WOMAN BEATS THE ODDS AND SURVIVES A STROKE.
Woman overcomes stroke
In June, when Stephanie Spooner accepts her master’s degree from the University of Ottawa, it will mark a major milestone in her recovery from a nearfatal stroke.
Spooner today tells the story of her seven-year odyssey — through surgeries, rehabilitation and university — to advance the cause of stroke research, and to highlight The Ottawa Hospital’s work in helping stroke patients reclaim their lives.
Early on the evening of her 21st birthday, Stephanie Spooner decided to squeeze in a workout before meeting friends at a pub.
Ottawa-born Spooner was a dedicated athlete: a competitive ringette player who also enjoyed volleyball, hockey, curling and rugby. Sports were a central part of her life. Her dream was to become a sports medicine doctor and to work with the Ottawa Senators.
By 2005, she was well on her way to that goal, earning top marks as a secondyear kinesiology student at the University of Waterloo. She loved the hubbub of university life. Her idea of a problem then was an assignment that wasn’t returned with an ‘A.’
Spooner’s 21st birthday, however, would prove a sharp demarcation point.
For many, the birthday separates adolescence and adulthood. For Spooner, it would divide life before and after a hemorrhagic stroke — an event that would stifle her independence and set before her unimaginable new challenges. Her idea of a problem would never be the same.
In the gym that day, Spooner was stretching on an exercise mat when she began to feel numbness on her left side. It had happened before, often in connection with a migraine.
But this time it was different. “This time,” she says, “the numbness wasn’t going away.”
So Spooner told a friend they should skip the workout; she collapsed on the way back to the change room.
In Ottawa that evening, Steve and Donna Spooner couldn’t process the news being conveyed by hospital officials in Waterloo. “Your daughter is in real trouble medically,” one official said. “You need to get down here.”
Both parents had spoken to their daughter only hours before to wish her a happy birthday. She had emailed them a picture of herself with the 21 roses they had sent. Steve Spooner, chief financial officer at Mitel Networks, said there had to be a mistake. But the official insisted. He reiterated the importance of their swift arrival: their daughter was being transferred to Hamilton by ambulance because her neurological problems were so serious.
The Spooners were in shock as they sped toward Hamilton. Stephanie’s siblings, Brendan and Emily, would follow hours later.
Twice during the next 13 days, decisions made by Steve and Donna Spooner would save their daughter’s life.
Steve and Donna will be in the audience, alongside hundreds of other impossibly proud parents, when their daughter receives her degree at the University of Ottawa’s convocation ceremony in early June.
Seven years after her stroke, Stephanie will accept a master’s in health administration.
“I’m sure I’ll cry,” predicts Donna. “I’ll be thinking about how far she’s come.”
Graduation is a time when all parents reflect on a child’s academic journey: from alphabet blocks to early readers to multiplication tables to school projects to exam jitters to university applications to residence goodbyes.
The education of Stephanie Spooner involved all those steps and many, many more.
After her stroke, she learned to walk again, to build sentences again, to type with one hand. It’s an odyssey that speaks both to one woman’s fortitude and to the collective power of family.
Stephanie’s sister, Emily, devised one-handed strategies for her while older brother Brendan, also an athlete, pushed Stephanie to get back on her feet. Her father has served as her academic tutor and advocate, while her mother has performed the duties of physiotherapist, masseuse, life coach and psychiatrist.
Says Donna: “As they grow and become a little more independent, you back away as a parent. But when something like this happens, you’re right back to square one.”
As they barrelled down the highway on the night of their daughter’s 21st birthday, the Spooners received a cellphone call from Hamilton General Hospital.
“If we don’t operate now,” a surgeon told Steve Spooner, “she will be dead within the hour.”
He told the surgeon to do whatever was necessary. They arrived at the hospital just after 2 a.m. and met the surgeon, who said their daughter had suffered a massive brain hemorrhage. Part of her skull had been removed to relieve the pressure. She was in a coma.
“It doesn’t look very good and we don’t know whether she will come out of it,” the surgeon said.
The Spooner family held vigil at Stephanie’s bedside, waiting for her to show some flicker of life. They slept in chairs. They read Stephanie’s favourite Harry Potter novels out loud. (She can recall hearing some of the chapters.)
Stephanie’s stroke had been caused by an AVM, an arteriovenous malformation, a knot of poorly formed blood vessels in the brain. It’s an extremely rare condition that affects less than one per cent of the population.
Researchers don’t know what causes the malformations, which are thought to be formed in utero. Often, the problem goes undetected until the vessels rupture, a likelihood that increases with age. Such an event is fatal in about half of all cases.
At Hamilton General, the attending surgeon asked the Spooners to remove Stephanie from the mechanical respirator that was keeping her alive. It was her ninth day in a coma. She was being fed through a tube. She was showing no response to painful stimulation. The doctor said she would probably remain in a vegetative state if she did survive.
The Spooners said it was too soon. Two days later, when the surgeon again asked them to let their daughter die, they demanded a new physician. A Guelph-based neuro-intensivist agreed to take over Stephanie’s case. “She’s young,” the physician said. “We’re going to give her a chance to see if she can get out of this.”
On the 13th day, Stephanie squeezed her mother’s hand. Later that day, she woke up.
Stephanie couldn’t speak since she had a tracheal tube. She couldn’t sit up and didn’t have the motor control to raise her head.
Soon, however, she managed to communicate with hand signals developed by her brother and sister.
Less than two months later, she entered The Ottawa Hospital Rehabilitation Centre in a wheelchair. She wore a helmet to protect her brain, which remained exposed. (Surgeons at The Ottawa Hospital had to wait another two months for her brain swelling to subside enough for them to reroute the defective blood vessels in her head, and to rebuild the missing side of her skull.)
Consultants advised the Spooners to renovate their home so that it could accommodate a powered wheelchair, but Stephanie would not hear of it. “No,” she said with the quiet confidence that had always defined her, “I will not be in a wheelchair for long: I will walk again.”
Medical technology has dramatically improved survival rates for stroke victims, but physical recovery continues to rely on oldfashioned concepts: determination,
“I’M SURE I’LL CRY. I’LL BE THINKING ABOUT HOW FAR SHE’S COME.” DONNA SPOONER
hard work, family support.
A sense of humour is also invaluable — and Stephanie’s siblings made her laugh even on the hardest days. Brendan, for instance, was quick to offer Stephanie hairstyling advice when surgeries left her with a shaved head not unlike his own.
Stephanie’s mother was at the rehab centre every morning by 7 a.m., while her father was there every evening. At first, Donna would help Stephanie put on her socks and eat breakfast since the stroke had partially paralyzed the left side of her body. But she soon encouraged Stephanie to do those things on her own, however difficult it was to watch.
Donna would accompany her daughter to physiotherapy to study how the professionals worked; she wanted to learn the same skills. Sometimes, staff would suggest that she go home and rest: “This is where I need to be right now,” she’d say.
The hemorrhage on the right side of Stephanie’s brain had impaired her ability to control the left side of her body. To walk again, she would have to re-engineer the neural pathways that govern movement. Repetition is the key to that motor relearning: it offers the brain the stimulation it needs to forge new connections.
As a kinesiology student, Stephanie was well-versed in the theory of brain plasticity that informed her physiotherapy. As a competitive athlete, she was motivated to make it work.
“As an athlete, my worst fear was being paralyzed and remaining in a wheelchair and there I was living my worst fear every day,” she says. “I didn’t want to be stuck in the state I was in for the rest of my life.”
Stephanie’s athletic career had taught her to push through pain. She knew to set short-term goals.
“Nothing comes fast,” she says. “You just have to keep chipping away and take the little gains that you barely even notice. But they add up to something.”
Just before Christmas 2005, Stephanie took her first steps in five months.
Back home in the new year, Stephanie set a new goal for herself: to return to school. But there were problems. She would sometimes suffer seizures from the scar tissue in her brain. Exhausted, she would often have to nap.
Stephanie also had cognitive deficits. Her math skills had reverted to a Grade 4 level and she had difficulty writing full sentences. Her short-term memory problems made it difficult to keep information at her fingertips.
Stephanie used web-based university courses to propel her brain’s recovery.
Donna Spooner had spent her career in education working with special needs children. Now, she devoted all of her energy to her own daughter, who was studying while engaged in full-time physiotherapy.
Stephanie insisted on returning to Waterloo in the fall of 2006. She was by then walking with a cane. “I’m kind of stubborn,” she admits, “and I really wanted to finish what I had started.”
Her physical therapists advised against the move, saying it would stall her recovery, but again the Spooners placed faith in their daughter.
“I have to say that was the hardest thing: to let her go back,” says Donna. “You’re so afraid something is going to go wrong. And you’re so far away.”
Says Steve: “We agreed we had to let her try it and be there if it didn’t work out. But it was the best thing for her: she realized she could get on with her life.”
Stephanie began with a reduced course load to accommodate her physiotherapy. Donna would travel to Waterloo every few weeks to run errands for her daughter, take her to medical appointments and stock her refrigerator with frozen meals.
Brendan and Emily took on more responsibilities at home to allow their mother time with Stephanie. “Each of us had a job,” says Donna, “we all pulled together to make it work for Steph.”
The next year, Stephanie returned to full-time studies and by June 2008, when most of her classmates were ready to graduate, she was only a few courses short of the mark. She was invited to sit on stage with the dignitaries while her friends received their degrees. The dean of her faculty interrupted the proceedings to relate Stephanie’s story. The audience gave her a thunderous ovation. Stephanie officially graduated four months later with an honours degree in kinesiology. That September, she began her master’s program at the University of Ottawa.
Stephanie began her first job earlier this year after completing her university course work. She’s now part of a team at The Ottawa Hospital that’s helping to introduce new electronic health records.
She hopes the contract leads to a full-time position, preferably something that involves working with patients. Although forced to abandon her dream of practising medicine, Stephanie believes the combination of real-life experience and classroom training gives her unique insight into patient care. “I am hoping I can still make a difference,” she says.
Stephanie continues to work on her mobility and has never stopped making gains. Three years ago, she discarded her cane. She has since learned to drive an adapted vehicle. During a recent girls’ weekend in Las Vegas, she went skydiving indoors.
Stephanie follows a rigorous home physiotherapy program. With her mother’s help, she practises navigating stairs without a railing and exercises on an elliptical trainer and treadmill, both modified by her father.
Sometimes, Stephanie can’t help feeling that she has been unjustly robbed of her youth. But she also recognizes that she’s lucky to be alive and to be gifted with a steadfast, loving family.
“I never really told them this, but I always wanted to be strong for my family and friends because I knew it wasn’t easy on them with what I’d been through. I felt sort of guilty for having them go through that.”