TRURO — “It never occurred to me to call 911,” said Millie, recalling her medical emergency in April. “Having a ‘stroke’ — it wasn’t in my vocabulary of things that could happen to me.”
Earlier that week, after caring for a friend who had just undergone a knee replacement, she drove from Miami to New York City, braving I-95 and Manhattan traffic. She enjoyed whizzing around by bike, and she was a globetrotter, having traveled to Hong Kong, Japan, and Indonesia.
Millie is a Truro resident in her late 60s. Her name has been changed to protect her privacy. A stroke has kept her homebound, “ruining” the active life she had led. But her story is by no means uncommon. Many Outer Cape seniors hesitate to call 911. And when EMS crew members come knocking, the elderly often decline an ambulance ride to Cape Cod Hospital — even if they need medical care pronto.
Millie’s symptoms emerged late on a Saturday night in April, when she was on the phone. Her words slurred together, and a feeling of “pins and needles” prickled her right hand. She figured she was exhausted after her Florida trip, so she went to sleep. About 24 hours later, on Sunday night, she called another friend, who remarked, “Your voice sounds strange. You OK?”
“I’m just tired,” Millie replied. Her friend pushed her to call 911, but she shrugged off the suggestion. “Don’t be ridiculous,” she said. “It’s Sunday night. I don’t want to be a bother.”
The next morning, she felt “weak and horrible.” Two friends brought her to Outer Cape Health Services. Her systolic blood-pressure reading was in the 200s — well above 120, which is considered normal. Soon she was in an ambulance, en route to Cape Cod Hospital. A CT scan and an MRI confirmed a stroke.
Old-Fashioned Yankees
Dispatcher Emilie Miller of the Wellfleet Police Dept. said some seniors feel a certain “stigma” about calling 911. “To them, it’s a last resort,” she said.
Interactions with first responders, said Miller, are thus confined to the “worst moment of their lives.” She and Sgt. Michael Turner have been delivering weekly meals from the senior center to 50 Wellfleet elders, which has provided a connection with them outside the context of emergencies. Miller hopes this outreach will change attitudes.
“Now, when people see Michael in uniform, they can feel far more comfortable talking with someone that they know,” she said.
Eastham’s Deputy Fire Chief Dan Keane said that when he worked in Sandwich, around 10 percent of patients would refuse transport to the hospital. In Eastham, the number is 40 percent. “I found this staggering,” he said. “We have a lot of hardy New Englanders on the Outer Cape. They’re good old-fashioned Yankees who don’t want to burden anyone.”
Keane said some seniors are convinced that an ambulance ride is a one-way trip to the nursing home. “The majority of our patients get stabilized and return home,” he added.
Truro EMS calls from April 2020 to the present totaled 481 transports and 431 refusals — a refusal rate of over 47 percent. Fire Chief Tim Collins pointed out that Truro has more seasonal residents than Eastham, and the total includes non-urgent cases.
Some elderly patients worry about troubling family or friends for the 45-minute ride back from the hospital. This concern has been addressed by three local councils on aging. In Eastham, Truro, and Wellfleet, EMS staff provide taxi vouchers for a free ride home from Hyannis. (Provincetown does not yet have this program, though it is being discussed.) Even with these vouchers available, though, Keane still finds himself making “sales pitches” to reluctant seniors. “After all,” he said, “we’re not in the business of kidnapping.”
According to the Mass. Office of EMS, patients over 18 can refuse treatment and transport if they are oriented to person, place, time, and situation. There must be no evidence of an altered level of consciousness, suicidal ideation, or impairment from alcohol or drugs. The refusal must be initiated by the patient, and there must be no communication barriers. If all these criteria are met, even patients who look like they are having a heart attack or stroke can decline transport, said Jesse Cappello of Eastham’s EMS. First responders will urge them to seek care, but the final decision rests with the patient. “Our hands are tied, unfortunately,” Cappello said.
Looking Ahead
Mornings bear some resemblance to Millie’s old life. “I wake up and feel like myself,” she said. Her heart rate is steady; her blood pressure, in a healthy range. “But the minute I get up and try to get out of bed,” she said, sighing, “I’m face to face with reality.”
Reality kicks in when she reaches for her four-legged cane, which can handle uneven surfaces and grassy terrain. But at the beach, with its dunes, Millie is limited to her blue walker. Filing in and out of her home each day is a “parade of people” — an occupational therapist, a physical therapist, a nurse, her crowd of friends. Stop & Shop runs, once a weekly routine, are now “daunting,” she said. The council on aging has offered to assist her with groceries, but Millie prefers calling her own shots. Medical professionals have mixed feelings about her driving. Currently, she can’t get behind the wheel — that is, “not yet,” she insisted. “We’re talking about a modified car.”
Millie has been prescribed Cymbalta, an antidepressant. “It’s hard being housebound,” she said. “I feel depressed about all the things I can’t do.”
“A lot of people don’t realize that the treatment for stroke must be given very quickly — we only have a few hours,” said Eliza Miller, an assistant professor of neurology at Columbia Medical School and a vascular neurologist with New York-Presbyterian Hospital. “The problem is that the majority of strokes don’t hurt. Patients may have slurred speech, a droopy face, or an arm or leg that’s a little weak — but they can still walk. And they think they can shake it off. But that’s when we miss our window for treatment.”
Dr. Miller often sees stroke patients in the office who did not come to the hospital in time to receive treatment. “And they are disabled,” she said.
Months ago, Millie underwent three-hour physical rehabilitation sessions at the Spaulding Rehabilitation Hospital in Sandwich. There, “they had a lot of gizmos,” she said. She recalled being hoisted on cables attached to a harness as part of her gait training. She received electrical stimulation. Several weeks later, after she was transferred to the Pavilion Rehabilitation and Nursing Center in Hyannis, she reached a milestone. Staff members cheered when, one day, Millie managed to twitch her thumb — a promising sign indicating that the brain is starting to “recover and rewire,” said Dr. Miller. Sensation slowly returned to her right arm, and today, she can feel the itch of a mosquito bite.
Just a couple of weeks ago, Millie slipped from her couch while putting on a pair of socks. She tried, unsuccessfully, to climb up a pile of pillows. She crawled on the floor, attempting to boost herself onto a chair. No luck. After 45 minutes, nearing midnight, she admitted defeat and grabbed a pillow and blanket. She slept on the floor until 6:30 a.m., when she called two friends who then phoned 911.
“It was almost 12 o’clock,” Millie said, when asked what stopped her from calling earlier. “I didn’t want to bug anybody. But when rescue showed up, they said to me, ‘Look, we don’t work nine to five. We stay up all night waiting for the phone to ring. This is our job.’ ”
