Alice Barclay is smiling a lot these days, and who can blame her?

Her grin, specifically a lopsided one, was a telltale sign and an important clue in real time that she was experiencing a dangerous and potentially lethal stroke. Of the many negative scenarios that might have occurred, Alice left the hospital within 24 hours with few adverse effects to show for her frightening experience.

There were several factors working in Alice’s favor that morning in early June. As a nurse, she knew she was having a stroke and quickly called 911. She was lucky to be within minutes of UCHealth University of Colorado Hospital, a designated Comprehensive Stroke Center, which provides the highest level of stroke care in the region. And she spent just minutes in the ambulance before being treated with quick life-saving action from the stroke response team at UCHealth.

“On the ambulance ride over, I thought to myself, ‘I hope I can get there in time. If not, my life is over, and I’m going to be disabled for the rest of my life.’ But that stroke team saved me. The room was full of people, and they were fantastic. I was lucky, lucky, lucky.”

For doctors and stroke experts, Alice’s good fortune served as a key reminder of how important it is to recognize the signs of a stroke and get help as quickly as possible.

“There are two essential factors in strokes: The first is that many people don’t know what the signs are, so we are always wanting to educate the community,” said UCHealth Stroke Clinical Coordinator Erin Giacomelli. “And the other variable is getting to the hospital in time.”

Alice, a 68-year-old pediatric home health nurse, was lucky in both respects. Her quick response and the care she received meant she was able to leave the hospital just one day after her emergency visit. And she didn’t have to face a long, challenging course of rehabilitation.

“I’m so grateful for everyone who saved my life. But someone along the way told me that I played a role as well, and in a way, saved my own life. I was proactive and got to the hospital as soon as possible,” she said.

Recognizing signs of a stroke: Alice’s instincts helped save her life

When Alice woke up on June 4, 2025, her right arm and leg felt a little strange. She dismissed the strange feelings at first, blaming her soreness on a bad night’s sleep. She hoped she’d feel better soon and headed to her car, intending to take a short drive to a coffee shop, but she pulled over almost immediately.

By then, she knew something was very wrong. She looked up in her rear-view mirror, smiled and noticed that her mouth was asymmetrical. Facial drooping is a telltale sign of a stroke.

“I knew from my nursing training that this was a sign of a stroke. Combined with the weird feeling on my right side, and I realized … this is bad. I thought, ‘Oh my god, I am having a stroke.’”

Alice immediately called 911. Firefighters arrived but were not certain she was in immediate danger. Alice trusted her gut and waited for the paramedics to arrive. She fell trying to get out of her car. Paramedics placed on a gurney and asked her to smile.

“They told me I was having a stroke there and then. They put on the flashers and sirens, and we were on our way to the ER. By the time we got there, only 15 minutes or so had passed. I didn’t feel that bad, but I was having a stroke the whole time.”

Paramedics took Alice to the University of Colorado Hospital ER on the Anschutz Medical Campus, where the stroke team was all ready for her. They knew that every second would count as they sought to prevent any neurological damage and physical impairment.

Every moment counts when it comes to a stroke

People who work with stroke patients often use an expression, “time is brain.” That’s because for every 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.

In the U.S., strokes are the fifth-leading cause of death and a major cause of long-term disability. Strokes can happen to anyone and can vary in appearance.

“The earlier we see patients, the more we can do for them,” Giacomelli said.

Stroke experts, like Giacomelli, remind people to think of the acronym FAST when it comes to awareness and treatment of strokes.

Remember FAST:

• F – Face: Look for drooping or an uneven smile.
• A – Arm: Check for arm weakness.
• S – Speech: Listen for difficulty speaking or slurred, jumbled speech.
• T – Time: The most important action you can take is to act fast. If you observe any of these symptoms, call 911 immediately.

It’s also vital to watch for:

• Balance: Sudden difficulty standing or walking.
• Eyes: Sudden loss of vision or double vision.

When it comes to strokes, every second counts. Calling 911 immediately can make a significant difference in how well a stroke survivor recovers. That’s because doctors can prepare for stroke survivors when they’re en route to the hospital and now have an important and powerful clot-busting drug called TNK that can stop brain damage in its tracks. To work effectively, TNK must be given within 4.5 hours after a person suffers a stroke.

Since Alice told the stroke team that she had gone to bed the previous night feeling well, the team was cautiously optimistic that her stroke occurred when she woke up, which meant she could be a candidate for TNK.

But they needed to be sure.

Stroke team assesses Alice to see if clot-busting drug TNK can help

There are two types of strokes: “hemorrhagic,” stemming from a brain bleed, or an “ischemic,” caused by a brain clot. Most strokes are ischemic. And TNK works on brain clots.

When Alice arrived, the stroke team first performed a CT scan of her brain. If she had a bleed, it would appear as bright white in the screen, but there was no sign of hemorrhaging. Next, she had an MRI to help gauge the timeline of the stroke to ensure it was within that 4.5-hour window for the TNK to work.

“When the clot goes to the brain, it acts like a clog blocking a drain in a pipe. In the best of circumstances, TNK breaks the clot up and gets blood flowing into the brain again,” said Dr. Nicole Gonzales, the neurologist who was in charge of Alice’s care when she arrived in the ER. “If the injury is not permanent, those cells trying to stay alive will recover.”

Alice’s case became a little tricky when the stroke team saw evidence in Alice’s brain of not only her most recent stroke, but of an older one as well, both in the same location.

Gonzales, who is also a professor of neurology at the University of Colorado School of Medicine, worked with neuroradiologists to examine the images in depth — and in real time — and determined that the older stroke signs were several months or even years old.

Knowing this, she was confident that Alice was a good candidate for TNK.

“We have this great treatment, but it is time-dependent,” Gonzales said. “My advice for everyone is to know the signs and symptoms of a stroke and call 911 immediately, because we have other advanced imaging that can extend the window of treatment if needed.”

Along with the do’s of getting help quickly, Gonzales offered some don’ts. These include not going to sleep if you are experiencing stroke symptoms. And don’t discount blurry vision and dizziness or challenges with balance.

“There is typically some degree of injury from a stroke. We get the most rapid recovery within the first three months. After that, you get some improvement, but it’s a slower process. But using TNK is a way for patients to have a chance for a full recovery.”

After doctors gave Alice TNK, nurses took her to the intensive care unit, and she was already on the road to recovery by the time she reached her room.

“I was getting the feeling and ability to move my face and right leg and arm. It was changing almost immediately. I was so happy then because I knew I would not have a disability,” she said.

Recognizing signs of a stroke early helped Alice avoid lasting damage

During her short hospital stay, Alice had several assessments, and she’s doing great.

“Alice was an amazing patient,” Giacomelli said.

She followed up with Alice in the days after her stroke with additional stroke prevention education. This is standard protocol with patients, including making sure they have connected with additional services if needed, such as physical and occupational therapy or other medical interventions. Prior to discharge, referrals are placed for all these therapies.

Giacomelli said it’s important for patients to work with their primary care provider, especially if they smoke, have high blood pressure or cholesterol or other chronic conditions that could put them at a higher stroke risk.

“Know your health history and that of your family, and work with your doctor to lower your risk of stroke as best you can,” Giacomelli said.

Alice’s stroke story ends with gratitude, recovery and a promise to quit smoking

Alice, who enjoys gambling in her spare time, didn’t take any chances the day she got herself to the hospital.

Alice now said her right arm and leg are “perfect” and that her mental state is “fantastic.”

Looking back as to when she might have had the undetected stroke, she recalled months before feeling off her game and losing her balance, though she didn’t think too much about it at the time.

Aside from a baby aspirin and some cholesterol-lowering medication, she is in good shape, and she has promised her 24-year-old twin grandsons, who came to visit her in the hospital, that she will try to quit smoking. (Learn more about free help if you want to quit smoking.)

“I feel wonderful and am so grateful,” she said. “I am thankful every day that I could take the TNK, and that I had such a wonderful, wonderful stroke team at UCHealth.”

Alice encourages people to listen to their instincts and consult a doctor if they suspect something is wrong.

“If someone says you don’t look like you’re having a stroke, it doesn’t mean you’re not. Go with your gut and take it seriously. It’s best to err on the side of caution. Pay attention and talk to an expert.”

“BE FAST” was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. © 2011 Intermountain Healthcare. All rights reserved.