"How is Matt? Has he arrived?" Audrey asked Jo as soon as she took her seat across from them. Her eyes were red and she was looking flustered.
"He's due to land in an hour" Jo replied flatly, running her fingers through her unkempt hair. "We'll know more when he gets to the hospital."
"What's going on?" Neil asked, with concern. "You guys okay?"
"They think his Mom has had a stroke" she said with a sigh. "He's flown back to Florida to find out exactly what's going on. His sisters aren't great with this kind of thing."
"I'm so sorry" he replied, reaching out and putting his hand over hers. "Don't you need to go too?"
"Not right now, but maybe in the next couple of days depending how things go" she said taking a large drink from her coffee but not giving away any more. Her eyes kept flickering back to check her cell which they would normally rib her for, but today was not the day for that.
They finished up their drinks in a sombre mood and left to carry on about their business which helped the hours pass by. At the end of the day, they insisted on meeting again and sat around the table waiting for an update. Jo confirmed Matts Mom had suffered a Transient Ischemic Attack (TIA) on right side of her brain - the side which is responsible for carrying out functions for the left side of the body.
Being qualified physicians, none of them needed an introduction to the causes and effects of a stroke. They all knew that a TIA is usually caused by a blood clot and can often serve as a warning of future strokes so should not be ignored, no matter how well his Mom might feel afterwards. When blood flow to the brain is blocked temporarily symptoms occur, which are similar to those of a full stroke, they are typically temporary and disappear after a few minutes or hours so for now, all was well.
Matt returned to California and was back to work at St Bonaventure within the week. He had tried to impress onto his Mom some important lifestyle changes but she was being particularly argumentative about it all and he returned frustrated, not confident that his other family members would follow through with her care.
"She doesn't seem to get that this was a warning shot" he sighed as he sat with Neil and Kevin in the break room where they were meant to be catching up on patient charts. "There are some factors that she can't do anything about" he continued while they listened intently. "The fact that she's getting older and that she's a woman are things we can't change but she's being so stubborn about the rest" he said shaking his head.
"Does she smoke or drink to excess?" Kevin asked. To much alcohol consumption raises blood pressure levels and using tobacco products can damage blood vessels leading to further attacks.
"She's never smoked in her life, she's proud of that" he replied. "And she only has a drink on special occasions so the only things she can really do is increase her activity levels and watch what she eats. But you try and get a woman in her sixties to join an exercise class, it's not pretty" he said with a half hearted laugh.
"At the end of the day, she's a grown woman capable of making her own health based choices" Neil pointed out to him. "Try and look at it as if you were her doctor and not her son" he suggested getting a nod of agreement from them both.
"It's just driving me crazy" he said with a sigh. "Being so far away is hard and getting her to Skype it's almost impossible" he smiled to himself.
"I hear that" Neil agreed. "My parents don't do technology very well then get frustrated when I can't make the weekly phone call! They are sent to test us I'm sure" he smiled, garnering a laugh from both of them.
As usual, the charts and the chatter was cut short by the sound of pagers ringing, getting a round of sighs as they pushed back their chairs, gathered their belongings and headed back out into the fray.
X
A couple of months later came another call from the Emergency Room at Tampa General Hospital. Matt was urgently pulled from the operating theatre mid procedure and given the news that his mother had suffered a much bigger stroke and had been rushed into the hospital on a 911 call.
As he changed quickly out of his scrubs, he barked orders down his phone to his family to let the doctors start her on clot-breaking drugs immediately. If administered quickly, the thrombolytic drugs could break up blood clots in the brain's arteries, which still stop the stroke and reduce brain damage.
This time, Jo went with along him and once they were settled and knew more, she called to update them. By all accounts, his Mom had been feeling under the weather for a few days. She had suffered with some bouts of nausea, was feeling generally unwell and was becoming increasingly agitated about it. Once she started slurring her speech and experiencing numbness an ambulance has been called right away.
"She's lost quite a bit of mobility" Jo started. "She'll bedridden for the time being. She can't move her arm or leg right now and is having some issues communicating."
By the time they had flown across the country, she had already had her CT scan results which gave a clear picture showing exactly where the bleeding and damage had occurred. Her echocardiogram was scheduled within the hour to see if the source of clot was in her heart to determine if it could have been one of those that travelled to the brain to cause the stroke in the first instance.
She was eventually diagnosed with an embolic stroke. The offending blood clot had indeed formed in her heart and moved through her bloodstream to the brain. The clot then got stuck in the brain's arteries, where it stopped the flow of blood and caused her stroke.
Since her TIA, Mrs James had been taking a daily aspirin but now she was going to have to start taking anticoagulants which would reduce her bloods ability to clot and help prevent any further strokes from occurring. Her road to recover was going to be hard work and would involve speech and cognitive therapies alongside her physical therapies.
Despite stroke being the leading cause of long-term disability, 25% of patients recover with only minor impairments and Matt was determined that his mother would fit squarely into that category. He dived straight into finding her the best speech and language therapist he could bloody mindedly insisting that even if she couldn't regain all her verbal communication skills, she would find a new way of communicating effectively.
X
The process was long and Matt stayed in Florida for the next few weeks taking compassionate leave from his duties in San Jose. Jo returned after a week but was missing him terribly while they struggled with the distance between them.
The foursome were taking a well deserved break in between procedures and were passing time speculating which of this years resident intake would fall victim to the axe. They recalled the end of their first year and marvelled, quite rightly, about how far they'd come since then.
Kevin had spoken to Delun just the week before and he was thriving in general practice as expected. He was gaining respect in his field and was inline to become a partner in his offices. None of them had heard from Alex in some time, he had dropped off the radar after a couple of years of sporadic contact. He posted pictures on social media now and again and he looked happy and well but that was about it.
"He transferring his residency to Tampa General" Jo said quietly when the conversation hit a natural lull. "And I'm going to go with him "
Their heads snapped to attention at the declaration, not believing what they had heard.
Kevin sat back heavily in his seat, tears filling his eyes. He had no words.
"What" Audrey exclaimed. "You're leaving?"
Jo just nodded.
"When do you go?" Neil asked quietly.
"End of next week" she replied, her own eyes filling up on hearing Audrey gasp and clap her hand over her mouth.
"So soon?" she asked.
"I'm afraid so. Matt needs me" she replied flatly. "There are a couple of vacancies in the Tampa area I'm going to apply for but right now, I just need to go."
There was a couple of seconds of silence which was broken by the sound of Audreys chair scraping back and her leaving the room without another word. Jo moved to follow until Neil covered her hand.
"I'll go" he said. "Talk to him" he said, nodding at Kevin who was sat looking shell shocked.
Walking briskly down the corridor he tried to think of where she would have gone, it couldn't have been far as she was still on duty. He asked a passing nurse to check the ladies locker room to no avail and continued his search.
Eventually, he saw her sat alone on a bench on the concourse to the parking lot. She looked up as he approached and the look in her eyes made his heart hurt. She was so sad.
"I thought if i sat in public, I wouldn't cry" she sniffed. "I was wrong."
"Can I sit?"
She nodded and turned her attention back to the floor in front of her.
"It's stupid, I know" she started. 'We're adults and I know we aren't going to stay together forever but I just wasn't expecting it to be so sudden."
"Florida isn't that far away and we are allowed vacation days, you know?"
"I know, I know, I need to go and apologise. I'm just not so good at making friends and having one of them up sticks and leave is just unsettling."
He took a breath before reaching his hand out, placing it gently on his shoulder. She turned abruptly and leaned into his embrace much to his surprise.
They sat for a few minutes in silence for her to compose herself before she sat back up.
"I'm going to go find Jo" she said quickly. "Before I lose my composure again" she laughed nervously.
Feeling a last surge of bravery, Neil reached out and took her hand.
"I'm not going anywhere you know?" he said as she turned and looked at him.
Seeing the sincerity in his eyes, she felt a small amount of relief seep in.
"I know" she smiled, squeezing his hand before getting up and pulling him to his feet. "Now let's go and arrange the farewell bash our friend deserves."