The call came at 10:00 P.M. Friday night. My sister Maura was on her cell phone driving to the hospital in Cleveland. The ambulance was on its way and our friend Joan was with Mom. No one had talked to Mom that day; she had not returned telephone calls, so Maura asked Joan to check on Mom and Joan found her unconscious on her bedroom floor. The flurry of calls began to siblings, dad in Hong Kong, doctors, and hospitals. By midnight, we learned that mom had a hemorrhagic stroke (cerebral hemorrhage) and was stable, and Dad was stuck in Hong Kong until Monday because of passport problems. As we drove to Cleveland, the issues began to emerge, and the prolonged process of caring for an ailing parent began . . . how could I have so much experience in health care, yet be so poorly prepared for this experience?

The first shock was the realization that we were in charge, at least temporarily. I have seven siblings, ranging in age from 35 to 50, and most of us have kids of our own. Still, Mom and Dad have always been "Mom and Dad" and we have always been "The Kids." With Dad in Hong Kong, we, the kids, were in charge. Thousands of people my age are finding themselves in the same situation. In fact, in the past week alone, while searching for solutions and explaining why I have missed deadlines and been late in returning calls, I discovered four more colleagues who are caring for ailing parents with similar situations.

The next shock has been the challenge of putting together an effective treatment plan for Mom. We find ourselves in the position of having to coordinate a team of doctors who are responsible for Mom's medical, neurological and rehabilitation issues, respectively. I always expected these doctors would work together as a coordinated team, but without our oversight, it seems like they would have little knowledge of what the other is doing. My mother has good medical insurance, my father is very persuasive, I have a degree and seven years experience in hospital management, and we have access to some of the best professionals and facilities in the country, but we remain unable to organize a fully coordinated treatment plan for my mother. I suspect that most stroke patients receive poorly coordinated care, but their families don't even realize it.

I have also been shocked by the lack of importance placed on good nutrition, providing emotional security, and other therapies such as massage within the rehabilitation program. The people in charge of the rehabilitation unit recognize the value of these approaches and welcome our ideas on how to build them into mom's therapy, but we are left to our own devices to assemble them. We have been only marginally successful in pulling them in. None of the other patients on the unit receives these additional benefits.

The physical and emotional demands of caring for my mother are greater than I could have ever expected. During the first six weeks of Mom's recovery, I dropped everything at work for two full weeks. During these weeks, I was at the hospital from morning until night. Usually, I did little more than listen to whatever mom wanted to say, hold her hand, or watch her as she slept, but I was completely spent each day. I have seven brothers and sisters, my father is healthy and devoted, and all of us are involved in Mom's care. I marvel at people who are caring for parents with far fewer family member to share the load.

I still ask myself if there is something I could have done to prevent this stroke, and struggle to figure out why it happened. For the past 35 years, Mom has practiced a lifestyle that any health promotion professional would emulate. She did yoga and aerobic exercise daily, ate a balanced whole foods diet, did not smoke or drink, spent lots of time with good friends and family, was involved in community and artistic endeavors, had a wonderfully positive outlook on life, and a remarkable sense of balance in life . . . in fact, she inspired the definition of optimal health which guides the editorial content of this journal: "a balance of physical, social, spiritual, intellectual, and emotional health." Unfortunately, she was a heavy smoker from age 18 to 39 and hypertension ran in her family. She also had three serious bouts with cancer. Could those risk factors have caused this stroke, or was it something else we do not understand?

No real answers, lots of questions, and a better realization of the challenges many other people are experiencing.

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion