'Angels' in the ED: Survivor Returns to Cedars-Sinai to Thank Stroke and Emergency Teams

Jerry Castro receives a hug from Laurie Paletz, RN, as stroke team nurse Nili Steiner, BSN, RN-BC, CEN, looks on.

Most people take something like making the bed for granted, but being able to do just that is one of many reasons Jerry Castro came to thank the "angels” of Cedars-Sinai's stroke team and Emergency Department.

That’s the message the 49-year-old Castro delivered when he returned to the medical center to credit the teams for saving his life after he suffered a potentially debilitating stroke in March. Members of the Ruth and Harry Roman Emergency Department and stroke team gathered in May to hear Castro’s emotional message.

"I feel like I did before my attack. I feel good," he said. "I feel happy, strong, more aware and very grateful to all you guys. Thank you so much.

"I never thought (having a stroke) would happen to me, but it could happen to anybody and it happened to me for a reason. God got me through it so that I am able to stand here now to thank the emergency and stroke teams for saving my life. Every single one of you is an angel to me – and I say that with my heart and soul."

Know the Signs of Stroke

  • Sudden numbness, weakness or inability to move the face, arms or legs, especially on one side of the body
  • Sudden trouble seeing in one or both eyes, including dimness, blurring, double vision or loss of vision
  • Sudden confusion or trouble speaking
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headache with no known cause

On March 17, a friend noticed Castro’s face starting to droop during a conversation. He also was having issues walking, and was slurring his speech. Castro himself didn’t realize something was wrong until his left arm went numb and his phone dropped to the ground. His friend rushed him to the hospital.

Brain cells die every second during a stroke, which is why it is vital that emergency medical services be activated immediately by calling 911.

"Not recognizing your own symptoms and not activating medical services are two of the major reasons why stroke care is delayed," said stroke team nurse Nili Steiner, BSN, RN-BC, CEN, who cared for Castro. Such delay can lead to permanent loss of cognitive and physical abilities, and even death. Steiner said rapid recognition of stroke symptoms and activation of emergency medical services is something they stress with patients before they leave the hospital.

Once the Cedars-Sinai's emergency department team determined Castro was having a stroke, they called a "Code Brain," which is when members of the Cedars-Sinai's stroke team responded.

On any given day, the stroke team is comprised of a neurology attending physician and stroke nurses. They work closely with the Emergency Department's physicians and staff to provide the patient with the highest level of care. That kind of teamwork is imperative to maintaining the level of care patients need, said Laurie Paletz, BSN, PHN, RN-BC, the stoke team’s coordinator.

"Every team has a most valuable player, and the stroke team's most valuable player is the Emergency Department," Paletz said. She also noted that professionals in the laboratory and imaging play a vital role in giving patients proper care.

Castro was taken to get a CT scan done within minutes of his arrival at the hospital.

"Rapid recognition is what is so important about the success of this outcome. The triage right away knew they needed to get him back there," Paletz said. "If he were sitting in a waiting room for two hours we would have missed the opportunity to help him."

During the scan, Steiner said members of the stroke team prepared to administer tPA – tissue plasminogen activator – which can sometimes clear a blocked artery, restore blood flow to the brain and reverse the stroke’s effects. When Castro’s symptoms worsened, the tPA was administered immediately.

There are serious risks associated with the use of the drug therapy, including bleeding in the brain or in other parts of the body.

"The stroke team had only a few minutes to sort things out and make the right decision, which they did," said Patrick Lyden, MD, who heads the Department of Neurology and is the director of the Stroke Program.  

Even after the tPA was administered, Castro’s health was still declining. A nurse and doctor in the neurointensive care unit notified neurosurgeon Michael J. Alexander, MD, who administered a intra-arterial thrombectomy. Alexander, director of the Cedars-Sinai Neurovascular Center, threaded a hair-thin catheter through Castro’s femoral artery and into his brain to remove a clot.

"And I am so grateful to each and every one of you," Castro said to the group. "I’m able to be with my family. I have a graduation with my niece that I’m going to be able to see. I’m a great uncle and my great nephew just had his second birthday that I got to celebrate with him last weekend."

Cedars-Sinai was among the first four medical centers in the country to achieve Comprehensive Stroke Centers recognition from The Joint Commission and the American Heart Association/American Stroke Association in Los Angeles County.

Additionally, the Stroke Program has received the American Heart Association/American Stroke Association: Get With The Guidelines-Stroke Gold Plus Achievement Award and the Target: Stroke Honor Roll Award. These awards are for compliance with guidelines that improve stroke care and for reducing door-to-treatment times when patients arrive at the emergency room.

Some of the key players who were instrumental in Castro’s care are Shlee Song, MD, associate director of the Stroke Program, and resident Mani Nezhad, MD. Other stroke team members include Nicole Wolber, BSN, RN-BC, and Betty Robertson, BSN, RN-BC, CEN.

"No one could do their job with out someone else doing their job, and doing it well," Steiner said. "It reminds me of very strong links where every department grasps arms, so we can ban together to surround this patient with all our technology and all our resources."

(l-r) Paletz, Nicolette Roman, RN, Castro, Steiner, Zachary Lutsky, MD, and Betty Robertson, RN