It was on the 17th hole at the Aurora Hills Golf Course earlier this spring when Pete Ryan ran into problems.
It wasn’t a bunker, a sand trap or figuring out what club to use that stopped him in his tracks. It was a life-threatening blood clot lodged on the left side of his brain that abruptly halted his work as a member of the groundskeeping crew.
It began like any other day for the semi-retired Pete, who began work at the course about two years ago to stay fit, be outdoors and keep busy. The job entailed cutting grass along the fairways and maintaining the roughs, greens and bunkers, along with other landscaping duties.
A golfer in his spare time, he enjoyed being on the course and it was a nice break from his previous occupation in the IT world. A Connecticut native, Pete spent 10 years in Germany after a 20-year career in the U.S. Navy before moving to Colorado in 2010 with his wife, son and daughter.
That April morning, he and the grounds crew set about sprucing up the course. After driving a small truck with dirt up to the 17th hole, Pete was spreading dirt around the tee box when suddenly he felt different.
He sat down on the ground. Luckily, he was with two co-workers. One noticed the right side of Pete’s face drooping — a telltale sign of a stroke — and immediately called 911. His other co-worker tried to reassure him.
“I can’t really describe what I was feeling,” said Pete, a 61-year-old Aurora resident. “I just felt off. It wasn’t painful at all. I remember it, but it’s fuzzy and patchy, like when you wake up from a dream.”
About five minutes passed.
The next thing Pete remembers is being a gurney inside a vehicle – the UCHealth Mobile Stroke Treatment Unit (MSTU). He recalls his shirt being removed and being asked by Devin Groves, the mobile stroke unit nurse, whether he could move his right foot.
“I was looking at my leg dumbfounded, like, ‘Why I couldn’t move my foot?’
I didn’t have any pain. I wasn’t panicked or scared; I was sort of confused, and by that point, I was just sort of along for the ride.”
The ride would take him to the emergency room at UCHealth University of Colorado Hospital on the Anschutz Medical Campus, where surgeons would remove the blood clot. He would wake up a mere two hours later in the intensive care unit with little to no side effects.
“It was a matter of being in the right place at the right time,” Groves said. “All the chips fell into place for Pete.”
Bringing advanced technology and ER services to Aurora residents
Pete’s amazing outcome is the direct result of the mobile stroke unit, an ambulance equipped with a CT scanner, lab testing equipment and clinicians trained to care for stroke patients with critical medication and on-board diagnosis. A telehealth system includes advanced audio and visual equipment allowing neurologists at Anschutz to diagnose and recommend treatment for patients in real time, as they read brain scans from patients being cared for in the mobile unit both on site and en route to the hospital.
“This is the best-case outcome for a worst-case scenario,” said Melanie Schwindt, a charge nurse with the Mobile Stroke Treatment Unit.
When UCHealth launched the mobile stroke unit in 2016, it split time between Aurora and Colorado Springs and was only the third of its kind in the country and the fifth in the world. In February, UCHealth Memorial Hospital Central in Colorado Springs began operating its own mobile stroke unit, meaning that the Aurora unit can serve residents full time, as well as make rendezvous with patients in small towns in eastern Colorado that lack advanced medical facilities.
Both Memorial and University of Colorado Hospitals are designated Comprehensive Stroke Centers, which provide the highest level of stroke care. Since 2016, the mobile stroke treatment units have been dispatched nearly 5,600 times.
“These units are really groundbreaking and innovative,” Groves said. “We’re bringing an ER to patients.”
‘Time is brain’ as every second counts
Every moment counts in an emergency. Those who work with stroke patients have an expression, “time is brain.” That’s because for every one minute that passes without oxygen to the brain, up to 2 million brain cells can be lost, underscoring the importance of identifying stroke symptoms right away so a patient can get help as soon as possible.
Strokes are the fifth-leading cause of death and disability in the United States.
“The longer you wait, the more damage strokes do, and the less likely a patient has for an optimal recovery,” Schwindt said.
Signs of a stroke are:
B: Balance for difficulty walking
E: Eyes for sudden loss of vision or double vision
F: Facial drooping on one side
A: one Arm is weak
S: Speech slurred or jumbled
T: “Time to call 911. Time is Brain!”
For Pete, his alert coworkers noticed that the right side of his face was drooping and that he was having trouble speaking – symptoms they conveyed during the 911 call. Because the call met specific stroke unit criteria, the UCHealth mobile unit was dispatched to the scene, along with Aurora Fire Rescue and its contracted ambulance service.
“I’m in the back of the unit, and we go off road. I looked out the window, and we were driving down the fairway, on the golf course, to the 17th hole where Pete and crew had been working,” Groves said.
“I’ve been a paramedic for 13 years, and I’ve taken the ambulance to some pretty weird places, but that is my first time on a golf course,” said Groves, who is also a nurse and has been on the MSTU for the past three years serving a dual role as a paramedic and a nurse.
When he arrived on scene, he quickly diagnosed that Pete had aphasia (inability to speak), was confused, and couldn’t move the right side of his body. It was obvious he’d suffered a stroke, but Groves had to determine which kind: A “hemorrhagic,” stemming from a brain bleed, or an “ischemic,” caused by a brain clot, which comprise most strokes.
The crew immediately went to work. Pete was moved to inside the unit where a CT scan was performed. If it was a bleed, it would appear as bright white in the scan.
Seeing no evidence of a hemorrhage, Groves next lowered Pete’s blood pressure, which had spiked, so he could be treated with an important and powerful clot-busting drug called TNK.
After the TNK was administered, the mobile unit’s CT technologist performed a CT angiogram on Pete’s brain, this one with contrast dye. If there was a blood clot, it would show on the scan as a light-colored mass, which it did.
Both CT scans were diagnosed and interpreted by a UCHealth teleneurologist at Anschutz who was working with Groves. The neurologist also was in contact with Pete’s wife, Mary, who received updates on his condition and made the decision to have him transported to Anschutz.
The neurologist then notified UCHealth’s Intervention Radiology Unit that Pete would be arriving shortly, allowing him to bypass the ER and receive the fastest-possible help. There, surgeons performed a thrombectomy, removing the blood clot through a small, thin tub inserted in his femoral artery in the right groin area. A wire and a catheter then were inserted through the sheath into the artery where the brain clot is located.
Within two hours of the initial 911 phone call, Pete was recuperating in an intensive care unit room. An immediate test measured the removal of the clot and whether the affected part of the brain was receiving full blood flow. The test, called a TICI score, showed Pete with a 3, the highest score possible.
Pete emerges unscathed from stroke
“At first when I woke up, there were four or five people in the room. They told me I had had a stroke. I answered all their questions like my name and the date, and they asked me to move my hands and feet. I saw that they were all smiling at each other … I guess I was in as good shape as I could have been,” he said.
His amazing recovery and his perfect TICI score were amplified by positive assessments from speech, occupational and physical therapists who found nothing wrong with him.
After a few days recovering in the hospital, Pete was discharged. Acknowledging he hasn’t been as diligent about his health care as he could have been, Pete said the stroke was a “wake-up” call.
Because his care team found he needed to have his aortic valve replaced, he returned to the hospital in mid-June for successful pacemaker surgery.
It’s possible that a clot developed around Pete’s damaged heart valve, became dislodged and traveled up to his brain causing his stroke. While he may never know why he had the stroke, he does feel very fortunate.
“I’m super thankful and super lucky. It couldn’t have turned out any better. From the mobile stroke unit to everyone in hospital, they all did a fantastic job.”
A reunion between patient and the frontline caregiver who helped save his life was an emotional one for Pete and Groves.
“It can be rare for anyone on the unit to reunite with a patient, so for me, it was very humbling and brought a smile to my face when I saw Pete walking and talking perfectly. He came up and gave me a big hug – it was great – he’s definitely one of my miracle stories for sure.”
Pete agreed. Before stopping at the 17th hole, he had almost ventured alone to another part of the course to take on another task, an action that likely would have resulted in a completely different, and much worse, outcome.
“One of the reasons it doesn’t seem real to me is that I feel absolutely fine; like there should be lingering effects, but aside from being a little tired, that’s it. I got so amazingly lucky, and I don’t want to waste this opportunity. I got a second chance.”