Stroke

by Ricky Monahan Brown

  Did the kids even rave in dank, under-the-stairs clubs anymore?

  Throughout my stroke experience, the physical therapists were my favourite therapists and they had the best equipment, too. Towards the beginning of my time at HJD, Michelle, my weekday PT, got together with her colleague, Rodney, and helped me arrange myself on the obviously blue floor of the gym. The two therapists were compact little balls of health who worked with an efficiency that suggested they could take care of me as successfully as they had taken care of themselves.

  Michelle relieved me of my left trainer and stuck a mark of infirmity on the inside sole of the shoe, under the heel. It was about the size and shape of a hen’s egg, perfectly matching the olive-grey of the shoe’s outside wall. Without prior knowledge of my situation, you wouldn’t have known that it wasn’t part of the original design. The egg quietly pressed into my foot like the black spot blind Pew pressed into the hand of Billy Bones, summoning him to his death by thundering apoplexy. Meanwhile, Rodney wrapped a lightweight grey and blue cuff around my leg, just below the knee. The cuff had a plastic casing set in one side that held a device resembling a pager. When Michelle had finished applying the conductive fabric sticker, she attached the gait sensor to the trainer, while her colleague began to program the remote control.

  All these items worked together as what the manufacturer, Bioness, called the L300 Drop Foot System. The system delivered small electrical stimulations in a timed pattern set by the remote control. The idea was that those impulses would activate the muscles in the leg to lift my foot to take a step. Except I was not ready to take independent steps. Even walking with foot drop was a dream. Instead, while I lay on the ground, my rehabbers lashed my reshod feet to a stationary bike. With the help of the artificially created impulses, I was able to cycle in a pleasing, mechanical rhythm. My inner sci-fi geek was elated! Lying on the floor, I pictured myself rampaging through Tribeca on Inspector Gadget-style mechanical legs. Or relentlessly marching up the East Side after having all my organic parts replaced so that, incrementally, I became a cyborg. Or sprinting uncontrollably north along Second Avenue, while Rodney and Michelle cacklingly controlled my limbs.

  A week later, Michelle guided me to a small room – a large cupboard, really – and introduced me to the Bioness Dynavision D2. It was a black, four-foot square board, dotted with a constellation of little, square, red and green LEDs that radiated from its centre. While I stood on an instability pad, individual LEDs blinked randomly. If a green LED flashed, I was to press the button it illuminated. If it was red, I was to control my impulse. In either event, I had to recite the number that appeared on the board, at eye level. It was like Dance Dance Revolution for stroke patients, and it was intended to help with visual, motion and attention deficits for patients with neurological injuries. I loved it.

  When we returned to the main gym room after that activity, my crackling peripheral vision picked out the poster on the wall furthest from the door, and I focused on it. Big, happy letters like you might see on a primary school project told me I was looking at a collection of photos of those who have passed through rehab in this gym before, and had entered THE NEURO-REHAB HALL OF FAME. In each picture, an all-star stood, grinning, among a row of triumphant therapists.

  ‘How do I get up there?’ I asked Michelle.

  ‘Just keep working.’

  I told her that making it onto the wall was my new ambition.

  Physical therapy became the tent pole that supported my entire rehabilitation. While my brain found it hard to gauge its own improvements, the gains PT produced were measurable, tangible and of huge encouragement. The elation these gains brought would radiate, like an exploding pattern of green and red lights, to improve my performance in speech therapy and occupational therapy.

  I woke up on 3rd November and tweeted: ‘Yay! Saturday! Even inpatients deserve a weekend.’

  Generally, there was no speech therapy during the weekend, and I was free of occupational therapy, too. On this day, my excitement arose because Steph, my weekend physical therapist, had noted my enthusiasm and asked if I would like double sessions at the weekend. I leapt at the chance. I loved physical therapy, and weekends in HJD had a tendency to drag. Beth would make her regular visits on the weekend – more, even – but with the paucity of therapy sessions, there was still too much time to fill.

  It didn’t hurt that Steph also seemed to enjoy our therapy sessions. We were good company for each other. After my catastrophic stroke, my relative youth still allowed room for important gains, and I displayed a cheery enthusiasm for PT. Steph responded well to the irreverence I have osmosed from Beth. She was tickled by my apparent invention of the word ‘rehabber’, and enjoyed my imaginary dismount from the parallel bars. This seemed appropriate. In contrast to Sonoko’s unremarkable prettiness, Steph’s handsomeness was quirkily notable, like that of a comedienne who unfurls her hair to gasps in the final act. It wasn’t so much that she was beautiful, more that her laugh and that smile had warmed the audience to her over the period of the feature. The smile that dominated all of her other features denoted a certain joie de vivre that complemented her devotion to her vocation. I liked to think that she would have been a lot of fun over a couple of pints in Boland’s.

  On this particular Saturday, Steph arrived to take me to the gym. When we got there, she watched me go through a series of exercises. I dragged myself up the four steps of the wooden staircase in the corner. They were stairs to nowhere, ripped out of the context of a home or a place of work. My left side had always been so dominant that, when playing football, I’d personified the barb, ‘His right leg’s for standing on.’ Now, both legs simply provided straightened, straitened support while my arms did most of the work supporting me, and I progressed along the parallel bars. Then Steph walked me through the basics of using a walking stick.

  The hospital had issued me with a cane that was a beautifully ergonomic piece of kit, nothing like the hook-handled, straight, wooden canes the old women in my mother’s church had used. It ran black from its foam handle through the crook that let me drive my weight through my forearm, down its metal body to the triangular rubber foot that allowed it to stand alone, unsupported.

  If you’ve ever walked with a walking stick, you’ll know it takes a bit of learning. Firstly, you hold the cane in the hand that’s on the good side. Initially, I found this counterintuitive; it was the weak side that needed the support, surely? Thankfully not, since my left arm was as useless as my left leg for now. Think about how you walk. If you’re able-bodied and you’re walking, you swing your arms as you walk. When you take a stride forward with one foot, the opposite arm swings forward.

  Holding the walking stick in my right hand allowed my right arm to absorb some of my weight as I walked. I was like Jake the Peg in that old song my mother sang to me as a child, with my extra leg. I followed a straight line down the centre of the gym, treadmills and apparatus forming an honour guard. My good middle foot moved forward and touched down, followed by my two side feet, the left and the little rubber triangle.

  It was as complicated as it sounds. It turned out that, even for the able-bodied, walking is a little miracle of perfectly timed moments. Most of the time, we don’t think about it. Even toddlers are expected to do it without a detailed breakdown of the constitutive elements. What I discovered was that walking is like a golf swing – with thousands of hours of practice, it simply becomes second nature, a matter of muscle memory which propels us effortlessly down the fairway. When we’re not expert, and have to think about each of the steps, things fall apart. The recovery of my weakened left knee was imperilled by a tendency to hyperextend, snapping my limb violently in and out of a straight-legged attention. I had to focus on walking heel-to-toe, a broken ceilidh dancer, so my left foot wouldn’t flatly slap on the floor like a lemon sole on an Edinburgh fishmonger’s counter. Even swinging my arms in an opposite pattern to my legs required thought, as I had a tendency to carry what Beth would call my
stroke-afflicted T. rex arm curled in halfway up my torso.

  Watching me turn to begin another short length of the gym with my stick, Steph pointed out another aberrant movement. As I turned, my foot didn’t swivel around the axis of my ankle; I had to move my whole leg. The movement was unnatural, and multiplied my turning circle. After being made aware of the shortcoming, I still couldn’t complete the manoeuvre. Watching Steph demonstrate how one’s foot turns a corner, I tried to copy the action. My attempts improved in increments, before sliding back as I tired. There wasn’t a bit of kit to help with this, but Steph had an idea. We sat together to form an islet in the sea of blue floor as she took off her right sneaker.

  ‘Give me your left,’ she instructed.

  My newly inexpert fingers fumbled the laces, and I wrenched the left shoe off my unfeeling foot. Steph produced a roll of what looked like black electrical tape from nowhere, about half-an-inch wide, and gaffa-ed our shoes together.

  ‘OK,’ she declared, pleased with her impromptu handiwork. ‘Put your shoe on, then I’ll slip into the other side, and we’ll practice.’

  That’s what we did. First, we stood together. Without having to think, Steph helped support me and curled her right foot through a short, easy curve. My left foot could only follow, but quickly, the movement began to feel natural. Even graceful, by my monstrous standards. Of course, that was the idea. With the brain lesions, and the atrophy, and the nerve damage running down my left side, I had no memory, and no muscle memory, of the movement. We were rebuilding it from scratch. Soon enough, something triggered. We sat on the edge of a mat and Steph extracted her foot from her invention. I followed suit, and she cut our shoes apart with a pair of short-bladed, ring-handled, surgical scissors. Where the hell were all these supplies materialising from? My trainer was restored to me, and I repeated the move, just me and my extra leg. Another breakthrough!

  A few days later, on 9th November, Michelle came to pick me up for another PT session. Earlier, a nurse had helped me locate the latest fresh set of workout clothes Beth had washed and brought from 15th Street. I dressed myself according to the instructions Sonoko had provided in occupational therapy. I sat on the edge of the bed, under a nurse’s supervision. I used my strong arm to dress my weak side first, for each piece of clothing. After I had complained about the cold up here on the ninth floor, Beth had brought me a pair of long, black, thermal underwear made by a sportswear company, over which I managed to put on a pair of grey shorts that almost reached my knees. A similarly sporty T-shirt in a cotton and polyester blend was covered by another, long-sleeved, cotton T-shirt in a lighter shade of grey. It had been a good morning, and I was amused by the reflection of my skinny frame’s covering of baggy T-shirt and, basically, black tights. I looked like a particularly unwell example of an early nineties grebo-punk. I tweeted my amusement to my friends: ‘Showered, dressed, breakfasted, Beth Monahan’ed. A good morning. If one can overlook that I’m dressed like a member of Ned’s Atomic Dustbin.’

  The response came quickly. Going by the time stamp, Beth must have been on her way to work. ‘Hey! I picked those clothes out!’

  I clarified that it wasn’t an insult. I was discovering a newly scraggy body with a lack of inhibitions and an almost total absence of judgement. If my broken brain was going to dress me as a nineties British pop star, I’d have been checking if I could now pull off Brett Anderson’s half-unbuttoned, body-painted acrylic blouse. So things could have been worse. Fortunately, Michelle was spared that indignity as she escorted me along the square corridor that ran around the ninth floor. In light of recent advances, I was walking with only the support of the flat, ridged plastic handrail that sidled around the walls. Concentrating on the minutiae of the components of walking, I didn’t see a troop of rehabbers passing.

  ‘Ha! You look ridiculous, Ricky!’

  We hadn’t advanced to looking around while shambling, so I stopped and checked my hold on the handrail before looking around. I wasn’t a person to whom people called out. I was just a shambly stroke patient.

  But Steph had. That comedienne’s laugh reached along the walls.

  It was when my therapist heckled me that I knew I was out of the woods.

  12

  The Magic Rutabaga

  It was after not being allowed solid foods, and then being appalled by puréed bread and most of the other soft slop that had been served to me at mealtimes, that I had lost that 35lb.

  Back when I was at Methodist, one of the doctors had taken Beth aside in the corridor.

  ‘Go and find something he likes,’ he had said. ‘It doesn’t matter what it is. As long as he eats something.’

  ‘He does enjoy those chocolate and vanilla puddings that sometimes come with his dinner.’

  ‘Perfect. Go down to the cafeteria, and get a bunch of them.’

  We took this direction seriously. Supplies from the cafeteria supplemented the lunchtime and dinnertime nutritional puddings I was already being served, and to the extent I couldn’t finish them, they were hoarded in the bedside cabinet for later. Now, Beth would also pop into the Barnes & Noble bookstore on her way to HJD, to pick up a cup of tea for herself, and a cream puff for me. The cream puffs tasted like they had been baked in small batches by a Brooklyn fairy godmother from flour, butter, eggs, salt and heavy cream, and then covered in smooth, intense chocolate.

  However, a Scotsman with a stroke cannot live on cream puffs and puddings alone. As my activities in therapy stepped up, Beth would sit by my beside each evening, ticking boxes on a menu as I declared my preferences for the next day’s meals. She did this partly to be, and feel, helpful, and partly because she was concerned I would forget that I’m a vegetarian, only to remember with horror when I realised what I had been eating.

  One night, I opted for an impossibly exotic side dish. Dinner arrived the following evening, and I tucked in.

  ‘What is this stuff?’ I asked.

  Its appearance offered no clue, so Beth took a tentative taste. ‘That’s your pureed rutabaga,’ she declared.

  ‘Oh! So that’s pureed rutabaga? I don’t like it.’

  I didn’t like the taste of it at all, but I loved the word ‘rutabaga’. A rutabaga may look like a neep on steroids, but I subsequently learned that it’s a cross between a turnip and cabbage, with all the exciting flavour explosions that would suggest. Still, the word took root in the surprisingly fertile soil of my re-wiring brain. An ‘eggplant’ may not hold a candle to the romance of the ‘aubergine’, but a ‘rutabaga’ suggested heights of exoticism that a ‘swede’ could not touch.

  By the end of the day, I had sketched my imaginary new friend, The Magic Rutabaga, on a napkin. Tottering on wispy legs, two thick leaves parted above his giant head, and he looked bloody furious. His eyes squeezed shut in disgust at the gods who had condemned him to bland flavourlessness, his uvula swung as he yelled, ‘AAARGH!’

  Our pal Paul took a look at the tortured countenance of Rudy the Magic Rutabaga and noted, ‘Once a year, in early February, he rises from the basement and feels bad about not being The Great Pumpkin.’

  ‘Great for scaring kids, though,’ I told him. ‘ “If you don’t eat yer veg, The Magic Rutabaga’s gonnae get ye.” Even I’m scared.’

  ‘You could make it a Valentine’s Day special. The Magic Rutabaga Falls in Love. His mom is mad because his girlfriend’s kale.’

  ‘Yeah, but The Magic Rutabaga is all about tolerance and acceptance and good nutritional values.’

  Paul had a six-year-old daughter, and knew that kids are predisposed to the triumph of good and ridiculousness. ‘That’s it!’ he declared. ‘We’re writing a children’s book!’

  Meanwhile, he and Beth were doing their bit to brighten up my nutritional regime. Beth had brought me a canister of fancy tea bags to replace the brackish horror of water contamination that was the hospital tea. It had a ridiculous name that was only made more absurd by the appending of its self-applied sobriquet, ‘The Aristocrat of T
eas’. Everything about the replacement Beth brought was better. These new bags were encased in a properly upscale, hexagonal red tin. Its lid fitted with a satisfied expulsion of air. The smooth silkiness of the bags themselves shone with a heavenly glow. I quite liked them, and declared as much to Beth when she arrived for her morning visit.

  ‘I’m finding that the hospital breakfast is immeasurably improved by that Barney and Sons Royal English Breakfast Tea.’

  ‘What . . . ? Oh, it’s not Barney, Honey. It’s Harney.’

  ‘Och. Those posh English and their made-up names. Tell Harney I’m sorry. And tell the boys, Hernard and Hartholomew, too.’

  Paul’s contribution rounded out breakfast nicely. He had asked Beth round for family breakfast on the morning of Sunday, 4th November. His apartment, tastefully and functionally appointed in the modern fashion of a well-to-do man who knows the value of things, smelled of baking bread. As befits a man with a PhD in black hole physics – and I have a theory that while cooking is an art, baking is a science – the flat more precisely smelled of flour, butter, salt and yeast that had interacted at exactly the right times and at the right temperatures to create a satisfyingly chewy, bready bread. The source of the scent sat in the kitchen, wrapped in an appropriately traditional dishtowel, with a knife nestled in the turned-over material.

  Beth dutifully delivered the delightful little bundle to my ward. The blessed package was a testament to the paucity of the English language. It would be an insult to Paul to let this beast of the yeast go by the same name as the soggy square that had previously besmirched my plate. This was manna.

  In fact, it went by a number of names. Paul had trailed its arrival as following ‘The Great Home Loaf Delay Experiment’. I guessed that this had something to do with his scientific method, but still harboured a suspicion that he was discussing some obscure prog rock band I hadn’t heard of before. Knowing that while spinning in the void, I was using my phone as a tether to the mothership of my old life, Beth and Paul co-ordinated the picking up of the bread through their Twitter accounts.