Act F.A.S.T.

The headaches started on Wednesday, October 5th. I had just returned from the post office after mailing the first full draft of my dissertation to my advisor. I was pretty proud of myself for meeting that deadline and was going to reward myself with a day of doing nothing taxing and catching up on TV shows. After almost a year of data analysis, no one had to convince me that I deserved this break. Even better, I would have the house to myself since my aunt Nancy was going to be out of town. By the time I settled into the couch though, my head was pounding. I took two Advils, wrapped myself in a comforter, and turned the TV on. This headache was not going to interfere with my agenda!

...oh, but it did. Since the images on the TV had become unbearable to watch, I moved to my bedroom. The headache lasted for hours, then days. The pain got worse. Much worse. My head felt like it was on fire. At one point, I jumped into the shower with my clothes on (I didn't realize they were on) just so I could cool my head/scalp with very cold water. I laid in bed until Saturday. My head felt  heavy and it was very difficult and painful to move my neck. I couldn't stand the light coming from my bedroom window so I pulled the blinds down and found comfort in darkness. I ignored phone calls and resorted to humming. For some reason, humming made me feel better. The Advils were not working. When I tried to stand up, I felt dizzy and unbalanced. After 12 hours or so, I finally mustered up the courage and energy and made my way to the basement, then to my car. The drive to the pharmacy that usually takes me 3-5 minutes took me almost 30 minutes. It was past about 2am. When I finally go to Walgreens and made my way inside, it was too bright to keep my eyes open. I collapsed on the floor and the attendant rushed to my side.

     "Ma'am, are you OK? Ma'am??"

     "Please.call.the.pharmacist."

     "The pharmacy is right there, can I walk you over?"

     "Please.call.the.pharmacist."

     "But ma'am, I can't have you lying on the floor. Could you at least get up?"

     "Please.call.the.pharmacist."

Finally, the attendant paged him :). The pharmacist towered over me and asked what the matter was. I told him that I had had a headache since Wednesday and that the pain was now unbearable. He asked a few other questions that I can't really remember now. He suggested that I get medicine for tension headaches and some Ensure since I hadn't had any solid food for some days. He asked if I wanted him to call an ambulance, but I declined. The drive back to the house was also slow and the automatic humming continued. Once home, I took the tension headache medicines. No change. Sunday morning, no change. Nancy got back on Sunday afternoon only to find me in pain. Because there was still no change on Monday morning (the 10th), Nancy insisted that we go to the ER. I had to cover my eyes since the sunlight made the headache worse. Three hours later, the ER doctor explained that I exhibited symptoms of a migraine. That also explained my sensitivity to light, the doctor said.

     "But I've never had a migraine in my life."

     "Well, migraines can happen for any reason. Your aunt tells me you are a graduate student and writing your dissertation. Stress can cause migraines."

The doctor prescribed migraine medication, but cautioned that everyone reacted differently and that it was a matter of finding the right one for me.

October 10th, 11th, 12th. That medicine was not working. The ER doctor asked me to go see my primary physician. I didn't have one, so I looked in the Cornell University out-of-network directory and picked the first Ghanaian-sounding name I found. 'Dr. A.' had just recently set up an office in Framingham, right next to the hospital where I had been to the emergency room. My visit to 'Dr. A.' on the 13th exposed other problems when he checked my blood pressure. The expression on his face was not encouraging at all. He immediately prescribed medication to regulate the blood pressure and explained: "for now, it's not about changing your lifestyle with exercise. You will do that when you get better. For now we need to keep this pressure under control." He asked how long I had had the migraine for. "Almost a week now, but the medicine they gave me at the ER didn't work". He confirmed what the ER doctor had said about the medicine reacting differently with everyone. 'Dr. A.' prescribed another migraine medicine (Fioricet) which affected my coordination and sense of depth perception even more. Although the pain was more pronounced on the right side of my head, the headaches were not as bad as before.

Five days later (the 18th), I woke up with what I thought were 'pins and needles' in my left leg and arm. I wiggled my toes. Well, I tried to wiggle my toes, but only felt numbness. With much difficulty, I got out of bed and tried to squeeze the fingers on my left hand. Also numb. I caught a glimpse of my face in the mirror and the left side looked different. I took a closer look and saw that my left side was droopy. What in the.....was going on??? I started to panic.

I don't know where this moment of clarity came from, but I quickly remembered the contents of an email that was forwarded to me some 6 years ago, describing the signs of a stroke (a droopy face being one of them). I raised my arms, but the left one didn't budge. Then I spoke out "it's a sunny day today", which sounded more like "beh beh beh beh beh". "Oh my God, was I having a stroke? At 31 years? How was this possible?" I thought to myself. I tried to grab my phone to call 'Dr. A.', but couldn't hold it in my left hand (it didn't occur to me use my right hand). I inched closer to Nancy's room, knocked on her door using my right hand and laid there, waiting... Nancy, who was not in her room at the time, almost had a heart attack when she found me sprawled on the floor, visibly ill. There was really not much to ask or say so Nancy ran to get the car, came back to carry me, and we headed to the ER (again). This time we drove directly to where the ambulance pulls up.

On the way there (3-minute ride), I had a very interesting experience. Because of the numbness on the left side, my body slumped to the left, with most of my weight resting on the seat belt. While Nancy uttered very comforting words to me and drove as fast as she could, I thought: "I don't remember the last thing I said to my mother / My room is not clean / I will not finish what I set out to accomplish in life / Nancy has been like a mother to me / Daddy died 4 days before his 51st birthday and so am I."

I snapped back to my reality when I was lifted onto the stretcher and taken to one of the ER rooms. Different machines were instantly hooked up to me and a medical team formed around me almost immediately. Nancy explained that I had been there 8 days ago and was told it was a migraine. "Dela, can you smile for me please?" one nurse asked. I tried. Although she didn't say it out loud, I watched her lips as she nodded to the doctor saying "stroke signs." 

      "When is your birthday, Dela?"

      "10.22.79" 

      "Oh, that's a couple of days from now!" 

Yes it is, lady. Don't remind me. Please don't remind me.

A CT scan, two unsuccessful and very painful spinal taps, and a very uncomfortable MRI later (six hours), 'Dr. T.' walks to my bedside and says: "Dela, we did find some abnormalities in your MRI. Looks like you have three large blood clots in your brain, on the sagittal vein, which goes along here (she showed me). That explains the severe headaches you have been having and  the mild stroke you suffered this morning. It's known as cerebral venous sinus thrombosis."

Blood what? You see, my mother had suffered a pulmonary embolism in September 2008 that nearly took her life and gave me the greatest scare of my life (indeed, I am still recovering from that traumatic experience). Blood clot in the brain? How does a clot form there and why? I had a thousand questions. Nancy and I were dumbfounded. As we tried to understand what was happening, doses of heparin (blood thinners) were injected into my stomach. 

The neurologist on call recommended that I be transferred to a dedicated neurology unit. There were no beds at Tufts, so the other option was UMass Medical in Worcester. Both are about 35 minutes from Framingham, in opposite directions. Off I was, strapped in a stretcher, sirens blaring. "How did I manage to end up in another ambulance? Was the broken ankle that required surgery in 2008 not enough excitement? Or was it going to be one major event per decade?" I tried to find humor where there was none.

About 15 minutes after I got to the UMass ER, the doctor said "Hi, I'm 'Dr. X.' I hear you suffered a stroke today. Don't worry about anything. We are going to take care of you. And no, you will not die." How comforting! A neurology resident came to ask a million questions, including the date, what state we were in, and the name of the current President: "I hope it's still Obama!", I said. "When is your birthday, Dela?" "10.22.79." "Oh! That's soon!"
I know..............

Some four hours later, I was wheeled upstairs to the Neurology Wing. The next morning, I felt the numbness again. When the nurse saw my face drooping, she screamed "get Dr. S. now!!" I couldn't believe it. Another stroke? And to have the nurse's eyes open so widely, I thought "this is not good." 'Dr. S.' and her team of residents made it in time and performed a series of balance and coordination tests. 'Dr. S' (a neurology surgeon) also took the opportunity to ask about language and intonation in West Africa as well as my Ghanaian background, American-sounding accent, and dissertation topic. Since my life was in Dr. S's hands, I obliged!

The inter cranial pressure persisted, but not with the same intensity. 'Dr. S' recommended that I take the next two months off to recuperate and warned that it might take longer to get back into the groove of things. I would be taught to self-inject heparin in the stomach area for about a week or two, while I started on coumadin (pill form of blood thinners that is essentially low doses of rat poison). The hematologist, 'Dr. T', recommended that we start a 6-month coumadin regimen, then see whether we would need to increase it to a year.... Being on coumadin requires a lot of changes in one's diet, including watching one's intake of Vitamin K (increases coagulation) very carefully. 

I came back home on October 21. The next day, I celebrated my 32nd birthday, filled with  gratitude. Four days prior, I didn't think I would see that house again. The next two months were characterized by visits -- every 3 days -- to the Anti-Coagulation Clinic in Worcester, to check my blood level. I then started going once a week. In early December, another MRI was done. I was experiencing chest pains, which prompted the hematologist to request a full body CT scan, in case the clots were breaking up into small pieces and traveling into my lungs (which could cause a pulmonary embolism). Another MRI was done in early December, confirming diminishing clot sizes. However, the neurologist ('Dr. H.') disagreed with the conclusions that the hematologist drew from the MRI and requested an MRV instead. Let's just say that he overspecialization of medicine in the US has its disadvantages.

The clots had disappeared by February, but I stayed on coumadin for two more months. I happily took my last coumadin pill at the end of April. To manage the dull pain in the head, the 'Dr. H.' prescribed amitriptyline, which has worked wonders. 


I won't go into how and where I found the strength to get back to the 14-hour/day schedule it took to write, defend, revise, and get final approval of the dissertation (January to August). I just want to take the opportunity to thank you all, my family and friends, old and new. I would not be here without your support, care, and love.

So why this long story? Well, you can imagine that during my recovery period, I had a lot of time to learn about the causes of a stroke. My aunt recommended that I read My Stroke of Insight by Dr. Jill Bolte Taylor, a neuroanatomist who suffered a stroke and wrote a memoir about her experiences as both a patient and a brain scientist. 

I also found out that October 29 is World Stroke Day and that 1 in 6 people will have a stroke it their lifetime. The email that I read years ago about stroke signs proved very useful. Allow me to use this opportunity to remind you all of some simple ways to help determine if  someone is experiencing a stroke:

• Act F.A.S.T:

(F) Face Drooping. Does one side of the face droop or is it numb? Ask the person to smile.

(A) Arm Weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

(S) Speech Difficulty. Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly?

(T) Time to call 911/get to the hospital. If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

• Ask the person to Smile, Talk, and Raise Both Arms (representing the first three letters of the word STROKE).

There are numerous resources online, some of which I have linked in this post. Please take the time to learn more about strokes, their causes, how they can be identified, and how they can be prevented. Your knowledge could save a life, if not your own.

Thank you for reading. The next post will be cover much less somber topics. That is a promise!

Where are the lights?

Today marks two months since I arrived in Lusaka. I apologize for my general lack of communication. I was simply not in the frame of mind to write anything coherent (not that this blog will be :). My mind was recovering from months of non-stop 'dissertating' (writing, defending, revising, and submitting). Moreover, my mind was adjusting to a new land and was in denial about starting adult life in earnest. All these matters contributed to a rather unsettling feeling. But not to worry, I kept mental (and sometimes written) records of my initial and repeated reactions as a newcomer. This first post will give a glimpse and summary of my first two months. Nothing earth-shattering or profound...

Here I am. I arrived in Lusaka late at night from Boston, via Amsterdam. I had been warned about the rather small size of the city's international airport and the fact that I would have to walk on the tarmac before getting to its main building, so that left no impression. After all, that was (and maybe still is) the situation at Accra's Kotoka International Airport (although these days, a bus takes you from point A to point B). A very tired bunch of passengers, we were welcomed by a rather upbeat female airport officer. Although many of us immediately got into our respective lines -- mine being the "Visa Holders" line -- she insisted that we could spread out into other lines since we were "all God’s children!" I took her advice and made my way to the "Zambians only" line. I figured that if I hid the front of my passport, it would not be until I was face-to-face with the immigration officer that I would reveal my non-Zambian identity. My plan worked, but the officer focused on what was crucial: my visa only allowed me into stay in the country for 30 days a year. Already knowing this, I nodded. My workplace has applied for a work permit on my behalf, which will take anywhere from 2-6 months to be issued. Until then, I have to get extensions every 30 days. I cringe at the thought of wasted passport pages, thanks to immigration officers who stamp passport pages with no appreciation for their value.

"Where are the lights?" That was my very first reaction after getting out of the airport. I was welcomed by a young Ghanaian couple (friends of a mutual friend) who showed me the best of Ghanaian hospitality by inviting me to stay with them until I found a suitable apartment. More on them in the next post...  “Is this a back road?” I asked. “Where are the lights?” The husband and wife chuckled. I was very surprised that the airport road, a major road, has such few lamp posts. Not the greatest impression on what was to come, I thought. As we got closer into town, though, I started seeing the lights. And many of them. Having been here for two months, I can now safely say that my initial reaction still stands (i.e. that the airport road needs to be well lit). But where there are lights, Lusaka is very well lit. Too well lit, in fact. The main shopping malls (Arcades, Manda Hill, and Levy Junction) remind me of the bright and migraine-inducing lights of Times Square in New York City. Houses are lit on all sides. Indeed, my land lady’s daughter (more on that in the next post) couldn’t understand why I hadn't thought of leaving the front light of my apartment on all night. “You will attract thieves” she explained. “What thieves?” I asked. But what I really wanted to say is: “Serious thieves will bring their own torch lights!”

Lusaka. The next morning, I went on a little tour of the city. All I kept thinking was how much Lusaka also reminded me of Accra circa 1999-2000 when it was at the cusp of its "development"… right before infrastructural expansion, massive traffic and road congestion, pollution, and increased crime rate. I was happy to be in a place so peaceful, but also excited to be here at this particular time in the city's evolution. And what a lovely and organized city it is. Definitely one of the cleanest African cities I have been to. The people of Lusaka (and presumably Zambia) are very friendly and have a healthy appreciation for good music and nature.

"You are very adventurous" Southern Africans are used to buying tomatoes and onions from shops that include a grocery section, but as a West African, I am used to going to the market to get my staples. One Saturday, I tagged along with my host and her friend to Soweto Market. There, I bargained for goods and felt quite at home. My next step is to learn Nyanja, one of more than 70 languages in Zambia. It is spoken widely in Lusaka and understood all over Zambia. I am learning my new city by the day, and so far, so good. In my next post, I will tell you about my adventures of driving on the "wrong" side of the road. Our office manager called me adventurous, for exploring areas and languages in such a short time.

Wilson. For the first six weeks, I had an arrangement with Wilson, a driver who operates from the taxi rank on Zambezi Road, in an area called Roma (where I was staying with the Ghanaian couple). We agreed that he would pick me up from home every morning and take me to my workplace in Kabulonga, about 25 minutes away (with traffic). We negotiated for 35,000 Zambian Kwacha (ZMK) ($7), one way. Even though the currency is called Kwacha, the slang for 1000 ZMK is "one pin".  I am still not sure where the word comes from, but that's how we say it around here! (Un)fortunately, the Government of the Republic of Zambia will be re-denominating the currency in January 2013, where the highest denomination will be 100 ZMK. I wonder whether 'pin' will be replaced?
Wilson was very helpful and sometimes too eager to do his job. On several occasions, he would call before I would, asking if it was time to come pick me up at work (admittedly, it was after 5pm, but I had also told him that I would work late). We explored new places together, and thanks to my roaming around the city, he was also introduced to several parts of his own city. Wilson started driving only about a year and a half ago. Before that he was a gardener in what he described as "an Indian man’s house" for 10 years. After realizing that this work would not get him as far as he wanted to go, he left the job and started a small business (mowing lawns). Soon, he saved enough to buy a small car and started to operate as a taxi driver. One thing that drove me insane with Wilson is that he would play the same song every morning and on repeat. It felt like I was in my own version of “Groundhog Day”!! His song of choice? "Omoge Mi" by P-Square, the Nigerian superstar duo. Needless to say, I have removed that song from my iPod mix! I learned a lot from Wilson and appreciated his entrepreneurial spirit, but the relationship was not sustainable. It was clear that I needed to purchase a car as soon as possible.

“We have knocked off” Why would an internet café in the middle of a busy shopping mall close at 5pm on a weekend, when customers are willing to pay for your service? “Because we too we have to go home and relax” the customer service guy explained. Evidently, I have been spoiled by longer hours of operation in the US and in Accra, Ghana. Only recently did Game, a subsidiary of Walmart, extend its weekly hours to 19:00 from 17:00. All this to say that I had to take a lot of time off work during the day to get anything meaningful done (setting up a bank account, buying basics and necessities for my new abode, etc.). The good news is that said internet café closes at 21:00 on weekdays and now that I have a car, I can stay until late without having to pay for an extra taxi ride home (I would have liked to walk back home, but the roads are deserted by 21:00).

3G..4G..a million Gs. Why don't I just get internet at home, you ask? Well, because it is not cheap! Who knew that browsing Facebook for 20 minutes and checking email for 10 minutes could consume (and I use the word intentionally) about 40MB? Oh how I have learned to be succinct and to the point when it comes to my internet usage! :) At the moment, it seems cheaper to go to the cafe where 60 minutes costs 9 pin and where there are no data restrictions. Access to the internet can also be bought as data bundles on phones or using a USB. Prices range from 5 pin for 10MB/month, to 300 pin ($60) for 3GB/month, to 800 pin ($160) for 10GB/month. One can also get internet at home, where the unlimited package (from 6pm to 8am) costs 1 million ZMK ($200) per month. I am focusing on unlimited plans because of how quickly megabytes are consumed even with the simplest tasks. Having only received two paychecks since my post-doc began, I think it wise to keep going to the internet café until further notice (or until a benefactor steps forward :).

So what are you doing in Lusaka? Variations on this question have been endless. Well, as many of you know, I finally completed my doctoral degree in Development Sociology and Demography at Cornell University this August. I applied for and was blessed to receive the highly competitive Fred H. Bixby Post-Doctoral Fellowship from the Population Council. I am now working as part of the research team of the Adolescent Girls Empowerment Program (AGEP). The goal of this 2-year fellowship is to be mentored by a Senior Researcher and to produce high quality deliverables (i.e publications) that will help catapult a novice like myself to new heights!

Thank you for reading my first post! More to come, so stay tuned!