Stroke, in 60 seconds

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Scene 1 · Opening

21.40. The film started ten minutes ago. She sat down in the armchair with her cup, the way she does every Sunday.

She puts the cup down beside the table, not on it. She tries again, and puts it down beside it again.

Scene 2 · The doubt

You ask her if she is all right. She answers, and the words are the wrong ones.

One side of her mouth is not moving like the other.

You have twenty seconds and a doubt. What do you do with them?

• Right move : I ask her to smile, to raise both arms, and to repeat a sentence after me.
  The face, the arms, the speech : Those three signs have to be looked for every time, and they have a name in the guidance. Three simple requests, said out loud, and you know in under a minute whether you have to call.
• Mistake : I fetch her a glass of water, that will put her right.
  She may not be able to swallow any more : Close to two thirds of stroke casualties also have trouble swallowing: the civil safety first aid recommendations say so in as many words. The glass of water then goes into the lungs, and you have just added a problem to the one that was already there. Nothing by mouth.
• Not the best choice : I type “mouth drooping” into my phone to see what it might be.
  Nine hundred thousand results, each more reassuring than the last : Your phone can do one useful thing tonight, and it is not reading. Three questions will give you the answer faster than the first result.

Scene 3 · The three signs

The smile comes out crooked. One arm goes up, the other drops. The sentence does not come out whole.

You look at the time: 21.42. Twelve minutes ago, she was fine.

Three signs out of three. What do you do?

• Right move : One of those signs would have been enough. I call 15 right now.
  One sign, one call : If any one of those signs is there, you call 15 or 112. There is no threshold to reach, no second opinion to get: the guidance asks for an immediate call, and the doctor on the line is the one who decides.
• Mistake : I will give it a quarter of an hour to see if it clears: maybe she slept badly.
  The quarter of an hour you have just lost does not come back : The fire and rescue services sum it up in one sentence: with a stroke, what counts is how quickly the person is treated. Those minutes had already started running before you noticed anything at all. All waiting produces is delay, and delay is paid for in lasting damage.
• Mistake : I call her GP, he knows her better than anyone.
  The surgery is shut, and that is not even the point : The health insurance guidance is explicit: the way to shorten the delay before treatment is to call 15 or 112 directly. The doctor on 15 is a doctor, he answers at night, and he is the one who can send the right thing to the right place.

Scene 4 · The call

The dispatcher : “Samu, go ahead.”

Timer: 40 seconds.

He is listening. What do you say first?

• Right move : The address, the floor, the door code. Then the three signs I saw.
  The place first, the signs second : Give the place and the exact address, the floor and the entry code, then describe as precisely as you can the signs that worried you. In that order: a crew that knows where to go is already moving while you carry on talking.
• Mistake : I tell him the whole thing from the start, in whatever order it comes to me.
  “Where exactly are you?” : He cut across you to ask, and he will be right to cut across you as many times as it takes. The place comes first because it is what sets a crew moving. The story can be told while the vehicle is on the road.
• Mistake : I give the address and hang up: I would rather look after her than talk.
  You had half the call left : You do not hang up before the person on the line asks you to. The dispatcher still has details to take and instructions to give about what to do until the crew gets there. By hanging up, you cut yourself off from the only help available.

Scene 5 · The time

The dispatcher : “What time did the first signs appear?”

This is the question of the whole situation. What do you answer?

• Right move : 21.42. I looked at my watch. Before that, at 21.30, she was fine.
  It is the most valuable thing you have : Note the time the first signs appeared: the health insurance guidance says this detail matters for what happens next. You are neither a doctor nor a paramedic, and you have just brought them something nobody else will ever be able to recover.
• Mistake : No idea, and it makes no difference anyway. Just get here.
  It makes all the difference, and he is going to ask again : The time the first signs appeared is written down because it matters for the treatments to come. You were there, so you are the only person in the world who can give it. Look at your watch, run the last ten minutes back through your head, and give a time.
• Mistake : I give him the time, and add that she had this six months ago and it went away on its own.
  An episode that clears on its own is one more emergency : Signs that disappear within minutes have a name, and the health insurance guidance is clear that the urgency and the need for proper treatment are exactly the same, because the risk of it happening again within twenty-four hours is high. What you have just told him is not reassuring: it is a history, and it makes matters worse.

Scene 6 · The wait

The dispatcher said a crew was on its way and that you had to stay with her.

She is still in the armchair. She looks as if she has understood that something is happening.

Seven minutes before they ring the bell. What do you do with her?

• Right move : I help her lie down flat, I stay beside her, and I give her nothing.
  Flat, and nothing in the mouth : The guidance asks you to lay the person strictly flat, or on their side if they feel sick or are vomiting. Nothing to drink and nothing to eat, and you tell her help is on the way. There is nothing else for you to do, and that is already a lot.
• Mistake : I get her on her feet and walk her to bed, she will be better off there.
  Her leg does not follow, and the hallway is hard : The health insurance page says to help the person sit down or lie down where they are; the national guidance asks for the casualty to be laid down. On one point the two agree: you do not walk her about. Unsteadiness on the feet is one of the signs you have just spotted: walking her about adds a fall to a stroke. The crew does not need her to be in a bed.
• Not the best choice : I tidy the living room: I do not want the crew seeing it like this.
  They have seen far worse, and they are not here for the decor : The only useful tidying tonight is clearing the hallway and opening the front door. The rest can wait until tomorrow.

Scene 7 · The crew

Blue light on the walls, two vehicles below, footsteps on the stairs. You left the door open.

The first question they ask you is the one you were expecting: what time did it start.

You answer 21.42. It is all you had, and it was exactly what was needed.