Jeremy M. Gernand, PhD, CSP, CRE Associate Professor of Environmental Health and Safety Engineering
Associate Department Head for Graduate Education
John and Willie Leone Department of Energy and Mineral Engineering
College of Earth and Mineral Sciences
The Pennsylvania State University, University Park, PA, USA
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My story is simply mine. I tell it only because it is a part of who I am today, and not to elicit sympathy or inspire anyone. What readers may take from this is up to them, but I share it in the hope that it may be useful to some.

On an early April day in 2017, I had run 2 miles in the afternoon on the treadmill that we had at home in the basement, and taken a shower, and was having dinner with my family. I was developing some intense sinus congestion associated with the tree pollen in the Spring air. I felt the beginnings of a headache and along with that, strangely, my vision seemed blurry. I mentioned how I was feeling and took some medication for the pain and congestion and tried to get some sleep. During the night, the severity of the headache and my sinus congestion only increased. I would spend as much time as I could in the hot shower and laying in bed while taking the maximum recommended amounts of painkillers. I skipped work for 2 days, though I did participate in a couple meetings by phone while sitting in a darkened room at home. The pain was intense. By the second day, the pain had subsided, but the problems with my vision remained. I made an appointment to visit a doctor.

On Saturday morning, my then wife drove me to my appointment with the optometrist. There, after some scans of my eyes, I took a field of view test where lights would flash around inside a small plastic dome, and I would click a button each time I saw one. The assistant preparing the machine did not seem to have a lot of experience with it, and it took some time to get it set up properly. We had to stop halfway through the test and restart because of some problem with the order in which we had conducted the corrected and uncorrected tests for the right and left eye. At the end of the test, I was not quite sure whether to trust what it would tell us. The optometrist returned a short time later, and told me that I was experiencing a loss in my field of view on the right side, but that I did not have a problem with my eyes. Both eyes were affected the same way. The problem must be in my brain, and he gave me a referral to the hospital to have an MRI scan.

My then wife drove me to the hospital; our kids were with us too, since it was a Saturday. I was still unclear as to what this new information meant, and kept wondering if it was all a mistake with how they tested my vision. Still, I did not feel that things were right, and I wanted to figure out what was wrong with me. At the hospital, they prepared me for the MRI, and took me back to the machine. My family went to pick up some lunch, as I had my scan. Following the scan, I sat in an empty room alone for a while waiting for the hospital staff or my family to return. The ER physician came back first along with a few nurses who started to prepare me for an IV. He told me that I had experienced a stroke, that a blood clot had blocked circulation in the part of my brain that was processing images from my eyes, and that was why I was having vision problems. My then wife and kids returned shortly after I got this news, and I went through the process of being admitted to the hospital for more tests.

I was discharged the next day. After more scans and blood tests, they could find nothing amiss, and I was referred to a neurologist for further care. I went home. I would keep re-reading my records from the hospital and understanding the facts but not quite feeling them to be true: MALE, 41 YEARS OLD, CEREBROVASCULAR ACCIDENT, ISCHEMIC STROKE. The other information that the hospital provided seemed to be directed at people in their 70s or 80s. It did not apply to me. I was otherwise physically able, the stroke had only affected my vision, but that was so intrinsic to how I worked and played and experienced the world. I could no longer safety drive a car. I kept spilling my drink at the table because I couldn't quite see it. I would hit my head on anything that unexpectedly protruded from the wall, like open cabinet doors. The medical personnel told me to expect that the changes would be mostly permanent. Healing and recovery for this part of the brain was a very unusual occurrence.

For the next 6 or 7 months, I needed 10 to 11 hours of sleep each night. I would land in bed each evening mentally exhausted from simple tasks like reading and writing and navigating around home and campus. Though my injury was invisible, it was still significant and I could feel the fatigue as my body tried to heal itself. By the end of the summer, I had completed all of the follow up tests and scans and now had an official determination that there was no attributable cause for my stroke. No underlying health condition or injury that could account for it. It was cryptogenic (a fancy medical term for an unknown or unknowable cause). People have often asked me as to whether stress was the cause, but that is unclear. I did not and do not have any of the medical indicators of chronic stress, but temporary acute stress is difficult to measure and study scientifically.

I participated in vision therapy on a regular basis for about a year following the stroke, and that was somewhat useful as I better learned to appreciate what the limits of my vision now were and what sensations I did still have. However, as expected, there were no measurable improvements in my field of view; it remains reduced by about 40% in total. This condition is called right homonymous hemianopia. I set about trying to adapt as best I could to my new situation. As I write this, I am a bit beyond 2 years past the stroke and the changes in my life that resulted from it. To make adaptation even more challenging, I also have a condition called otosclerosis that predominately affects hearing in my right ear, so I wear a hearing aid. It is difficult for me to notice anything on my right unless I am looking directly at it. This has major implications for navigating in crowds.

I still do not drive, and do not expect that I will ever do so again. We bought a new house within walking distance to work and with easy access to the bus system. New delivery services and ride sharing services have also eased the burden associated with being unable to drive, but it continues to be something that limits what I can participate it on a personal and professional level. What continues to be a more daily impediment is how the limited field of view affects reading and writing. While the mechanics are mostly the same, the speed at which I can do them has been reduced. I have found that normal 8.5-inch wide pages are too wide now to read comfortably. The 2.6-inch wide screen of my phone or the 4-inch wide screen of a kindle are about as wide as I can read and feel as I did before. Anything wider requires me to follow along each line carefully with my eyes, row by row, which after 23 years of formal education and 17 years of professional work, is not how I was accustomed to consuming written documents. It is taxing. I easily miss important details when I attempt to visually scan a document. So, I read slowly and carefully, move things to a format I can browse on my phone, or decide to do without.

Though I can adapt most of my professional work around these limitations, that itself requires additional efforts. I have to contact others to help convert documents and explain why pdf files are not accessible to me, and it simply takes longer to do important tasks than it used to. Outside of my job, accommodations are less easily forthcoming. I occasionally find myself focusing on the loss that these events effected: not being able to drive, not being able to play racket sports, not being able to easily browse the library. These things seem both big and small at the same time.

I don't necessarily like being an object lesson in the impact of low probability events. Given my education and experience, I understand these kinds of things better than most, but that is of limited benefit in learning to accept them personally. However, I am still able to work and contribute professionally and support my family; outside of my current limitations I have a clean bill of health. I remain grateful that I can still see my sons grow up, that I can still teach engineering students how to analyze and mitigate risk, that I can still mentor my graduate students in learning to do risk-relevant research. I still look forward to the future, even if it will not be exactly as I originally imagined it.