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With every minute that passed, his brain was being deprived of oxygen, risking irreversible damage. It was larger than the earlier one, affecting a much larger area of his brain. The neurology stroke team ordered an immediate CT scan, which revealed a new clot. He was unable to speak or move his right arm. Lichtenstein suffered a second, and much worse, stroke. That night, it was determined that the clot-busting drug had done its job and surgery was not needed. If a clot had still been present, the neurology stroke team would have called in the interventional neuroradiology (INR) team to determine if he needed emergency surgery to remove the clot. Lichtenstein was evaluated upon arrival in the ER to see what steps to take next. This specially equipped ambulance is designed to get stroke victims the immediate help they need to prevent damage to the brain, and Lichtenstein was given tissue plasminogen activator (tPA, the “clot-buster”) while he was still en route to the hospital. The stroke, caused by a blood clot in the brain, easily could have claimed his life, but a 911 dispatcher called for the new Mobile Stroke Treatment Unit (MSTU) from NewYork-Presbyterian. Lichtenstein had already had a stroke – and a major stroke of luck – earlier that evening, when he’d experienced the dizziness, confusion, and deterioration of speech that signaled a brain attack. It was a profoundly moving experience for both of us.

Then, a few months ago, I treated a patient whose blood flow in the left half of the brain was completely blocked and who was in some sense of the word dead (or at least perilously close to it) when I saw him suddenly come back – at my hands. Until recently I’d never witnessed it personally. Vascular specialists, who work with patients experiencing conditions and disorders of the blood vessels, often talk of the “Lazarus effect,” a phenomenon in which a patient revives after coming to the brink of death, as happens in stroke or heart failure.