Amelia Bedelia Goes to Medical School
Rutgers Stroke Center team saves Amelia Bedelia author Herman Parish
'Dr. Gupta says I won the lottery – three times in a row. We beat the odds, surviving three crises – the aneurysm, the hydrocephalus, and the vasospasms – making a complete recovery.'– Herman Parish
In May of 2014, Herman Parish awoke early one morning with “the worst headache I ever had,” he recalls. Still, he thought he’d get on with his plan for the day: to continue working on Amelia Bedelia Cleans Up. The book was slated to become the latest in the well-loved series created in 1963 by Parish’s aunt, the late Peggy Parish.
Three generations have grown up with tales of Amelia Bedelia, a delightful, literal-minded housekeeper. In 1995, seven years after his aunt’s death, Parish decided to continue the series, expanding it to reach a wider range of young readers with stories of
Amelia growing up as an equally literal, comic and charming child. He has added 39 stories from picture books to chapter books.
But that day’s plan was not to be. When Parish stood up from bed, the headache exploded with unbearable pain. He collapsed, unconscious and not breathing. A “thunderclap” headache, one that ranks 11 on a scale of one to 10, is often the first symptom of a stroke or brain aneurysm. Luckily, Parish’s wife, Rosemary, a trained nurse, was nearby. She heard him hit the floor and immediately called 911.
Emergency medical technicians transported Parish to the emergency department at nearby University Medical Center of Princeton at Plainsboro. Often, when a cerebral artery ruptures, it hemorrhages blood into the brain, with devastating consequences—and indeed, a CT scan revealed “a brain full of blood,” says Rosemary Parish. Her husband had suffered a life-threatening hemorrhagic stroke and required the most advanced care.
Fortunately, the Comprehensive Stroke Center at Robert Wood Johnson University Hospital (RWJ) was only 20 minutes away.
Extraordinary People Offering Exceptional Care
“A situation as complex as Herman’s requires the resources, both human and technological, of a dedicated, multidisciplinary center like the one at RWJ,” says neurosurgeon Gaurav Gupta, assistant professor of neurosurgery, Robert Wood Johnson Medical School. Gupta is the director of cerebrovascular and endovascular neurosurgery and the New Jersey Brain Aneurysm and AVM Program, a partnership between the medical school and the hospital.
The Joint Commission–certified stroke center offers a comprehensive, multidisciplinary team led by two outstanding specialists in brain aneurysm treatment: Gupta and Sudipta Roychowdhury, clinical assistant professor of radiology, Robert Wood Johnson Medical School, and director of interventional neuroradiology, Robert Wood Johnson University Hospital.
By the time the ambulance arrived at the Emergency Department, Parish was in a coma, and his brain was beginning to shut down. A sophisticated 3-D CT angiogram revealed a catastrophic rupture of an aneurysm in the right vertebral artery. This is one of the four major blood vessels that feed the brain, and this type of aneurysm can be particularly dangerous and challenging to control.
Blood had leaked into the water system of the brain, clogging it and creating a condition called hydrocephalus. It put pressure on the brain that risked damaging the tissues, potentially leading to long-term neurological problems or death. To relieve the mounting pressure, the team inserted a tube into the brain, an external ventricular drain, to divert the cerebrospinal fluid.
Repairing the Dissection
Next, the team transferred Parish to the Stroke Center’s state-of-the-art Neurointerventional Suite, one of the most advanced in the country. Through a small incision in the patient’s groin, a catheter was inserted into the femoral artery. Guided by fluoroscopy—a real-time, moving image on a giant television screen—the team then threaded a series of slender catheters through the network of arteries that led into Parish’s brain.
“Our arteries are like the interstate highway system,” says Gupta. “All the blood vessels of the body are connected to each other. The femoral artery was like an entrance ramp, our route to I-95—the aorta—which we followed past the kidneys, liver, heart, and carotid artery, to the ruptured vertebral artery, in his brain.”
Inserting a microcatheter into the original catheter, they de- livered a stent to the ruptured artery in the hope of supporting it. “We didn’t like the look of it, though,” says Dr. Roychowd- hury. “We were afraid it would rupture again, so we combined the stent with a coil (an ultrathin metal spiral), so the dissected artery was both supported and permanently blocked.”
“Fortunately,” says Gupta, “nature has designed us to have two each of many parts—right and left, front and back. Having both a right and left vertebral artery gave us the option of blocking off the damaged vertebral artery, while preserving the flow to the most important blood vessel of the brain, the basilar artery. That was essential.”
Through the tube in the brain, they washed as much leaked blood as possible out of Mr. Parish’s brain to reduce the risk of a potentially deadly condition called “cerebral vasospasm,” constriction of the irritated arteries, which can lead to a second stroke.
Vasospasms did develop, however, four days after the surgery. To keep the arteries open, Gupta and Roychowdhury “sprayed” them with the drug Verapamil, accessing the brain through the external drain. Then, three days later, without warning, a major vessel, the critical basilar artery, began to spasm, defying the Verapamil.
Without alternative treatment, Parish would have survived only a few more hours, so the doctors took a radical step: they performed a balloon angioplasty (inflating a tiny balloon inside the constricted blood vessel), to open this major cerebral artery. “The surgery itself was life threatening, and only a handful of surgeons have done it,” says Gupta. “But it worked: the artery was opened, and blood flow was restored. We’d made it over the ‘third hump.’”
Altogether, Herman Parish spent 17 days in the intensive care unit, where he overcame a “calamity a day,” he says. Rosemary Parish devoted her waking hours to her husband. Her day started as doctors made early morning rounds, and she stayed with him until she had to go home to sleep. “Herman was receiving phenomenal care,” she says. “Dr. Gupta seemed to be there around the clock, but I was determined not to be absent. I wanted to be there for both of our sakes, holding on to my firm vision for his recovery.” Their three children gave their parents love and support throughout the ordeal.
Tricking Death and Saying Thanks
Fortunately, the worst was over. “Dr. Gupta says I won the lottery—three times in a row,” says Parish. “We beat the odds, surviving three crises—the aneurysm, the hydrocephalus, and the vasospasms—making a complete recovery.”
After regaining strength in a rehabilitation center, Parish returned home. He gradually returned to writing, resuming Amelia Bedelia’s adventures where he’d left off.
He completed Amelia Bedelia Cleans Up, dedicating it to Gupta and Roychowdhury, and later visited RWJ to present a signed copy of the book to each member of the large staff involved in his care. Finally, he resumed his visits to schools to talk to the children about writing and about Amelia Bedelia. “It was tough at first,” he says, “but it soon felt like easing back into a comfortable suit of clothes.”
From Parish’s first day at RWJ, he wore a bracelet identifying him as “Brody Taylor,” an alias proposed by the ICU team to protect his privacy. Almost no one at the hospital knew that a popular children’s author was in their care. “We take patient privacy very seriously,” says Gupta.
Months later, after returning home, Parish recaptioned a New Yorker cartoon and sent it to Gupta, along with a thank-you to the Stroke Center staff. In the cartoon, a bespectacled man responds to a knock at the front door, only to find “the grim reaper” waiting for him.
“Herman Parish?” responds the man, in the new caption. “Sorry. My name is Brody Taylor.”
And Death left, empty-handed.
A version of this article appeared in the Spring 2016 issue of Robert Wood Johnson Magazine.
Illustrations: Lynne Avril