When 15-year-old Rachel Vasquez-Villalobos took to the basketball court at Point Loma High School last November, it was quickly clear that something just was not right.
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“I remember when I dropped the ball three times, I was so clumsy,” Rachel recalled. “I remember falling, and I wasn’t able to completely talk at all.”
Her speech grew muddy, and some noticed that the right side of her face had started to droop. School officials called 911 and her dad, Johnathan Villalobos, who beat the ambulance to his daughter’s side.
Time in the military taught him that what he was seeing definitely needed help from a hospital, so when the paramedics arrived, he stopped them from unpacking their diagnostic equipment, encouraging them to simply scoop and scoot.
“I was just like ‘let’s get in the ambulance, we’ll figure it out on the way,’” Villalobos said.
It was that quick action, and subsequent interventions down the line, that allowed Rachel, now 16, to walk unaided among a crowd of medical professionals Thursday. They gathered in La Jolla to celebrate the collective effort that put her back on her feet.
The race for Rachel’s life sent a Falck ambulance screaming through Point Loma traffic, running traffic lights as first responders discussed the situation with her dad, who jumped in the back of the ambulance. Where to go was something of an open question. Kids with the most-severe medical problems are routinely transported to Rady Children’s Hospital. But this teen was showing symptoms of a stroke, a condition that most often affects adults.
“They asked me where I wanted her to go; Rady is where they handle children, but UCSD Hillcrest is the place to go for strokes, but the thing is, they may turn us away,” Villalobos recalled.
UCSD, in the end, seemed to be the better bet. It was closer and a designated stroke center. That turned out to be the right call.
Within 89 minutes of arriving at UCSD Medical Center, a surgical team inserted a tiny probe into Rachel’s femoral artery to suck the clot from the blocked blood vessel in her brain. The surgery itself took just 11 minutes, a quarter of the 45-minute completion goal for such procedures. All told, the goal for an entire response, from the first observed symptoms in the field to restoration of blood flow, is four hours. Rachel’s response took 134 minutes, beating the goal by nearly two hours.
In stroke care, they say “time is brain” because a person’s gray matter cannot last long cut off from the body’s blood supply.
“If she hadn’t gotten to us until, say, five hours after, her stroke would have been much more significant; there would have been permanent damage,” said Dr. Jeffrey Steinberg, a neurosurgeon and chief of cerebrovascular neurosurgery at UC San Diego Health.
It turned out that a previously undetected hole between the upper chambers of Rachel’s heart, called a patent foramen ovale, a “PFO” in medical terminology, likely caused the stroke, allowing a blood clot that normally would be filtered in the lungs to reach her brain. Surgery closed the portal, preventing future recurrences.
While the skill of the hospital’s stroke team was essential in delivering quick results, there were plenty of wins outside the hospital as well.
Strokes, after all, are uncommon in young people.
The American Heart Association estimates that 800,000 strokes occur nationwide every year, but only about 2,000 of those affect children and adolescents. Indeed, stroke is overwhelmingly an adult medical problem, with the rate of occurrence doubling for each decade of life after age 45.
Falck paramedic Connor Sprague and emergency medical technician Edgar Zentella, who responded to Rachel’s call, were able to see past their patient’s age and immediately accept that the symptoms they observed were very likely caused by a stroke.
In such a situation, sticking to training, Sprague said, makes the difference.
Training dictates evaluating every patient on a specific stroke scale, regardless of age.
“We ran the scale, and if it walks like a duck and it talks like a duck, at the end of the day, it’s a duck, right?” Sprague said. “At the end of the day, we have all of those tools in place, all of those stroke skills, to make sure that we provide the best patient care that we can.
“Sticking by those is a good way to go faster.”
Today, a stranger watching Rachel talk would not notice that she had ever suffered a stroke. Control, she said, started returning about two days after the clot was removed. Physical therapy gradually restored muscle control. She said that some can still detect a little slur in some of her words.
“It’s just some words and just a little bit,” she said.
Rachel, now 16, expressed gratitude for the adults who supported her. They had worked together like a relay team in a life-and-death race. Ultimately, their united efforts gave her the stability she needed to finally focus on college applications
“Honestly, I’m just so grateful that everyone moved quickly, that everyone was making sure that they didn’t waste time,” she said.
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