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A Very Simple Stroke | Jun 18, 2009 10:12

GUEST: David Herkt

Eight months ago, David Herkt suffered a severe and disabling stroke. This is his story of what happened that day, and what happened on the road back.

Part 1: The Last Day

A stroke – it is generally a word we use to describe the gentle, running touch of a human hand, but it can also be the one we use for an explosion of a blood vessel in the brain with more or less devastating results.

On my last day, November 20th 2008, I woke up with what I thought was an unexpectedly severe hangover.

I'd had a friend over the previous evening and between the two of us, me more than him, we'd polished off a third of a bottle of over-proof Ukrainian vodka.

I was really into vodkas. I had five bottles of differing brands, chosen with some experience, in the freezer. It was an area of taste in which I had developed expertise. I used to think of it as keeping in touch with my Polish heritage.

So a third of a bottle did not seem that much, comparatively speaking.

There had also been a number of cigarettes, some new music and a shared joint or two of marijuana. It was a semi-regular Boys' Night, without the benefit of more temperate partners.

So a hangover afterwards wasn't exactly a new thing, though this one's intensity felt more than a little undeserved. I'd even complained about feeling bad before I went to bed.

I had just finished directing a TV documentary and I was busy looking around for work in the increasingly tenuous area of factual television in New Zealand's modern media environment. I was tired from a full-on year, and I knew I was drinking and smoking too much. It had got to the stage where I wasn't even enjoying either of them.

That final morning was dully normal. There was me, what I thought of as my hangover, and a world where not only did I need a job, but I also probably had to create the position in order to fill it.

There was a new digital widescreen TV just out of its box that needed to be set up so it could be used. There was the supermarket shopping. There was banking to sort out. I had a whole list of social obligations that had been put on the backburner for months.

I was home alone. I had not long finished lunch.

Strangely, courtesy of my computer's memory, I can resurrect my last minutes in great detail. I know the websites I visited. I know what I saw. I know the music I played. My words and exchanges are logged in the records of online forums. My final minutes of being myself are all still there, preserved in some sort of digital Pompeii where I can, if I wish, discover me as I was…

I don't usually go to analgesics immediately for a hangover. I wait until I really have to – which does mean sitting around feeling off-colour for hours if need be. You did the crime, you do the time. Suddenly, though, my head was splitting.

It is indicative of how severe the pain was, in my own scheme of things, because I immediately went straight into the bathroom, got two Panadeine, went to the kitchen, filled a glass tumbler with water, and washed those powdery pills down.

Then I headed for bed.

By the time I got into the bedroom my limbs did not seem to be working properly. I can remember having difficulty actually getting up onto the bed.

I think it was a barely controlled fall more than anything else.

Once I had hauled myself up onto the mattress, I found I couldn't sit up straight. I kept falling sideways or backwards, like a badly positioned doll. I kept on trying and failing. Struggle to sit upright. Fall over. Struggle. Fall.

And amid the confusion as to what was happening and why, there was nausea and the pounding of a headache that had been ratcheted up to stadium volume.

It is about here that my own memory begins to fail. I am still desperately trying to sit up on the bed, and falling over, again and again. I'm bewildered because I do not know why this is happening to me. I'm just toppling over every time I try to sit up. It has never happened before. Why is it happening now?

I attempt to use my knowledge and experience to work out what to do. For a while I focus on finding my centre of gravity, composing myself around it so I can sit upright. It seems to work until I move again. Then I topple over.

I can't really remember making the call to my partner at work. I do know my mobile must have been luckily to hand. There was no way I could have managed to get to it if it wasn't. I do remember, though, being nearly reduced to tears as I repeatedly misdialled a number I knew by heart.

It could have been much, much worse.

Later on, I got to talk to someone who'd lived alone and it had taken him two days, post-stroke, to make it downstairs from his bedroom to reach the landline.

Part 2: Contemporary Crisis Unit

My stroke was a haemorrhage – where a blood vessel ruptures and bleeds into the brain. It was not an age-related condition.

It was simply a weakness in an unusual little knot of veins in the left hemisphere of my brain that had been quietly waiting to burst. The possibility of it happening had always been there, unsuspected since my birth.

When a haemorrhagic stroke happens it affects a large area of the brain, is usually severe, and carries a high risk of death.

The MRT images of it that I saw much later were remote from me personally, as only images on a computer monitor can be. There is that biblical quote from the Book of Genesis where, "the Spirit of God moved upon the face of the waters". My stroke looked just like that on the phosphor screen in the specialist's office – a large cloud of blood in the middle of my brain, a fine darkness suspended there like a grainy veil that obscured things.

If it hadn't been my own brain I was looking at, I would have just gone, "huh," and clicked on to the next image.

But I was now learning a wake-up routine where the nursing staff in Auckland Hospital would ask me if I knew what had happened to me, where I was, the month or the day of the week, and the year.

I also had to live with the fact that I'd often get most, if not all, of those answers wrong. And I'd be corrected.

For those first days, I felt white-hot. I was molten. It was nothing to do with my measurable temperature. It was how I initially experienced myself. Something had happened in my mind that had seared me clean. It had been blindingly bright. I could feel its remnants like the fading radiation of the Big Bang at the origin of the universe.

In the beginning, the first week or so, I was often a being of light – where before I had experienced myself as a fleshy, lumbering body, with a history, a pulse, regular breathing and a slightly age-expanded waistline, now I only knew me as a burning blaze.

It is hard to describe.

Sometimes I felt comforted by this blasted whiteness, as if having its purity and intensity there meant that there was nothing else bad that could happen to me ever again.

At other times it was just too bright, as if it was the apocalyptic aftermath of some unholy war through which I was struggling to find my way home.

Underneath, though, for better or for worse, I was still me.

The silent conversation I was having with myself in my thoughts seemed to be entirely normal. I could remember historic dates – 1066, 1492, 1773, 1939. I could quote memorised poetry to myself – "Let us go then, you and I/ When the evening is spread out against the sky/ Like a patient etherised upon a table..."

I knew my personal back history, mother's maiden name, my partner's name, computer passwords, relevant medical history, my pets' names and ages....

My past seemed intact. There didn't seem to be any noticeable holes. Looking at it from the inside, that is, because I still had to learn an absolutely essential fact; the human mind has an immense capacity to delude itself and it easily and unobtrusively fills in the gaps.

I was certainly having difficulty speaking. Where my thoughts seemed to preserve all of my old bounce and opinions, I couldn't communicate this. I might have been able to think it, but somehow, I couldn't say it. I couldn't quite put things into the words I wanted.

I certainly couldn't walk. After a twelve hour period of confusion, where sometimes it appeared that I couldn't use one side of my body, and then suddenly I could, everything settled down.

The right side of my body was useless. I couldn't move my right arm or my right leg. My face hadn't been touched by the consequences of the haemorrhage, so at least I didn't have that facial drag or sag often associated with people who have had strokes.

I was also a medical entity. My whole world had become a hospital ward deep in the new block of Auckland Hospital.

The view out of the window above my bed was just the neo-brutalist architectural struts and trusses of the building's large inner light-well. It is something you can't see or know from the outside. There was no sky. It was a little like suddenly living in the space-station sequence of 2001: A Space Odyssey. Everything was clear, hard, modern, and enclosed.

The opioid drugs also helped my sense of insulation.

Becoming a hospital patient brings out the inner junkie in us all. Mine didn't need much assistance. In my surviving memories of that first week, there was more than one long instance that involved getting topped up with increasing doses of one of the more potent synthetic painkillers. I knew what it was. I knew what it did. I wanted more. I was getting given more. My nurse was helpfully complicit.

So my first week was warm and pain-free and distant. It was like being locked into an elevator with a muted recording of Matt Monro singing Lennon and McCartney's 'Yesterday' on repeat and not really worrying about anything else. Reality was a very long way away.

Though I do remember having odd dreams when I slept.

I had just been researching spinal injuries for a documentary. I'd even paid a visit to the Otara Spinal Unit and had another scheduled. All this information had got mixed up in my mind, so I had dreams about a non-existent Miramar Spinal Unit and the words 'Spinal Dogs' written as a tattoo and worn by tough and near-forgotten men with spinal injuries in wheelchairs. There was a Wellington suburban milk-bar bleakness about the whole thing.

I do not remember eating or excreting in that first week. I can't describe what I ate, nor how I organised the other end of the process. I was only just managing to communicate to visitors coming in from an outside world that was remote and somehow unnecessary – I relied on the very human fact that most often they'd want to talk about themselves, and so I gave them that chance.

In my few moments of remembered consciousness I generally looked out over my fellow patients with a benevolent, much sedated love.

I was, to put it bluntly, out for the count: couldn't walk, could barely talk, and didn't fully realise the enormity of everything.

I really didn't know how fucked I was. There was me, the painkillers, 24-7 nursing care, and imaginary elevator music happening somewhere deep in my mind. What need did I have of any realisation of what would soon become some very unpleasant truths?

Part 3: Too Dumb To Die

I was trying to kill myself. There are few options available to a suicidal, bed-bound patient with cognitive problems, so I was using the cord of the bell-push that I usually used to summon a nurse when I was in need of one. It was a bulky cord and it wasn't adapting particularly well to the purpose for which I was employing it.

I'd wrap it around my neck and pull hard on it, but the moment I flaked out from lack of oxygen, the tension in the cord would release, and the strength of my automatic bodily responses meant that I'd be breathing again in a heartbeat.

I couldn't get it organised to do otherwise. A decent knot was beyond me or my materials. I managed the complex process three times before exhaustion made me give up amid tears of frustration.

I just didn't want to continue to be me – and where and how I was being me. At that moment I had no future, I thought. I had just been brought face-to-face with everything. The result wasn't pretty.

Early on a Friday morning, a week after my admission to Auckland Hospital, I had been moved to Rehab Plus, just off Carrington Road. It was a few kilometres in physical difference, a very short trip on the North-Western Motorway, but decades different in terms of immediate physical surroundings.

I don't mean to be precious, but these things do matter, particularly when all you have are environmental cues.

From a contemporary crisis unit, I was moved to a rehabilitation unit that was around forty or fifty years old. It was in an industrial area. It was down a dead-end road, past warehouses. It was shabby. There was green enamel paint on the walls, brown synthetic fibre carpet down the corridors, heavy linoleum on the ward floors. The ceilings were low. The fittings much used.

It felt like a bad place compared to the antiseptic, electronic world I had come from, with all its sensors and the gentle beep of its heart-monitors to lull and comfort.

I felt abandoned.

I also had to confront several things.

I had no control over my excretory systems. I wet my disposable adult nappies and the bed at night. I was re-experiencing the warm and sodden feelings of very early childhood. I couldn't get it together to push the summon button to call a nurse when I needed a piss. Half the time I even didn't know I had a summon button, let alone where it was.

I was also learning that in spite of my belief that my world-view matched up to reality, it didn't. I was being tested by rehabilitation staff with an eye to finding out where the problems were and what needed to be done. Simultaneously, I was learning just how big a malfunction I was experiencing and how much of my brain was affected.

The tests were excruciating. They were American tests. There were American cities like Chicago and states like Minnesota in their titles and people did American things in them. You wondered a lot about vacations and Fall and candy.

Most often, in the beginning, I couldn't do them at all. Though I did know they were simple, and that other people could probably understand them easily. I just couldn't find the keys that would unlock the answers that I knew were deep in my brain.

There was 'before' and 'after' to deduce, relationships to discover, names to remember, things to count, spaces to explore. I hated these problems without exception. They became a nightmare ground on which flat characters with names like Sidney and Kate faced confusing situations and raised questions that I mostly couldn't answer.

Physically, I couldn't walk. I could feed myself, with my left hand just managing a fork or a spoon. I could barely talk. There was a glitchy stuttering that somehow ruined every perfect mental sentence I constructed on its way out.

Measured against technology, I was also unfitted for a modern environment. I couldn't operate my mobile phone. It was a Nokia, but even Nokia's allegedly intuitive interface didn't survive my own personal stroke test. My iPod did, but only just.

I had actually turned my phone off, because I no longer knew how to answer it when it rang. I couldn't have dialled a number myself and I certainly couldn't text. If you consider a mobile phone to be an integral part of a contemporary lifestyle, then this was an epic fail.

Put all these things together with a sense of hopelessness and abandonment, at the mercy of bad architecture and institutional decor, with adult diapers and hospital food and no more opiates on demand, and in my case it resulted in an unsuccessful, though no less heartfelt, suicide attempt.

It was fury that would finally bring me out of it.

Wetting yourself at night was always an issue, for you, and for the staff. I learned, through nurses talking, that there was a whole unsuspected language around bed-folds and bed-linen. There were draw-sheets, macs, cuddlies...

And there was also a Kylie. It is the brand name of a mattress protector, so every time a urine-soaked bed was changed around me, I ended up being forcibly reminded of the bubbly Australian pop singer. "What about the Kylie?" one nurse would ask another over me as I sprawled there on my stomach, sodden with cooling urine at 2:00am.

I was contemplating Kylie a lot over those first weeks, for the ten minutes or so it took to restore the bed to dry.

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