“I Survived a Stroke”
First came a few small ones, and then came the big blow. But I’m very lucky
NO ONE WANTS TO BELIEVE THAT, IN A MATTER OF hours, they could be laid low by a stroke, lying in bed, barely able to move or talk. But it happened to Ron Smith. Here he describes the devastating attack, and his long and unpredictable road to recovery. I stood in the doorway of the bathroom of our home in Vancouver Island, Canada, watching my wife Pat prepare to go out to lunch with friends. As I leaned against the door jamb, and took in an eyeful of the woman I have loved for close to half a century, saying goodbye and telling her to have fun, I felt a bit odd. Not nauseated or faint, simply odd, inside myself. Perhaps a bit weak. Nothing out of the ordinary that a brief lie down wouldn’t cure.
So I bid my wife au revoir and sprawled out on the bed. I drifted to sleep. When I awoke, two hours had passed. I staggered to my feet and thought, I’ve got to get some work done. I made my way to my study, sat down at my computer, and noticed my right hand was sluggish. My fingers were moving in slow motion.
I paused. This was def initely strange. I had developed the habit of searching the Web for the peculiar things happening to my body as I got older. So without thinking – and I’m not sure why I did this – I typed “stroke” into Google. I can’t say why I typed “stroke” and not “flu” or “Lyme disease” or “heart attack”.
I found the common symptoms for stroke: sudden numbness or confusion, trouble seeing or walking, dizziness or severe headache. I also found several tests. Can you raise your arms? Can you smile? Can you make up and repeat a complete sentence?
I lifted my arms above my head. I smiled.
So I told myself, you’re not having a stroke.
I figured I had done my research and, still feeling tired, went back to bed. I had the flu, that was it, although the image of my uncooperative hand still nagged at the back of my mind. And I still felt odd … perhaps a little light-headed, or dizzy.
About 4pm Pat came home. “You’re still in bed!” she remarked. “Yes,” I admitted. “Are you still feeling poorly?” “Yes.” “Do you think we should head into emergency?”
“No,” I insisted. “I’ve probably got the flu. I’d be wasting their time.”
Another hour passed and I still felt ‘odd’ and a bit nervous that my symptoms persisted. Finally Pat insisted we head for the hospital. She dropped me off while she went to park the car. I weaved my way into reception, my
legs feeling quite feeble, almost wobbly. Pat joined me, and after checking in, we took seats in the waiting room.
Shortly after a man called my name and gestured towards an examining room. At last, I thought.
The doctor asked for a detailed account of what had been happening to me. He performed a number of tests. He asked me to touch my nose, and then follow his finger with my eyes. He told me to count backwards by sevens. He had me squeeze his two fingers with each hand. He tested my reflexes.
I passed every test, so I thought what I’d been experiencing was just some temporary malfunction of the wiring. I was perfectly healthy.
“I’d like to keep you in for observation,” he said.
My jaw dropped. “You’ve got to be kidding,” I exclaimed. “Didn’t I just pass your tests?”
“No. I wouldn’t kid about this. And yes, you did pass all the tests.” I stared at him, dumbfounded. He would tell me later that even though I had passed all the tests, there was something in my account that set off alarm bells. “You might be having what we call a stuttering stroke ( progressive stroke),” he explained. “It happens over several hours, perhaps even several days. You’ve likely had a number of mini-strokes since this morning. If that’s the case, the likelihood of being struck by a larger stroke is very probable.”
I looked around the room, then finally made eye contact. “OK,” I said.
We stepped out of the examination room, and the doctor talked to Pat. She nodded as he explained his diagnosis. Then he told us to take a seat. Someone would be along as soon as they had a free bed.
Pat sat beside me working on a crossword puzzle, while I fussed and squirmed in my seat. I remember trying to find a comfortable way to sit, something I suddenly found extremely hard to do. Then it happened. The light started to disappear. Close in on itself. Into a tunnel.
Soon there would be no light. There would be an absence. Of everything. Of everyone. Of Pat. “I’m dying,” I said. I was terrified.
Diagnosis Confirmed
I could hear Pat calling for help as I slowly slid to the floor. Then the room filled with intense white light. I was surrounded by people who hoisted
THE LIGHT STARTED TO DISAPPEAR. SOON THERE WOULD BE NO LIGHT. THERE WOULD BE ABSENCE – OF EVERYTHING
me onto a stretcher and whisked me into a treatment room where they inserted an IV and attached me to monitoring machines. I could hear bleeps and beeps, and people assuring me I was in good hands.
“What is happening to me?” I asked. My voice sounded like an old phonograph record spinning too slowly. The words seemed heavy and thick. I saw Pat standing in a corner, fear in her eyes.
The next thing I knew my clothes were being removed. My pants came off. My arms rose above my head and my shirt slipped off.
“Aren’t you a lucky man,” a nurse told me. “You’ve got five women undressing you.”
I laughed and agreed, but it was dawning on me that my movements were no longer voluntary. The lights dimmed. Pat kissed me on the forehead and departed. I was alone.
I remember nothing else about that night, except a vague recollection of being shunted back and forth through a fluorescent glare, never conscious of where I was going. I had been sedated, which was a good thing, or I may have plummeted into the black hole that engulfed me. I curled up, thinking the prenatal position offered me the most reliable protection against free fall.
When Pat returned in the morning she told me the doctors had confirmed the diagnosis – I had suffered a stroke. How severe it had been, no one knew yet. It would be another 36 hours before I was told what I never, ever thought possible: that I might be paralysed on one side of my body. Soon I was to learn that not only could I not move, but when I went to form words, my tongue was heavy, and my vocal cords twisted. My words were strangled.
As I lay there, the confusion was overpowering. Everything seemed so vague. So alien. Nothing made sense, no matter how hard I tried to slot a sight or sound into a compartment of my brain.
In the afternoon of the second day a woman came into my room and said I had been assigned to a bed on the fourth floor. Pat packed my belongings, and the porter rolled me up to the acute-care ward, past people shuff ling along in nightgowns and patients in wheelchairs.
As soon as I had been transferred from the stretcher to the bed, a curtain was whipped around its track and I was partitioned off from the rest
IT’S UNSETTLING TO HAVE YOUR CHILDREN SEE YOU SO VULNERABLE. FOR A MOMENT I FELT DESPERATE, AND ALMOST ASHAMED
of the room. A nurse told me, “If you need assistance, just press the buzzer on the pillow. Someone will come.”
I don’t know what kind of magician she figured I was. I couldn’t reach the button, and even if I could, I lacked the strength to press it.
Pat stood at the end of the bed, shoulders hunched, trying to console me. “Nicole will be here tomorrow,” she said. “She’ll drop off Flora at school and catch the 10.30 ferry.”
Nicole was our daughter, an archaeologist who lived with her partner Iain and their daughter, Flora.
I yearned to close my eyes and sleep. I could see Pat was anxious to get home, facing a rainy commute in rush hour. But I think she feared she would be abandoning me.
Finally I said, “Go. Please. I need to sleep.”
As she kissed me, my head lolled to one side and I watched her through my eyelashes. She looked so, so tired. Then she was gone.
I Started to Cry
My sleep was interrupted by people taking my blood pressure, my pulse, my blood. I was made to sit up and swallow several pills. When Pat arrived mid-morning of the next day, I woke up torn between panic and a huge sense of relief. Panic because the stark reality of what was happening was finally beginning to sink in, and relief because my most reliable connection to the outside world was seated at my elbow. She would protect me. I was certain of that.
Later, I saw a face peek around the curtain. Nicole. I wanted to leap out of bed and embrace her, but all I could do was lie there like a beached whale. It’s unsettling to have your children see you so vulnerable, and for a moment I felt desperate. Almost ashamed.
I had always presumed my daughter saw me as a figure of strength, as someone who would protect her. I had a sense of having let her down. Of disappointing her.
She leaned over and kissed me. “Oh, Dad,” she said. “I’m so sorry.”
“Me too,” I said, sounding like I was chewing on a mouthful of rubber bands.
Although I was thrilled to see her, I remember the precise time of Nicole’s arrival because I was so famished. I hadn’t eaten for two days. It was just past noon and it appeared as though they had forgotten me again. I asked Nicole if she would fetch the nurse. I wanted to know why they were starving me.
Meanwhile, I turned to Pat. “Have I ever told you about that time in Paris when I passed out from hunger?” I couldn’t get over the sound of my own voice; I was mangling words as they stumbled off my tongue. “Yes,” she said, “several times.” “Then I won’t tell you again,” I tried to joke. “I don’t want to repeat myself. You might think I’ve lost my mind.”
As she took out a sudoku, I recalled the last time I was this hungry was during a trip I took to Europe. I closed my eyes and searched through my reel of images. I was amazed at how much I remembered of living cheaply in London and Paris.
“So your daughter tells me you think we are starving you?” This was not a voice from my memory, but a young nurse leaning over me.
“I’m hungry,” I said. “Even a bowl of gruel would be nice.”
She took my pulse. “We’re not al- lowed to give you anything to eat. Not until the Swallow Lady has been to see you.”
I stared up at her. “Swallow Lady. Who’s that?”
“The speech therapist. She’ll be by tomorrow to give you some tests to see if your swallow mechanism is working. We don’t want you choking on your food.”
“I can swallow,” I said. “I’ve swallowed a bucket-load of pills in the last two days.”
“Yes, but that’s different,” she replied. I’m afraid you’ll have to continue taking nourishment from the IV.”
As the nurse disappeared beyond the curtain, I muttered, “Swallow Lady. What’s next?”
Nicole sat on the edge of the bed, with a look of concern. She took my hand and squeezed it. What Nicole saw when she looked at me must have been scary – my incomprehensible speech, my general confusion, my mood swings. I was like an incomplete sketch of myself. I was beginning to feel as though I was no longer a part of this world, and over the next few weeks this disengagement intensified.
Pat stood up and announced she was going for a walk. I was happy she wanted to take some time for herself. Besides, this would give me an opportunity to be with Nicole.
“You keep kicking me,” Nicole said and smiled. “Are you hinting that I should leave?”
“No, of course not,” I said. “They’re spasms. I can’t help it.”
I was suddenly afraid she might go. I struggled to find a way to let her know how grateful I was that she had come to visit. Then she smiled again. “Just teasing. Did you say spasms?”
I realised I needed to speak more clearly. “Yes, like cramps,” I said slowly. “They hurt, like someone is jabbing me with a knife.”
“Can they do something?”
I WAS BEGINNING TO FEEL AS THOUGH I WAS NO LONGER A PART OF THIS WORLD, A FEELING THAT WOULD ONLY INTENSIFY
I could hear the strain in her voice. Her face, so young, became a map of apprehension.
“I don’t know. I think they’ve given me a muscle relaxant, but it’s not working.” Without warning, I started to cry – as if something within me had suddenly broken down or a spring that held things together had sprung. I lost control, and no matter how hard I tried I couldn’t stop the tears.
The Swallow Test
Shortly after Pat returned from her walk, a rehabilitation doctor appeared at the end of my bed. At first, he told me, they thought my stroke was fairly mild. Nothing had showed up on the CT scan. But a second scan had revealed that I’d had an ischaemic stroke – an obstruction in a blood vessel – on the left side of my brain, causing paralysis of my right extremities. “What caused it?” I asked. “We don’t know. I’d guess hypertension. Your blood pressure was very high. But you have other conditions that could have been contributing factors.”
I started to replay feelings of guilt. Risk factors for stroke include high blood pressure, diabetes, high cholesterol, sleep apnoea and being overweight. I qualified on all fronts. I had indulged a host of bad habits for far too long.
“The good news,” the doctor said, “is that a bed has become available
in rehab. You’ll be put on a six-toeight week intensive rehab course, followed by eight weeks as an out– patient. You need to be willing to work hard. What do you think?”
“Yes, I can do it,” I answered, although at the moment my body suggested otherwise. “Count me in.”
But first I had to pass the swallow test. I longed to meet the Swallow Lady since I was so hungry. When the smell of hot food wafted along the hallway, all I could think about was my empty stomach. When had I ever been this hungry?
Again, I recalled my trip to Europe and the day in Paris when I paced in front of an eatery, staring through the window at the food. I hadn’t had a decent meal in three weeks.
Later that same day, I collapsed from hunger. A woman kneeled down beside me. “Are you OK?” she asked. I was scared. I was famished but had no money for food; and I was exhausted and ashamed, with no place to go. The woman helped me up. She brought me to her small hotel and arranged for the proprietor to give me a room and feed me for two days.
And now, as I lay in bed, my memory reminded me of the generosity and caring nature that sustains hope at the core of human consciousness. And I was learning that memories help you find yourself, help you reconnect with the person you’re losing.
The next morning Pat and Nicole were both there when a man and two women arrived to take me for a walk. “The faster we get you up, the better we can assess your needs,” the man explained.
My right side didn’t appear to be working, but nevertheless, with one swift movement they had me perched on the side of the bed. “We’ll walk as far as Nicole, OK?”
I stood, slightly stooped, looking across the room at my daughter. I shuffled, my left foot lifting, my right foot dragging behind. Each step seemed like a gigantic task. I almost lost heart halfway across the room, but I refused to give in.
I walked a distance of only six metres, but Nicole seemed excited and applauded my performance. “Oh, Dad,” she said. “You did it. I’m so proud of you!”
I felt drained of energy. But Pat reassured me, “Well done, dear. These are the first steps to full recovery.”
“Congratulations,” the therapists chimed in. “You’re ready for therapy.”
Back in bed, I slept. Then a woman
I WAS LEARNING THAT MEMORIES HELP YOU FIND YOURSELF, TO RECONNECT WITH
THE PERSON YOU ARE LOSING TO THE STROKE
quietly entered the room. She carried a notebook and pen, and a bag that contained saltine crackers, some apple sauce and a box of juice. The Swallow Lady. “Are you ready for the tests?” she asked. “They are really quite simple.”
“Yes,” I said, ready to show her I could swallow.
She leaned over the bed and placed her fingers gently on my throat. “Try swallowing for me.”
What could be easier? But my mouth was dry and my throat constricted. I couldn’t swallow. The harder I tried, the more my throat tightened up.
“Relax,” she said. “Try moistening your mouth.”
I managed to work up some saliva. Then my chin pushed forward, my neck stretched and I swallowed.
“Good,” she said. “Well done. Everything appears to be working properly.” She scribbled in her notebook, then passed a cracker to my good hand. “Now, try eating this cracker, but do it slowly, in little pieces.”
Immediately, I took a good-sized bite. The cracker stuck to the roof of my mouth. I couldn’t chew, and only managed to spit it out. “Nibble,” she said. “Tiny bits.” I felt like a fool. How could I not swallow? But I did as she suggested, taking a tiny bit of cracker, and then swallowed.
“Good, now try this. Sip slowly.” She poured a small amount of apple juice in a paper cup and I drank it, forcing myself to concentrate on each stage of swallowing.
The therapist smiled. “You’ve done well. You’ve passed the test. For the first few weeks your food will be minced or pureed. But you must eat and drink slowly and carefully. This is only one of the many things you’re going to have to relearn how to do.”
Relearn. That word would become ALONE WITH MY THOUGHTS, I WAS TERRIFIED. I DRIFTED IN AND OUT OF SLEEP, AND THROUGHOUT THE NIGHT, I WEPT a mantra of my therapist communi– ty. I was about to learn that restoring what has been damaged is a very complicated process.
“Will I Recover?”
My first night in the rehab ward was terrifying. Alone with my thoughts, I no longer felt like I belonged to the human race. My brain kept taking tours into my distant past. I drifted in and out of sleep, and throughout the night, I wept.
Yet memories, I was convinced, were the one touchstone I shared
with my old self. They worked like a metaphor to help establish my new claim on ‘being’. A part of my brain was damaged, but other parts seemed to be working overtime to compensate for what I had lost.
And thankfully, Pat would not let me feel sorr y for myself. Nor were the staff tolerant of any signs of quitting. As I travelled through the halls in my wheelchair in the weeks to come, what I heard was a chorus of voices raised in a song of healing. Rarely did I hear anger or annoyance escape anyone’s lips but my own.
That first day I had an appointment in the gym. “Do you know the way?” a nurse asked me. I then realised they expected me to wheel myself to the gym. Good luck, I thought. I couldn’t go in a straight line. My right arm hung lifeless in my lap, and when I pulled with my left hand, I did doughnuts.
“Drag your lef t foot along the ground as you push,” a nurse advised. When I tried, I managed a few metres before I veered right and smashed into the wall. “Perseverance,” she called out to me.
I repeated the lurching motion, once again smashing into the wall, then continued down the hal l, swerving to my right, almost colliding with an elderly woman. Then, to my surprise, I bolted forward in a straight line towards the gym. “I’m assuming you’re going to the gym,” Pat said from behind me.
“Yes, is that you?” I asked. “Thank you. They expect too much of me.”
“They want you to do as much as you possibly can yourself.”
As we entered the gym a woman approached us. “Hi, I’m Deena, one of your physiotherapists.”
I fancied her the second I noticed the light in her brown eyes. Over the next hour she introduced me to the equipment. First we worked on getting me into a standing position, then she told me what I could safely use – mostly the stationary bike and the weights and pulleys.
“Two things,” Deena said. “Always remember to apply the brakes when you leave your chair. Otherwise you could end up on your bottom. And repetition. Repetition is what retrains the brain. And builds up muscle memory.” “Will I recover?” I murmured. “All in good time.” She paused. “Recovery is very slow after a stroke. You need to be patient.”
I LIFTED MY PARALYSED ARM AND SWUNG IT IN A CIRCLE. I HAD MOVEMENT FOR THE FIRST TIME SINCE MY STROKE
Gains and Losses
The goal of ‘mirror therapy’ is to fool the brain. A mirror was placed by my right shoulder, my right arm behind the mirror. Then with my good hand I performed several simple exercises, staring in the mirror as hard as I could.
I drummed my fingers, formed a fist, flexed the fingers of my left hand. I did this slowly so my brain took in the movement, pausing then repeating, for about a half hour. I stared at the mirror. I knew that registering the movement in my brain was critical.
What I saw, of course, was the reverse image. I thought I was looking at my right hand doing the movements. Not my left hand. My brain was being fooled.
Or was it? I wasn’t sure. My right arm still lay on the table behind the mirror. But I was determined to embrace this little deception. I think these exercises helped forge new pathways between the hemispheres of my brain.
One day, after a few weeks, Nicole was sitting opposite me when she jumped to her feet and shouted that my damaged hand had mimicked the movement of my good hand. At first I didn’t believe her, but then I lifted my paralysed arm and much to my amazement flung it in a circle, hitting the mirror, which went sliding across the table.
I let out a whoop. I had movement in my arm for the first time since the day of the stroke!
By using mirror therapy in combination with meditation – where I focused on my hand and attempted
to travel in my brain down my arm to the tips of my fingers – I was hopeful that I would recover use of my body.
Gradually, I regained movement on my damaged side. I was able to stand on my own. I started to climb the stairs in the gym, hanging onto the railing. I could pedal the stationary bike for 15 minutes. And I was now able to transfer myself to the toilet without assistance.
Sure, I sometimes became morose, feeling naked and raw and tearful. But I had taken a vow: to remain positive and happy. And recover.
Then one morning, the week before Christmas, five weeks after my stroke, the rehabilitat ion doctor came to see me. “Would you like to go home for Christmas?” he asked. “Then if things work out, you’d return in the New Year as an outpatient for three months.”
I was both elated and a bit scared at the prospect. “Who’ll take care of me?” I asked.
“Pat. Your wife? You do remember her, don’t you?” he said and then smi led. “We think you’re ready. Pat’s keen to give the idea a go. We’ll supply all your medications and requisitions for the aids you need – wheelchair, walker, anything to make your home more comfortable.”
OK, I thought, being home was a good choice. As the doctor turned to leave, he smiled and said, “Merry Christmas”.
I spent most of Christmas Day sleeping. I crawled out of bed, transferred to my wheelchair and joined Pat for breakfast. Within an hour I was back in bed. Nicole, Iain and Flora arrived on Boxing Day. As soon as she saw me, my granddaughter frowned. What happened to Poppa? She was intrigued by my wheelchair. And fearful.
“They’re my legs,” I told her, “until Poppa gets better.”
The sorrow I felt at that moment choked me, and if my lips had parted, the whole neighbourhood would have sworn they’d heard a lone wolf cry in the wilderness.
As they were leaving the next day, Flora said, “Poppa, please get better.”
A year would pass before she felt confident enough to approach me and wrap her arms around my legs. What a moment that was to treasure. By then I was walking with a cane.
Meanwhile, my weeks of outpatient therapy were monotonous, but the benefits were immeasurable. I pedalled a stationary bike, did leg lifts, did squats and arm pulls. I was finally able to pronounce a word without confusing the vowels and consonants.
My emotional control was still quite fragile. I would weep when I saw scenes of poverty on TV. Silly jokes could give me unstoppable giggles.
I’VE LEARNED THAT there is nothing smooth or predictable about stroke recovery, but also no limit. The old notion that there is a limited window in which to achieve rehabilitation is simply false, whether it be six months, a year, two years. So like most stroke survivors, I expect full recovery. But full recovery doesn’t necessarily mean a total return to the person we used to be, identical in every respect. Full recovery in this sense rarely happens. With the passing of time, even in the normal world, people change.
So it’s unlikely I’ll return to be the person I once was, physically, mentally, or spiritually. I have both lost and gained things that define who I am as a person. But with the advances in treatment and therapy, I believe I can continue to repair and rebuild, and find a place for myself in my reconfigured world where I will feel both valuable and valued.