Harrison Ogle

3/27/2023
Professional Roles II

Psychology of Stress Project

Interview Schedule:
Background information
 Who? My aunt
 Diagnosis: R CVA
 Cause: Unknown: Doctors think there might have been a tear in her right internal carotid
artery, but upon imaging they were not able to find anything and were never able to
confirm
 When: February of 2004
 Age at the time of the stroke: 29 years old
 Comorbidities or previous health conditions prior to the stroke: none
Health prior to/at the time of the stroke
 In the week, days, or hours prior to your stroke, did you notice any changes in your
health?
 Where were you at when you had your stroke?
 Was anyone there with you when you had it? Were you taken to the hospital by someone
or did an ambulance take you?
 What do you remember as you were having your stroke? What was it like shortly after?
 Did you receive the clot busting drug? Any other testing/imaging done?
 Was anyone with you in the hospital at this point in time?
 Do you have any recollection of emotions or memories from that night?
Acute Care stay following stroke
 What impairments did you have in the days following your stroke?
 How long did it take you to recognize that you had a stroke and that you were unable to
do certain things?
 What were your emotions and mental health like after recognizing that you had a stroke?
 Was their anything or anyone that comforted you during this time? Who was there with
you on a consistent basis in the hospital?
 What were your experience with healthcare professionals while in the hospital?
 What did you find was the best way to grieve with your current situation
Inpatient Rehab
 How long were you in inpatient rehab? Did you have just PT and OT or did you have
you have speech as well?
 What were your interactions with healthcare professionals like at this point? Any
difference from the acute care setting? What was your overall experience like in
inpatient rehab?
 What did you feel went well during this phase of rehab? What memories or emotions do
you remember having during your rehab?
 What were your emotions and mental health like at this point? Was anything easier or
harder? What were your biggest worries or fears during this time?
 Who was there with you during your time in inpatient rehab? Did you find it helpful
having people around?
 What kept you motivated while in inpatient rehab?
Months to 2 years following stroke
 What was it like going back home? Did you find any new challenges that you didn’t
experience while in the hospital or inpatient rehab?
 What were your emotions and mental health like at this point? Did you notice any
changes? Did you feel you were better able to cope at this point? What were some of the
difficult times and situations like?
 How was reintegrating back into society like for you? Besides physical challenges, were
there any emotional or psychological challenges?
 Were you on any medications following your stroke? Did you receive any home health or
outpatient physical therapy?
 What were your goals at this point?
 Did you have to make any modifications to your home? Did you have to have anyone
around to help you out at home?
 Where you able to return to work? What was this like for you?
 What was it like to socially integrate back into society with your friends and family? Any
boundaries or experiences you would like to share?
2 years to present time
 What made you decide to have kids? When did you decide to have kids? What were your
pregnancies like? Did you receive push back from doctors?
 What are some things you never thought you would be able to do again that you can do
today?
 Do you have a new outlook or perspective on life since your stroke? What are somethings
that give you purpose and meaning in your life?
 Do you still experience challenges today? How do you address those challenges?
 What does life look like today?
 What are some things that worry you about your future?
 Psychology of Stress Paper

The beauty about life is that we all experience it in our own unique way. No two lives are

the same and we get to make the most out of own lives and experience life in a way that best

suites us. Unfortunately, life doesn’t always go as planned. My aunt is a great example of how

one moment can change your life and the way you experience it forever.

In January of 2004, my aunt started to experience pounding headaches, indescribable

facial pain, difficulty hearing, noise sensitivity, and “floaties” in her eyes seemingly out of

nowhere. She was a healthy, newlywed 29-year-old who loved to run with no previous history of

any medical conditions of any sort. These symptoms persisted for the next couple of days

making work difficult which rose enough concern that she decided to reach out to her PCP for

medical advice. Her PCP did some medical screening, but determined that nothing was wrong

with her and referred her to an optometrist for further screening. The optometrist then

determined that she had ocular migraines and told her, “you’re lucky you don’t have the

headaches that go with it.” The thing is, she did have those headaches and she had never had

migraines before. She left frustrated and feeling that nothing was adding up or making sense in

terms of the doctor’s explanation. Something else had to be going on, and she was right. My aunt

and her husband worked together in the same accounting firm and were out at lunch two days

later when she noticed her vision and hearing had suddenly worsened. She felt a sense of panic

and daunting feeling of something terribly wrong, but she chalked it up as one of those ocular

migraines in order to give her self some peace of mind. Unfortunately, 3 hours later while she

was sitting at her desk, her left hand suddenly clenched up on her and she had that feeling once

again that something was wrong. She called my uncle who ran over to her cubicle to help her and
by the time he got there she was unable to move, had facial drooping, and slurred speech. 911

was immediately called and she was rushed to the hospital where she was given tPA and sent for

an angiogram which showed a hematoma and potential dissection of her internal carotid artery.

Due to the physical and emotional trauma the stroke had on my aunt, she was really unable to

remember or relay any information about her experience and emotions in the days following her

stroke. She described that time in her life as a blur and credits her brain to blocking out any

emotions or experiences at that time since it was such a traumatic time in her life. She was able

to recall generalities like who was there during the time, the neurological testing they did, and a

few other large events, but the details and specifics of that time are missing. She said it took

about 5-7 days for her to comprehend the reality of her stroke and the impairments she was

dealing with. Emotionally, it was like a ton of bricks came crashing down on her at once. She

was experiencing any and all emotions at once, each one cutting deep and overwhelming her

leaving her mentally, emotionally, and physically exhausted. In her words, “The “old” Kristin

and person everyone knew died that day, but at the time, I didn’t realize the new me had been

reborn.”

Interestingly, she felt no resentment toward her PCP or optometrist who had screened her

prior to and potentially missed signs of a larger, more life-threatening issue. She understood that

given her young age and seemingly perfect health status at the time that the idea of a stroke or

vascular issue wasn’t even on the table. “I don’t think any of my doctors could have prevented

my stroke” explained my aunt. “Yes, I felt like something bigger and more complex was causing

my problems, but never did I think it was a stroke.” I think this speaks to her character and just

how strong and understanding she is as a person. She could have easily blamed the doctors for
her situation and allowed anger and hate to fill her mind and heart, but she didn’t. This of course

isn’t easy, but was necessary for her grief and acceptance of her new life to come.

Throughout our interview, she made it very obvious that she was in the Acceptance stage

of Grief based on the Kubler-Ross model of grief and grieving. Acceptance in the sense that life

after stroke is going to be different and more challenging than life previously, but that she can

still live a life of meaning and purpose. According to the model, this stage is characterized by the

stabilization of emotions and re-entry into life and reality knowing that there will be ups and

downs, but life goes on and you can continue to adapt and grow.1,2 Throughout her journey and

recovery from stroke she has transgressed through each stage of grief as she went from acute

care to in-patient and then to home. During each change in setting and progressive recovery she

experienced all stages of grief because as she recovered she would experience new and difficult

situations and challenges that were unique and not previously experienced by her. When she

progressed from in-patient rehab to home she experienced the lowest point of her life mentally

and emotionally. She felt lost in her new life and couldn’t comprehend how she could ever

reintegrate back into life and society. Life had no purpose and she was struggling to find

meaning when she had so many issues and problems going on. This led to her being on

antidepressants for over a year and seeing a mental health professional to help cope with life

after stroke. Ultimately, faith and her relationship with God helped bring her out of the dark hole

consuming her life. Through religion, she was able to find meaning and new found purpose that

led her to aggressively pursue outpatient rehabilitation. She wanted to be able to go back to

work, have hobbies, be a wife, and start a family, and the only way she could do that was if she

took control of her life. Today, she has two kids, works, mows the lawn, shovels snow, and does

just about anything and everything you and I are able to do despite only having function in one
arm. Yes, she has plenty of days where she gets upset or frustrated that she can’t do something,

or something that used to be simple is now complex and challenging, but she doesn’t dwell on

those situations. “Of course I still have difficulties with a lot of things and I have my bad days,

but I don’t let those consume me or affect me like they used to. Being upset or mad doesn’t

change the fact that I have a stroke, so instead I give myself a few minutes to feel that way and

then I move on with my day.” She is not someone who lets her stroke define who she is or lets it

get in the way of her doing things which she mentioned multiple times. While stroke has

changed her life in a negative way, she feels it has offered her a new unique experience with a

greater appreciation and outlook on meaning and purpose in life.

My aunt has always been one of my core purposes for wanting to work in healthcare and

help care for people. I was lucky enough to have seen her multiple times throughout her time in

in-patient rehab and even watched my dad work with her when she would visit us or we would

visit her. Having the opportunity to sit down and actually talk about her stroke and better

understand everything that happened was an invaluable experience for me. I learned things that I

had never knew prior to this interview like the symptoms she was having in the 2-3 weeks prior

to her stroke. As soon as she started talking about the issues she was having my mind

immediately went to vascular compromise or issues. This then brought some feelings of

frustration because I felt the healthcare system and her doctors had failed her. How could they

have missed that and then just dismissed it as ocular migraines? It felt like a disservice had been

done, but then I tried to put myself in their shoes. Her is a young and healthy individual coming

into your clinic with complaints of what seemingly could be migraine related symptoms. Serious

pathology or physiological compromise probably isn’t at the top of the list since she was such a

healthy and young person. You also don’t want to mistakenly medically complicate the situation
and cause unnecessary panic or worry to the patient because that doesn’t help the situation either.

It is a tough situation and dilemma to be in and makes me wonder if I have ever dismissed some

pathologies based on previous medical history and current patient presentation instead of really

listening to their current complaints. This is where I think narrative medicine has huge

implications for physical therapists and is something I want to incorporate as part of my practice.

We need to let the patient have the spotlight and fully engage with the story they are telling us

recognizing emotions and concerns they express during their story, and in response to what we

tell them. If we want to practice best practice like we say we do then we must actively participate

in best practice and incorporate narrative medicine principles into our practice.

Another thing that struck me throughout this interview was her admiration and

appreciation for all members of the rehab team along her journey to recovery from stroke. She

spoke highly of PT and OT mentioning that they always gave her hope and inspiration that she

would be able to do anything she brough up to them. The approach was “yes, there is a way you

can do that” or “we can figure out a way to do that” instead of just dismissing things because she

had a stroke. When she decided she wanted to have a family some of the doctors where hesitant

with one of the doctors saying, “How are you going to take care of your kids?”. She never had

anything bad to say about her physicians, but I don’t think her experiences with her physicians

were as impactful and meaningful as those with the rehab team. She gave so much credit to the

rehab team’s willingness to go above and beyond to help her regain function and improve her

quality of life. “They helped me figure out how to do things I specifically wanted to do, but they

also helped me with things I never even thought of that were actually helpful for me to complete

a lot of different things. They are family to me and I wish I could still go to therapy on a regular

basis.” This statement is why I chose to go into rehab. The impact we have on our patient’s lives
and the relationships we are able to build with our patient’s is second to none. This is a reminder

of why the long nights and early morning’s are worth every moment and why I will continue to

push myself to be the best possible clinician I can be for my patients.

After this project, I really think I gained a new perspective on how long the grieving

process can be and just mentally and emotionally affected our patients can be. We tend to focus

on the physical challenges that our patients are facing, but I’d argue that the mental and

emotional aspects are just as challenging if not more challenging. Stroke is not something that

happens and then eventually you get over and move on with life. Grieving and coping continues

as you progress through rehab and may look drastically different at different points in our

patient’s progression. I would have thought that my aunt’s lowest point would have been in the

acute care hospital when she first came to terms with stroke and when her impairments were the

worst. Instead, it was upon her integration into society and reality even though she had

progressed enough to go back home and discontinue medical care. It was the point where she had

gained just enough function and confidence to return to society, but not enough to be successful

and understand where life goes from there. It was insightful to hear and I think it is a pivotal time

where physical therapist can give them the confidence, guidance, and function to be successful in

their new life moving forward. Life and our experiences are unique to each and every single one

of us, but we have the opportunity to help our patients experience life in a meaningful way that

gives them purpose.

My love and appreciation for my aunt has grown as a result of this project and I think I

gained a new perspective on what gives life meaning and purpose.

References:
1. Stroebe M, Schut H, Boerner K. Cautioning Health-Care Professionals. Omega
(Westport). 2017;74(4):455-473. doi:10.1177/0030222817691870

2. Five stages of grief - understanding the Kubler-ross model - psycom.

https://www.psycom.net/stages-of-grief. Published June 7, 2022. Accessed March 28,
2023.
3. Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and
Trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897
4. Whittemore R, Dixon J. Chronic illness: the process of integration. J Clin Nurs.
2008;17(7B):177-187. doi:10.1111/j.1365-2702.2007.02244.x
5. Hughes AK, Cummings CE. Grief and Loss Associated With Stroke Recovery: A
Qualitative Study of Stroke Survivors and Their Spousal Caregivers. J Patient Exp.
2020;7(6):1219-1226. doi:10.1177/2374373520967796