Neurology

Seeing stroke symptoms, spouse’s 911 call helped save Jim’s life

Jim Schmaling and his wife.
Jim and Michelle Schmaling.

A 50th wedding anniversary is a highly momentous occasion for any couple, but for Jim and Michelle Schmaling of Whitewater, WI, reaching their golden anniversary on April 13, 2021 was extraordinarily meaningful.

About five months earlier, Jim and Michelle were out walking their dogs one early November afternoon when Jim, now 73, suddenly started to lag behind his wife.

“Are you ok?” asked Michelle, after looking back at her husband.

“I’m not going to make it,” was Jim’s frightening reply. Michelle was further alarmed when Jim could not follow her directions to look to his left.

Michelle didn’t realize it right away, but Jim was having a stroke. A large clot in the back of his head was interrupting the flow of blood to the brain, killing millions of neurons each minute and putting Jim’s quality of his life in great jeopardy.

Instinctively, Michelle called 911 right away – a simple but life-saving act that set the stage for a series of events that ultimately led to Jim’s amazing recovery.

Nikki Storm, the Schmaling’s younger daughter, happened to be working that afternoon in the Emergency Room at Fort Memorial Hospital in Fort Atkinson, just 10 miles from Jim and Michelle’s home.

“My co-worker Carole handed me the phone, saying it was my mom,” says Nikki, a health unit coordinator in the ER. “Mom was frantic and out of breath and said my dad was coming to our hospital in an ambulance because he suddenly became disoriented and could not follow her instructions.”

Daughter immediately suspected a stroke

Working in an ER, Nikki immediately suspected a stroke, alerting everyone who needed to know that her dad’s ambulance would arrive shortly. Doctors, nurses, imaging technicians and other staff prepared accordingly to ensure no moment was wasted.

Fort Health Care emergency physician Eric Snell, D.O., met Jim at the door. After observing and examining Jim, Dr. Snell agreed that a Level I stroke was almost certainly the diagnosis. Due to COVID-19 hospital visitation restrictions, Michelle had been keeping in touch from home. (That very month, Jim and Michelle both tested positive for COVID about two weeks apart.)

Brain scans made Jim’s stroke diagnosis official. As not much time had elapsed since his first symptoms, Jim was eligible for a clot-busting intravenous treatment called alteplase or TPA.
Seeing how large Jim’s clot was, Dr. Snell called UW Med Flight, knowing that UW Health – one of just five comprehensive stroke centers in Wisconsin – offered the highest level of medical resources to treat Jim. With Med Flight on the way, Michelle and her other daughter, Laurie Wilson, hopped in the car for the short drive to Fort Atkinson so they could watch Jim’s flight take off for Madison.

Just before he was taken from the Emergency Room to the helipad, Jim looked at Nikki, who took her father’s hand.

“Dad, you’re in good hands,” she said. “They’re going to take good care of you.”

Jim’s speech was slurred, but three words came out in return: “I love you.” Nikki darted across the street to meet up with her mom and sister. All three had lumps in their throat as the Med Flight helicopter whisked Jim into the sky.

“I knew he’d get excellent care at UW”

“It wasn’t easy watching him go, because I’d no longer be with him,” Nikki says, “Still, I knew he’d get excellent care at UW.”

Another good sign, Nikki thought, was learning that the Med Flight physician flying with her dad, Dr. Wade Woelfle, was someone she knew through work.

“Dr. Woelfle works mostly for UW Med Flight, but he also works part-time at our ER here in Fort Atkinson,” Nikki says. “He and I have worked several night shifts together, which made the whole situation more comforting.”

Triggered by Dr. Snell’s call from Fort Atkinson to Madison, UW Health’s stroke team prepared immediately for the likelihood that Jim would undergo a mechanical thrombectomy, a minimally-invasive clot-removing procedure performed by a team consisting of a neurosurgeon, anesthesiologist and an endovascular physician, nurse and technician, among others.

Fortunately, Jim remained stable during the 13-minute flight to Madison, staying awake and lucid enough to understand everything Dr. Woelfle or the Med Flight nurse said. By 4 pm, the helicopter had landed at University Hospital, where Jim was wheeled into the Emergency Department.

Knowing that Jim had a large brain clot, UW Health physicians ordered CT perfusion imaging, which shows how much of the brain is damaged and how much can be saved.

“Most of Jim’s brain was still looking good,” says UW Health neurosurgeon Azam Ahmed, MD. “Given the size and location of his clot, we moved ahead with the mechanical thrombectomy. Similar to a cardiac catheterization, we go in through the femoral artery in the groin, guiding a small catheter and instruments through the arteries until we reach the brain,” says Dr. Ahmed. “Once we reach the right place, we ‘fish’ the clot out,” he says. “It’s like using a stent on a stick.”

The procedure was over shortly after 6 pm, and Michelle was back in Whitewater as the UW Health team repeatedly updated her by phone.

Great relief after clot was removed

“The nurses were awesome,” says Michelle. “Once they told me the clot was out and Jim was doing OK after the procedure, I felt a great sense of relief,” she says. “Once he was in a room, the nurses took all my calls and answered all my questions.”

Jim spent the next four days recovering at University Hospital. On Thanksgiving 2020, he was transferred to UW Health’s Rehabilitation Hospital in Madison for nine more days of physical, occupational and speech therapy. Aside from some vision disturbance in his left eye that ultimately resolved, Jim was doing quite well by the time he came home in early December. He has no memory of the stroke or the four days in the hospital, but nobody considers that a bad thing.

“Most patients improve after we perform a thrombectomy,” says Dr. Ahmed. “About half of them – including Jim – recover dramatically. They arrive in a bad way, unable to speak or move on one side. A few days later, they walk out of the hospital. It’s kind of a Lazarus-like procedure, and when you see people like Jim leave functionally independent, you know you’ve done some good for someone that day.”

Dr. Justin Sattin, a UW Health neurologist who took the original call from the Fort Atkinson hospital, says the entire process worked like a well-oiled machine.

Time is the greatest enemy

“When it comes to strokes, UW Health’s system of care really stands out,” says Dr. Sattin. “Time is out greatest enemy, and we are set up to jump into action on several fronts. Our Access Center, Med Flight team, Emergency Department, our ability to share images among hospitals and our ability to use video to observe and communicate with some of our distantly-located patients all contribute to this capability. Each piece is vital to the task of getting people like Jim here as safely and quickly as possible so Dr. Ahmed and his colleagues can do their amazing work.”

Jim’s case also illustrates how valuable people like his wife, Michelle, are to preserving a stroke victim’s quality of life. As soon as she knew something was wrong, she didn’t flinch.
“Sadly, some people don’t call 911 the way Michelle did,” says Dr. Sattin. With a stroke, there simply is no time to wait it out, sleep it off or even call your primary care doctor. Millions of brain cells die each minute and they cannot be brought back, so recognizing stroke signs and symptoms is absolutely critical to preserving the patient’s ability to function independently.”
Less than two months after coming home from the Rehabilitation Hospital, Jim returned to work. With his vision fully recovered, he also was able to resume driving by April 2021.

“He is back to his usual joking self,” says his daughter, Nikki. “To remember how he looked the day of the stroke and see him now, you really wouldn’t have a clue that anything happened.”

For a couple that just celebrated 50 years of marriage, no material gift could exceed the value of Jim’s remarkable recovery from a major scare just five months earlier.
“We are extremely lucky to reach this great milestone together, knowing that the outcome could have been very different,” says Michelle. “We have so many people both at Fort Memorial and UW Health to thank for making this such a happy occasion.”

BE-FAST: How to recognize stroke signs and symptoms

Each letter in “BE-FAST” stands for an important stroke sign or symptom. If a person shows even one of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.

Is there a sudden loss of balance or coordination? Ask the person to walk in a straight line or touch their finger to their nose.

Are there sudden vision changes? Ask if the person has double vision, blurry vision or cannot see out of one eye or both eyes?

Does one side of the face droop or is it numb? Ask the person to smile.

Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

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?

Is there a sudden onset of a terrible headache?