The Anatomy Of A Stroke

The Anatomy Of A Stroke [Day 1]

It began some time around 4am on Monday [19 December] morning. “It was really weird, ” he later told me, “… everything seemed to happen in slow motion.”

My step-mother heard the fall, and found my father, a contortion of awkward limbs on the bathroom floor. Naked, initially he seemed more concerned by the preservation of his dignity than being aware of the relative urgency of dealing with the fire that had been stealthily ignited in his brain.

I received a call a few hours later, still not entirely sure what the situation was. However, when I arrived at A&E that situation was suddenly snapped into sharper focus; clearly no longer the possible issues associated with his chronic neck and arm problems. The fire had been raging deep within the very essence of him. The diagnosis now confirmed as an ischaemic/infarct stroke: a blood clot on the brain.

Although clearly exhausted, I was heartened by his relative lucidity; recalling the moment he’d got out of bed to go to the bathroom and various things that had happened since his admission and in the days before. But now here we were, together, alone, for a seemingly endless few hours, awaiting a bed for admission. He drifted in and out of sleep, occasionally complaining of the pain in his head, and his hip – he has two hip replacements. A man, in his later years, of complex health.

Time crawled, a degree of surreality as the A&E whirled around outside my bubble. Eventually, though, he was admitted to a ward and the dust began to settle on the day. Finally, now more relaxed and comfortable, self-deprecating and dry sense of humour in tact – briefly naked again, surrounded by three nurses, he remarked on the apparent vulnerability regarding their disconcerting use of the word ‘stroke’ – I kissed the soft white hair of his head, he thanked me for everything and I headed home; I was told the next day or two would reveal more.
The Anatomy Of A Stroke [Day 2]

They say the sun always shines on the righteous. One way or another, of late, I’m beginning to feel increasingly like the Chilean miner they accidentally left behind! And now, I’ve fumbled around in my pockets, lit a match, and blinking into its shadowy light, there’s my dad slumped in the corner.

Today was a bit of a shock; even after yesterday. When I got to the hospital, my step-mother had made it in a few minutes before me. I’d last seen her after leaving him yesterday and was relatively upbeat, in terms of reassuring her that he was still in there. But now, we both sat in front of this man neither of us barely recognised; he still had moments of apparent lucidity, but it was a curious mix of references that seemed to be combining leaking memories, displacement and gallows humour. And on the outside, this shell of a man, now inescapably etched with the remnants of that uncontrollable fire. A man, quite literally, cut in two: the right side trying desperately to hold onto our memory of him; the left side taking on the appearance of a once much loved, but long since abandoned, home.

The stroke team have been excellent. And, Jo, exceptional. She gently took our slightly shell-shocked selves into a quiet room and sat patiently with us, explaining and fielding our scatter-gun questions as they randomly crowded out the tiny room. At the end, though, we were no longer under any illusions. He has suffered a ‘really big stroke’. And, protracted recovery notwithstanding, for a while, even with the medication on board, he remains at significant risk for another event and also the threat of pneumonia and other infections.

The recovery – if, when and how much of it comes – will be measured in weeks and months.

Today was their wedding anniversary. Are you still going out tonight? “Of course. We’re going out to the Upton Inn.” Are you going to drive? “Why not?”
The Anatomy Of A Stroke [Day 3]

My father appears to have discovered the secret of one hand clapping.

I stared at him quizzically. He knew I was there, but he was somewhere in his own world, flickering his hand back and forth, sometimes slowly, sometimes faster, for no apparent purpose yet extremely focussed in his conspicuous task. ‘What are you doing?’ I eventually asked. He laughed his newly lopsided laugh, “I’m clapping.” Meanwhile, his left hand remained entirely motionless, steadfastly refusing to join in the applause. It would seem that in his head he was indeed clapping, but his eyes revealed something entirely different. I say ‘eyes’, but his left, of course, currently another casualty of muscular dysfunction. “Sounds good to me, ” he said, and laughed again.

After yesterday’s lurching sideways shock, it was good to have an important part of him back; lucid again, much brighter in the eyes, yet no longer in hospital: “I’m at the Upton Inn.” A dry sense of humour makes for a strange bedfellow at times like these, but it was genuinely him. And I think he’s going to need the sense of humour in the weeks and months ahead.

My dad. Alan. Now rapidly approaching his 79th birthday. And yet, even with his two hip replacements, an already dodgy arm and a chronic neck problem that was meant to see him attend the pain management clinic early in the New Year… this time last week, he played 8 holes of golf! Moaned about the pain, the freezing weather and his current form, roughly in that order.
The Anatomy Of A Stroke [Day 4]

As I walked down the ward, there he was, sat up in a high backed chair, his left arm draped across a pillow on a large tray clipped into the chair – the whole scene taking on a curious time lapse quality that had seemingly taken him back to childhood. The team had put him in the chair using a hoist and a complex series of movement restricting straps.

‘Show him what you can do with your leg, Alan,’ said Jo. Dad somewhat theatrically waves his right leg in mid-air, the surgical gown riding up like a can-can girl from the Carnival of Freaks. ‘Not that one!’ He was smiling, his eyes and face already notably brighter than yesterday.

“I’m going to take a penalty*,” he said. I looked down, his face a picture of contorted focus… nothing. Then, after a handful of seconds that hung in the air like an hour, his left leg sharply snapped out and back from the knee; a sudden spike of electricity. “Oh, bugger… I missed.” Smiles all around, none of them broader than that belonging to my step-mother, eyes now welling with happier tears, sat a few feet away. We were all hugely encouraged, but this was still only the beginning of the long road ahead.

I had to hear the slightly disconnected story of being meticulously restrained in the hoist that had landed him in the chair. “I thought they were strapping me into a parachute and putting me in a bomber over Germany.”

My dad. Alan. He was born in 1933, in Bristol: due to it’s aircraft industry, one of the cities notoriously blitzed during the course of the Second World War. I know the experience had a profound affect on him as a child, but it’s not something he really talks about. He spent his entire working life at the BAC [the British Aircraft Corporation]; mostly as a gifted toolmaker, and in his later years, with flight operations. One of his tasks… packing parachutes. He’s never jumped out of a plane, though, with or without one… until now.
The Anatomy Of A Stroke [Day 5]

My dad is always clean shaven, usually to within an inch of his life, utilising ripping upward strokes with the kind of razor that would probably have me hiding behind the couch. So it’s also been strange going in and seeing the ever expanding field of stubble creeping across his face, quietly adding to the unfamiliarity. Myself, I tend to lean toward the designer stu… uh, laziness. I cannot lie. [Essentially: don’t shave for about six days, beard begins to itch, resultant shave, rinse and repeat. When people meet me they’re invariably left with a first impression of smart or borderline hobo, depending on which part of the cycle they should bump into.]

Prior to my arrival this afternoon, he’d been shaved by a male nurse from Tonga, was sat virtually upright in his chair, eyes conspicuously flickering with life. The overall transformation was quite extraordinary: the guy sat in the chair looked remarkably like my dad!

“Well,” he said, “I was worried you might try and kiss me again.” Our inter-family affections aren’t exactly legendary. “And it was beginning to feel a bit like two hedgehogs mating.”

As well as the obvious visual improvement [the left side of his face had lifted, too – now able to drink without that post-dental work backwash we’re all familiar with], there was notably more movement in his leg and there was even a little movement in his arm. When I think back to how he was just three days ago. Extraordinary.

He’s also warming with increasing enthusiasm to the idea of this document. [Another reason to shave?! Make himself presentable to the world. I’m ready for my close-up?! : )] “I could be famous. It might become a book or play, or something. I noticed there are signs to a theatre just down the way.” Uh, it’s not that kind of theatre dad. ‘He knows that,“ my step-mother quickly replied. I knew that. He knew that. He was even sharp enough to share a joke at her expense. We laughed again.

I asked Jo on the way out if we were in danger of getting ahead of ourselves here? She said the signs are hugely encouraging, and at this rate the preface of ‘months’ to recover may well begin to pull back to a greater emphasis on ‘weeks’, but it doesn’t diminish the size of the stroke. There’s still a long way to go yet. And more than a little leg room for the less positive aspects of my dad’s personality to re-emerge.
The Anatomy Of A Stroke [Xmas Eve: Day 6]

It was early evening before I managed to get in to visit and my footsteps quite literally echoed down the corridor leading into the ward. There were no other visitors, a skeleton staff and a swathe of empty beds; everyone who could be home for Xmas, long gone. An eerie calm now drifting through the normally animated and industrious air.

Dad greets me with a slightly weary smile and “I’ve not had such a good day today.” He says this without a trace of either humour or irony…

Thirty minutes in his company, however, soon reveals still further measurable improvement; brighter in his thinking [and demeanour, when more with it], almost effortless flexing of the knee, a creeping reaction in his arm and even the merest hint of a grip appearing in that, the most stubborn, hand.

That subconscious autonomic greeting, then, another reason for this document. We’ve all curiously enjoyed his sharp and gentle humour slicing through the otherwise heavily underpinned tension of the week. But this is also going to be a potentially significant factor in his battle to recovery; his humour can sometimes mask a default personality which will often sit with a drink held in a glass measured as half empty rather than half full.

The challenge facing the majority of stroke survivors is certainly multi-layered: the brain [already extraordinarily impressive in its rewiring project], the mind and body combining. The latter’s coupling intrinsically linked. Recovery is ultimately often measured in desire, determination and commitment to the challenge. [e.g. To actually do all the physio exercises that he didn’t do after the last hip replacement; rather than bemusedly complain about a lack of progress and an incredulity as to the lack of recovery via some mysterious form of osmotic ether!]

Festive baubles to you and yours. Next update is likely to be in a couple of days or three.
The Anatomy Of A Stroke [Xmas Days]

My friend Amy wrote the other day: Life matters. Dignity matters. Love matters. And if Xmas encapsulated anything, in all its strangeness this year, it was how they all came together with the spirit of hope.

Dad has continued the gentle upward curve over the Xmas period: his mind becoming increasingly clearer; his appetite slowly returning; once hoisted out of the bed he can now stand for short periods; and I’ve quite warmed to the steely determination he’s begun to adopt with the more stubborn left hand – attempting to crush mine in our newly adopted handshake. An auspicious thumbs up on the progress, so far, then.

Oh, and I won this year’s traditional, familial Xmas Day arm wrestling competition. Albeit the winning of the coin toss arguably proved important. Best of three, alternate arms, I won the toss so chose to start on the left for a 2-1 win. Result! : )

As the rewiring continues, the daytime dreamlike hallucinations are apparently curiously entertaining. Birds flying in through the window and sitting on the bed opposite. Dogs casually wandering down the ward. Random faces appearing in the curtains. And the fixtures and fittings occasionally swirling around in elaborate dance formations. I’ve been there when this happens. He’s perfectly awake and lucid, describing the scene as if its inexplicable that I can’t see it, too. And yet, as soon as he closes his eyes, opening them again wipes the hallucination away like a real life Etch-a-Sketch. The strangeness and charm of stroke recovery.

“Reaching out for a hand that we
can’t see
Everybody’s got a hold on hope
It’s the last thing that’s holding me”

– Guided By Voices
The Anatomy Of A Stroke [Day 10]

‘Of all people who suffer from a stroke. About a third are likely to die within the first 10 days. About a third are likely to make a recovery within one month. About a third are likely to be left disabled and needing rehabilitation.’ The Stroke Association 2011.

It’s still admittedly early days, but to our and the stroke team staff’s collective incredulity, it’s looking increasingly likely that dad will predominately, if not entirely, inhabit that middle third category.

I’ve often had my doubts as to the complexity of my dad’s brain. But now, thanks to recent events, I think we’ve finally had it confirmed beyond any lingering doubt: it’s quite a simple one. I mean, to have made such extraordinary progress from where we were barely a week ago, clearly there’s not a lot in there to go wrong, eh?

So, today you get him in his own words, from the journal [below] I tactfully gave him for Xmas. My dad’s never been much of a writer. And he’s certainly never [to my knowledge] had a journal. So this is all new territory. All part of my subconscious feeling that was the catalyst for this documentary, all the psychological tooling up for what seemed like the challenge of his life.

You also get to subtly witness another aspect of my dad here. We’ve been through a great deal together in our time – notably after being cast adrift when my mother suddenly left home when I was 12-years-old [taking my then not-quite 2-year-old sister with her]. I’d find it difficult to adequately express how much his support through the baffling teenage years meant to me, but it’s also no great surprise, here, to witness his somewhat perfunctory prose. He’s a genuinely lovely man, but emotion and feeling would often require an electron microscope to locate. Maybe the journal will find them?

Update: [Day 11] I’ve just put the phone down to my step-mum, effusively telling me that in front of the disbelieving consultant/stroke team on rounds this morning; dad got out of bed, walked to the kitchen, made himself a cup of tea, drunk it, then walked back to bed. : )
The Anatomy Of A Stroke [Week 2]

The brain is an extraordinary thing. And to witness its innate ability to rewire only adds to its weird and wonderful aura. But along with the brain, comes the mind. And with it, the real challenge begins.

The images here quite clearly illustrate the brain’s remarkable, largely autonomic, rewiring capacity. In just two short weeks; from a starting point of complete paralysis of his left side, dad can now walk, head [and catch] a ball, and the hardest thing of all: pick up and place small plugs into a cup. [If you look at the right hand image, you can see the tension in his background right hand. He also lifts his left leg too, such is the effort involved in that task. The complex mechanisms of the hand are notoriously the slowest to respond, and require the most ongoing work.]

All this has been incredible to see. And, removing all the wishes and hopes from the equation, it’s honestly the last thing my step-mum and I had expected in this time frame. But now, there’s a new hurdle on the track… his mind.

A couple of days ago we had a meeting with the entire stroke team [doctors, nurses and physios], every one of them remarking on his exceptional progress. The mood was buoyant. And finally suggesting, at this rate of improvement, he could be home in a week; something which seemed completely incomprehensible not much more than a week ago. And there sat dad, silent, distant. All perspective seemingly lost. To him, that week sounded like a month, a year!

It had been creeping in for a couple of days now. The gentle humour receding, the anxiety and the grumpy emerging. I say, emerging, but in reality, re-emerging. It was partly where the idea for the journal came from, sensing this part of the challenge that lay ahead of him; to maybe give him an empowering outlet for those feelings and emotions when they came.

One thing my step-mum is slowly realising, she appears to be getting back exactly the same man that came in; the man of his more later years. Two weeks ago a blood clot slice him in two and his brain responded incredibly. And now, two distinct slices of his personality – the genuinely lovely, determined and the humorous, and the anxious and the grumpy – are responding to the challenge. And which balance of those characteristics gain the upper hand may well be the ultimate arbiters to his level of recovery.
The Anatomy Of A Stroke [Week 3]

I took this photo about an hour after he came home from hospital today. His 79th birthday. All things considered, an extremely welcome present.

Within 5 minutes of getting home my wife somewhat incredulously caught him half way up a step ladder into the loft, “There’s another walking stick up here somewhere…” Yeah, well, we’ll be sure to get it down for you and put it on the stretcher when they take off in another ambulance after you’ve broken your neck! Unbelievable.

Dad continued to make steady physical progress throughout the first week of 2012, but it seems clear that the autonomic rewiring has finished and now it will be down to the daily visits of the physiotherapists [for 6 weeks] and his own motivation to reinforce and strengthen those newly constructed neural pathways.

Here you can see how his left hand is attempting match his right but, despite immense effort on his part, stubbornly refuses to comply; the arm and hand tiring quickly as the tension of the movement slowly evaporates. The index finger is working much more effectively now, in tandem with his thumb, but the second, third and fourth fingers currently remain ‘mostly asleep’. Dad often reports the sensation of holding something which isn’t there. [Er, like a step ladder?!]

During the week he had another scan of his neck which showed severe stenosis of his right carotid artery. On the plus side, this is virtually guaranteed as the cause of his stroke, but with his rating at 70-75%, means he will need to return to hospital on Wednesday for a carotid endarterectomy. Think: your drains need rodding to clear a blockage, then apply that image to the artery in your neck.

Obviously, as with any operation, there’s a risk – of death and/or of a second stroke [between 1-5%] – but it will reduce the likelihood of a second stroke occurring within three years, essentially a daily living form of Russian roulette, by 33%. So, it’s a bit of a, umm, no-brainer.

Psychologically, dad’s currently dealing with the idea of the operation, but is otherwise in good spirits and very happy to be out of the acute ward. Two guys sadly died during the week and, as we were leaving, another is now on permanent oxygen and fading. When we take a look around us, the reality of dad’s progress in less than three weeks since admission is truly blessed and remarkable.