June 10, 2014

When Life—or Near Death—Becomes Your Teacher

by Bonnie Eissner

Last summer, Robert Goldfarb, Ph.D., a professor at Adelphi’s Ruth S. Ammon School of Education, suffered a series of strokes. He was 65 and fit, with no family history of stroke, and, as a specialist in applied linguistics, he was—and remains—a noted expert in stroke recovery. Widely published on the topics of aphasia and stroke recovery, he is a member of the Academy of Aphasia and the Academy of Neurologic Communication Disorders and Sciences. “I have taught and worked with thousands of students and patients with speech, language and swallowing disorders following strokes,” he says. Life became Dr. Goldfarb’s teacher, and he shares his lessons with us.

What do you think triggered the strokes?

There was undetected atrial fibrillation. In A-fib, one of the heart chambers beats irregularly, and doesn’t fully pump. Blood pools at the base of the atrium, and when blood stops circulating, it starts clotting. After a couple of hours, when normal (“sinus”) rhythm returns, and the atrium pumps vigorously, blood clots are expelled from the heart. Some of these clots ended up in my brain.

Your first stroke was minor, but emergency room doctors missed it. Why do you think they misdiagnosed you?

They were neurologists, and used only brain scans that don’t immediately show effects of a stroke unless there is bleeding in the brain. They didn’t monitor my heart. As my cardiologist said a couple of months later, “You go to a pizza guy, you get pizza.”

What were the consequences of being misdiagnosed at first? 

I was told it was safe to drive and to travel. This resulted in my first episode occurring while I was driving on the Northern State Parkway at highway speeds. Fortunately, I recognized that my right side was getting weak and was able to get away from traffic before I became paralyzed.

You experienced the symptoms of a major stroke—a cerebrovascular event—gradually. In your words, it was “not like a light switching on, but…like a light on a dimmer.” Why do you think this was? How typical is this?

Actually, it was surprising to me. There was no loss of consciousness, no seizure and onset was more gradual than the prior TIAs [transient ischemic attacks or mini-strokes]—not what I have read and taught all these years.

What most motivated you during your long and difficult recovery?

I was determined to get back to work, even if it had to be in a wheelchair. My daughter was recently engaged, and life has been very good to me. I felt very fortunate to have retained my cognitive and language abilities, and was sure I could surmount any physical deficits.

As painful as the experience has been for you and your family, what have you learned from it?

I learned that even without a cognitive deficit, you need an advocate in acute care and rehab, as the overwhelming experience of being newly paralyzed limits the ability to concentrate. I also learned that, while it is crucial to be compliant with a daily exercise regimen, the fatigue can be beyond description.


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