My father's stroke

James writes:

I never thought this would be a medical blog, but the events of the New Year have changed that for me and Dara.

On December 30, 2006, at around 6:30 pm, my father, Carl Panero, suffered a stroke while dining at a restaurant on Block Island, Rhode Island, where he lives. Friends immediately noticed unusual behavior--an inability to communicate, and confusion. The Island police and doctor were summoned. They diagnosed stroke-like symptoms and readied the local airline for a medial evacuation. My father was off-island within an hour, and admitted to Westerly Hospital. Once stable, within the evening doctors transferred my father to the ICU at Rhode Island Hospital in Providence.

An MRI scan has revealed that my father either suffered a hemorrhagic stroke or a more unusual type of stroke called an amyloid angiopathy. Both concern bleedings into the brain. Amyloid is not your typical stroke that is brought on by high blood pressure and high cholesterol; my father was remarkably healthy in those two areas. His stroke was rather the result of weakened blood vessels in the brain, most likely caused by age, and of blood leaking into the brain from these weakened vessels.

A sizeable amount of blood was discharged into the left front side of his brain. This could have caused permanent damage to his faculties of speech, reason, and some motor coordination. We will be able to determine the extent of this damage within the next several days, as the blood is broken down naturally. In the meantime, my father is being monitored for seizures and other complications caused by the swelling of these blood deposits. Doctors report that he had a number of small seizures on the evening he was admitted, and two large seizures the morning of 1/2. Although they have been unpleasant for him, these events most likely have not caused additional long-term damage. My father continues to be on anti-seizure medication to reduce the chance of their reoccurrence.

Aside from the seizures, my father appears to be in stable condition. He is generally aware of his surroundings, able to move--in a weakened state--with some encouragement, able to nod, able to communicate through facial expressions, able to understand basic commands, able to digest food. He is also able to say a few basic words--yes, no, hello--but not able to speak or write beyond that.

My father has been improving at a good rate and has been evaluated to be eligible for acute rehabilitation. This means that his evaluators believe he will be receptive to 3 hours a day of physical, occupational, and speech therapy--the highest level. Within a week of the stroke he was transferred to a nearby rehab center. Here he can continue to be monitored by the doctors who admitted him at the time of his stroke. The average rehab time is two to three weeks.

Unless there are complications to his condition, the worst stage of my father's stroke is now behind us. He will only improve from here. How much he improves, however, is an inexact science and varies greatly patient to patient. Physical therapy will work to strengthen his body to the point that he can move again on his own. While no part of his body became immobile by the stroke, the right side of his body is noticeably weak.

My father has been impaired mainly by what doctors call expressive aphasia. This means that while he is able to understand many of the words spoken to him, he is not able to process the language and grammar to respond. This affects both his power of speech and writing. The hope is that as the blood drains out from the stroke area within the next couple months, and the nerve endings damaged by the blood begin to function again, through rehabilitation he can regain some expressive capabilities. He is already able to walk on his own, with supervision. Memory, reason, speech, and other cognitive functions are still noticeably impaired, although also improving. While he is responsive to the therapists, and seems to understand the need to engage in his own recovery, his attention can flag. He is also prone to confusion.

Now the puzzle for Dara and I--we are his 'health care proxies'--is where my father should go next. He lived on his own on Block Island. Now that's no longer an option.

No one is ever fully prepared for these scenarios, but we have been fortunate in the support and advice we have received from friends and family. My hope is that through this weblog, we can also at times share some of the things we've learned in helping out my father's recovery.

Bi-coastal Pronvincialism

Dara writes:

I got some very good feedback on a recent post about Target from a woman in Alabama. She reminded me that New Yorkers can be very provincial; Ms. Herbitter averred that while compared to the MoMA Design Store Target might not be much, compared to Wal-Mart it is manna from heaven.

While we New Yorkers can navel-gaze, we can also forget the rest of the country and zoom right on out to California. One example of our coastal myopia is the writing of Kim Severson for the "Dining" section of The New York Times. Her role seems to be bringing dispatches from California; no wonder: until recently she was a staff writer at The San Francisco Chronicle. Don't we have enough voices from CA?

This past week, Ms. Severson wrote about a fire that destroyed a beloved Northern California inn. The caption below the photograph of the inn read as follows:

"RUSTICITY Manka’s Inverness Lodge was known for its quirky menu."

For a moment I thought I was going to read about a quaint little restaurant of which I would not have otherwise known. Instead, Ms. Severson informs her readers that

"Manka’s fed actors like Frances McDormand and Brad Pitt and writers like Isabel Allende and Robert Haas."

Indeed, the day of the fire, actors Maggie and Jake Gyllenhaal were guests at Manka's. The thing is this: if I want to encounter Jake Gyllenhaal, I can nibble chicken paillard at the over-discovered Manhattan restaurant Pastis (as I recently did and sat next to him). If I want to read about food and scenery a bit more extraordinary, I might need to look beyond food writers whose main pipeline is the next Jet Blue flight to Oakland.

Movies: Letters from Iwo Jima

Dara writes:

Clint Eastwood's new film "Letters from Iwo Jima" is not a date movie. James proposed it as such. I should qualify by saying he and I are both interested in traveling to Japan, which interest provided extra motivation for shelling out the $11, especially when we primarily Netflix films nowadays.

"Letters" is the flip side of Eastwood's recent film "Flags of Our Fathers." Both movies depict the battle on the island of Iwo Jima during the Second World War. While "Flags" shows the American story behind the iconic image of our men raising the flag on the top of Mount Suribachi, "Letters" shows the hell the Japanese soldiers endured while they fought to their deaths.

The movie reveals what the roughly 20,000 Japanese soldiers do to prepare for the Americans to arrive on Iwo Jima, and then what happens when the Marines land. The island is inhospitable, and the General leading the troops learns quickly that no reinforcements will be sent. His soldiers know the cause is lost but must follow their military tradition of dying honorably, either at the enemy's or their own hands. This result is extremely punishing. Bombing takes up much of the movie. Many soldiers take their own lives, which is devastating. I left the movie down and pained.

Mr. Eastwood's film succeeds on several levels. He develops his characters quite well, so that we feel for them. Ken Watanabe plays General Kuribayashi. He is dignified and innovative, but many soldiers suspect his modern methods. The ancillary characters shine. The scrappy kid who doesn't want to be there, Saigo, is our hero. Shimizu, whom Saigo suspects of being a spy, is in fact, as we learn through flashbacks that round out the lives of several characters, completely honorably. And Nishi, a former Olympian, is tragically handsome. Daring and gorgeous, he is the most vulnerable of the men; he cries when his horse dies and befriends a wounded Marine, with whom he can speak of American film stars.

The deaths of many of these characters moved me to tears. The look of the movie is stupefying. Much of the action takes place in the caves the soldiers dug into Mount Suribachi to avoid attack. As a result the light is dim and gloomy. Mr. Eastwood allows us to feel as never before for the Japanese side; even though I kept saying to myself, "they sided with Hitler!," I could not help but feel for these men. (Of course, a similar movie about the hidden lives of the SS could never be staged, for obvious reasons. I wonder what certain Chinese viewers, against whose ancestors the Japanese committed atrocities, might think of this film.)

Mr. Eastwood's film falters, too. It is too long by a bit. One only needs to see so much bombing to get the point. In many scenes, nothing happens. I suppose the filmmaker captures the amount of waiting that war entails, but must the audience wait, too? Maybe. No war film, I suppose, completely escapes sentimentality. In one scene, when the soldier whom Nishi has befriended dies, Nishi reads a letter clutched in the dead soldier's hand. The soldier's mother has penned the note, and for some reason, when Nishi reads it, all the Japanese men surrounding him stand, as if to attention. The note ends, "Do what is right, because it is right." Nishi then sends his men to battle with those last thoughts as their rallying cry. This feels contrived, but the sentiment strains further when Saigo says to Shimizu (I'm paraphrasing), "I thought all Americans were savages, but that soldier's mother's words, they could have come from my own mother." Oh, really, Mr. Eastwood? Is that similarity between sides what you want us to feel?

I questioned seeing the movie when I left. I felt dogged and drained. I thought about our current world and how Mr. Eastwood might have been making a point about jingoism. General Kuribayashi and his men, almost all 20,000 of them, fight to death even though they know they have lost. Such nationalistic blindness has been ingrained. I hope we do not have such blinders on.

Postscript: "Letters" brings to four the number of movies I have seen in the theater this year. The others being "Borat," "The Devil Wears Prada," and "Sophie Scholl," about a young woman who resisted the Nazis. I am not sure if "Thank You for Smoking" counts, since I walked out of it. I actually didn't think it was so terrible, but James and I saw it squeezed in next to my parents in a tiny theater in Connecticut. We were about to get married and I think more than a satiric film we needed strong cocktails.