Stroke

by Ricky Monahan Brown

  Ricky Monahan Brown suffered a massive haemorrhagic stroke in 2012. During recovery, he realised he had stories to tell. His writing has subsequently been published in books, magazines, journals and newspapers. He received a Stroke Association Life After Stroke Award for Creative Arts in 2016, and lives in Edinburgh with his wife and their son.

  First published in Great Britain by

  Sandstone Press Ltd

  Dochcarty Road

  Dingwall

  Ross-shire

  IV15 9UG

  Scotland

  www.sandstonepress.com

  All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form without the express written permission of the publisher.

  Copyright © Ricky Monahan Brown 2019

  Editor: K.A. Farrell

  The moral right of Ricky Monahan Brown to be recognised as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

  Translation of Hon’ami Kōetsu poem reproduced by kind permission of the Philadelphia Museum of Art

  The publisher acknowledges subsidy from Creative Scotland towards publication of this volume.

  ISBNe: 978-1-912240-45-6

  Cover design by Mark Swan

  Typeset by Biblichor Ltd, Edinburgh

  Contents

  Author’s Note

  1: You Had an Orgasm, I Had a Stroke

  2: Classy Girl

  3: The Valley of the Shadow of Death

  4: Frankenstorm

  5: For Whom the Bell Tolls

  6: The Shit Doesn’t Hit the Fan

  7: Hot Shower Action

  8: Zumba’s Biggest Losers

  9: Speech Therapy

  10: Occupational Therapy and Dream States

  11: Physical Therapy

  12: The Magic Rutabaga

  13: Quiet: Patients are Healing

  14: Thanksgiving

  15: Never Enough

  16: Sisyphus

  17: Disability and Benefits

  18: Valhalla

  19: Jacobite Warriors

  Epilogue: As Good a Place as Any

  Acknowledgments

  For you, Pickle. Obvs.

  Author’s Note

  As I write in these pages, many survivors of strokes, brain haemorrhages and brain injuries have stories about their experiences that have been practiced many times. We find our way to narratives that make some sort of sense of those experiences and our losses. I’ve tried my best to tell my story accurately in a way that makes sense to me. Some names and identifying characteristics have been changed to preserve anonymity, and a composite character or two appears herein. Throughout most of this story, my brain is broken, and I hope you’ll make allowances for that.

  1

  You Had an Orgasm, I Had a Stroke

  Like all the best boy meets girl, they fall in love, boy suffers catastrophic brain injury stories, this one started on a normal day. My girlfriend Beth and I had arranged to take my ten-year-old daughter on a playdate with a schoolmate to the New York Hall of Science. Six hundred eccentrics were displaying their glorified high school science projects as part of the World Maker Faire, among them an amateur mad scientist who was presenting his Zombie Detector Machine.

  The detector worked simply enough. Professor Frankenstein read a set of simple questions from his script. ‘Have you travelled abroad in the past year?’

  ‘Yes. We visited my father in Edinburgh in February.’

  He tapped away at the machine. ‘Have you recently suffered any bites?’

  We were in New York, and it was September. ‘I’m almost certainly being bitten by a mosquito right now!’

  Tap-tap-tap.

  ‘And do you ever experience a craving for brains?

  Since I seemed to be in enough trouble already, I figured that I might as well admit to a regular craving for haggis from a butcher just across the Hudson River in New Jersey, and all the warm-reeking, gushing entrails that might involve. Besides, Beth and I were vegetarians, so the haggis we would actually order was meat-free and my admission of having eaten haggis around the anniversary of the Declaration of Arbroath (or, as we would have it in New York, Tartan Day) was no worse than an admission that I might have been eating kidney bean brains. Even if that would be two sets of organs for the price of one.

  Frankenstein handed me a lightweight metal box and instructed me to press a button. When the button was pressed, the front of the box would light up to spell out either the word HUMAN or the word ZOMBIE, and the participant, applicably labelled, would show up on the monitor included in the exhibit.

  My answers added up to only one conclusion. The blood was daubed on the wall – I was a ZOMBIE.

  Beth was HUMAN, but my daughter Elizabeth was a ZOMBIE, too, so I wasn’t too concerned about my diagnosis. In fact, being a practically invincible member of the undead army could have been seen as a boon. For a start, there were more life and death scenarios to be navigated at the Faire.

  Elizabeth and I climbed into a submarine simulator, within which a pair of participants had to complete a set of instructions and tasks – press this button, spin that wheel – to avoid having a load of water dumped on them. Not exactly the Lusitania, I thought to myself, but it was certainly a bit soggy. In the end, even that was neither here nor there, as a rainstorm opened up over Queens and we were all soaked to the skin soon enough.

  That was the last time I felt rain on my cheek the way a person is supposed to.

  The Hall of Science and its grounds began to empty, and the three of us got the subway back to Brooklyn. We dropped Elizabeth off with her mother, a drive-by drop off, since my estranged wife and I had been separated for over two years. Our divorce had been sliding towards the acrimonious, and most of our conversations would end with her calling me an asshole.

  We left all that behind, returned home to pick up our pink Malaguti scooter, and rode out to Red Hook for a game of pool in a quiet little bar. We hit the back room and had a couple of beers while sinking a few balls. Although I had recently been labelled as one of the undead, my hand-eye coordination held up pretty well, and we halved four games. We whiled away some more of the early evening chatting with the motorcycle-loving proprietors, and by the time we were pulling our helmets on to head back to South Park Slope, Beth and I were convinced we were the coolest, most charming couple in the borough, what with our sexy moped, our pool skills, our bar-owning, hog-riding friends, and a skinful of beer. We luxuriated in each other’s company a little longer, and headed to Toby’s to share some pizza and a couple of large glasses of Italian red. An excellent meal, in lovely company, that fully deserved to be rounded off by a quick smoke, so, as was our wont, we idly chatted over a couple of Parliaments in the late summer air before heading home.

  It could hardly have been a more pleasant day. I was able to forget for a moment that the previous day I had been sacked from my job as a financial lawyer in Midtown Manhattan; that other than to visit my mother in hospital and return for her funeral, I hadn’t been back home to Scotland for years; that my ex-wife Linda was probably right – I was a bit of an asshole. It was good to live in the moment for a moment.

  Back at the flat, as I had sex for what would soon seem to be the last time, I couldn’t have been more in the moment. For her birthday, I had made Beth a piece of art that listed 32 general things I liked about dating her on one side. On the other side, it listed 32 things I liked about our lovemaking. The feel of her skin was thing 12 on one side, and things 5 and 28 on the other.

  Tonight, it felt like a million butterfly wings caressing my flesh.

  It wasn’t unusual for me to be short of breath after a session. Or to be so awash with dopamine, norepinephrine, oxytocin and o
ther naturally occurring uppers and downers that I would feel nauseous. An inability to string together an articulate thought in the aftermath of our lovemaking was nothing odd. In short, for me to be so intensely affected by our sex that I would complain of feeling ‘weird’ on this particular day would not be strange.

  ‘Honey, I’ve got a weird feeling in my left-hand side.’

  ‘What does it feel like? Do you think you’re having a heart attack?’

  ‘I don’t know,’ I replied, thinking of my father’s coronaries. ‘I mean, I’m not experiencing a vice-like pain in my chest or anything like that.’

  ‘OK. Relax for a minute. Do you need your asthma inhaler?’

  ‘No, I think I just need to lie quietly for a bit. I’ll be fine.’

  ‘Good.’ She smiled. ‘Look, I’m going to kill you with sex one day, but not today.’

  It was a fair remark. I was being entirely coherent and calm. We had been having a lovely day. There was no reason to panic. Still, after a minute or two, my left side was still feeling . . . I couldn’t describe it. Odd. Tingly. Nervy?

  ‘Sweetie, it might not be such a bad idea to call an ambulance,’ I admitted. ‘I think I’m going to be OK, but I don’t want us to be up all night worrying.’

  I had begun to harbour suspicions that I was dying. I remember, very strongly, not wanting to make too much of a big deal about it. We had had a lovely day, and there was no need to spoil it by overreacting to something that, at first, seemed like it might pass with a quick lie down and a glass of water.

  ‘Don’t worry.’ I smiled. ‘Everything’s going to be fine.’

  That was the last thing I said before I lost consciousness. It wasn’t entirely a lie. Beth was bright and smart and funny. I thought she’d do just fine without me.

  I was acting like William Bennett, the San Francisco Symphony’s principal oboist who suffered a cerebral haemorrhage midway through a performance of Richard Strauss’s Oboe Concerto. Bennett managed to fall – or more accurately, collapse – in such a way that, as he went down, he was able to hold his oboe aloft for a violinist to take it from him.

  I get it. He didn’t want to cause a scene.

  Fortunately, Beth had been around enough Scots, and dated this one for long enough, to be able to translate my subtle suggestion that we call an ambulance as HOLY CRAP! I think I’m dying!

  Curiously, I have no recollection of panic or fear. Before all this happened, I had always been scared of death, but in the face of my own mortality, I was calmly monitoring the way I felt and trying to communicate with my girlfriend about how things were progressing. As well as having the sexual charge to kill a man, Beth is scary smart and very practical. If I ever needed a layperson to give me sound advice about how to proceed as the feeling was receding in my left side and my brain was literally exploding, she’d be the person I’d choose. What I thought swiftly became irrelevant as I lost consciousness, becoming blind and deaf to the mess, puke and snot that were accompanying my departure from this mortal coil.

  As Beth coped with my post-coital passing and the arrival of the emergency medical technicians who staffed the ambulance, I was somewhere altogether more pleasant: standing in my late grandfather Hugh’s back garden in Buckie. Not only could I see it perfectly in my mind’s eye, I could feel the sandy, coastal Morayshire soil running through my hands. Given what I later found out was going on in my head, the illusion I conjured for myself was miraculous.

  Surprisingly, the garden served as a setting for diagnostics, where I could perform some scientific experimentation in a safe environment. Although Beth and I had been worried about the possibility of a heart attack, given my racing heart and the strange sensations on my left-hand side, my unconscious self had other concerns. The clear difference in feeling on my left and right sides had me worrying about a stroke, which only became apparent to me as I wandered through the hallucination of Hugh’s back garden. Like the real garden had been twenty years previously, it was sectioned into six squarish areas. Each part corresponded to a different part of my body. Looked at from above, the upper-left part of the garden, closest to the house, represented the left side of my face. It was a bit of a mess, frankly, and overgrown. Not the way I remembered it at all.

  As I noticed this, I somehow became aware that I couldn’t feel the left side of my face. I resolved to spend the remainder of my time in Buckie figuring out what was going on. I was worried about my face. If I was having a stroke, it was related to hot times with a beautiful woman, and I didn’t want that sort of thing being messed up by having a droopy face. Back in the real world I might have been concerned about dying, but here I was going to wander around that bloody garden until I had convinced myself that my face was OK. Even if I couldn’t do that, it was peaceful here.

  ‘I could stay here forever,’ I thought.

  Then, somewhere else in my mind, I saw a sparkle of garnet in Beth’s hazel iris, and I knew that I’d crawl over my own corpse to see her one more time.

  While I was enjoying a spring afternoon in a mostly well-tended Morayshire garden, Beth had called for that ambulance I’d suggested. This was a good thing. The first important step in surviving and recovering from a stroke is getting prompt medical attention. Apparently, clot-busting medication can reduce the odds of suffering a long-term disability if administered within three hours of the first symptom. Not that clot busting would do me the slightest bit of good: I was having a haemorrhagic stroke, not an ischemic stroke; my stroke was the result of blood vessels bursting in my brain because of massively elevated blood pressure, not any clotting in those blood vessels.

  The reputation that strokes have for being an old person’s affliction is understandable. Ischemic strokes account for the vast majority of strokes. The focus on the clot-based nature of most strokes makes them sound sluggish, particularly when combined with the way popular culture tends to depict the stroke victim. Slow-moving. Slurring. A bit like a zombie.

  That is to say, strokes are not always dramatic. My fellow survivor of cerebral haemorrhage, the legendary Edinburgh-born musician Edwyn Collins, took a characteristically louche and well-mannered approach to his stroke, even ascribing the feelings of nausea and vertigo he experienced to food poisoning. A full two days passed before he was admitted to intensive care and his major cerebral haemorrhage was diagnosed.

  My cerebral haemorrhage, though, was not a cardie-and-slippers event. It wasn’t even an indie music, Postcard Records stroke. Fuck, no. It was a punk rock, 1978 Sex Pistols in San Francisco stroke. The lead man in the drama was coughing up blood, the main sentiment being expressed was that this was no fun at all, and nobody could reasonably expect to see the protagonist perform live again.

  A haemorrhagic stroke occurs when a blood vessel bursts inside the brain. That doesn’t do justice to what had just happened to me as a team of paramedics squeezed into the bedroom. They measured my blood pressure somewhere above 300/200mmHg: high enough to kill two men. A blood vessel ‘bursting’ inside the brain is, at best, a Green Day stroke. American Idiot on Broadway Green Day. Ersatz punk rock. A cerebral haemorrhage at over 300/200mmHg is when a blood vessel explodes inside the brain.

  We were lucky, then, that we lived just eight short blocks from the nearest hospital. Time is of the essence when responding to a stroke, and it took those paramedics just a few minutes to arrive at our apartment, assess the situation, and remove me to Brooklyn’s New York Methodist Hospital.

  It’s hard for me now to describe the scene at Methodist as I was presented for admission to the emergency room, mainly because I was unconscious. Usually, it’s quiet and professional. The large, dark wood admission desk radiates an aura of calm. There are no gurneys slamming through swing doors. I would say that the place has that unmistakable hospital smell, but it doesn’t. There’s just a pleasant, fresh scent of cleaning supplies. Nothing overpowering.

  As one comes through the main hospital entrance into the lobby, a long ramp curves up and to the right, both
to cater for the slope that gives the neighbourhood its name, and to allow for the inability of patients, stretchers, IVs and the like to climb stairs. There are skylights everywhere, adding to a pleasant sense of airiness, and giving one a sense of weightlessness.

  I’ve heard stories of other New York emergency rooms where you have to change into a gown in the toilets. ‘Not the first one,’ the nurse will say. ‘It’s being cleaned.’

  This will be because that first toilet is awash with blood.

  Methodist Hospital in Brooklyn, on the other hand, would be as good, as peaceful, a place to die as any.

  2

  Classy Girl

  One of the funny things about a haemorrhagic stroke – and there are a few, I promise – is that the haemorrhagic aspect, the intracerebral bleed, only lasts for maybe ten seconds. About the time it took you to read that sentence. Such a little slice of time for such a devastating event.

  While haemorrhagic strokes only account for about fifteen per cent of all strokes, they are responsible for more than thirty per cent of all stroke deaths. My posture as I was rolled into the emergency room indicated that I was comatose and showing signs of severe neurological impairment. That put me at a grade five on the Hunt and Hess scale of diagnosis, with an approximately 90 per cent chance of mortality. If the blunt reality of that wasn’t enough, the doctor who turned out to be my neurosurgeon noted that there was a one-in-twenty chance of a ‘good outcome’, where a good outcome would be surviving in a non-vegetative state, free of serious paralysis.

  The paramedics had arrived at our flat within three minutes. Within another five minutes, I was in the emergency room, with more people working on me than Beth could count. The first thing they did was intubate me and hook me up to a ventilator. This is common procedure for the victim of a haemorrhagic stroke, because the patient’s impaired consciousness puts them at risk of aspirating saliva, snot and other such secretions. This can cause any number of problems, from choking to a type of pneumonia.