Victoria resident Wally Hop Wo pulled up in front of the cabin outside Nimpo Lake, preparing to pack up after four days of deer hunting. His plan for the evening was a trip into Bella Coola to visit relatives. What actually happened was much different.
When Wally stopped his truck, he suddenly felt dizzy and his arm was tingling.
“I opened the door but I couldn’t get out so I sat there for a few minutes. Eventually, I managed to get out and around to the tailgate, but my arm kept tingling, my head was spinning, and by now my words were slurring.
“My brother-in-law saw me and I guess he knows the symptoms of stroke because he drove me right to the Anahim Lake nursing station.”
That’s what Wally, 70, a retired millwright, remembers as he reflects back to Friday, Oct. 27. (He spoke to us by telephone several days later from the neuro rehab ward at Victoria General Hospital.)
Brother-in-law Carl Harestad, though, chastises himself in the clarity of hindsight, saying it took him about five minutes to realize Wally was having a stroke.
“He threw me off a bit because his symptoms cleared up. I was kind of in denial too because he’s such a healthy guy, but when he started having trouble talking again, we headed to the clinic.”
That’s when things went into high gear and, fortunately for Wally, everybody from the agency nurses at the nursing station to the neurologist in Kelowna directing his care – and all the players in between – did everything right.
“I would like to say the entire staff at Anahim Lake and the paramedics were absolutely key in his medical care and transportation to Williams Lake,” says Carl, who works in the maintenance department at Bella Coola Hospital.
RN Bonnie Skinner, the agency nurse working at the Anahim Lake facility, which is operated by the First Nations Health Authority, took Wally’s medical history and knew he needed a higher level of care fast.
While she got him ready for transport, another nurse got on the phone with the BC Patient Transport Network (PTN).
Neurologist Dr. Aleksander Tkach was working at Kelowna General Hospital when the call came in from the PTN about a possible stroke patient in the remote Chilcotin.
“I was on the phone with the emergency physician on call with Patient Transport and the nurse from Anahim. We tried to figured out what had happened and when. It became clear we needed to treat him with tPA, which is a drug that breaks down blood clots, but it has to be given quickly because every minute two million brain cells are dying.”
He said it was compelling to listen to the emergency physician co-ordinating the fastest mode of transport. They quickly determined there was a helicopter near Anahim that could take him to Cariboo Memorial Hospital in Williams Lake.
Meanwhile, Wally told the nurse at Anahim that he had undergone an aneurysm repair in the spring and the urgency really ramped up.
“When I heard his history, I just looked at the paramedic who happened to be at the clinic and he went right out to open up the ambulance doors,” recalls Bonnie. “That was the quickest medi-vac I’ve been involved with in 18 years. It was a whole team working together to get the man out.
“If you talk to Wally, tell him I’m sending him a hug. He was such a nice man, so polite even though he must have been really frightened.”
Dr. Tkach says the decision was made to fly Wally by helicopter to Cariboo Memorial Hospital in Williams Lake where the on-call physician was keen to take on his care. The medical team there had participated in a mock stroke tPA patient exercise in May. This was going to be the real thing and it went like clockwork.
Back at Tatla Lake, Mike King, owner/operator of White Saddle Air Services Ltd., got the request to fly a stroke patient to Kamloops. Rules prevent helicopter travel after dark so he said he could only make Williams Lake. When he got word to do it, Mike, his wife and son went running to the hangar to push out the Bell 407, which he described as “like a race car – really fast.”
He flew to Anahim Lake in 20 minutes, two attendants, Ted and Robin, climbed on board with Wally on the stretcher and they were at Williams Lake airport in an hour where an ambulance was waiting.
Ten minutes later, Wally arrived at Cariboo Memorial and was taken immediately for a CT scan, which was sent to Dr. Tkach for reading and he was also able to see him on videoconference. Then the thrombolytic therapy was ordered.
“His door to needle was very fast. It was impressive to see that, even in a remote area, he got treated quickly,” recalls the neurologist.
Wally says 30 minutes later, he could lift his leg and arm up. “Before that medicine, I couldn’t do anything.”
He improved and was moved by ambulance to Kamloops where he stabilized and monitored before going back to Victoria.
Wally says he arrived at Royal Inland Hospital at about 3 a.m. and he was scanned again.
“I had about four scans altogether at both hospitals. At RIH, I was in the emergency department’s trauma unit, 7th Floor for telemetry monitoring and then 5th Floor stroke unit. Everywhere I went at all the hospitals, people were great. The nurses and doctors were excellent. They couldn’t have been more fine.”
After four days, Wally was flown to Victoria General Hospital in his home community. His wife, Wanda, who drove to Kamloops when she first got word of his illness, headed for home by road.
Wally spent a little over two weeks in the neuro rehab ward at Victoria General and was discharged on Nov. 16.
Wanda says the whole family is so happy to have Wally home and grateful for the care he received at every step of his journey.
“He’s doing so well because of his own strong spirit, because of my brother’s correct assessment and quick action taken right at the beginning, and because of the excellent care he’s had everywhere. It’s just awesome. He’s been so impressed and pleased with all the really authentically caring people who looked after him. And I feel the same,” says Wanda, her voice breaking slightly.
Dr. Tkach agrees Wally’s case was an amazing example of systems management – from pre-hospital to transport to emergency department to in-patient to repatriation to Victoria.
“I believe we have entered a technological era where excellent stroke care can happen regardless of location.
“This highlights the great work that’s been done with patient transport and the hospital teams following stroke protocol and the effect it has on patients. It also demonstrates the amazing quality of care as he now avoids disability and also got back to his health authority quickly where that care continued.”
Susan Duncan is a communication consultant with Interior Health.