Saving Jana’s Brain: Rapid Stroke Response Makes the Difference

Posted on:

May 6, 2024

One second you’re fine. The next you’re on the ground, unable to control your body and struggling to breathe. 

That’s how the nightmare of a stroke started for Jana Epema and her family. 

Six months later, Jana is thankful to be alive, talking and walking. While she’s still dealing with some physical struggles, the Epemas know it could have been much worse. 

The lifesaving actions of many –  including the stroke-certified emergency department at CHI St. Joseph’s Health – made all the difference. 


Crackling Noise

It started with a crackling noise in Jana’s ear. The Epema family had been traveling back from Moorhead in two cars on December 30th. Jana and daughter Sydney stopped at a store to pick up a few things.

“I told Sydney that something’s going on. I don’t know what it is but I need to sit down. I just sat on the floor,” she said. 

That’s the last thing she remembers.

Husband Brad was a few miles behind in another car when Sydney called with the alarming news. “She says ‘Hey, something’s going on with mom, mom is lying on the ground here and I can’t control her.’”

A store clerk had already called 911 as Brad rushed to the store.

“By the time I got there, she was lying on the ground and she was drooling and unresponsive,” he said. “It was probably five minutes and then the ambulance was there. It was really quick.” 

The EMTs went to work and loaded Jana into the ambulance for transport to Park Rapids. From the front seat of the ambulance, Brad was relieved to hear his wife talking and answering the EMTs’ questions during the 9-mile drive. 

When they pulled into CHI St. Joseph’s Health, the couple parted ways as Jana was wheeled in and Brad headed for registration. “I gave her a kiss and grabbed her hand,” Brad remembered.

Moments later, he heard an overhead announcement – words he says he’ll never unhear: “Stroke Code.” 


Stroke Code

The same words that alarmed Brad sent an entire team into action. 

When patients present with stroke symptoms, St. Joseph’s has an acute stroke process with protocols that allow the acute stroke team to implement a stroke code activation. 

This code speeds delivery of acute therapies that can improve the outcomes for patients.

“We practice for these and do mock drills so we can move things along,” said Laura Gonska, ED/ICU Director. “We have practiced and done a lot of preparation to be able to get people where they need to be in a timely manner.” 

Brad didn’t find out until later that Jana bypassed the emergency department and was being rushed to radiology for a CT. “When you call a stroke, we don’t even stop in the ER. We go right back to do a CT scan,” Gonska said. 

A quick CT scan is essential because it shows what kind of stroke is occurring, which determines how it is treated.

  • 87% of strokes are ischemic, meaning they’re caused by a blockage of an artery and more rarely veins, and can be treated with clot-busting medications. 
  • 13% of strokes are hemorrhagic, and are caused by bleeding which is treated with surgery and medications.

“Time is brain” is the saying for stroke, because with each passing minute more brain cells are affected.

“That’s why we try to get the CTs as quickly as we can,” said Larry Kobriger, MD, Emergency Medicine Physician. “The sooner you get it back, the sooner you can decide what to do.”

Months later, when they met again, Dr. Kobriger told Jana and Brad he’d thought about them that winter. 

“I knew we were in trouble when you came in and you were answering questions and you were trying to follow directions,” Dr. Kobriger said. “Then within five minutes your eyes were looking in totally different directions.” 

With confirmation from CT that the stroke was ischemic, Dr. Kobriger rushed to the next step. Brad remembers the doctor coming into the room with urgency, telling him what the clot buster drug was, and asking his permission to administer the medication.

“I’m like, yeah, absolutely,” Brad said. 

Jana Epema is surrounded by members of the CHI St. Joseph’s Health stroke team who saved her life. Pictured (from left to right): Larry Kobriger, MD (Emergency Department), Jana Epema (Patient) and Caleb Roiko, RN (Emergency Department).


Stroke Ready

The Epema’s didn’t know then that St. Joseph’s had received the Community Champion Award for creating a meaningful, long-term improvement in quality of stroke care. In addition to this award from the Minnesota Department of Health, St. Joseph’s is also designated as an Acute Stroke Ready Hospital (ASRH). 

The ASRH designation is part of a coordinated statewide system of care to ensure hospitals and Emergency Medical Service providers are equipped and ready to provide the fastest and best possible stroke care.

What Brad saw that day was a flurry of activity and people surrounding his wife with care. 

One was Caleb Roiko, RN, ED nurse. He says there’s a protocol for every step that’s taken for stroke care. 

For example, testing the patient’s blood sugar level is the first step, but the EMTs had already done that. The decision to give clot busting medication also affects the protocol.

“We try to do anything beforehand, like lines or drains, that could cause bleeding before we give the clot buster,” Roiko said. 

That meant placing a Foley catheter because Jana was sedated, running IVs and managing her blood pressure. Even before that, Jana had been intubated to secure her airway. 

We’re making sure you’re comfortable with that, so we’re giving you medications for that,” Roiko said. 

Brad remembers Roiko squeezing that intubation bag the entire time.

“You must have got carpal tunnel from squeezing that bag for I don’t know how long,” he said. 

Care continues as the clot buster medication begins to take effect. 

“We do blood pressure, full vital signs and a neuro check every 15 minutes the entire time you’re here,” Roiko said. That means checking pupils and reflexes, and looking for any sort of body movement.

Meanwhile, arrangements were being made to transfer Jana to Fargo for care. Bad weather grounded the helicopter and a fixed wing plane was down for repairs, requiring a wait for a plane out of Grand Forks. 


Waking Up

After a flight Jana does not remember and an 85-mile drive to Fargo for the family, the wait continued to see how much damage the stroke caused. 

“It was probably about 4 in the morning,” Brad said. “I was sitting on the couch and I heard the nurse say, ‘Oh, good, can you move your arms? Can you move your legs? And move your feet?’ And I’m like, yeah, that’s pretty good I think.” 

Jana was still intubated and needed to be sedated so she wouldn’t try to pull out the tube.

“Then about 7:30 to 8 o’clock in the morning they came in and took the tube out and she was great,” Brad said.

Jana could talk and she could move her limbs – all good news. She would be discharged home a few days later. 

The next months brought therapy visits to improve her strength and stability and doctor’s appointments to try to address the atrial fibrillation — the irregular heartbeat – that likely caused the stroke. Jana is also dealing with vision issues and has not been able to drive or work. Still, the entire family is thankful for how well she is doing. 

“It was pretty valuable that they pushed that clot buster drug,” Brad said. “I think that saved her from having who-knows-what. We are very grateful for the life saving care Jana received at St. Joseph’s, the quick response in Osage from the First Responders and EMS team from North Memorial Ambulance.”

After suffering a stroke, Jana Epema found herself surrounded by the skilled and compassionate team at CHI St. Joseph’s Health. Now, with recovery well underway, Jana and her husband Brad share a hug of immense gratitude with their health care team. Pictured (from left to right): Larry Kobriger, MD (Emergency Department), Brad Epema (Patient’s Husband), Jana Epema (Patient) and Caleb Roiko, RN (Emergency Department).


May is National Stroke Awareness Month

Do you know the signs and symptoms of stroke? B.E. F.A.S.T. is an easy acronym to help you remember them—and perhaps save a life.

Balance – Sudden loss of balance

Eyes – Sudden change in vision

Face – Facial drooping, uneven smile

Arm – Arm numbness or weakness

Speech – Slurred speech, difficulty speaking

Time – Call 911 and get to the nearest hospital 

In the event of stroke symptoms, calling 911 is the best method to get you the urgent care you need. They will get you safely to the right hospital and be able to start your care quicker. Never drive yourself or a loved one to the Emergency Department. Always call 911!

About CHI St. Joseph’s Health

CHI St. Joseph’s Health is a 25-bed critical access hospital serving communities in Hubbard, Becker, Cass and Wadena Counties since 1946. In recent years, CHI St. Joseph’s Health’s award-winning teams received several national honors including: The Joint Commission Top Performer on Key Quality Measures in surgery; Top 100 Critical Access Hospital, HealthStrong; WomenCertified’s America’s Best Hospitals Women’s Choice Award in obstetrics; and the Studer Group Fire Starter Healthcare Organization of the Month among other national, regional and state recognitions.

About CHI

Catholic Health Initiatives, one of the nation’s largest health systems, was formed in 1996 to strengthen the Catholic health ministry for the future. With deep roots in the tradition of expressing Christ’s love by caring for those in need, Catholic Health Initiatives serves more than four million people each year through acute care hospitals; long-term care, assisted and residential-living facilities; community-based health services; home care; research and development; and reference laboratory services.


Contact: Sonja Day
Communication/Marketing Manager
CHI St. Joseph’s Health
600 Pleasant Avenue
Park Rapids, MN  56470