The pain in Thomas Witakowski's head hit crushingly hard and fast. He struggled to slide to the floor from his bed, dial an ambulance, and crawl to the front door that he opened a crack for paramedics.
An abnormality on a blood vessel had burst in the back of his brain, spurting blood like an open spigot into the space between the skull. Witakowski was having a stroke and hanging on the edge of death.
The last thing he remembers after getting rushed from his Kaisertown home into the Mercy Hospital emergency room is a feeling of overwhelming agony and hearing someone say, "OK. That's it. Let's go." Then he lost consciousness.
Witakowski wouldn't wake up from a coma for more than a month. When he did, it would be to the sound of music.
He underwent a sophisticated neurosurgical procedure to stop the bleeding in his brain. But it was music that helped lead him out of a long darkness.
"I was fighting to find my way back and finally got back to the land of the living. And I really believe it's music that did that," said Witakowski about a medical experience that began in 2016 and continued through last year.
He is telling his story now to bring attention to stroke and music therapy. This seems fitting. The 60-year-old Witakowski has devoted his life to music.
He is an associate music professor at SUNY Buffalo State and he conducts the school's Philharmonia Orchestra, as well as the Amherst Chamber Ensemble and Buffalo's Chopin Singing Society.
Witakowski, who exudes enthusiasm when he speaks, also previously served as organist and choir director at St. Casimir's Church in the Polish neighborhood where he grew up. He plays violin and bass, and taught voice. But conducting and teaching are his passions.
"The orchestra is my instrument. You're at the top of the pyramid, managing the musicality of all these people and the psychology of all the players. There are so many little pieces to connect to create the experience," he said.
Stroke kills about 140,000 Americans each year. About 15 percent of the cases are hemorrhagic, meaning an abnormality in a blood vessel bleeds into the brain, but they are responsible for 40 percent of all stroke deaths and significant disability, according to the National Stroke Association. In this case, a bubble known as an aneurysm formed on a weakened vessel and ruptured. Quick treatment is essential to preventing lifelong medical complications or fatalities.
After Witakowski entered the hospital on Dec. 2, 2016, physicians threaded a tiny tube called a catheter through his groin and up into the artery containing the aneurysm. Through the catheter, they deployed soft platinum metal coils as thin as hair to pack and seal off the defect, and to stop the bleeding.
Medical staff kept Witakowski in a medically induced coma – a strategy to rest the brain after serious injury – for a few days and then waited for him to wake up.
There were no guarantees. About half of the patients die with this particular type of bleeding injury in the brain. Of those who live, only about one-quarter eventually return to normal life after rehabilitation, neurosurgeon Dr. Lee Guterman noted in a review of the case.
"The thinking was that he was not anticipated to live long. It was very bad. If he survived, it was likely he'd have significant deficits and would need people to help him live for the rest of his life," said Alexandria Foley, the hospital's stroke coordinator.
Witakowski was off a ventilator but remained minimally responsive. Only when doctors or nurses applied painful pressure to his fingernail, a common method for assessing neurologic activity, did he show a slight response.
It was during this period, that a stream of visitors came to his bedside and performed for a silent audience of one. Friends sang Polish Christmas carols. A priest he knew well sang from a book of Polish church hymns. Students from Buffalo State played pieces for guitar and violin.
There was a turning point when SUNY Potsdam's all-male a cappella group, The Potsdam Pointercounts, visited Mercy Hospital in early 2017 after frigid temperatures forced cancellation of a performance at a nearby school. A nurse wheeled Witakowski's bed into the corridor of the neurointensive care unit when the group stopped to sing a few tunes.
Suddenly, Witakowski began to stir. He raised his hands and then slowly gestured as though holding a baton and conducting an orchestra.
"Even now it gives me the shivers to think about it," he said, recalling the incident based on what others told him. "The nurses are going, 'What's he doing? What is that?' And that's when they knew that I was in there somewhere."
Low-tech therapy plays a role in stroke recovery. Among an assortment of approaches, nurses, therapists and others try to incorporate important aspects of a patient's life that will trigger a response, or encourage them to try harder in the difficult work of recovery – things with an emotional resonance like children, art, or pets.
"People need to be engaged in their own care," Foley said. "You need to find that thing people want to live for."
For Witakowski, once it became clear that music was his passion, staff gave him massive doses of it. Every time a nurse or doctor stopped by his room, they tuned in a piece on their phones and turned up the volume.
You don't need to be a doctor to know that music activates the brain. We live our lives in a musical soundscape. It influences moods and emotions. It evokes memories.
But a growing body of research also attests to the healing power of music. A 2017 review by the Cochrane Library, an independent organization that examines medical studies, found that music interventions for acquired brain injuries, including stroke, appear to help with such issues as walking, motor skills, communication and quality of life.
Dr. William Coplin, a neuro critical care intensivist, is a music-enthusiast himself and ran through an eclectic gamut of genres to stir Witakowski, holding a phone to his patient's ear. The music ranged from the supremely difficult to play Paganini Caprice No. 24 to the punk rock of the Descendents to the frenzied neoclassical Swedish guitar metal of Yngwie Malmsteen.
"The idea is to direct something toward what the patient understands, whether it's cooking, horse racing or bad humor. You're trying to figure out what you can do to wake up someone. Music was his wheelhouse," said Coplin.
One piece especially resonated with Witakowski. It's the one that he associates with pulling him out of the trance-like state – Beethoven's monumental Fifth symphony, with its iconic opening of da-da-da-DAH. The Fifth has come to represent the idea of marshaling willpower to triumph against the odds, just as the composer created classical masterpieces in the face of worsening deafness.
"He may not have intended it this way, but that symphony has become a musical emblem of struggling against fate. What is so great about it, is that after all of this dark music in the key of C minor, you reach this blaze of glory in the fourth movement where all the brass come in, and it moves from that darkness and that struggle to triumph. And that's always been for everybody, but particularly for me, the struggles that we triumph against. I wanted to catch a little of that inspiration," Witakowski said.
Waking up is only the start. Stroke can change you. Weeks in a coma left Witakowski weak, stiff and thin. Like so many other stroke patients, he felt trapped inside a body that no longer worked right, that now failed him. The simplest tasks, even reading, seemed out of reach.
"My mind and my body were just a mess. I was getting depressed because it's like I realize that I can't do anything that I used to do. You're lying in a bed thinking you're going to have to retire. Everything in your life is changed, and I sort of gave up," Witakowski said.
Music rescued him again. He was in his hospital bed listening one evening to Verdi's "Aida," the extravagant opera set in ancient Egypt. It was a classic production, with monumental sets, many extras and a big orchestra.
"I'm picturing this overwhelming scene and imagining what it must be like on the stage, and I started to cry. This is so beautiful. This is who I am, and I'm not ready to give it up yet. That was the moment where I told myself I don't care what it takes. I felt as though I was at the bottom of a mountain, and I've got to crawl on my hands and knees to the top," he said.
Whatever his rehabilitation required, Witakowski tried to do more. If a therapist asked for 15 repetitions of an exercise, he would do 30. At night, after being loaded into a wheelchair, he pushed himself until he could make it to the end of the hallway and back on his own.
He was discharged from the hospital in mid-February in 2017, but continued rehabbing at home for many months. He returned to teaching last fall with only a handful of lingering effects. There's a shunt in his skull to drain fluid, and his left eye is misaligned, causing double vision. He wears Fresnel prism glasses to correct this.
His desire to nurture his students and watch them grow is stronger than ever. He knows he's lucky to be alive.
"It's been a lot of hard work, and is still a struggle," said Witakowski. "But I would tell people in similar circumstances to never give up."