Bethany suffered the ischemic stroke—caused by a blood clot in her brain—on a January evening after coming home from basketball practice. She was in the shower when she suddenly became paralyzed on the left side and unable to talk without slurring her speech.
"I didn't know what was happening. Because there wasn't any pain, I didn't think anything was wrong," says Bethany. "I figured if I could just get up on my feet, I could walk. I didn't realize there was actually something seriously wrong." Listen
An ambulance rushed Bethany to Memorial Hospital and Health Care Center (MHHCC) in Jasper where emergency physician Dr. Christopher Scipione determined she was having a stroke. He knew the only hope for Bethany was a clot-busting drug called tissue plasminogen activator (tPA), but the drug carries heavy risks, including potentially fatal bleeding in the brain. Additionally, the drug was tested in the elderly population and is not commonly used for young patients, making Scipione hesitant to give her the medication.
"Prescribing a medicine that's 'off label'—let me put it this way, I would not do that under these circumstances," says Scipione. "I defer to the definitive specialist." Listen
Scipione needed a neurologist's expert opinion, but MHHCC currently does not have one on staff. However, the newly established robotic telemedicine partnership gave Scipione a direct line to Dr. Alex Abou-Chebl, an interventional neurologist at the University of Louisville Hospital Stroke Center. Highly respected in the area of stroke, the hospital has formed a regional stroke network in which 15 community hospitals mostly in southern and western Kentucky have access to U of L expertise with the use of robots. Listen
Fortunately for Bethany, MHHCC had joined the partnership just a few months earlier, making it the first and only Indiana hospital to do so. Within minutes of contacting Abou-Chebl in Louisville, Bethany's much-needed specialist was "in the room."
"We control a robot that pulls up into the patient's room," says Abou-Chebl. "We can see and hear. The patient, family and caregivers there can see our face on top of this robot, and we have direct interaction with everyone. I can examine the patient in almost the exact same way I examine a patient who's right in front of me. The only thing I can't do is physically put my hands on the patient. With a greater degree of confidence, I can be certain as to what's going on and make recommendations." Listen
Abou-Chebl says the ability to get an expert's opinion—and get it quickly—likely saved Bethany's life. While tPA is a powerful drug, it must be administered in a very narrow three-hour window after the onset of a stroke. Additionally, Abou-Chebl says every second after a stroke is critical, because 1.5 million brain cells die with each passing minute. Listen
Bethany's mother, Mary Miller, remembers when Abou-Chebl—via robot—told her the same statistic after he finished examining Bethany. Listen
"He told us, 'You don't really have time to think about this decision. She needs this drug now,'" says Mary.
Mary says the drug's effect was "extraordinary"; within minutes, Bethany started showing significant improvements, even lifting her left leg. She was taken by helicopter to Louisville in case she needed more invasive treatment, but when she arrived, the clot had broken up, and she showed even further improvement with full mobility on her left side and clear speech. Listen
Bethany's mother says she can't bear to think what the outcome might have been if MHHCC didn't have the critical connection to the stroke center. Scipione admits it "would be difficult" to convince a neurologist over the phone to issue tPA. If the robotic partnership hadn't been in place for Bethany, she likely would've been transferred to the stroke center without getting the drug, losing valuable time. Abou-Chebl says Bethany would be a "far different person" or may not have survived the stroke without the partnership in place.
"[Bethany's case] is beyond rewarding. The elation when she starts to recover—you can't put a price on it," says Abou-Chebl. "Taking calls 24 hours a day—you don't do that for any other reason than wanting to help people. It's what we live for."
Nearly four months after that January evening, Bethany's back on the basketball court, doing well in the classroom and has no lingering effects from the stroke.
Scipione says the robotic partnership helped produce an outcome that is "as good as it gets." He believes robotic telemedicine will be an increasing trend in the medical industry, helping combat specialist shortages. Listen
"The majority of emergency departments across the country are small and don't have every specialist," says Scipione. "[Robotic telemedicine] could be applied across many specialties to gain consultation for patients by doctors who are remote to the location."
The American Heart Association in Indianapolis is working with the Indiana Rural Health Association to establish more telemedicine partnerships for community hospitals throughout the state—critical connections that could greatly benefit Hoosiers like Bethany who need access to life-saving care.