STROKE

RUTHANNE URQUHART


We have met the enemy
and it is us.
Walt Kelly



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part FIVEThe hospital's rehabilitation clinic was good as far as it went; the physiotherapists were as helpful and innovative as they could be. Neither was adequate; this inadequacy stemmed, quite simply, from a lack of funding. Clinic staff had reached the point of dissatisfaction whereby we stroke patients and whichever family members were available (in my case, my mum) were treated one day to a slide show about the rehab clinic. Several speakers asked us point-blank to write letters to local and provincial politicians and to media advocating financial support for rehab programs and facilities.

At the time, I smiled inwardly because to make such a request of a room full of wheelchair-bound people with short-term memory problems and who couldn't hold pens seemed ridiculous. However, I know my mum responded, as did I later on, when I was able. The advocacy was needed.

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A physiotherapist worked with me at least once a day in the clinic. At first, I did the things one expects to do in such a place: I put square pegs in square holes; I sorted things according to size, colour and shape; I assembled three-dimensional puzzles. I stretched and exercised. And grew vocally, insistently impatient for bigger and better things.

The physiotherapist responded by heaving me onto an exercise bike, which served two purposes: it reminded me that I was still very weak and was expecting too much too soon; and almost immediately, I was too tired to talk.

Later on, she sent me somewhere in the hospital to help a volunteer worker dice a mountain of vegetables for salsa. I can't remember why such a task was being done outside the kitchen—a staff member's birthday party rings a bell—but it was, and I participated. As well, each day the nurses on the Floor received from the laundry a huge bag of face cloths and towels that needed sorting and folding. I requested and received that task.

I learned I could wield a knife in a numb hand with minimal risk to myself and those around me. I learned I could do laundry when I got home (whoopee). The important lesson was learned by my brain, not my mind. It learned that bilateral demands would continue to be made upon it, that it must either heal or reroute impulses to the right side of my body.

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I had been told I would not be discharged until I could walk, and climb stairs. One afternoon, the physiotherapist announced I was ready. My son came to witness the launch, and of course my mum was there.

As the physiotherapist stood me up at one end of the hallway outside my room, I juggled options. If I held the four-footed cane in my left hand, I couldn't feel the wall-mounted safety bar in my right. And yet I couldn't use the cane in my right hand, either. So, cane in left, and the illusion of safety on the right. I knew I was going to fall, break something, crack my head, start the bleed again. I was very frightened. I had never, until that moment, felt fragile. I remember standing there in the hall, seeing patients much older than I watching my progress, and realizing how frightening such an undertaking must be for them – less strong, with arthritis and bad hips and poor vision; genuinely fragile. That realization didn't make me less frightened, but it kept me from whimpering out loud, and it kept me from giving up.

My son was 10; his youth excused his expression of dismay when he saw that walking, in my case, bore little resemblance to walking. I had no such excuse. I don't know why I hadn't realized how difficult it would be, how much work I still had to do, but I hadn't.

My son recovered almost instantly, and he wheeled my chair behind me while my mum held her breath. When I'd managed about 25 feet of hallway, the physiotherapist called a halt to that day's effort. All three congratulated me, and I accepted their words of encouragement because maintaining my balance while not feeling the floor under my foot was indeed an effort. I had glanced in the strategically placed mirrors several times to see if my foot really was on the floor.

However, the overall result was not satisfactory as far as I was concerned, and I slipped into a depression that lasted several days. I had been frustrated; I had been angry. But that resolve-sapping depression was new and, in a distant sort of way, frightening. Given the slightest bit of encouragement, I'd have happily settled into that "just let me sit here while the world goes by" state of mind that I had seen in other patients.

Luckily, I had long since convinced Mum I didn't want help with anything, and so she offered none. The nurses, confronted daily on all sides by that attitude, avoided me like the plague. Even the cleaning staff, normally friendly and chatty, stayed away in droves. Everyone was kind, but everyone knew exactly what I was capable of doing, and left me to do it. I had no choice but to do for myself, and the physical activity, sweetened by ongoing small successes, got me back on track. And when the depression lifted, I was more than a little ashamed of myself, and wound up working twice as hard as I had been, which was not a bad thing, either.

We often learn the best, the quickest, with a degree of incentive and stress; necessity is the mother of invention. I have learned that this is also true after a stroke, when that healing/rerouting process is going on. When I saw family members doing, doing, doing for stroke patients, I sometimes wanted to say, "Let him struggle a bit. Let her get angry. Let him get a bit tired."

I often found I would have increased strength/co-ordination/stamina the day after I'd pushed myself that little bit harder or further. I also found that recovery was a lot like giving birth: that red-faced, out-of-breath, fumbling, cursing after-breakfast routine of washing and dressing was forgotten when it was achieved – or could at least be laughed about with satisfaction and pride.

As my brain healed, I realized that I would not remain dependent, that I would not be a burden in all ways, for all time. Life, not simply as a state of being but as a collection of possibilities, was once again attainable. And that realization was the most significant facet of my recovery.

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Once I was walking on my own (with the cane), I would visit the rehab clinic at least twice a day, and the physiotherapist and I would shock other patients with what we chose to do to me.

I would at first kneel and later stand on the large, raised mats, with my eyes closed, while she tiptoed around me, unexpectedly pushing me. That taught my brain to once again initiate those minute, unconscious balance adjustments we do ten thousand times each day. Or, she would dump an umbrella stand's worth of canes and crutches on the floor, like pick-up sticks, and I would totter through the pile, trying not to touch any. That taught me to pick up my right foot, to be aware of what that foot and leg were doing without walking hunched over to watch them, to balance – and to realize that if I fell down, it didn't hurt, didn't damage and didn't matter.

The last test I was required to pass before I could go home was climbing stairs. That four-step plywood flight in the rehab clinic looked like Mount Everest. I climbed and descended, over and over. Coming down was by far the more frightening of the two; I promised myself that, once at home, I'd descend on my backside, the way I'd taught my kids to do it when they were toddlers.

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