At 25 years old, Jasmine West woke up in hospital in an unfamiliar body.
She could hear and see, but had no power to move. All she could do was blink, and cry.
"I was thinking, my life is over," she said.
"I'm never going to run again. I'm never going to do anything again. This is it."
Just one month earlier, Ms West had been on the other side of the hospital curtain — working as a sterilisation technician at Warrnambool Base Hospital.
She was putting stock away one afternoon when she collapsed.
Ms West said medical staff told her she was likely pregnant or had vertigo, and sent her home with anti-nausea medication.
In the meantime, a clot had started forming in her brain.
"I was really messed up," she said.
"My boyfriend at the time tells me that I woke up crying, saying I'd had an out-of-body experience, and my words were slurred. I couldn't wee.
"I somehow managed to get in the shower. I remember vomiting."
Her boyfriend brought her back to hospital. Ms West said a CT scan revealed the clot, but it was written up as machine error.
"My mum was telling them it was stroke. They ignored all my stroke symptoms," she said.
Ms West said she believed medical teams did not consider stroke as a serious option because she was young and fit.
Effects of delayed diagnosis can be severe
About 108 Australians have a stroke every day. Almost one fifth of those are aged 18 to 45.
According to stroke neurologist Vincent Thijs, the number of young people having strokes across the country has been rising, despite overall incidence declining.
He said this has been partly due to improved detection, but also an increase in diabetes, obesity, high blood pressure, and sedentary lifestyles.
Despite this, stroke continues to be seen as an older persons' condition — including by doctors.
"There is disbelief in the medical systems, who still think strokes cannot happen in younger people," Dr Thijs explained — a "cognitive bias" that can lead to dangerous, even deadly delays in diagnosis.
He said there is also a lack of understanding about how stroke presents differently in young people, often developing slower, and first appearing as vertigo or a migraine.
Late diagnosis means late treatment. With 1.9 million cells dying every minute after a stroke, any delay can be the difference between recovery and permanent, life-changing injuries.
"If you think of the impact on a young person having a stroke, that affects their family, it affects their work, it affects absolutely everything," Stroke Foundation CEO Lisa Murphy explained.
"They're living with that stroke for a longer period of time than somebody who is older."
Only 35 per cent of all Australian patients with acute stroke reach hospital within the critical 4.5-hour window, with worse outcomes for those in regional and rural areas.
Ms West was already at hospital when her stroke occurred. In theory, she should have been in a good position for speedy treatment and recovery.
But she didn't receive a definitive stroke diagnosis for almost 48 hours.
"By the time they had found it, it was too late to do any clot busting drugs or clot retrieval or anything like that so they just put me on aspirin and hoped for the best," she said.
After three weeks on life support, she woke up in hospital with locked-in syndrome — a very rare condition where someone is unable to move or speak.
Struggle continues despite partial recovery
Ms West was "locked in" for three months.
Then, one day, she opened her mouth and, miraculously, it formed a word: "Yes."
Seven years later, she has re-learned to walk and talk, and lives independently with her whippet, Penny.
Ms West studies sociology full-time, and volunteers with a community health services provider. She can even drive, just using her left foot.
Dr Thijs said it was extremely uncommon for people to survive locked-in syndrome, let alone to live independently after it. He said Ms West was a rare case.
But it could have been a different story altogether if she had been treated sooner.
It's a sliding doors moment that Ms West, who still can't walk long distances unassisted and struggles with her speech, thinks about often.
"It does hurt because I do feel very much grief for the fact that there was a part of me that died," she said.
"But I'm kind of happy to be a guinea pig to show that hospital that there are young people that have strokes, and do not dismiss anything."
When asked about Ms West's case, South West Healthcare, which runs Warrnambool Base Hospital, said it was continuing to review its stroke pathways and had adopted the state's stroke telemedicine program, which provides round-the-clock remote access to neurologists.
"As medical practitioners, there is no reason to rule out a diagnosis of stroke based purely on a person's age," executive director Kate McConnon said.
"However, there are times when patients present with non-specific symptoms that do not always immediately point towards stroke, which can make a diagnosis for clinicians incredibly difficult and can delay important treatments."
The Stroke Foundation has been advocating for a stroke registry to get data on how hospitals are performing on stroke diagnosis and treatment.
Young people left out of post-treatment
The Florey Institute's stroke research co-lead, Julie Bernhardt, said delayed diagnosis was just one half of a system not set up to deal with young people.
The other half was about the follow-up after they left hospital, she explained.
"It's like being dropped off a plane without a parachute," Professor Bernhardt said.
"Young people might not actually be referred to rehab because there's an assumption that because they're young they'll actually do much better than someone who's older."
What support does exist has often been designed with older people in mind, meaning there's a lack of support around things like getting back to work, driving, dating, sex and pregnancy.
The Florey Institute recently launched a digital tool providing young stroke survivors with more holistic clinical care and long-term support across all areas of life.
The service is currently being trialled in Victoria and, according to Professor Bernhardt, will change the game for young people living with stroke.
It will also involve research around the cause of strokes earlier in life to improve identification.
"If you don't know at 26 why you've had a stroke it can be pretty disabling to think — 'Is it going to happen again?'" Professor Bernhardt said.
Ms West said such thoughts could be overwhelming at times, but she took control where she was able to.
"I'm lucky enough to be able to have what I have and live 100 per cent independent," she said.
"I probably under-appreciate my story a fair bit. I've never fully realised the complexity of what I've achieved.
"Maybe I am a bit of a miracle."
