When he was 24 years old, my first husband had a stroke. A blood clot blocked a vital artery deep in his brain. One side of his body fell flaccid. Speech and language fled. To all of my urgent questions, the neurologists at Massachusetts General Hospital could only reply, "We don't know." They didn't know why it happened. There was no way to dissolve the clot or reverse the damage. They simply tried to keep him alive and waited.
Six days later, he died. His post-mortem report meticulously detailed the anatomic extent of the clot and subsequent damage, but did not explain where or why the clot had formed. It told part of the "how," but not the "why." Even then, I realized that "Why?" was more than a medical question. It really was "Why him? Why us? Why now?" I kept that report, looking at it periodically when some new medical news item about stroke caught my eye.
Years passed. I remarried and became an academic general surgeon. I developed a practice in which I rarely had to say, "I'm sorry, there is nothing I can do. Maybe someday they will know more."
Decades passed. New, highly effective treatments for stroke became available. I noted each advance with satisfaction and a touch of sadness. My own career narrowed more and more, first into cancer surgery, and then exclusively breast cancer. As I followed my patients in the long years after their operations, some relapsed. Now I was the one who could not explain "Why?" A few said, "Maybe others can be helped . . ." as if consoling me.
Almost forty-five years later, a neurologist reviewed my husband's case and found a possible cause. Carotid dissection: the separation of layers of the artery wall, blocking flow and causing blood to clot. Here at last was an answer to my first "Why?"
Then he told me that the team who cared for my husband was the first to describe this particular cause of stroke in young adults. He had combed through the original papers in our medical library, and the timing was right. My husband's case might actually have contributed to their efforts.
This was not an answer to my deeper "Why?" but it would do. It gave me hope that something was learned, that others were helped. It gave me peace.
Iowa City, Iowa