“Our arteries are like the interstate highway system,” says Dr. 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.” Without alternative treatment, Mr. 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 Dr. Gupta. “But it worked: the artery was opened, and blood flow was restored. We’d made it over the ‘third hump.’ ” Altogether, Mr. 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 ortunately, the worst was over. “Dr. Gupta says I won the lottery—three times in a row,” says Mr. 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, Mr. 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 Dr. Gupta and Dr. 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 Mr. 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 Dr. Gupta. Months later, after returning home, Mr. Parish recaptioned a New Yorker cartoon and sent it to Dr. 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. M Inserting a microcatheter into the original catheter, they delivered a stent to the ruptured artery in the hope of supporting it. “We didn’t like the look of it, though,” says Dr. Roychowdhury. “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 Dr. 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.” Vasospasms: “The Third Hump” hrough 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, Dr. Gupta and Dr. 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. 8 Robert Wood Johnson I MEDICINE