9-1-1: “What Is Your Emergency?”

On May 15, 2022, my life changed forever. In an instant, I was the closest I have ever come to death, or at the very least, a silent existence trapped inside my head. Up until that point, I had never known how truly terrifying it would be to never again be able to communicate effectively with another human being. You see, I had a severe stroke on that beautiful, sunny day in May. That was my emergency.

That stroke suddenly put my life in perspective and made me reexamine my priorities. I felt ashamed of how much time I had wasted in my life as I caught a tiny, fleeting glimpse into the eternal abyss. Surprisingly, thinking back on the moments when I was strapped to a gurney and flying down Interstate 35 in the back of an ambulance, I was remarkably at peace. Part of me was still very much in denial as I tried to calm myself so that I could speak to the Paramedics next to me, and part of me finally relented to the situation I found myself in as I gave myself over to their care.

Watching someone experience a serious illness, accident or even death can make others feel very uncomfortable, not knowing quite what to say or how to act. I’m sure you know what I mean. But I am here to tell you that looking someone in the eye and holding their gaze when they are going through a crisis, or placing a reassuring hand on a shoulder and letting that person know ‘We’ve got you. We are taking you for help,’ can be the most comforting expression of humanity in those tough situations. I was the fortunate one that day. I had such capable people around me, taking me for help. Fast forward five months later, and I am typing this blog for you. I want to tell you of the beautiful evening I had last night, finally meeting the people that saved me, the true heroes of that day. (See my 5/21/22 blog entitled, A Day Like Any Other, . . . NOT!, for the full story).

It was Monday of this week when I received an email from Tom Modin, the Neuroscience Outreach Coordinator for Saint Luke’s Health System here in Kansas City. He had been trying to get the EMT team from Kearney Fire & Rescue together for a while now to present them with an award for my particular case. It simply read, ‘Will tomorrow the 18th work for you at the Fire Station, 7pm? More info to come . . .’. I read it again. Here it was. The night that I would come face to face with the team that saved my quality of life. I had thought about this moment often. I wrote back, ‘Yes let’s do it! . . . So glad it’s finally happening. I’m a little nervous (but in a good way)!’. What do you say to someone you have never met before who has had such a profound impact on your life? I had thought about this a hundred times. I decided rather than write a formal speech of sorts, I would wait until the moment before addressing them and speak from the heart. I wanted my comments to be spontaneous and real. I felt that I owed them that honesty. This night, and the Award from St. Luke’s, was all about them after all.

The next night, John and I, along with my brother-in-law, niece, and nephew, arrived at the firehouse a little before 7pm. It was dark and quiet when we arrived. We walked around the front of the building and found the door, separate from the garage area that housed the emergency services vehicles, and entered the building. We were greeted by a friendly, soft-spoken man in uniform who directed us toward a conference room down the short hallway to the left. Upon entering the room, I saw that there were more people than I had expected, including EMT students, sitting at tables, and standing around the perimeter of the room. I said a brief “hello” and we took a seat in the back of the room next to Matt Listhartke, also a firefighter/EMT who introduced himself to us. He often hosts award ceremonies like this one but tonight he was in the audience. After a few minutes, Tom walked to the front of the room and began his introduction.

“Life is full of ‘What the heck?’ moments such as stepping on a chewed piece of gum, a car pulling out in front of you as you drive down the road, and many other things that happen on a normal day. On May 15th, 2022, Kelly Koley experienced a big ‘What the heck?’ moment. She and her husband John were doctoring an injured chicken when she became unable to speak and fell to the ground with sensory and weaknesses to her right arm. To John, this was a huge ‘What the heck?’ moment. Recognizing something was very wrong, he called 9-1-1.”

I was riveted by this story. Surely, he wasn’t talking about me? But he was. Tom continued, “The chain of stroke survival starts with detection. John had just detected something was wrong and acted promptly. Kearney Fire was dispatched, and within eleven minutes had arrived upon the scene to care for Kelly. I think that is fantastic timing, especially because I know the road was closed, and they had to go the long way around to get to their country home. Paramedic Steven Giacone quickly recognized that Kelly had profound right-sided weaknesses of her face, arm, and leg, along with complete aphasia, she was unable to speak at all. If you read his chart it says, ‘she couldn’t talk, was confused, and she was not following my commands well.’”

I had a vivid flashback to the first and last time I had ever seen Paramedic Giacone. He was kneeling beside me on the grass, talking to me, and then lifting me up and running with me to the ambulance where the rest of the crew was waiting. Tom went on to describe how everything fell into place and how quickly I arrived at St. Luke’s. It was definitely a record.

He continued to describe in detail the fast action of the Emergency Room staff and physicians upon arrival. “One hour from stroke onset, Kelly arrived at St. Luke’s Hospital and was taken straight to CT. Nine minutes after arriving in the Emergency Room, her scan was found to be negative. With acute stroke, we always want a negative reading. This means there is no blood in the brain. During those nine minutes, a lot of things happened. I.V.s were started, labs were drawn, and an assessment was done by the ER Nurse, the Code Neuro Nurse, and the ER Physician. Remarkably, all within that first nine minutes.”

There was a murmur around the room. It was truly remarkable how everything came together in those few minutes. He continued, “Her CT revealed that her left middle cerebral artery, the largest artery in the brain, was occluded, and there was a large area shown on the profusion study of salvageable brain left. She was a perfect candidate to go into Interventional Radiology (IR). She was prepped and taken there quickly. In the IR suite, a successful mechanical thrombectomy was completed using direct aspiration requiring only one attempt to restore complete blood flow to the left side of Kelly’s brain.”

I thought back to that moment, lying on the table in the Operating Room, feeling an icy cold throbbing up the left side of my head, and looking at a picture of my brain on a large television screen. I remember listening to the doctors and nurses talking softly to each other, and then a flood of relief when I heard one doctor say “There, I got it.” That was Dr. Holloway. I will always be in awe of his skill, threading a tiny needle and tube into my femoral artery, running it up that artery into my brain, and then sucking the blood clots out. He told me later that ten years ago they did not have this technology. It is truly remarkable.

In the photo below, you will see the two clots that were removed from my brain. Tiny things, but deadly all the same. The photo of my brain with the yellow arrow indicates where the clots were, and in the final photo, you can see the blood flow returning after the clots were removed, like a large dam that was removed from a raging river. Immediately after the clot removal, I could once again speak and move my right arm and hand, but I was not allowed to move my right leg or sit up for four hours after this procedure until the femoral artery was safely resealed.

Tom was winding up his comments now, “Post-intervention, Kelly was taken to the Neurosurgical ICU (NSICU). Her first neurological exam after getting to the NSICU had a finding of only mildly slurred speech. On her MRI, it did reveal that she had had several small acute strokes to the left side of her brain. She worked with, and was cleared by all therapies, and after three days was discharged to home without any neurological deficit. Due to John’s quick recognition, and calling 9-1-1, the stroke chain of survival was set in motion. Thank you, John (clapping). Paramedic Giacone recognized stroke symptoms that were consistent with large vessel occlusion and did not waste time on scene prior to transporting this patient to a comprehensive stroke center for the best care that she could get. She was able to receive quick treatment with I.V. Thrombolytics, and then Interventional Radiology, reversing all of her symptoms and allowing her to continue life without any deficits.” Tom concluded by passing out award pins for Excellence in Recognition to John and the entire team. Here is the Award itself.

I was still taking all of this in. Here I was, listing to his story in a roomful of attentive people, equally as impressed by it all as I was. Yes, it was me he was talking about, and I was not immune to stroke. Nobody is. I got up and made my way to the front of the room. I began to thank them, and it was as though the floodgates opened. The words and emotions poured from me, and I was surprised that I could hold it together as long as I did.

“Hello, Kearney Fire & Rescue. I’ve waited a long time to be here with all of you tonight. You know, May 15th is a day that I’ll never forget. Thinking back on it, I realize now, you can go to the gym as much as you want to, and you can eat rabbit food as much as you want to, but when something is going to happen, it simply will, and then you just hope and pray that you have the great response like I did. I remember being in the back of that ambulance, and it was going pretty fast (crowd laughs). It is funny that I was aware of everything that was going on around me and I can’t help but think that when you look at somebody like me, that looks completely out of it, they can still be very conscious of everything around them, and that was the case with me. I remember Dylan was sitting to my left, Steven was sitting to my right, and I kept trying to tell myself ‘If I can just calm down and say the words, I can tell them all that everybody is just overreacting’ (laughter). Well, lucky for me that wasn’t the case, and I ended up at the hospital. Within two hours and forty-five minutes, that was from the beginning of my stroke until the end of my thrombectomy, I was talking, I was walking, it was a miracle. I have to tell you there really are no words. Thank you does not really sum it up to . . . I’m going to get emotional now . . . (quiet laughter), but it really does not sum it up. You really did save my life. You all, along with my husband . . . you know, it’s a miracle that I’m standing here today being able to articulate these things to you. So, thank you so much. I really appreciate it. O.k., here I go (tearful voice, quiet laughter). But thank you so much Kearney Fire & Rescue. I really appreciate it (applause).

I began to walk back to my seat at the back of the room when Steven Giacone stands up and walks toward me. He puts his arms around me, and we embrace. This time he is not carrying me up a grassy slope to a waiting ambulance. This time it is a reassuring comfort. An acknowledgment of how vulnerable we humans are, and how ultimately, we very much need each other. I was privileged too to meet Steven’s lovely wife Jessica, who is a nurse at, of all places, St. Luke’s Hospital.

Tom asks, “Matt do you have anything that you want to add?”

Matt responded, “For St. Luke’s, thank you for all you do. (And then to me) Thanks for being gracious enough to share your story. Not everybody wants to, you know, have their case made a big deal, but whether you are a Nurse, an EMT Student, an EMT, Paramedic, Firefighter, a Neuro-Interventional Radiologist, an ER Nurse, or a CT Technician, there are so many people that just need to hear that what they do everyday matters. We have to deal with a lot, and it is just so refreshing when we have a patient that lets us remember why we do what we do when we decided to make that career choice. It is not about St. Luke’s, it is not about Kearney Fire, it is about you having a life with your family, and that is why we do what we do. Whether you are behind a desk pushing papers, or out there in the field doing the work, it is all because of stories like this. So, thank you for the courage to let us tell your story.

“Of course,” I said. I felt so humbled by this, and thankful to really understand that there are people out there, like those in this room, that choose a life dedicated to helping others.

Tom addressed the room again. “I have one more thing to add to the whole story. Kelly did a write-up for us, and I submitted it to the American Heart Association. This case was chosen above all other cases for this year’s Regional Brain Saver Award,” (loud applause).

Matt added, “It’s a private vote. We submitted the case, but we couldn’t vote. It was unanimous.”

Tom added, “So we will be getting with AHA soon because they will want to do a virtual talk about that story. It will be a zoom type recorded call and it will be played at our virtual regional stroke symposium.”

I was stunned, and again completely humbled. All I could utter was a feeble, “That’s amazing.”

Matt started to stand. “One of the things we do, if it’s ok before we leave and disperse, is to get the care team and the poster and the family together for a photo.

“Absolutely,” I said, and John and I started to get up from our seats.

Back Row, L to R: (Driver) EMT Bobby Higgins a/k/a “Leadfoot”, EMT Dylan Misel, Front Row, L to R: EMT Student Nicole Sexton, EMT Keith Keplinger, EMT Steven Giacone, and next to me, my husband, John.

At this point, Steven spoke to me. “I want to also say thank you for your kind words in your blog afterward. It was very well written."

We sat back down again. “Thank you,” I said.

He continued. “As Matt said earlier, we see so much all the time, and we hardly ever get a good outcome. So, it is really nice for us when we get these instances. This is one of the few times I have gotten to meet a patient again after truly doing something to help them. Your part in the story, about being fully aware, I had a new EMT and an EMT student with me that day. I knew, from the moment I laid eyes on you, what was going on. I wanted this to be a teachable moment for them, and I remembered my training many years ago. Part of that was that you may have been fully aware, and I was trying not to scare you. I wanted to try and keep you calm but take it as a teaching moment and let them know this as well.”

“Well, you did a great job,” I said. “Actually, you made me feel reassured in a very uncontrollable situation, so I appreciate that very much.” And then jokingly I added, “When you picked me up off the grass that day, I remember thinking ‘Oh my goodness, I’m heavy!’ but you did it with no problem,” (laughter).

He responded, “Well, you are a lot more petite than most,” (more laughter).

From across the room, Deputy Fire Chief Mike Desautels added, “What is the first thing to happen in an emergency?” A few of us tried to guess. After a few moments, the Chief said, “Denial. When you have just that headache or just that stomachache. No one initially believes that they are having a stroke or heart attack.”

He was right, of course. I was in denial for most of the time on my way to the hospital. At one point in the ambulance, a thin finger of fear did tap me on the shoulder and I thought, ‘Is this really happening? Is something really wrong here?’ I started concentrating on my breathing and had no trouble there, but I was suddenly paying attention.

The Award Ceremony ended, and Tom thanked everyone for being there.

Afterward, I had a conversation with Steven and Matt. I recounted a funny memory of being in the ambulance and Steven and Dylan had taken off my blue rubber 'chicken boots' which are really covered with honeybees. When we arrived at St. Luke’s, I saw Steven with my boots, handing them over to the Emergency Room staff directly upon arrival. I remember feeling relief as I wear those boots every day. It was a surreal memory, but funny when I think about it now.

Matt spoke about the miracle of modern medicine, and how everything came together so well in my case, even to the point that my clots lodged in an area of my brain that was still large enough for the IR equipment to get to. He asked me if I had any residual shortcomings after the stroke.

“I do, actually,” I said. “My handwriting has changed, and it is more difficult to write, but thankfully I am still able to type. I still have tremors also, mostly in my right arm and hand, but I understand they are supposed to decrease with time.”

So, this special night belongs to my ‘A Team,’ Bobby, Dylan, Nicole, Keith, Steven, and of course, my husband John. Thank you all so very much. I would also like to thank Tom Modin, the incredible Neuroscience Outreach Coordinator for Saint Luke’s, for his fortitude in making this night happen, and ensuring that Kearney Fire & Rescue finally got the Award they so deserve. I hope this helps, in some small way, to bring awareness to all of the self-sacrificing, brave, incredible human beings out there that make Rescue not only their work, but their life’s calling. We would be lost without you. Lastly, a special shout out to my brother-in-law, who dutifully recorded these proceedings so that I could have an accurate account of the evening to relay to you.

Until next time . . .

K.

Strokes are insidious, sneaky things. They don’t discriminate against any individual. They affect people in every stage of life from children to athletes to seniors, and everyone in between. Recently, while writing this blog, my family lost someone very close to us from a stroke. She was a fit, vivacious world traveler, full of fun and energy, and life. She will be very missed. Rest in peace dear Annie. There will be a cèilidh when we are all together again.