My head and my heart.

My head and my heart.

1.

One year ago, I quit my job to become an independent consultant.

I liked my job, especially the people I worked with. But traditional employment had always left me a little unhappy. It boiled down to a lack of control: other people determined where I worked, when I worked, what I worked on. Even in companies I liked, I felt stifled by corporate culture.

I had always been drawn to careers that would keep me out of cubicles. Writing, teaching, journalism—sure, they involved desks, but I was in charge of myself. I could set my own daily schedules and pursue my own goals. And for years, I hoped that my work as a strategist would take me back to that self-determined space.

When the right opportunity came along, I knew it I had take it. I put in my two weeks’ notice and tried to figure out my new role as a consultant. I didn’t feel particularly prepared, and for a short while I was double-booked: finishing my full-time job during the day, crafting deliverables for my first client at night. I was excited, and terrified, to finally be taking total control of my career and my life.

One week later, I had a stroke.

 

2.

It was a Sunday night. I was making dinner. I was holding a cutting board in my left hand.

And then: I wasn’t. I didn’t even hear it hit the floor.

When people think of strokes, they think of one side of the body crumpling and losing feeling. But it’s not pins-and-needles; you don’t feel the loss. When part of your brain stops breathing, your awareness gets rewritten.

For a few brief minutes, I didn’t just lose my left side; I never had a left side to begin with. An arm hovered in front of me, out of the blue, as though someone were reaching to hug me from behind. I marveled at it: where did it come from? Whose was it?

In my dissociation, I reached towards it. As my right hand grasped its palm, reality snapped back like a rubber band. I am holding my own hand.

I felt strange. I tried to speak, and the words melted in my throat. My tongue felt dull and heavy; my jaw refused to move. Something deep inside my head made a sensation like a camera shutter: click-click-click-click-click.

Waves of dizziness washed over me. I touched my face and realized I was drooling from the left side of my mouth.

That’s when I panicked. I don’t know how I knew it, but the only thing I could think was: I am having a stroke.

I was 32 years old.

 

3.

I waited an hour before I went to the hospital. This was stupid. I was trying to regain control of my speech, trying to disperse the lightheadedness, trying to stop shaking.

More than anything, I was trying to convince myself that I was fine—that anything was wrong with me other than a stroke. It’s a migraine. It’s vertigo. It’s exhaustion. It’s a panic attack. It’s, it’s, it’s.

The emergency room admitted me before I even entered the waiting area. Doctors and nurses flocked. Neurologists asked me to read cards with simple words printed on them: baseball, mother, sheep, hum. They asked me to raise my arms, then pushed on them. They hit my knees with rubber mallets.

Everyone kept saying, “You’re so young! It’s not a stroke!” Everyone was kind, smiling, but dismissive. They called it a “stroke-like event.” They drew blood. They ran tests.

 

4.

I was in the hospital for three days. I lay in the stroke ward—the youngest person there by decades—covered in heart monitors and riddled with IVs. I wasn’t allowed to shower. I felt fine, and I felt like an invalid.

I waited for test results. I waited for doctors. I barely slept. I stared at the walls, practically papered with FAST posters—directions for recognizing victims of stroke:

A poster showing the warning signs of stroke.
This was one of at least five different “FAST” posters in my room.

I spent a lot of time thinking about my brain. Something was wrong with it. I had felt it flicker and snap; I had felt it go dark and then light again.

I thought about how my body had its own agenda. How I was at the mercy of synapses, blood, biology, things I couldn’t see. For all the control I’d been trying to impose on my life, there was none here. There was nothing I could do.

 

5.

My MRI came back with white whorls on my cerebellum: like scars, the neurologist said. They were old strokes, strokes that had come and gone and branded my brain in their wake.

M R I photo of my cerebellum.
This is a real photo of my real brain. That is literally my cerebellum.

This was evidence that this had happened to me at least twice before. In my sleep, perhaps, or hidden in the Trojan horse of a migraine. Silent strokes. Strokes mistaken for a moment of lingering vertigo.

That’s when the doctors started paying attention. I could feel the air currents shift, the way they changed their tone, their posture. No one kept repeating my age anymore. No one smiled.

They ran more tests on me. I learned it wasn’t about my brain at all; it was about my heart. It was about how it pumped my blood, and how that blood stuck and flowed. The muscle that kept me alive was sending little scattershot clots through my veins like a gun.

 

6.

I was diagnosed with a PFO—a patent foramen ovale, or a small hole in the heart. At first when they said it, I heard “patent ornamental valley.” I love the idea of my heart as a landscape.

Normally, little clots in the blood break up as blood circulates through the body. But some blood—and any clots—can skip that step if there’s a PFO. The express lane to gray matter.

Which is how I had a transient ischemic attack, or TIA. Also called a “mini-stroke,” it’s a small-enough clot that the body can usually dissolve it on its own—leaving little or no permanent damage. An hour after it occured, I was able to move and speak normally again.

I am unbelievably lucky.

TIAs are also referred to as “warning strokes,” because they frequently precede a larger, more severe stroke. For this reason, doctors take TIAs very seriously. I was immediately put on statins and bloodthinners, a standard but aggressive course of treatment.

I saw a barrage of doctors in the weeks following the attack: a cardiologist, a neurologist, a hematologist. It seemed like every doctor referred me to more doctors. I had follow-ups and specialists and lab appointments. I had my blood tested weekly to determine how thick or thin it was, how much control the drugs gave us over my clotting.

 

7.

Meanwhile, I worked.

I said goodbye to my coworkers and began working out of my living room. I threw myself as best I could into my new project, which took up any time I wasn’t spend in medical appointments. I completed deliverables; I found more clients; I rejoiced over wearing yoga pants every day.

I was also scared, confused, and feeling incredibly fragile. I struggled to stay focused, to prove that I hadn’t quit my job in vain. I messed up client communications and barely met my deadlines. I mismanaged my finances and cried a lot.

I also began taking care of myself. I practiced yoga and took up running. I drank less. I slept more. I returned to knitting and spent time with my dog. I kept my pace of life slow, at first because I felt delicate, but later because I felt healthier.

It was a process of gaining and ceding control. I could control my approach to my work, the quality of my thinking, my interactions with clients. I could control when I needed to think, when I needed to move, when I needed a break. I could not control for the possibility that, at any moment, my body might choose a different, darkened path.

 

8.

In the year since going independent, I have not once regretted my decision. I love my job. It is just as remarkable to run my own scene as I thought it would be.

I no longer take the statins and bloodthinners that constituted my treatment for the seven months following the TIA. I will be on a daily aspirin regimen for the rest of my life. It keeps my blood thin enough that my cuts take days to heal. I bruise like ripe fruit.

I don’t know why these two enormous events occurred at the same time. They’re forever linked: I cannot tell the story of starting my business without telling the story of my stroke. I cannot talk about my choices without realizing how little control I had.

I still don’t know what caused the stroke. I know what happened inside my heart and brain, but not why, not how the clots formed. I never will. It is one thing I still need to let go of: the desire to know, and therefore control, something inherently unknowable and uncontrollable.

It is the uncontrollable, in fact, that has made my tiny choices all the more important to me. Strange things will always happen. The unexpected, the inconvenient, the downright terrifying will occur. Life is appallingly unpredictable.

I hope I always make big, messy decisions anyway.

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