Jane Hanson's only remaining reminder of the massive stroke she had Nov. 4 is the boot on her right foot and the walking cane — complements of a broken ankle from a fall that night.
Hanson had been trying to plug in her computer when she started laughing, thinking it was funny that she couldn't see the port where the cord needed to go.
One of her sons saw something else, though — a horrifying blank look on her face that told him something was seriously wrong.
As he rushed to find a phone to call 911, Hanson tried to stand up to show him everything was OK, becoming entangled with a footstool and breaking her ankle during a fall.
Three months later, the pain and lack of mobility are a constant reminder of the injury, but things could have been so much worse.
Hanson said she remembers most of that night: the paramedics showing up to her home, the ride in the ambulance, the arrival in the emergency room at Bryan West Campus and the terrible throbbing pain in her ankle.
Other things she doesn't remember and only knows about because her doctors and family members told her later. That includes Dr. James Bobenhouse, a Bryan Health neurologist, telling her sister and mother that the shot of "clot-busting" medicine — the first-line treatment for stroke — didn't work and that her situation was grave.
Bobenhouse recommended doing a thrombectomy — a surgical procedure to attempt to remove the clot causing her stroke — but warned it was risky.
With Hanson incapacitated by her stroke, the decision fell to her sister, Ann Kansier, who was her medical power of attorney.
Kansier, who works for Bryan Health as assistant manager of care management, faced a tough choice: The surgery was risky and could kill her sister, but doing nothing could leave her severely disabled.
She said she knew her sister wouldn't want to live like that, so she gave her OK.
Without the surgery, "This would not have been the person you see sitting here," Kansier said.
About 800,000 people in the U.S. have a stroke each year, and around 18 percent of patients die. Thousands more wind up permanently disabled.
Thanks to some luck and the skill of her medical team, Hanson did not become one of those people.
"We got it all."
Those are the first words Hanson remembers hearing after Dr. Kyle Pfeifer, an interventional radiologist, performed her thrombectomy.
She said she sensed fear in his voice but also excitement at having been successful.
Pfeifer said that when a stroke patient needs a thrombectomy, it means things are extremely serious.
"These are major, major strokes," he said. "These are patients that typically are going to die."
Pfeifer said in Hanson's case, the clot was in a major artery that supplies blood to the brain, and it was completely blocked off.
The thrombectomy involved making a small incision in Hanson's groin area and threading a catheter all the way up to the location of the clot in her neck.
In Hanson's case, Pfeifer said he had to use two different tools to remove the clot.
One was an aspiration catheter, which he said acts like a vacuum cleaner to "suck" the clot out. That was only partially successful in Hanson's case, so Pfeifer also had to use what's called a Solitaire device, which is a stent attached to a wire.
He used the expandable stent to essentially "capture" the clot and pull it out.
Hanson's stroke was on the right side of her body, and one of the common effects is problems with language and speech.
That could present a huge obstacle for someone like Hanson, who speaks four languages and works as an adviser and senior instructor in the English as a Second Language program at the University of Nebraska-Lincoln.
But it turned out she was lucky.
"The first thing I did when they told me I had a stroke — I checked my Spanish," Hanson said.
It was all there.
"I thought how lucky I am," she said.
Hanson left the hospital 17 days later with virtually no complications from her stroke — other than the broken ankle, which required surgery.
"Just a tiny bit of hearing loss," she said.
"Amazing" is the word she uses to describe how the pieces all fell into place the way they needed to for her.
"If one single thing had been wrong in the process of getting here (to the hospital) rapidly, I wouldn't be here," Hanson said. "That's humbling."
Mary Ellen Hook, stroke program coordinator for Bryan Health, said that from the hospital's point of view, all patients should "be like Jane."
That's because the main key in Hanson's treatment and recovery was the speed with which she got to the hospital.
"People need to know that speed is essential," Hook said.
Not only does that mean getting to a hospital quickly, it also means recognizing the signs of a stroke as quickly as possible and calling 911 rather than have someone drive the patient to the hospital.
"Is her recovery remarkable? Yes it is," Hook said. "But it doesn't have to be atypical."
She pointed out two other recent stroke cases, both elderly men, who got to go straight home from the hospital after a few days with no need for rehab, largely because they got to Bryan quickly and received prompt treatment.
The treatment standard that hospitals and doctors have followed for years is that stroke patients must be treated within six hours of showing symptoms. Any longer than that, and lack of blood flow will cause irreparable damage to brain tissue.
A new study that came out last month shows some patients may still have a good outcome after 16 and even 24 hours.
The best outcomes, though, usually occur for those patients who are seen as soon as possible.
In Hanson's case, she was in an ambulance on her way to the hospital within 15 minutes of her stroke. She was lucky to be at home with her sons. And she was lucky to be in Lincoln, where the hospitals have advanced programs for treating strokes.
"I was here in the place I needed to be when I needed to be there," she said.
Hanson returned to her teaching duties at the beginning of the second semester.
She said the stroke made her reconsider her priorities, and she now plans to slow things down a little and try to simplify her life a bit.
"It makes you look at your life and makes you look at what is important."
At least two city leaders who have been considering running for mayor in 2019 raised money last year and paid for work by political consultants, according to campaign reports to the Nebraska Accountability and Disclosure Commission.
Mayor Chris Beutler, a Democrat, and City Councilman Roy Christensen, a Republican, have both indicated in the past they would consider running for the office next year. But neither has publicly made a final decision.
Beutler, currently in his third term as mayor, donated $14,000 — most of his campaign funds — in 2016 to help build the new Woods Tennis Center. But he said that depletion of his campaign account was not a sign he would forgo running for a fourth term in the spring of 2019.
Christensen is serving his second term on the Lincoln City Council. His name is often tossed around when there's speculation on who might be interested in the mayor's job.
Beutler raised more than $16,000 last year and spent most of it — almost $14,000 — on campaign consulting and fundraising, based on the 2017 report filed last week with the Nebraska Accountability and Disclosure Commission.
Christensen raised $18,460 in the last six months of the year, after successfully running for a second council term, based on his campaign report. He spent more than $14,000 on consulting work and fundraising.
Although neither Christensen nor Beutler has confirmed they will be a candidate in the 2019 mayor’s race, raising and spending money on consulting work is likely an indication they are at least considering it.
“You have heard people talking about Mayor Beutler running again and rumors of Roy Christensen running, so it makes sense they would be raising money,” said Rod Edwards, a political consultant.
“Even if they decide not to run, Mayor Beutler can give his money to other candidates and Roy can use his for a future campaign,” Edwards said.
Raising money several years before an election is not unusual. Candidates are starting to raise money earlier and beginning actual public campaigns earlier, Edwards said.
It's a good idea to begin early, said former mayor Don Wesely.
Wesely said he didn’t start to raise money until the December before the April primary when he ran for mayor. And he “got a lot of hard words from supporters that I needed to get started earlier.”
“The sooner you start, the better organized you are and the more focused you are,” he said.
Mayor’s races can be expensive. Beutler spent more than $430,000 in 2015 when he won his third term. His opponent, County Treasurer Andy Stebbing, spent more than $200,000.
Another city leader who many believe has considered a bid for mayor, Leirion Gaylor Baird, raised no money during the last six months of 2017, nor has she spent any money on political consulting. She does have about $10,000 remaining in her campaign account from her successful 2017 race for a second term on the council.
Another council veteran, Jon Camp, carried over more than $28,000 from his council race last year, but campaign reports indicate he has spent no money for political consultants.
WASHINGTON — When Jerome Powell is sworn in Monday as the new chairman of the Federal Reserve, the pride of the moment may be tempered by Powell's recognition of the risks that lie ahead.
A ferocious sell-off on Wall Street on Friday — with stocks tumbling and bond yields rising after the January U.S. jobs report suggested higher inflation ahead — served as a blunt reminder of the challenges Powell's Fed will face.
At his Senate confirmation hearing, Powell stressed his intention to carry on the cautious approach to interest rate hikes that his predecessor, Janet Yellen, pursued in four years as Fed chair. Yellen was able to oversee a gradual rate policy because inflation posed no threat: It ran below even the Fed's 2 percent annual target throughout her tenure.
The Powell era could be entirely different. The job market is tighter. Wages are up. Federal debt will likely rise. Tax cuts could accelerate growth.
All of which seems likely to drive up inflation, which is what spooked investors Friday. The main question, is by how much? For weeks, investors have been demanding higher bond yields. On Friday, after the government said average pay rose year-over-year in January at the fastest pace in more than eight years, the 10-year Treasury yield reached 2.84 percent, a four-year high.
The Powell-led Fed would be pleased to see inflation finally reach its 2 percent goal. The problem would be if it were to surge well above that level. The Fed would face intense pressure to accelerate its rate hikes to tighten credit and curb inflation.
That's where the risks come in: If the Fed tightened credit too little, inflation might surge out of control. If it tightened too much, a recession could result. Steering a safe middle ground has proved tricky for the Fed throughout its history. It has sometimes miscalculated how fast to raise rates and triggered an economic downturn.
In December, the Fed predicted that it would raise its benchmark short-term rate three times in 2018, just as in 2017. Yet some economists now foresee four increases. And those rate hikes would coincide with the Fed's continued paring of its bond holdings — action that puts upward pressure on rates for long-term consumer and business loans.
"The next phase of managing the economy may not be as easy," said Diane Swonk, chief economist at Grant Thornton, who expects four rate increases in 2018. "The Fed may have to raise rates more quickly because the economy is stronger."
For now, the economy that Powell's Fed will preside over shows strength and resilience. Unemployment is at a 17-year low. The economic expansion, already the third-longest in U.S. history, appears to be improving after a long stretch of subpar growth. On the surface, it might seem that all the Powell Fed needs to do now is serve as caretaker for a high-flying economy.
But the Fed always has felt compelled to respond to threats before, not after, they arise, while there is time to prevent high inflation or an economic slowdown.
"Everything points to a more aggressive Fed under Powell," said Mark Zandi, chief economist at Moody's Analytics.
No less an authority than Alan Greenspan, who led the Fed for 18½ years until 2006, expressed worries last week that dangerous bubbles might be forming in the financial markets, in part because of high federal debt resulting from increased benefit spending as baby boomers retire and the $1.5 trillion in tax cuts now taking effect.
"We are dealing with a fiscally unstable long-term outlook in which inflation will take hold," Greenspan said in an interview on Bloomberg Television.
The two most recent U.S. recessions were caused by bursting asset bubbles. The pricking of the dot.com bubble led to a brief recession in 2001. And the collapse of the housing bubble ignited the 2007-2009 downturn, the worst since the Great Depression of the 1930s.
The current recovery began in June 2009. If it lasts until June 2019, it would tie the longest expansion on record — the one that lasted from March 1991 to March 2001.
Although the expansion has been marked by slow economic growth, that very trait might ensure its durability: Plodding growth has kept inflation low and prevented the economy from overheating.
"I don't think a recession is on the horizon," said Sung Won Sohn, an economics professor at California State University, Channel Islands. "We have had one of the slowest periods of economic growth on record, and I think slow means it will go for a longer period."
For that forecast to prove correct, the Powell Fed will need to manage its rate policy with exceeding care. Friday's jobs report showing wages rising 2.9 percent over the past 12 months — the biggest such jump since the recession ended in 2009 — suggested that the Fed may be entering an era of higher inflation and a need for higher rates.
With Yellen's departure, the seven-member Fed board will have only three members. President Donald Trump has nominated Marvin Goodfriend, an economics professor who has long urged the Fed to raise rates more quickly, for one vacancy. Goodfriend awaits Senate confirmation.
But the president hasn't yet nominated anyone for the three other vacancies. Those selections will be critical in determining the Fed's pace of rate hikes and in carrying out Trump's desire to loosen bank regulations. Powell's responsibility will be to forge a consensus among the board members and the 12 regional Fed bank presidents who help set monetary policy.
Powell will be the first Fed leader in three decades without a Ph.D. in economics. But David Jones, the author of several books on the Fed, said that Powell, with his background as an investment banker, reminded him of the longest-serving chairman, William McChesney Martin, who led the Fed from 1951 to 1970. Martin also lacked a doctorate in economics but had extensive knowledge of Wall Street.
"Powell, like Martin, understands markets, and I think he will be as plain-spoken as Martin," Jones said, citing Martin's famous summation of the Fed's job: "To take away the punch bowl just when the party gets going."