Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF September 22, 2017 | Archived Issues

Meetings and Events

Preventive and Consultative Heart Center of Excellence Quarterly Meeting
Sept. 27

Annual Meeting of the Medical Staff
Oct. 16

These events and more are listed in the medical staff calendar on the Cedars-Sinai website.


Grand Rounds


Upcoming CME Conferences


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue.

Submit your milestones and comments.

Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

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A Life in a Day – Gabriel Goldberg

Nestor Gonzalez and Gabriel Goldberg 480px

Nestor Gonzalez, MD, (left) and Gabriel Goldberg mark the one-year anniversary of a lifesaving neurological procedure that restored the former Cedars-Sinai patient to good health after suffering a severe stroke.

Almost one year ago, the life of Gabriel Goldberg came down to a handful of hours at Cedars-Sinai.

Today, the energetic 44-year-old photographer — who has worked with Jennifer Lopez, Lady Gaga and Matt Damon, among others — looks like the picture of health. But last Labor Day weekend, while exercising at a Beverly Hills gym, he nearly lost everything.

Shortly into his workout, Gabriel started feeling dizzy, experiencing weakness on his right side and struggled to speak. Moments later, he felt sharp, hot pinpricks on his face. The room flipped sideways.

When an ambulance arrived, paramedics quickly surmised that Gabriel was having a stroke. They raced to Cedars-Sinai, home to one of three comprehensive stroke programs in Southern California.

Gabriel was no stranger to medical challenges. Born with a congenital heart condition, he had managed it for decades with a healthy lifestyle, medications and corrective surgeries, including one as an adult to install an artificial heart valve. But nothing prepared him for what happened on Sunday, Sept. 4, 2016.

"I had open-heart surgery when I was 31. I was ready for that," Gabriel said. "But this was like getting eaten by a shark. You are aware of what's happening and you can't stop it."

Gabriel is one of about 1,200 patients treated each year by the Cedars-Sinai Stroke Program. After an event, stroke patients like Gabriel must receive medical care within a tight window — about six hours — for the best chance of survival and preserving quality of life.

Through a review of medical records and interviews with doctors and nurses, The Pulse reconstructed a day-by-day sequence of the major events in Gabriel's care at Cedars-Sinai.

Sunday, Sept. 4, 2016

  • Gabriel is weightlifting when his symptoms appear. He dials a friend, who immediately calls for an ambulance. By the time the conversation is over, Gabriel lacks the strength to hold the phone.
  • Paramedics arrive. They note Gabriel is "foaming at the mouth" and that his eyes are moving in different directions.
  • Cedars-Sinai receives a "Code Brain" page, which mobilizes a stroke specialist team in the Emergency Department to prepare for an acute stroke patient.
  • Gabriel arrives at the Emergency Department.
  • Medical tests are immediately performed to assess Gabriel's condition and to begin developing a strategy for care. "There were seven or eight doctors and nurses yelling all around me," Gabriel recalled. "They kept asking me, 'What's your name?' 'Who is the President?' and 'How old are you?'"
  • A CT scan is performed and shows no evidence of hemorrhage. After the test, a nurse asks Gabriel what his biggest fear is. In stumbling language caused by the stroke, he replies that it is not being able to walk, talk or shoot photographs again.
  • Gabriel begins receiving a tissue plasminogen activator, a clot-busting drug administered intravenously that is commonly referred to as tPA. He initially is given 10 percent of the dose, then the remainder over the next hour.
  • A CT angiogram of the head and neck are performed. Results show significant blockages of the distal basilar artery, which supplies the brain with oxygen-rich blood.
  • The tPA intravenous drip is completed. It "steadied me," Gabriel said. "At least at this point, my symptoms weren't getting worse." The tPA is very effective at dissolving smaller clots, but often fails to break up larger ones like Gabriel's.
  • It was becoming clear that Gabriel would have to undergo a novel and highly complicated procedure called a mechanical thrombectomy. The delicate procedure, which utilizes a tiny stent retriever to remove blood clots from the brain, requires advanced neurosurgical training and sophisticated operating skills. "It's extremely difficult," said Laurie Paletz, RN, stroke program coordinator in the Department of Neurology. "It's like threading a needle where the thread keeps turning and circles around itself."
  • Nestor R. Gonzalez, MD, a nationally recognized neurosurgeon in mechanical thrombectomies, will perform the surgery.
  • Gabriel is prepped for the procedure and taken to the interventional radiology suite on the eighth floor of the Medical Center. "We have the conviction that time is brain," Gonzalez said of treating stroke patients. "You want to intervene as soon as possible for the best outcomes. Time is critical."
  • The procedure begins with the puncture of Gabriel's right femoral artery. A catheter is threaded through the artery from his groin up to the blockage in his brain. Of the precision and intense concentration required, Gonzalez made this comparison: "In the last Olympics, something about Michael Phelps before his swimming event caught my attention. He had this deep breathing. His eyes were almost in a place you couldn't see. He was clearly under stress, but it was not a bad stress. It was a stress that gave him focus. Every time we do one of these interventions, we focus in the same way. We focus on doing the best we can for the patient, and we use the stress as motivation."
  • The stent retriever opens and grabs three clots in Gabriel's brain. Tests soon confirm blood flow has been restored fully to the brain. After waking up in the Neuro Intensive Care Unit in the Saperstein Critical Care Tower, a nurse asks Gabriel his name. He replies in an uninterrupted fashion. "I thought, 'That's what I sound like,'" he said. "It was a huge relief. It was overwhelming."

Gonzalez Reunites with Stroke Patient 220px

Goldberg gives his physician a hug.

Monday, Sept. 5

  • Less than 12 hours after he suffered a life-threatening stroke, Gabriel connects via FaceTime with his parents, who live in Connecticut, and is able to explain his condition in a clear voice.

Tuesday, Sept. 6

  • Gabriel is transferred from the ICU to a non-critical care unit.

Thursday, Sept. 8

  • Gabriel is discharged from Cedars-Sinai.

Stroke survivors are often left with lasting residual damage, but Gabriel had none. Four weeks later, he returned to work and resumed his previous activities. His first photo assignment was shooting Katy Perry's birthday party.

"The biggest thing I've realized is that Dr. Gonzalez didn't just save my life," he said. "He saved my quality of life."