June 16, 2011, passengers board a commercial flight from Frankfurt Airport to JFK. The captain of the flight begins his announcement, “Good afternoon, ladies and gentlemen. This is your captain speaking….” This is your typical international flight: passengers settle in, flight attendants prepare for take-off. But, we need to mention one very important detail. The captain of this flight is Mark, and this is his first flight since his stroke a year and a half ago. This scenario might seem impossible, but this is the incredible story of one stroke patient who was able to recover 100% and work again as a commercial pilot.
The day when things changed
One moment can change everything: a healthy, young pilot getting ready for a jog suffers a stroke. With a little bit of luck, a lot of support, and an amazing amount of determination, Mark overcame the odds and got his life back.
It started off like any other Sunday morning. November 29, 2010, Mark, then 50 years old, with a 20+ year career as a commercial pilot, was preparing to go for a run. Running shoes laced up, he was ready to go but decided to grab some water before heading out. As he was getting his water, something happened. Something in his brain crashed, but he didn’t know what. He had to sit down on the floor and couldn’t speak.
Mark’s wife came in and, because she luckily had listened to a radio program about stroke a week earlier, she recognized the signs. She immediately called an ambulance and help was on its way. Within 15 minutes, the ambulance arrived.
Getting help early
Upon arrival in the hospital, Mark received an MRI scan, an imaging technique that allowed the doctors to identify a blockage. They gave him the option of receiving blood thinning medication but warned that this could also cause bleeding in his brain. He and his wife decided that taking this risk was worth it because this medication could stop further damage. Fortunately, the medicine released the clot. Mark was lucky that his wife and doctors reacted quickly to his situation.
After two to three days of testing in the hospital, the doctors found the cause of the stroke. Mark had a condition known as PFO (patent foramen ovale). This is a hole in the heart. Many people have it, and it is often undetected. However, it can increase the chance of blood clots. And this is what happened to Mark.
It looked like Mark’s career as a commercial pilot was over. Some doctors told him that he could never fly again. His cognitive abilities were severely affected. Memory and attention skills were damaged. This was a hard blow to Mark, but he still wanted to get back as much of his life as possible. Living in a busy home with his wife and two children, things didn’t slow down for him. And as it turned out, this was a very good thing for him.
Treating the PFO
After being released from the hospital, Mark went to visit his family doctor. His doctor recommended that Mark see a friend of his who does a procedure that closes the hole in the heart. The procedure is not without risks, but faced with the option of being on blood thinners for the rest of his life or going for the procedure, Mark decided to have the hole fixed.
The procedure is done via a catheter through a vein in the leg. The surgeon leads the catheter to the heart. Using the assistance of X-ray and an echo machine, the surgeon guides a closing device to the location of the hole. The device is placed over the hole and left there. Scar tissue forms around the device, and the hole repairs itself. It worked for Mark. Four months after the procedure, his heart was healed.
PFO is fixed, but what about the brain?
Now that his heart was fixed, it was time that Mark starts focusing on fixing the damage caused by the stroke. He started rehab. The right side of his body was affected. Although he had most of his physical capabilities, his right arm was weakened. After four weeks of physical therapy, he was given the ok to drive.
Physically driving worked, but he couldn’t remember how to get anywhere. Routes that used to be second nature to him were out of reach.
He could remember the names of his family, but not the names of other people. Finding things in his home office was nearly impossible. The problem that started out as a hole in his heart left him with many holes in his memory.
Getting back to life
His employer gave Mark access to care. The doctor from the airline examined him and gave him hope. He encouraged Mark to work hard on his rehabilitation. He told him about cases where stroke patients regained 100% of their function. The airline doctor felt that Mark had a good chance to accomplish the same. He explained that some things could be retrieved again, and other things might need to be relearned, but it was possible.
Other doctors and therapists told Mark there wasn’t any hope to fully regain the memory and attention abilities that were lost. And being able to fly again seemed like an impossibility. After all, it is a profession with some of the strictest regulations. However, Mark focused on the hopeful voices and kept going.
In April 2011, he started training with a neuropsychologist. And he used the activities of his daily life as training. With the help of his family, “getting breakfast ready” turned into a daily memory training routine, recalling the processes and steps. His kids played Memory with him every day. His wife would give him a list of things to buy at the grocery store that he tried to memorize as much as possible but often found himself looking at the list. He found cognitive training games like Dr. Kawashima’s, ‘How Old is Your Brain’ online.
By September, 10 months after his stroke, his doctors told him his skills were back to normal. He could function in normal life.
Getting back to work
Once he got back to regular life again, his next thought was getting back to work.
Mark played the guitar before. Encouraged by his doctor, he started to play again. However, it didn’t come easy. At first, he could only remember pieces of songs like “Take it Easy” by the Eagles or “Sweet Home Alabama” by Lynyrd Skynyrd. Sometimes he mixed up the order of the songs and sometimes he couldn’t remember the lines. His sequential memory was not ok, but he took this practice as training for over half a year. And the songs started to come back to him until he could take it easy as he played.
Mark decided to study his pilot books and materials again. He had cards that outlined important procedures of his job. These cards included instructions about what to do in certain situations like when a system breaks down. In his pre-stroke life, Mark needed two days to review the information and then he knew it. Two days didn’t cut it anymore. Now it took him six weeks until he felt like he had the information back in his memory. However, it did come back. This was the first time he noticed for himself that he was improving. His doctor and family had noticed improvements along the way, but for Mark, this was measurable. Sure, it took a little longer than before, but it was clearly possible, and this kept him going.
A pilot needs to know the landing procedures for each airport he flies to. He started simulating this at home, relearning the patterns for different flights, memorizing the layouts of different airports and the special procedures that each airport has. He was doing this for himself without knowing if he would be able to fly again. But, this is what he knew how to learn.
After about 18 months, the airline doctor felt like Mark could be okay to fly again. Mark took a test that checked his cognitive abilities, and everything was ok. But this test was for everybody, not specifically for pilots.
Getting the ‘go-ahead’ to fly
Then the airline doctor recommended that Mark undergo a flight simulation test. This test included a one-hour pre-flight briefing, a four-hour simulation, and a 30-minute debriefing. Motor control was perfect. There were no impairments. As soon as he was in the situation again, the ability to fly came back.
He passed the test with the simulator and got the ‘ok’ to fly. He then went through the normal safety and control tests to be able to captain a flight again. 18 months after his stroke, Mark captained his first commercial flight again.
Everything went well. Mark felt a little slow in the beginning but eventually got back to himself.
What kept him going?
Were there moments when Mark just wanted to give up? Not really. He just kept trying to do the things he did before. Sometimes he was successful, sometimes not. It took over a year to regain most of his previous abilities. But, being in the middle of a lively family really helped him. There was no time to stop or give up. No time to think too much about what he couldn’t do. He just had to do things the best that he could. There was no other option.
Where did Mark find the motivation to keep training even though it was unclear if he would fly again? He was only 51, and his kids were just 9 and 12 years old. Deep inside himself, there was an urge to keep going. He had a lot of life in front of him.
Mark also had a good support system. The airline doctor and his family never gave up on him. The airline doctor always felt there was a chance for him to fly again if he worked a lot on it. In addition to his cognitive training, Mark kept up with his jogging and strength training, both two times a week.
Advice for other stroke patients in recovery
We asked Mark for his advice to other stroke patients: Take each day for what it is. However hard it may be, keep training and don’t give up hope, but don’t stress yourself. Don’t focus on the endpoint and goals because that can be frustrating. Be diligent but patient with yourself. Recovering from a stroke is not a linear route. It will have its turbulence. If you can’t get something to work, take a break. Don’t get frustrated… just stop and try again later.
Take your recovery as your job. Mark worked every day on training something, for three to four hours a day. He took weekends off and started again on Monday. Mark felt that his breaks were as essential as his training.
Mark shows that with the right support team, the right attitude, and hours of hard work, full recovery is possible – even to the physical standards of a commercial pilot. The pilot’s way to rehab worked – approaching even crisis situations step by step, staying calm, controlling what you can control, relaxing about what you can’t.
Eight years later, and the stroke is no longer a prominent topic for him or his family. He was able to move on with his life, and now November 29th is just another date.