Quintin usually spent his first period of school in the library. That day, he was agitated and couldn’t recite his school ID number, says school librarian Cheryl Carr. When he wrote it instead, the numbers were illegible. “Quintin has beautiful handwriting, and he couldn’t form the number nine — it was like a big circle,” says Carr. On his way out of the library, he crashed into the door.

Carr wasn’t sure what was going on, so she asked Quintin’s second-period math teacher, Shinaide McAleavey, to watch him. “I think there’s something seriously wrong with Quintin, and I think it’s medical,” Carr told her. McAleavey did as requested. And when Quintin couldn’t tell her his own name — and when she saw that the right side of his face was drooping — she walked him down the hall to the school nurse.

Quintin’s symptoms had subsided by the time they reached the nurse’s office, and his vital signs were normal. Jodi Klass, RN, hadn’t gotten a complete download about Quintin’s behavior from McAleavey, and she thought about just sending him home.

“But he couldn’t answer questions appropriately — he said he’d had tomatoes for breakfast and gave his birthday as a year in the future,” she says. So Klass called 911. By the time Quintin got on the stretcher, the weakness and facial drooping had returned.

Luckily, Connetquot High School is only 10 miles from South Shore. When the ambulance pulled up, emergency physician Matthew Schwartz, DO, was there to meet it.

“The initial call we received from EMS was for a 17-year-old with altered mental status,” he says. That can have a multitude of causes, from head trauma to infection to drug ingestion and more. “Quintin was confused — but he also had a facial droop, and one side of his body was weaker than the other. Those are classic symptoms of a stroke.”

To Dr. Schwartz, the pieces were fitting together, even if the picture they formed seemed unlikely. “There’s a saying that time is brain — if someone is having a stroke, the longer you go before initiating therapy, the more brain cells die and the greater the chance of permanent disability,” he says. “So the clock was ticking. I needed to go with my gut.” Within 30 seconds of Quintin’s arrival in the ER, Dr. Schwartz called it. “Code stroke!” he yelled.

Dr. Schwartz’s team moved fast. Step one was a computed tomography (CT) scan to look for a blockage in the carotid arteries, the major blood vessels that feed the brain. It’s difficult to overestimate the importance of these arteries: They supply about two-thirds of the blood to the brain. Quintin’s scan showed that he had a blood clot in his left internal carotid artery — a big one. The clot extended all the way up to his middle cerebral artery, a main artery in the brain itself.

“That’s a large stroke,” says Dr. Schwartz. “There was a huge chunk of brain tissue on the left side of his brain that was without any blood flow.”

With both a stroke and a blood clot confirmed, step two was administering a blood-thinning medication called tenecteplase (TNK), a potent thrombolytic medication, or clot-buster, TNK is most effective if given within three hours of the onset of symptoms, but may still be beneficial if given up to 4.5 hours after. Quintin’s episode fell within that time window.

Even with a delay caused by having to sedate Quintin twice to get the CT scans done (changes in the brain can cause agitation), the emergency team managed to assess, test, diagnose, medicate and prep him for surgery to remove the blood clot with incredible speed.

“I think the official time was 31 minutes,” says Dr. Schwartz. “We were very happy about that.”

After his thrombectomy, Quintin was closely monitored in the Linda and John Bohlsen Neuroscience Intensive Care Unit, under the care of neurologist Daniel Santos, MD. Three days later, he was transferred to Northwell Cohen Children’s Medical Center for further testing to try to determine the stroke’s cause.

Strokes in kids under age 18 are rare: Studies suggest 1.2 to 13 cases per 100,000 children (though experts say some cases may be missed). Black children and male children seem to be at greater risk, for reasons that are unclear. And Quintin’s recent bout of Covid-19 may increased his risk further; Covid triggers inflammation throughout the body and temporarily causes the blood to become abnormally thick, which may increase the chances of a blood clot traveling to the brain.

The tests at Cohen Children’s Medical Center also revealed that Quintin has something called a patent foramen ovale (PFO), a small hole in the heart between the left and right upper chamber. PFO exists in everyone before birth, but generally closes soon after; if it remains open, it may raise the risk of stroke. Quintin will have surgery to repair his PFO soon. And just in case, his medical team prescribed a daily low-dose aspirin to keep more clots from forming.

Quintin’s memory of that day is confused. “It’s like a fever dream,” he says. What’s not in question is his gratitude to his health care team. “The doctors saved my life,” he says.

The doctors won’t forget Quintin, either. “He was in the back of my head all day,” says Dr. Schwartz, who stopped by to check on Quintin around 10 pm, at the end of his shift. “He was awake, talking, making sense and moving the right side of his body,” he says. “It was a remarkable day. You deal with so much as an emergency doc that you have to guard against getting burned out. But a case like that, when you can make such a difference in a kid’s life, can help to motivate you.”