On a Monday morning a little over a year ago, Rutgers molecular biology professor Abram Gabriel had just returned from a family weekend in Maine. Gabriel, then 54, was talking in the hallway with a lab associate at the Center for Advanced Biotechnology and Medicine trying to ignore his headache – he’d been having what he thought were sinus headaches for weeks – when he realized the left side of his body felt numb. Suddenly the headache tightened; he felt dizzy.
Credit: Nick Romanenko Rutgers professor Abram Gabriel and his wife, Janet Heroux, at home in Princeton.
“I thought, “I can’t die in front of this man,” Gabriel said. “I’m feeling really bad,” he told his colleague, who offered to drive him to the emergency room. But Gabriel, a trained physician, knew he needed an ambulance – and fast. He was having a stroke.
That early recognition saved his life. The 911 call alerted the radiology department at nearby Robert Wood Johnson University Hospital in New Brunswick that Gabriel would need immediate attention. Still conscious but slurring his words, Gabriel underwent a CT-scan and an angiogram.
“When we saw the initial results – a catastrophic bleed in his brain stem – we weren’t sure there was anything we could do,” said Dr. Sudipta Roychowdury, one of two interventional neuroradiologists who attended to Gabriel.
Gabriel’s stroke was hemorrhagic – unusual in itself. More than 80 percent of strokes are ischemic, precipitated by clots that block the blood supply to the brain. But the cause of Gabriel’s bleed was even rarer: an abnormal connection between the arteries in the face and the veins in the brain known as a dural arterio-fistula. In a five-hour surgery, Dr. Roychowdhury and Dr. Irwin Keller, also an attending neuroradiologist at UMDNJ-Robert Wood Johnson, closed the faulty connection between the blood vessels and injected Onyx – a liquid embolizing agent akin to silly string – into the fistula behind the eye and into a draining vein within the brain stem.
“A catastrophic bleed in the brain stem is usually a fatal occurrence,” said Dr. Keller, a member of the New Jersey Stroke Advisory Panel. “But because of how quickly Abram made it to the hospital, we were able to stop it.”
In January, after two months in the hospital, Gabriel came home to Princeton. “That he is alive is a miracle,” said Janet Heroux, his wife of 24 years. And, most days, Gabriel agrees, he’s lucky. The stroke left the cerebral cortex, the part of the brain that affects memory and analytic skills, intact. His intellect is as sharp as ever.
The Gabriel family – Janet, Mimi, Gabriel, Simon and Ian – vacationing in Maine. Mimi and Ian are students at Rutgers.
But the massive jolt that tore and stretched the blood vessels and delicate nerve tissues in the midbrain affected Gabriel’s coordination, balance, and speech.
“The most frustrating part is not being able to walk and having to rely on others, not being able to speak on my own behalf. My voice is quite soft,” said Gabriel, who forms his words with great difficulty. “People assume I’m retarded or slow because I speak slowly. But people with strokes are complex and not simple-minded. They need to be treated as adults.”
Keeping up his spirits during the slow, uncertain rehabilitation is a constant struggle for Gabriel, for whom achievement has come easily and often. As an undergraduate at Harvard, he studied molecular biology and biochemistry, and then headed to Johns Hopkins for a medical degree in pediatrics, which he obtained with time off to earn a master’s in public health at the school.
He opted out of a medical career after the sequencing of the genome in the early 1990s rekindled his love of research, and in 1992 accepted a position with Rutgers’ Department of Molecular Biology and Biochemistry. Now an associate professor, he has spent nearly two decades teaching and studying mobile DNA and its role in the genetics of disease. In recent years, he’d moved from bench science to health policy research, and at the time of his stroke was deep into a statistical analysis of sickle cell studies.
While still in the hospital, Gabriel read science journals and kept in close contact with his Rutgers colleagues. Early on, he had little stamina – three physical therapy sessions each week nearly did him in – and needed a nap each afternoon. But by late spring he began to get his energy back. He could sit for longer periods at the computer, search the internet, and type.
By late spring, he began talking to Heroux and his department about returning to Rutgers and, in June, attended his first faculty meeting. “It made everyone feel good to see him,” said Steve Brill, his colleague of 18 years. “I think we all look at Abram and say ‘there but for the grace of god, this could be me.’” During the fall, he took on a six-session module of an upper-level molecular biology course. Ruth Steward, a department colleague, drove him twice a week to the class which took place at a large oblong table, with Gabriel in his wheelchair using a wireless microphone and speaker to amplify his voice.
Shaunak Kamat, the TA for the course, said some of the students had difficulty understanding Gabriel’s speech, but he worked hard at engaging them. “I think the students were impressed that he came back to teach, and they were very respectful,” Kamat said. “They did as well on the exam as they might have had it been any other professor.”
He is scheduled to teach a graduate seminar in the spring. “Going back to work has been motivating, and meaningful,” said Heroux, a public health professional. “If Stephen Hawking can do it, then why can’t Abram?”
Gabriel is determined to walk again. If he stays motivated and sticks with physical therapy, his doctors say there are reasons to be hopeful. The brain has a great deal of plasticity, which means it can be trained to compensate for dead or damaged areas. Prognosis is difficult, however, because studies of Gabriel’s type of stroke don’t exist. “Most people who have bleeds in the brain stem pass away,” Dr. Roychowdury said. With stroke, in general, however, there’s no magic formula for predicting the outcome, nor is there a set timeline for recovery, which can take a long time, maybe a lifetime.
As horrific as the experience has been, Gabriel refuses to wallow and tries to look at positive outcomes. “I’ve become more accepting of life’s knocks and other people’s frailties, less determined that my way is the best way,” he said. He is thankful for his gracious friends and overwhelmed by the support and love of his family, although he insists they maintain their lives and not be slave to him. He savors the small moments of joy. Two weeks ago, on the anniversary of the stroke, he had his first glass of wine in a year.