The Surge of Recovery?
Long is the night that never finds the dawn
Macbeth act V scene V
3.1 …. Through the holes in your string vest….
Sometime after the weekend (I still had little sense of time) the doctor who had spoken to my wife saw me alone for the first time and chatted as he carried out the examination. When the medic explained what had happened and what was going on inside my head all thoughts of going back to work abandoned. There was an infarction in the brain tissue which knocked out the cells that controlled movement on my left side. Apparently, the doctor was saying that a bit of my brain was dead or dying. It wasn’t so bad that a bit of me dying but why could it not have been a different part of my brain. The bit that remembers to send Christmas cards would have been good, it never worked well anyway. It would have been easy to live without the bit that had eventually managed to understand Pythagoras’ Theorem too, even now, with time on my hands I have never wanted to work out how high a church steeple is, nor has there ever been a need to. As the doctor’s examination continued my body was prodded and poked, hit with a rubber hammer, (it hurt, which was good.) and he asked me various questions like "what is your middle name." I could have earned a PHD in knowing things about myself but the seriousness of my condition was revealed when I confessed my real age despite always having been able to knock at least five years off (ten if there are any attractive women around.) There was little feeling on the left side. When the pointed end of the rubber hammer’s handle was drawn down my arm quite firmly I felt nothing. When the hammer hit around elbows and knees, there was a reflex response which meant there was some chance of recovery.
Following a general review of my condition, during which I was informed that sometimes stroke patients did eventually make a good recovery, that there would be an initial surge of progress as my brain tissue sorted itself out and previously unsused bits took over from the tissue that had been lost, after which progress would be slow there came the lecture that everyone surviving a stoke seems to get. "You life has changed fundamentally and you must not allow this to make you depressed or allow yourself to feel anger and resentment" and all that. When asked about the recoveries I had read of some people making he said I should not build up my hopes but try to come to terms with the idea of spending the remainder of my life in a wheelchair. Recovery from a serious stroke was rare. Then came the bad news. Despite various drug regimes being tried, my blood pressure had not responded and was dangerously (I think he actually said "ludicrously") high. "We’ll keep trying," said the doctor, " and we will crack it in the end." Noticing he had not actually committed himself to cracking it before it cracked another artery made it seem there was not much ahead for me. Even so I was not particularly downcast. When Teri came in a little later we shared a few laughs and talked about a little bit of my brain having died and did a duet of Cole Porter’s "Every Time You Say Goodbye (I die a little)" earning ourselves some odd looks.
Unofficial Medical Note
While I was working on a completely different project some time ago I needed to look up the Latin root of the word farce. I had an idea where it came from but wanted to be sure. Among other modern words from the same Latin root I noticed that the medical buzzword "infarction" which, like farce (and a well known colloquialism meaning "to demonstrate love, physically") is derived from the Latin Verb farcire, to stuff (its true - trust me). So when a doctor tells you that you have an infarction it is merely a pretentious way of letting you know you are stuffed. (worldly individuals may prefer to substitute the past participle of the colloquialism here.)
3.2 Everybody was Kung Fu fighting
At some point my bed had been moved from a very secluded corner of the ward to a more open area. Perhaps there is a feeling people would rather shuffle off this mortal coil in some privacy because the move seemed to coincide with a slight upward shift in mood. Being nearer to the centre of things however made it impossible to remain oblivious of the surrounding chaos.
If anybody still needs proof that the price of the material and technological advances of the past half century has been the surrender of our collective sanity, they should spend some time in a hospital. I have never had a high opinion of efficiency in the National Health Service but even from this starting point I was appalled by the way in which the hospital was run. (I had not really stopped working at that stage - the fact that my final project had been in a hospital probably did not help - because I could not help watching what was going on and thinking about how each task could have been accomplished more effectively. . Some say that the public expectations of the Health Service are too great while others talk of the "Dark Forces of Conservatism" and an ingrained resistance to change in the hierarchies. Wearing my "management consultant" hat I have to observe that the management systems in operation throughout the health service were apparently designed by a protegee of my old games teacher, Major "Josh" Bolland. The school had fairly enlightened educational policies in the early ninetten - sixties (torture and ritual mutilation were not encouraged) but one of Josh’s tasks was to try to instil something resembling discipline into a bunch of adolescent, anarchic intellectual idiots (none of us understood Pythagoras’ theorem but we all got full Marx for modern philosophy) and try to turn us into a future generation of leaders without relying too heavily on physical violence. One form of punishment the ex - army officer devised that did not involve spikes, heavy weights, clubs or long poles with nails in the end was known as penal drill. Under the supervision of one of the more psychotic prefects, recidivists would gather in the school yard and have to run round in circles for ten (one drill) twenty or thirty minutes. Josh obviously believed that the more time people spend running round in circles the more organisational ability they will develop. This idea survives in all areas of public service and particularly hospitals.
Where was I? Oh yes, madness.
There is no consistent definition of sanity of course and running round in circles is not necessarily a sign of madness. Most of us are mad in some way. Many people who are in hospital at any time are psychologically disturbed; I certainly displayed some symptoms of being, well, several bricks short of a wall, a few prawns short of a barbie, two sanswiches short of a picnic, not quite as balanced an individual as the man my friends were familiar with, but I’ll tell you about that in a while. One of the people on the main ward (I’ll call him The Gnome) had been left seriously bewildered due to fluid in his brain cavity following an attack of meningitis. Apparently a tube needed to be placed in his head to enable fluid to drain away. When I arrived he badly needed draining. Shortly after my arrival The Gnome paid me a visit. He was ambulatory but confused and though he persistently disturbed other patients the ward was permanently understaffed and the nurses could not possibly keep him under supervision. On his worst days The Gnome wandered constantly, molesting people as he fancied. He walked up to my bed with a strange, jogging gait and a vacant grin on his face, introduced himself and began going through my personal possessions, putting on a favourite T - shirt and wandering off with some other small items. A nurse retrieved them for me. The next time The Gnome came around, Teri was there to lead him back to his own bed. My wife could not be there constantly however and he returned later while the nurses were busy with evening meals. The Gnome’s idea of a good time at that stage in his treatment was drinking urine. He spied my catheter bag, made a beeline for it and tried to remove the tube so that he could get at the contents of the bag. The plastic bag, Gnome and the alarm were all on my left and there was little I could do. (I don’t believe the nurses placed the alarm on my useless left side deliberately or because they were thoughtless. They simply do not have time to think. The acute care ward probably had around thirty beds occupied by people in very serious condition. There were never enough staff available to attend to all that needed doing.) Eventually I pulled myself up into a sitting position, reached over with my right arm and gave The Gnome a hefty shove. Luckily he let go of the catheter tube as he fell back.
Gnome had other unsavoury habits. Wanking was one. I am not narrow minded by any means and having no religious convictions I see no reason to condemn those who indulge in the sin of Onan. Hospitals are no longer administered by holy orders so there is no official sanction on patients practising auto - eroticism if they can find any privacy. The Gnome was a gregarious fellow though, he liked to share his pleasure. I awoke sometime during the night to find him standing over my bed and aiming at me while bashing his bishop to use the vernacular. Just over one week after surviving a serious stroke I had to defend my dignity. Hoping my artery had healed sufficiently to cope with the rise in blood pressure that would result from an adrenaline rush I rolled onto the side of the bed, got my right leg on the floor and with my left leg tucked under me and propping me up, grabbed The Gnome by the throat. Sure of his undivided attention I informed him that even though seriously ill I would find the strength to rip off his head and ram it up his rectum if he ever again came anywhere near me. Another patient, wakened by the commotion, had rung the "emergency" alarm and the staff nurse arrived just as the point was about to be emphasised.
"Calm down Ian, you’ll kill yourself." the nurse, a young Irishman called Sean said.
"Not before I’ve killed him," Sean, who had a rather athletic physique, led/carried away Gnome, who was always very obedient for this particular member of staff. It was not so with the female nurses and I saw several struck, not with any great force but it is not the kind of thing people should have to endure at work.
When Sean had given The Gnome "something to calm him down" he returned to check on me. "He’s been terrible tonight," the young man confided. He raided the nurses station, ate my sandwiches and drank the urine samples that were waiting to go to the lab. There’s a doctor coming down to look at you."
Sean related the story of the incident as the duty doctor examined me. "You seem well able to look after yourself in a fight considering your condition" she said, very amused.
I smiled and in the best Marlon Brando voice possible in the circumstances told her "I cudda been a contender."
3.3 Hey, you. Get off my cloud.
The madness in the Gnome’s story was not the illness that affected his behaviour of course but the institutional insanity that prevented anybody in authority from admitting that there was a problem in case the responsibility for acting to resolve it fell upon them.
The following day my brother Graham brought Teri to visit. Both were absolutely appalled when they were apprehended by another patient who was zimmering back from the Television room to our side ward, and told of the previous night’s drama. They rushed to my bed, expecting to find me in a critical condition again.
"That old guy from the corner bed told us you had a punch up with a nutter" said Graham. "What the hell has been going on?" I told them. It should be pointed out that The Gnome was not "a nutter," his disturbance was due to the after effects of a near fatal illness. Still, I was in no condition to bother about being politically correct. The man was a disruptive element in the ward, an obstacle to the progress of others and, in annoying other patients a danger to himself. When a person with some authority had been flushed out of the management bunker Graham made all these points. The usual stream of excuses was made (no authority to restrain The Gnome, lack of funds, procedures to follow, administrative protocol etc.) "I am not asking for preferential treatment for my brother," Graham told them, "but if you do not take whatever steps are necessary to guarantee his safety while he is in this hospital, the next time you see me I will be accompanied by a lawyer, reporters and a television crew."
It worked up to a point. An extra agency nurse was on duty that night. The Gnome did manage to escape his minder but had enough sense to keep away from my area so I only heard of his nocturnal adventures second hand.
When we are seriously ill we do many things that could be considered outside our normal behaviour pattern. For the vast majority of us bedwetting for example, is completely out of character in normal circumstances. Continence is one of the many casualties of illness so when somebody has an ‘accident’ in hospital it is no big deal. Most of us while recovering from trauma and under heavy medication wet our bed at sometime. I certainly did. The Gnome went one better however. He wet someone else’s bed. - while the person was in it! At that point it was understood that he had to go and he was moved to another unit for surgery. We heard that after the operation The Gnome made a good recovery and returned to his job.
3.4 ....and I think I’m going out of my head....
I was not without "head" problems myself at this time and have no idea if some of the things experienced, (or at least remembered - the mind can play strange tricks) were due to the pressure on my brain, the grief my brain cells were experiencing at losing a few million of their friends or the side effects of the pharmacopoeia that was hitting my system every day. Over each bed was a reading lamp. The shade was a metal cone with a round metal bulb holder protruding from its apex. On the beds opposite, the backs of these assemblies pointed towards me presenting a narrow neck on a round body. In the half - light of the ward at night I was sure I could see pigeons looking at me from the bed frames. It wasn’t scary, in fact I quite liked them but I wondered why the hospital tolerated wildlife in the wards. Another evening, during a spell of very warm weather Teri, having pulled the screen around the bed to give me some privacy so that I could have the covers pulled down (I’ve never liked pyjamas) had dozed off in the armchair. My own half sleep was interrupted by the sound of rasping breath. A glance in the direction the noise seemed to be coming from revealed bandage swathed face peering at me, with eyes, nose and mouth visible through the bandages. Thinking it was The Gnome looking for revenge I pulled myself up to a sitting position. The face disappeared although the sound continued. On lying back the bizarre face appeared again. "What do you want," I said, "***k off! This is my bed." The breathing noise continued
"Look, go away. You’ve no right to be here." The face ignored me and carried on breathing noisily throughout the one sided argument. At last Teri woke up and asked me what was going on.
Recounting the incident made me realise the face was merely the pattern on the screen distorted by the folds. The noise was a nebuliser being used by a man with breathing problems. The experience may have been half dream, half hallucination but for a few moments it had seemed very real.
It was about two weeks since the stroke. People kept talking about "the surge of recovery" but there was no evidence of it. The trouble was that I expected to wake up one morning, leap out of bed and run off down to the shop for my newspaper. Unfortunately it is not a surge like that, more like a tectonic plate moving around the globe at a few millimetres per year. Well, that how it seemed to me. My left leg was still immobile and the matching arm flopped about limp and lifeless. Inside my head things may have been going on at a tremendous pace as communications systems tried to find a way to work around the damaged bit. I was sleeping less, conversing less monosyllabically appearing generally more alert and complaining about hospital food. (Breakfast was OK but samey, they did fish quite well most of the time and served an absolutely delicious Cheese and Leek Pie. Apart from that every recipe the kitchens tried seemed to turn out the same: an ’orrible sloppy mess with low fat creamed potatoes and two veg.
Andy, a former colleague from the project in Stockholm came to visit me while taking a break before his next assignment in Brussels. It was his second visit. I did not remember the first.
"Keep your chin up, Ian," he said. "Its good to see you looking better. I have to be honest, last time you didn’t seem to be aware I was here. (I wasn’t) I wondered if we would see you again but it looks like you are pulling through." Now that doesn’t sound very encouraging but he spoke of my improvement with such genuine warmth and enthusiasm that his visit lifted my spirits. After spending some time alone with Teri later I pulled her head close to my mouth and whispered "You can relax now. I’m going to be OK eventually, I promise." She was still spending most of her time at the hospital but was at least getting home for a night’s sleep.
"You are giving up on being back at work by new year?" she asked.
"Oh yeah, I need a long rest, I’m burned out. Perhaps its time to think about doing something else. Downshifting, you know."
"How about retiring? Its just a suggestion." she said patiently.
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