Robert Trierweiler, MS, a certified rehabilitation counselor, outlines the steps a...
U.S. Senator Mark Kirk talks about his recovery and return to work after a stroke
Ann Ahlers May 21, 2013
“You may have a stroke today.”
That’s what Senator Mark Kirk was told in the hospital on the afternoon of Jan. 21, 2012.
Kirk woke up that morning for a regular day of meetings in downtown Chicago. He was dizzy at the bathroom sink and felt numbness in his left arm.
By midday, a staffer drove him to the emergency room at Lake Forest hospital, where he received an MRI. The doctor informed him that his left carotid artery had dissected, which meant that the vessel was not conducting enough blood and oxygen to the brain.
The stroke came soon after.
Angels and Anger
Kirk’s next memory was a few days later in the intensive care unit at Northwestern memorial hospital in Chicago.
He describes his time in the ICU as “gauzy.” To relieve swelling of the brain, he had undergone a craniectomy, a surgical procedure to remove part of the skull, and was receiving narcotics for the pain. He did not have any awareness of where he was. Concepts that most people take for granted were beyond his grasp—even the idea of “me” and “other” was beyond him. He could not move his left leg and did not even realize it was his own. He remembers thinking, “Oh my gosh, they’ve told someone to lie in bed with me.”
There was a moment, under heavy medication, when he thought his time had come. Three angels appeared to him. “Mawk,” they said in heavy New York accents, “We wanna introduce awselves. When we were down here, we weren’t really angels. If you want—it’s totally up to you—you can come with us.” He chose to stay.
In those early days, he remembers feeling angry and combative. Like many patients who find themselves awakened several times a night, he battled with the nurses and doctors. “Every intervention hurts,” he says. “They say it’s just a check on you but it’s going to hurt.”
After moving out of the ICU, Sen. Kirk took up a short residence at the Rehabilitation Institute of Chicago (RIC), next door to Northwestern Memorial. He immediately began his rehabilitation therapy.
In the beginning, he had difficulty with standing and balance. The left side of his body, including his leg, arm and trunk muscles, was not able to produce enough strength to keep his balance. He told Mike Klonowski, his main physical therapist, that he felt like he had dead weight for a leg, which according to Klonowski, was a “pretty accurate statement.”
Kirk spent nearly 11 weeks as an inpatient at RIC, then transitioned to a day rehab program. He received physical therapy, occupational therapy, and speech and language therapy. His physical therapy included an intensive eight- week gait training program for stroke survivors. The senator had a sort of “boot camp” arrangement under Dr. George Hornby, whose philosophy is to treat all stroke survivors as athletes. “He really didn’t care if you were tired or depressed that day,” says the senator. “[He] put you on the treadmill till you dropped, literally.”
While on the treadmill, the senator was supported by a well- measured harness. The therapist would speed up the treadmill and when Kirk stumbled, the harness would allow him to fall forward until his nose was just inches off the track.
“At no point was it an easy task,” says Klonowski. “We had him working very hard during his sessions.”
In many stroke rehab programs in the U.S., most patients in physical therapy take between 400 and 800 steps per session. In one of his best weeks, the senator took between 2,000 and 4,000 steps per session.
Kirk affirms that his recovery was accelerated by being pushed that much harder. “I remember getting into that PT lab and not wanting to be there,” he says. “I was very fortunate. It was the best thing that could have happened to me—to be pushed in that way.”
No Time for Nap Time
Sen. Kirk understands the extreme fatigue that many stroke survivors experience—“you’re 2,000 hours behind on nap time. You could fall asleep at the drop of a hat.”
At first, a stroke survivor is still getting used to how his or her body is moving after the stroke and the urge to rest is immense. “Think about when you have the flu,” says Klonowski, “all you want to do is lie down and take it easy. But [after a stroke], it’s no time to lie down and take it easy.” He explains that the time right after a stroke is the best opportunity for the brain to heal more quickly and the body to respond at its best levels. Working in rehab with a greater frequency and intensity creates an optimal environment for plasticity (the capacity of the brain to change its neural pathways). Says Klonowski, “the changes you make are the building base for what you want to do later,” such as walk or return to work.
Getting moving has many benefits for stroke survivors. Movement, exercise and therapy are not only valuable in the rehabilitation and health of the brain and body, but also release endorphins, which can relieve depression and create a more positive attitude.
For these reasons, Sen. Kirk believes that caregivers and family members should get the stroke survivor exercising as much as possible. “Sure,” he says, “they will complain up one side and down the other about how tired they are. But you have to release your inner drill sergeant.”
Back on the Hill
If anyone had tried to tell Senator Kirk that he could not or should not have tried to return to work, there is “no way in hell” he would have listened.
Mike Klonowski was there this January, when the senator climbed the Capitol steps to return to work a year after his stroke. Having seen where the senator had come from, Klonowski was inspired by what he had accomplished. “As a therapist, you don’t often get to see such dramatic returns. It’s a feeling I can’t shake.”
As for the myth that many stroke survivors have heard—that you stop improving six months or a year after the stroke—it isn’t true. “You will still see changes,” says Klonowski. “They won’t be as dramatic. You’ll continue to achieve once you get into an environment where you’re doing what’s important to you. Put in the time and preparation at the beginning, and you’ll continue to improve.”
Not the end
The senator says he is a much better person after his stroke. He has now become very close to his sister—a relationship that did not exist as strongly before. “It’s nice to spend so much time with her because she has the same twisted sense of humor I have,” he says. “Having grown up in the same environment, there’s no inside joke she will miss.”
Politically, he has been thinking about low-income Americans who “may not roll into a big event like this with Blue Cross Blue Shield, like I did as a government employee,” or those whose insurance allows only a limited number of rehab sessions. The senator would like to find a way to scientifically determine how much rehab the typical stroke patient needs to recover and return to the workplace. In this way, he’ll have hard evidence to back up legislation that would make rehab more accessible.
Kirk is striving to be a better senator by getting to know each individual he works with, including key events in their lives and each person’s unique background. “They are not just their state. They come with all of the subjects of their lives,” he says. “What unites us is far more than party. We are all Americans, all elected to the office of U.S. senator. I saw it that way after the stroke.”
Sen. Kirk also hopes to inspire stroke survivors, particularly in his home state of Illinois. He hopes people will say, “Look— Kirk bounced back. He was climbing the Capitol steps within a year of his stroke.” To anyone who has survived a stroke, he will say, “This is not the end. You can recover. It will get better.”
In the end, the senator relishes the chance to be alive. “If this had not gone well, I’d be in a box in the cemetery and the biggest thing that would have happened to me that day would be the ants crawling next to my ear. How boring that would have been. How good it is to be alive.”
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