James Hall is one of 35 people to experience a documented pontine stroke—a stroke that leaves a person's mind trapped in a body that is dead. Once brash, cocky and philandering, Hall enjoyed the high life, but all that changed in an instant. In fact, after his stroke, his life was nearly terminated by his physicians, who believed he was brain-dead. Was he really alive? Friend and colleague Patton Howell, Ph.D., helped reveal that Hall's mind was fully functioning. Here is an account of his stroke and the days following it.
On the morning of April 11, 1991, James Hall didn't wake his wife to say goodbye. In fact, he hardly noticed her. Looking through his closet, he picked a designer Harris tweed suit and coordinated tie. Leaving his rambling ranch house in fashionable North Dallas, he drove his Jaguar to his psychiatric offices. There, he called the manager of his West Texas ranch, saying he would be out in a few days to oversee the year's branding of cattle. Later, he was on the LBJ Freeway to the airport.
During the flight, he sensed that something was wrong. He had just made it to the men's room when he vomited. Maybe he had had too much alcohol.
Getting the rental car was a chore as usual. The gearshift seemed awkward; he felt disoriented. This was not his Jag. Something felt urgent. What is...? Hospital! Had to find a hospital. It was hard to read the signs.... Where was he? Lost. A truck stop loomed ahead. He parked the car somehow and dashed through the rain. It was late at night. He needed to urinate badly. Where were the rest rooms? He found them just in time. Now he must ask for directions. He approached the girl behind the counter. She seemed frightened.
Did he look as if he were going to rob her?
“I am just lost,” he tried to explain, and his words became a jumble .
She looked at him with alarm. He couldn't even understand himself; he stumbled off. The rain had become a slow drizzle as he fumbled to unlock the car. He drove off into the strange black night.
Suddenly there was a loud ringing in his ears. He spotted a graveled shoulder, pulled over and leaned his head back on the car seat. The ringing didn't go away. Ahead through the slow rain he saw what looked like an official building of some kind. The ringing got louder; he eased the car across the highway and stopped in front of the building. Legs. The legs. Head. Pain, pain, pain, pain.
Locked in
Susy, James' wife, answered the phone at five the next morning. Someone from the Akron, Ohio, hospital told her that Dr. Hall had had a serious, life-and-death stroke. Susy flew to Akron. At the hospital, she was greeted by a visibly embarrassed doctor, who told her that another woman was already there taking care of James. Susy said, “Then, in that case, she can have him.” Later, the other woman left the hospital; she was not coming back. A few days later, a former patient of James' provided a private airplane that flew James home to Dallas.
Back home, Susy called me for help. The staff of the Dallas teaching hospital had assigned James his own suite. I approached the door and leaned my head against it for a moment and tried to prepare myself. Susy slipped out and thanked me for coming. Inside, it was like breaking into a sepulchre. The room was absolutely still. It had the atmosphere of an empty room, as if no one were alive. I approached the bed slowly and contemplated James' body. His skin was cold. It had no resilience. His body was like a laid-out corpse.
Think of someone's face—even in sleep there are subtle signs of awareness of the outside world, imperceptible movements around the eyes and mouth. The skin has a radiance that reaches out and touches you. When a person is dead, that radiance disappears. The tone of life is gone.
I reached over and pushed the skin on James' face. Nothing. I pushed the flesh of his shoulder. It was like pushing a shoulder of beef at the grocer's; no response, no tingle of life. Suddenly my hand darted out to the carotid artery in James' neck. Yes, his body was alive.
Problems of the brain and mind were my field and one in which I have written extensively. I began pacing the room, waiting for Bill Moore, a colleague and friend of ours, to arrive.
Bill always looked as though he would be more comfortable outdoors. He had overseen the training of two generations of psychiatrists at the Southwestern Medical School here in Texas. Bill was known to be a mountain of strength in crises such as this, but now he appeared pale and haggard. The reports of his old friend's condition left his eyes brimming with pain.
This was the classic Locked-in Syndrome. The statistical chance for survival was one out of 10. More than that, what was the chance of a meaningful life without his body? The statistics on this hardly gave James a chance.
The lack of tone in James' face implied that the stroke must have occurred in the pons area. I showed Bill the sketch I had made: an artery split in the midbrain by the pons. Apparently there was a blockage, probably cholesterol, in the artery, which caused the split. Not only did brain cells die from the lack of blood, but they were traumatized by the pressure of blood leaking from the split artery. I guessed that this midbrain pons area had been wiped out along with much of the lower cortex.
