What is a stroke?

A stroke occurs when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain.

When either of these things happen, brain cells begin to die and brain damage occurs.

When brain cells die during a stroke, abilities controlled by that area of the brain are lost. These abilities include speech, movement and memory.

How a stroke patient is affected depends on where the stroke occurs in the brain and how much the brain is damaged.

Source: National Stroke Association

How to check/respond to a possible stroke? Use the FAST test

F: Face - Check ability to fully smile; look for drooping

A: Arm - Can they raise their arms? Are they weak?

S: Speech - Is there a problem speaking, forming words?

T: Time - Get medical treatment quickly.

Imagine an earthworm just like the one you might see on the pavement after a hard rain. Only it's not an earthworm.

It's a blood clot.

It is long and narrow, the same shape, length, consistency and size of an earthworm. And it is in your brain shutting down the flow of blood that keeps you alive.

Now imagine you are an 85-year-old man heading for the bathroom. It is 4:30 a.m. You are on the floor. You are confused because you can't move the left side of your body.

Your wife comes to you. "Smile at me, Jim," she says. But the left side of your face won't cooperate.

"Wrinkle your forehead," she says. Nothing happens either.

"Jim, you've had a stroke."

A year later, Jim Edwards, the former South Carolina governor, former U.S. Secretary of Energy, and former president of the Medical University of South Carolina, sits on his porch of his home in the Old Village. There is no view like it anywhere in the Lowcountry, offering a wide panoramic swath of the harbor, along with the diving shows by pelicans and slow-moving kayakers. His wife Ann, a retired nurse, sits next to him on a matching rocking chair. If not for her fast response and stroke diagnosis, Edwards could have been alive, but paralyzed, or with significant weakness to one side of his body.

"I'm just blessed that I was here," Ann says, while praising the emergency care he got at MUSC.

The stroke hit on June 7, 2013. There had been no sign it was coming. That previous afternoon, Edwards had been a part of the ceremony recognizing the nine-millionth visitor to the nearby Patriots Point maritime museum. No one noticed anything out of sorts with Edwards, an oral surgeon who helped build the modern Republican Party in South Carolina, serving as governor from 1975-79.

Later that night, though, it hit hard, pinning him on his back like a defenseless turtle, with a near-total shutdown of his left side.

"I fell and was on the floor and I couldn't turn over," he said. "I just couldn't understand why I couldn't turn over."

Against his stubborn wishes, the nurse in Ann Edwards overruled her husband and called 911. The couple's granddaughter, Catharine Wingate, also lived on their property. At the time she was studying to be a physician's assistant at MUSC. Local EMS arrived within minutes.

Speed was important in getting Edwards to a hospital since every second of delay could lead to irreversible or long-term damage. Think of the message delivered on the first day of class for any medical student studying stroke treatment: "Time ... is Brain."

South Carolina without a doubt is the buckle of the nation's "stroke belt." Bad diets, sedentary lifestyles, diabetes, hypertension, smoking and obesity all help play into data that gives South Carolina, North Carolina and Georgia the highest rates of stroke and stroke-related death in the region. Recent state health stats show more than 2,330 people died from stroke in South Carolina in 2012 while close to 15,000 people were treated for stroke in South Carolina hospitals in that same period. It is the state's third-leading killer.

When the ambulance was directed to MUSC, all anyone knew was that a VIP was on the way. On call that night was neurointerventional radiologist Dr. Imran Chaudry.

The procedure performed on Edwards is known as a thrombectomy. A CAT scan, a special X-ray test, showed Edwards had two blockages: one in his neck, and one in his head. To reach them, doctors had to run a catheter up his body after entering an artery in his groin area.

For the neck blockage, the team performed an angioplasty by ballooning the vessel and placing a stent in it to keep it open. Once that was done, Chaudry said the team navigated other catheters called the Penumbra aspiration system beyond the neck to the blockage in his head (middle cerebral artery). "From here we were able to aspirate (or suck out) his clot," Chaudry said.

The procedure took 30 minutes, much less than the 90 minutes that it would have needed before today's technological advances.

Minimal sedation was necessary, meaning Edwards was alert and could hear bits and pieces of what the surgical team was saying throughout his time on the table. Studies indicate patients who are awake rather than under general anesthesia tend to do better.

Edwards showed instant physical improvement once the blockages were cleared; within moments vital blood flow returned.

"He basically got better immediately on the table after we removed the clot," Chaudry said. "It's probably one of the most rewarding procedures that we do. A lot of them will get better right in front of you."

Edwards recalls "through the vagueness" the surgical team chatting about "fishing" in describing as they found, grabbed and retrieved the nuisance worm clot. He keeps a photograph of the blockage in his living room, eager to show off the size: 5 centimeters, or about 2 inches.

"Most people go around showing pictures of their grandchildren," he said. "I go around showing pictures of a clot that they took out of my brain."

Chaudry said the takeaway from Edwards' stroke is that the response by everyone involved was relatively quick. "His family recognized that he was having a stroke and didn't wait around thinking 'It's mild, it's going to get better,' " he said.

Edwards suffered no permanent loss in brain function or to his physical dexterity. A year later, he considers himself at full recovery. Among his to-do list is getting back on the tractor that churns the soil at his country property north up the coast.

Edwards turned 87 last week. He and Ann will celebrate their 63rd wedding anniversary in September.

Reach Schuyler Kropf at 937-5551.

EDITORS' NOTE: Previous versions of this story incorrectly identified the position Edwards held in the federal government. He was Secretary of Energy.