old mother.

“I heard these guttural sounds coming from my mother through the phone and realized immediately that she was having a stroke,” says Mrs. Gavin. “I said, ‘Dad, she needs to go to the hospital!’”

Despite the extreme blizzard weather, Mrs. Gavin’s husband drove their SUV to her parent’s house and she rode in the ambulance to the hospital. Her husband stayed with her father, who had only recently recovered from a severe heart attack.

The paramedics determined that Mrs. Maher was having a transient ischemic attack (TIA), which is a mini-stroke that produces stroke-like symptoms but no lasting damage. On the ride to the hospital, Mrs. Maher began to regain her speech.

She was taken to the Emergency Department at Saint Barnabas Medical Center where she was immediately accessed by Christopher Freer, D.O., chairman of the Department of Emergency Medicine.

“Dr. Freer was wonderful and he took her right away,” recalls Mrs. Gavin.

After the first assessment, mother and daughter were waiting in one of the treatment rooms. There was a discussion about the need for a bedpan, and slowly Mrs. Maher stopped speaking to her daughter. Mrs. Gavin suddenly realized that the silence was not embarrassment, but another stroke episode.

Mrs. Maher was having an acute stroke. She could not speak and was paralyzed on her right side. Dr. Freer immediately called Stuart Mendelson, M.D., attending neurologist on call, who could not get to the Medical Center because of the severe weather. Together, they discussed the case and presented the choices to Mrs. Gavin.

Life-Saving Medication in the Nick of Time

Both Dr. Mendelson and Dr. Freer recommended that Mrs. Maher be given tissue plasminogen activator (tPA) to treat the acute stroke.

The injected medication could potentially reverse any stroke symptoms if it was given in less than 180 minutes from the onset of the condition. However, Dr. Freer explained, there was a small risk of death from intracranial hemorrhage.

“The majority of strokes are ischemic strokes, which occur when clots block the blood flow to the brain,” says Dr. Freer. “tPA can help dissolve clots in ischemic strokes if given within three hours of the initial symptoms. However, if someone is having a hemorrhagic stroke, caused by bleeding in the brain, tPA could worsen the stroke or cause increased bleeding.”

The physicians expressed confidence that Mrs. Maher was having an ischemic stroke. Mrs. Gavin recalls that she was shaking and crying as she made the decision to have tPA administered to her mother. She looked on as tears ran down her mother’s cheek, falling from eyes that stared straight ahead without comprehension,

“I looked at my mom and knew she would not be happy to remain in this condition,” says Mrs. Gavin. “Even though I was a wreck, I believed the doctors that there was a very good chance that the injection would reverse the effects of the stroke.”

Not long after the tPA injection, Mrs. Maher went from being unable to speak or move her right side to a complete return to her normal faculties by the following morning. Mrs. Gavin was able to bring her mother home to stay with their family.

“I was very pleased to have helped Mrs. Maher and have such a positive outcome,” says Dr. Freer. “I remember that Mrs. Maher’s daughter was very upset with the state her mother was in, unable to speak or comprehend, and weak on her right side. She asked me if there was anything else we could do besides giving her mother aspirin.”

I contacted Dr. Mendelson,” continues Dr. Freer, “and we discussed using tPA. Mrs. Gavin was aware that there was a chance that this medication could worsen her mother’s symptoms or even kill her, but it also could potentially improve or reverse her symptoms. I stopped by to visit Mrs. Maher the next day and she was sitting up in her hospital bed smiling and thanking me. It was a very gratifying experience.”

Mrs. Maher has slowly recovered and the couple recently sold their house and moved in with their daughter after Thanksgiving 2005. Now, when a snow storm hits, Mrs. Gavin has her parents safely by her side.

“I can only be grateful about the care she received at the Emergency Department,” says Mrs. Gavin. “The only line of communication during the snowstorm was the phone, and I was very pleased by the way the doctors worked together for my mother. I can’t imagine what life would be like for my dad and all of us if she could never have spoken again. It is a wonderful thing to have her back.”