Stroke symptoms: important actions you should take to perhaps save your life as well as creating a better quality of life after your stroke

Similar to a heart attack, a stroke is an emergency that requires you to seek immediate medical attention. Perhaps the most important action you can take is getting to the hospital as soon as you recognize these symptoms. Immediate treatment is the key to improving your outcome.

 

Rapid diagnosis and treatment of a stroke can minimize damage to your brain tissue and improve the chances of survival. Do not hesitate calling for an ambulance as your symptoms subside as many seemingly attacks are often followed by full-blown strokes.

 

Here are some of the symptoms of a stroke and the immediate actions you should take.
   1. sudden weakness or numbness in the face, arm, or leg on one side of the body
   2. sudden loss, blurring, or dimness of vision or difficulty seeing in one or both eyes
   3. mental confusion, loss of memory, or sudden loss of consciousness
   4. slurred speech, loss of speech, or problems understanding other people
   5. a sudden, severe headache with no apparent cause
   6. unexplained dizziness, drowsiness, lack of coordination, or falls   
   7. nausea and vomiting, especially when accompanied by any of the above symptoms
 
Recognizing a Stroke
STROKE: Remember the 1st Three Letters....S.T.R.
Now doctors say a bystander can recognize a stroke by asking three simple questions:
S  Ask the individual to SMILE..
T  Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently)
    (i.e. It is sunny out today)
R  Ask him or her to RAISE BOTH ARMS.
If he or she has trouble with ANY ONE of these tasks, call an emergency number immediately and describe the symptoms to the dispatcher.
New Sign of a Stroke -------- Stick out Your Tongue
( Ask the person to 'stick' out his/her tongue.. If the tongue is 'crooked', if it goes to one side or the other, that is also an indication of a stroke.
.
Actions To Take
    * Stay calm, but don't downplay any of the symptoms or hesitate to take prompt action.
    * Call or have someone call an ambulance. (Dial 911 in most parts of the United States.) Be sure to give your name, telephone number, and exact whereabouts.Note the time of the onset of symptoms.
    * While waiting for the ambulance, the person having the stroke symptoms should be made as comfortable as possible and should not eat or drink anything other than water.
    * If an ambulance cannot arrive within 20 to 30 minutes, have a family member, neighbor, or someone else drive the stroke patient to the hospital. Under no circumstances should the person experiencing the stroke symptoms drive.
    * Notify the stroke patient's doctor. The doctor can provide the hospital with the patient's medical history, which may be important for determining the best treatment.
    * At the hospital, be sure to list any medical conditions the stroke patient has (such as high blood pressure or diabetes), any allergies (particularly allergies to medications), and any medications the patient is currently taking, including over-the-counter remedies, vitamins, and dietary supplements.

 

Nearly 800,000 people in the U.S. have a storke each year. While most are 65+ almost 25% are younger. Reducing your risk factors and being aware of the symptoms can help in prevention.
 
Medical Disclaimer: This information is not intended to substitute for the advice of a physician.

 

If you have experienced a stroke or have a friend or loved one who has, this information written by Mickey Padnos, an American currently living in France and recovering from a major stroke will be helpful and provide insights on what someone who has had a stroke is thinking and has gone through..

He starts with the actual stroke itself and takes you through his thought processes and therapy.

Chapter I
On November 17, I had a stroke. I had just returned to Paris from a trip abroad; I had taken a brief nap after a quick bike ride to get my bread and cheese for breakfast; I got up from my nap to fiddle around a bit on the computer; I had  closed the computer and stood up to head back to bed; and ZAP,  it hit me. Painlessly, silently, lethally, I fell to the floor like a load of bricks, and I couldn’t get up, not even to jack myself into the low-to-the-ground bed next to which I had fallen.

I knew right away what had happened. I mean, I was on the floor; the right side of my body was paralyzed; what could it be?  Obviously,  I had had a stroke; now if I could just get back into bed, I’d have a good, restful sleep and I’d be back on my feet in a day or two. If I could just make it back into that goddam bed!

Easier said than done. Left leg up first, fine, easy to do, but it turns out that one leg and one arm does not provide the leverage necessary to hike oneself up from floor to bed.  After many tries, I was still on the floor; and now I had another problem; which was that I was getting  cold. Because I like to sleep in a chilly room, the windows were all open, and I was lying on a bare wooden floor. I began to get chilled, and as I was dressed only in a light jacket  -- thrown over my shoulders to protect me from the chill as I worked on the computer—I began to feel seriously unhappy.

It was not an impossible effort to use my left hand to yank the cover off the bed and slide it under my backside. After a brief tussle, I managed to get myself slightly comfortable; and I probably even slept. (I was, after all, very tired: I was seriously jet lapsed from the trip, and a stroke is an exhausting event.)
But the sleep was hardly tranquil.  I was very cold; the floor was hard; and to make matters worse, I suddenly developed a severe stomach ache.I absolutely HAD to go to the bathroom. No  matter what else happened, a toilet had become, as the French  say, “primordial.”

Now here was a serious dilemma. My friends had been nice enough to invite me to stay  with them for a few days: was I going to repay their kindness by waking them up in the middle of the night and asking them to help me to the bathroom? They’re very kind and generous, but there’s a limit! They had offered to be my hosts for a friendly visit, not my caretakers; I didn’t WANT to change our friendship; I didn’t WANT to ask for their help!

I wrestled with these moral dilemmas for some time on the hard and freezing floor, but after a while I no longer had a choice; I needed help, whether I liked it or not, and I called out, as loudly as I was able, “Au secours!’  Just for good measure I cried out “HELP!!!!!”, even though I knew that my friends spoke no English. 
At first, there was no response: my strangulated cry was greeted by-----------silence.
I cried again, “Au secours!”
Silence.  
After several minutes, I tried again; but the result was always the same: silence.
And that’s when I began to REALLY  get unhappy.
I was now very cold. and very, very tired. And I DESPERATELY had to go to the bathroom, which was about 20 feet from where I was lying.

If you are an able-bodied person, navigating the 20 feet from a bed to a bathroom in the middle of the night is not a particularly  daunting task.  MIllions of people take such a stroll every night of their  lives; I myself had been doing it regularly for years, if not for decades.

But going 20 feet from a supine position with only one arm and one leg is quite a different story. It is a story that involves writhing, not even crawling; it is a story that involves an exhausted man pushing his one good heel against a smooth wooden floor that gives no purchase; it is a story that involves two doors—bedroom and bathroom-- with two handles that seemed miles above my reach (think of Alice reaching for the cup that says Drink Me); it is a story that is much more fun to tell about than to live through.

I eventually did make it to the bathroom –the trip seemed to have taken at least an hour-- and I eventually accomplished  what I had come to accomplish, but on the floor, not on the toilet, as I had no way to lift myself up to the seat. (I was in an agony of guilt about leaving a mess for my friends, but by that time I was so exhausted and cold that I almost was beyond caring). And I eventually fell asleep on the tile floor in the bathroom, wedged Into a corner of the room into which I had inadvertently  crammed myself so  tightly that I could not move (Try it for yourself sometime: lie barefoot on the floor and try to pull yourself towards your foot with only one leg and no purchase whatsoever!)

 It was nearly 8 o’clock when my friends finally awoke.  I don’t even want to imagine what it must be like to climb sleepily out of bed and to wander lazily towards the kitchen and suddenly to discover the friend to whom you had recently said a pleasant goodnight sprawled  unconscious on the floor, wallowing in his own mess, and moaning, in a feeble and pathetic voice, I’m so cold, which is apparently all I was capable of saying. It must have been a pretty awful way to start the day  

My own first memory of that ghastly morning is of opening my eyes and hearing my friend Patrice saying,  “The first thing we have to do is call the sapeurs-pompiers.”  --France’s front-line emergency responders—and my next memory is of Patrice giving me a blanket: the first warmth I had had in nearly 8 hours.(I think the stroke took place at about 11:00; Patrice and Christiane found me nearly 9 hours later.)

My next memory is of the sapeur-pompiers having some rapid phone conversations with a neurologist,and  then giving me some rapid tests; of Patrice finding my Carte Vitale –the magic card that indicates membership in the French heath care system-- in my wallet and giving it to the sapeurs-pompiers; and  then of being carried down the  5 flights—5 flights!--  of narrow stairs in my friends’ apartment building by two strong young sapeurs-pompiers who  trundled me into an ambulance. I remember being delivered to Laribiossiere, a nearby hospital which is one of France’s best neurological facilities..
Unintentionally, I was about to get a first-hand experience of the French medical system.

CHAPTER II
Accompanied in the ambulance by my friend Patrice, I arrived at Lariboisiere in a piteous state. I was so tired that I was nearly delirious; I could not move; I was filthy from my adventure in the bathroom; I was freezing cold.

Above all, I was extremely upset. I could scarcely talk (my voice, I was told by my wonderful son who suddenly materialized at my side, was incomprehensible over the telephone)  and I could hardly move.
 Who had I become? Michael Padnos, unable to talk? No, no, NO! I was no longer myself, I was no longer ME, I had become some kind of vegetable and I was terribly, horribly upset.
Upon my arrival at the hospital,  I was immediately taken in charge by competent hands. As far as I remember, I was given some tests; I know for sure that I was given a generous dose of kindly and reassuring words –that part I do remember--and I was quickly taken to a private room in the ICU and bathed. Within minutes I was soundly—and warmly --asleep in a divinely comfortable bed.

Lariboisiere, like most of the other hospitals in France, is a public institution, a part of the national health system. (France also has a system of privately-owned cliniques, but the state hospitals are so excellent that even people who can afford the relatively expensive clinques often choose the public hospitals, just for the quality of care.) In the state hospitals, the doctors, nurses and orderlies are state employees; they are entitled to all the benefits of state service, including a decent and dependable salary, generous vacation time, health and retirement benefits (like all French people) and a relatively stable and secure professional life .

The life of a French civil servant is generally a decent life, with time to enjoy the pleasures of life in this rich and beautiful country:  an outing with the kids, a three-star restaurant (it’s amazing how many ordinary Frenchmen have visited a one or more three star restaurants, which conventionally charge $300 per person for a meal), maybe a trip to the seashore or the mountains.

This arrangement might be called “Respect for family values.”  In America it is  often called  “the nanny state” or “socialized medicine” or other  condescending or pejorative terms that are designed to prove that ‘’it’s not for us” because it “destroys individual initiative“ and  otherwise is “just not American”.(What is American, apparently, is to work two or three jobs in order to make ends meet, a practice that is unheard of in France. )

Did I find  the French system “overwhelmed by bureaucracy” or otherwise indifferent to the  needs of the patients? Most assuredly, I did not. I found the nurses, doctors and physical therapists not only professionally competent but also generally sympathetic to the patients’ needs; I found the system to be efficient, highly professional and entirely user-friendly. I have no complaints whatsoever about my treatment by the French medical system; on the contrary, I give it the highest praise.

After three or four days in the ICU, I was transferred to a semi-private room in the neurology ward—a transfer that I was told could be made because the doctors were persuaded that my condition had stabilized and that I was no longer at risk of a second attack. I was, in their opinion, “on the way back.”
A stroke is a terrible, terrible event. Stroke is the second leading cause of death in America and Europe; it is the leading cause of adult disability; it is a major cause of high medical costs, because the survivors customarily require extensive rehabilitation, which usually means months or even years of medical assistance.
 
For the victim, it is a catastrophe. As in an automobile accident or a heart attack, the victim goes in one instant from being  an autonomous, fully functioning human being to being  a vegetable--  or worse. BEFORE the stroke, the victim was an ordinary guy, walking, talking, arranging his life; AFTER the stroke, the victim is a patient – if he’s lucky enough not to be a corpse—and his entire life is focused on “getting better”: a concept which  previously had been as distant from his thought process as the stars in the heavens. 

The majority of strokes occur when a  blood clot travels through the body and gets caught in a vein in the brain. When that happens,   the surrounding area of the brain is deprived of blood; unless the patient is given medical help within a  very short time—two or three hours at most-- the area dies.
Where does this clot go, and does it completely or only partially block the vein? Who knows. If it totally  blocks a critical place, you’re  a goner, either immediately or later; if it happens to travel to a less critical area  or only partially blocks the flow of blood, the brain  can recover by “learning”, in a nearby area, some or all of the functions that were wiped out by the clot.

In my case, to my great good fortune, the clot had travelled to a less critical area of the brain and I never lost control of my vital functions. That means that I was never incontinent (thank heaven) and I never lost the power of either  locomotion  (I  was never completely paralyzed) or speech.  (I know I sounded pretty weird for the first few days, but after a week or so I sounded, at least to one of my friends , 90% normal.)

Some of the people in the hospital were not so lucky .My first roommate, once I had been transferred out of the ICU, was an elderly Moroccan who had totally lost his ability to speak French and most of his ability to speak Arabic;  my second roommate, a really tragic case, was a 39-year old man who could not utter a word and could scarcely move. He wore a diaper and a drain on his pecker; he spent most of the day asleep; he was fed by the orderlies on a diet of pap, because he could not safely chew or swallow ordinary solid food. –and this happened in the land of steack frites and canard a l’orange!!
Pooh pooh, you say, not my problem. The only people who get strokes are the elderly, and I have a long way to go before I fall into that category.

Wrong again. Old age is certainly a risk factor in developing a stroke, but the staff tells me that there is no limit to age of stroke victims, and there is not even a preponderance of elderly patients. The youngest patient they have ever seen on the ward was only 14 months old; the guy in the next room is only 33. (He collapsed at work, bang, just like that, and was brought to Lariboisiere the same way I was, by the sapeurs-pompiers, and here he waits .Although he is certainly more ambulatory than I –he never experienced any paralysis --he is  arguably  in worse  shape than I am because the doctors fear he may be at risk of a second attack, and I am apparently in the clear on that score.)

What causes strokes?  Doctors can’t say for sure, but they do know that the risk goes up for older people, for diabetics and smokers, for people with high blood pressure. According to popular  mythology, it is also stress-related, but  the doctors never told me that.
One thing they do know for sure is that stroke is caused by blood clots, which occur particularly in people with high cholesterol and thick blood.  To reduce your risk, therefore, you should lower your cholesterol; above all, people over 50 should take a baby aspirin every day of their lives. Aspirin is a blood thinner; it is cheap and easily available; no one has any excuse for not taking an aspirin a day.
 
And for me, what comes next? Little by little, tiny step by tiny step, I have to re-learn how to be an ordinary person. I have to learn how to walk normally  (I can already walk a few steps by myself, and it’s only two weeks after the attack); most of all, I have re-learn how to re-use my right hand and arm, in which I have –I hate to say it--  almost no motion. (Imagine what THAT is like! Your brain issues an order to your hand  --to squeeze a ball, for example  --  and nothing happens!  It’s a phenomenal betrayal, and there’s not a thing in the world you can do about it except, in the words of the old joke, practice, practice, practice.

Every day, every minute, is a new challenge. One of the tests doctors or nurses give you regularly is to see whether you can squeeze a proffered hand:  at the beginning I had not the tiniest reaction  to that test, and now, two weeks later, I can move my fingers just a bit.  And the physical therapist tells me my progress is phenomenal!  

I cannot close this chapter without a word about the chief physical therapist on this ward, Fredreric Lherbe, who, it seems to me, is a truly inspired, and inspiring, medical professional. 
A man in his early fifties, Frederic is physically strong, vigorously upbeat with patients and staff and an intellectual powerhouse, both in his professional and his personal life.  (He met his wife while singing in a baroque chorus; he is given to interrupting the manipulation of my right thumb, whose musculature he explains  in detail, with observations from philosophers like Husserl and Kirkegaard, neither one of whom, I blush to admit, I have ever even read.)

Frederic loves his work, and his dedication to the patients is both dramatic and visible. 
Apparently the approved approach to physical therapy is to smile and say “tres bien,” even when the patient has not been able to make the tiniest movement. All the therapists say it; but when Frederick smiles and says “tres bien”  his entire face lights up, and the patient is persuaded that he has accomplished a major achievement—which of course is a motivation for the patient to try even harder the next time.

I am not the only admirer of Frederic on the neurology ward. I have noticed that the nursing staff and the orderlies also defer to him, for the reason that he is quite obviously the smartest, the most experienced and the most capable person on the floor.  (Frederic always uses a sheet to tie the young man in the next bed into his chair, to prevent him from falling  -- the other personnel  do not--; Frederic stops me on my little walks down the corridor  to show me a better way to walk; he shows the orderlies how to make the beds and he shows them clever ways  to make the patients more comfortable.  

              .
 But these words do not really go the essence of Frederic’s  talent, which was visible to me the first time I met him. That talent lies not only in his profound understanding of the nerves, muscles and tendons that must be reactivated in a stroke victim –I suspect that most physical therapists have that same knowledge – but in his astonishing ability to communicate that knowledge  in a reassuring way to the patient. When I am with Frederic, I would not be afraid to gallop down the hall, if he told me to gallop; I have quite an absolute trust in his judgment, and would  follow his directions, and his analysis of my situation, wherever they would take me, and that could be to the ends of the earth.

About a week ago, I was working with Frederic when he suddenly directed me to stand up. I was quite sure I would not be able to obey his order, but I had trust in his judgment, and, therefore, sitting on the side of the bed, I moved my feet according to his directions and raised my eyes for further orders.

“OK,” said Frederic, “On your feet.”
And to my immense astonishment, slowly and hesitantly, I stood up -- all by myself.I had tears of happiness in my eyes; when I looked at Frederic, I saw that he was grinning from ear to ear.
 “In my profession,” he said, “there’s a special term for an event like this:  we call it a wonderful, precious gift.”
I knew what he meant. He meant that I was getting better, and that his therapy was working, and working well..
Merci Frederic. And  merci to the French medical system!.

CHAPTER III                  
By the end of my stay in the Lariboisiere, I had made a lot of progress. In my first two weeks as a Stroke Victim I had learned to walk up and down the hall; to go the bathroom alone and to move the fingers on my right hand. Particularly on the last day, I could see that I was in fast forward: I took many walks down the hall, almost always without aid or support; I was walking faster; I was progressing rapidly.
 But let’s not exaggerate: I was still a long way away from normal.

 I could walk, but only hesitantly, sticking close to the wall and its protective bannister. I could go to the bathroom alone, but it was only about six feet from my bed.   I could move the fingers on my right hand, but I still could not grasp anything or use my hand productively, the way a normal person uses his second hand. (Fortunately I am left-handed, so my left hand did not have to learn a whole new set of instructions.)

 My useless  right arm reminded me of the case known to generations of law students as the Florida diddle case. In that case, to the students’ unexpurgated  delight, an elderly man was charged with enticing. an innocent young girl to “diddle with his rag-like penis, lifeless and inerectible, fit to serve as nothing but a connection between his bladder and the outside world.” My right arm was not connected to my bladder, but it was pretty much lifeless and inerectible. I had a long way to go before it would return to normal.

 Fernand Vidal, the rehab center to which I was sent, is just a few blocks from Lariboisiere and I arrived just before lunch. Once again, I was given a bunch of examinations  (“Do you feel this? Does it feel the same on the left and right side? Do you feel my touch on the bottom of your feet?”) that I had been given a thousand times before. Once again, I was asked where I was when it happened, etc., etc., etc.
 But now the medical conclusions were different.  “I see that you’re having some trouble swallowing,” said the young doctor who was examining me. “I think we’ll start you off on a soft diet, until we’re sure that you can swallow correctly.”  

“Do you mean mush?”  I asked, appalled. ”But I’ve been eating normal food since my first day in the hospital!”
The doctor frowned.
“Do you tend to cough a lot while you’re eating?”
I admitted that I did cough a bit while I was eating.
“That’s because you have a slight paralysis on the right side of your throat. Why don’t we try a softer diet for a day or two.  If you’re very unhappy with it, we’ll go back to the normal way of eating.”
And so I was served a diet of pap for lunch and dinner.  In the land of steack frites and canard a l’orange,
 
Fernand Vidal is a rehab center, which, it turns out, is not at all the same thing as a hospital. Laboisiere’s job is to make sure the patient is healthy and stabilized, which means for the stroke victim that his blood clot is dissolved and that he is not in danger of a second stroke.
A rehab center has quite a different function. A rehab center assumes that the patient’s medical situation will not deteriorate further  --in other words, that it’s as bad as it’s going to get—and that their job is to bring the patient back to a semblance of normalcy.

As a practical matter, this difference seems enormous to the patient. In the hospital, I spent the whole day reading (War And Peace, immense thanks to Francine for the Kindle) and noodling around on the computer, and I spent about 30 minutes per day, on weekdays only, with Frederick The Great, my physical therapist. 

At Fernand Vidal, by way of contrast, I have PT for an hour in the morning; a communal lunch; ergometrics (whatever that is: it seems to involve putting pegs in boards) and then more PT in the afternoon.

And the PT is also different.  At Laboisiere, it was Frederic and Frederic alone, pushing and shoving and making profound philosophical observations; at Fernand Vidal, PT is conducted in a special room with various kinds of balls and cushions, a treadmill, parallel bars and an electric bicycle; with special ladders, benches and staircases. 

There are also many people present in the room, and all the therapists seem to be young women in their twenties, well-trained and informed, totally professional – and just a little bit lacking in what the Russians call ( forgive me, I am profoundly immersed in War and Peace)  – soul. Soul was.an attribute that Frederic possessed in abundance..

On Day 2 in rehab, I learned something fascinating about the brain. The therapist was trying in vain to get me to move my thumb in a certain way, but the motion was absolutely impossible: the brain was deaf to my entreaties and the thumb remained insistently, obdurately, inert.
And then suddenly, paf,  the thumb responded to the order and moved exactly as directed.  And it did not make just a feeble, tiny effort, it made precisely the complicated movement that had been commanded.

 I was astounded by the event, which seemed to me miraculous.
I mean, the brain had said “no” many times, in no uncertain terms; and then suddenly the brain said “yes, I‘ll  do it,” with perfect clarity. It was like an on and off switch, and the brain suddenly lit up and said, “On.”

What did I conclude from this incident, which was similar to the experience of one of the other patients, who had lost his memory and his ability to speak for entire month, but was now speaking normally and remembering quite well?  I certainly am not a neurologist or a philosopher, but the incident does say one thing to me: don’t give up!, Even when the brain seems to be saying NO with a firm voice, it is apparently much more receptive to new commands than one would have thought possible.
I therefore conclude that more-or-less anything is possible, even for an old codger like me. 
And so I go on.

PS  On Day 2, I was returned to a normal diet.  It’s hardly the Tour d‘Argent, but quand même , it’s a lot better than mush.

Chapter  IV
 
Not every day is a great day. Although greatly cheered by some long and wonderfully cordial calls from friends (merci Jean-Francois, merci Michele!)  I awoke feeling weary and weak; I seemed to be walking much more slowly and incompetently;  my speech was slurred and my hip hurt. I felt logy and lethargic.
And it was snowing in Paris, which always makes me think of Mimi, dying in the third act of La Bohème.
And no one showed up in the lunchroom. I ate mostly alone, with one inarticulate companion for conversation.

Even PT on Day III was not too great. The therapist was mostly busy with other patients and every motion seemed like a huge effort.  I missed Frederic The Great, who had a magical ability to make his patients feel that they were getting better even when the muscles were unwilling to obey the orders of the brain. I always felt better after a séance with Frederic.

But there’s nothing to be gained by feeling sorry for oneself. I  learned long ago (thank you, Elena) that there’s only one way out of gloom and despond, and that is forward. It’s onward we go, and the devil take the hindmost.

The day ended with me spilling my mushroom soup all over my tray —the first soup with any flavor since my arrival—and accidentally sliding from my chair to the floor while reaching for the phone.  I was certainly unharmed; but to my intense exasperation, I was not able to get up without help; so I angrily growled gggrrrrr and pressed the button for the nurse to  come and pick me up..
 
Good grief and goodnight!  Let’s try for a new start tomorrow!
 
Postscript
 
One of my friends asked me what paralysis feels like.  For me, I had the same surface sensations on both sides of my body (I can feel the difference between a pin-prick and a gentle touch, just as one does normally) but when I order the right side to do something  --walk normally, pick up an object, raise my hand to scratch an itch—nothing happens.  It’s as if the message doesn’t get through; it’s as if the part of the brain that governs the right side of the body is dead.
It drives you nuts!  
 
CHAPTER   V
After an extraordinarily dreary Wednesday  --I’ve listed my various woes, which included   a  dark,  snowy, lugubrious sky  which, I learned later, paralyzed all of Paris  —Thursday dawned  bright, clear and cheerful, and I felt much better. I was once again walking with considerable confidence; my speech had returned to normal (for me) and my hand seemed to be back to its usual (useless, but improving) state. Maybe the physical therapist was right: I was just over-tired on Wednesday and I collapsed.

Recovering from a stroke – if you’re lucky enough to recover, which many people are not -- is a slow and agonizing process.  Your progress is measured by a slight improvement in dexterity, or by a generally more stable gait -- and on many days, nothing seems to be happening at all. 
And yet, today I was noticeably better. I was able, for example, to successfully use my right hand to help my left hand fasten my belt, which is something I could not do yesterday or the day before. 

Fastening my belt seemed like an important achievement. It meant that I could dress myself, which is a big step forward from lying helpless on a bare wooden floor, which is how I began three weeks ago. I suppose it is even a big step forward from yesterday, when I most definitely had to get help to perform this simple task -- although Frederic the Great might have been able to teach me some elegant manipulation that would have enabled me to perform this  operation without assistance -- and he would have accompanied his explanation of the relevant muscles and tendons with a wry commentary on the nature of self-sufficiency, or perhaps on the philosophical meaning of despair, a constant specter here in the Land of the Maimed and Disabled.

Oh, well. Frederic is there and I am here:  I have to make do with the resources at hand, not the resources in some other place.

I learned today that the average stay in rehab is three months.  It looks likes my stay is more likely to be in the nature of three weeks, and  that I have a good chance of breaking out ---I mean, of being released—by the first of the year, which means less than a month in rehab. That’s one-third of the average time.

On good days, things seem OK here on the ward. People are friendly, the staff is helpful, everything clicks along at a well-paced clip.

On bad days, whoa Nellie. The boogie man of despair makes frightening noises; the aches and pains seem incapacitating;  the orderlies seem to be working full-time to Make The Patient  Suffer. 
Today, which definitely was one of the good days, the Ergo lady asked me if I would like to go for a walk or visit a friend in the city. The idea terrified me (I can hardly walk down the hall, let alone down a crowded Paris street, in the middle of Christmas shopping season.) but maybe in a week or so I could give it a try.

Why not! Eventually I have to go back to the real world:  why not start sooner rather than later?

 

CHAPTER VI  
 A friend asked me the other day what I have learned from this experience.

            First, I learned from the event with my thumb that I can do a whole lot more than I ever imagined possible.   “No” is probably the wrong answer, whatever the question

     The second thing I’ve learned is that everyone is mortal, including me.. We may no longer be living in the time of the Napoleonic Wars (I’m still in the middle of War and Peace: does this wonderful book never end?)  and probably Prince Andrei could have been saved by modern medicine; but sooner or later the bell is going to toll for all of us , and that means for me as well as Prince Andrei (whose father, by the way, is killed by a stroke.).

            The moral is, live life to the fullest now, not tomorrow or next week.

            I have to admit that that probably has always been my philosophy: I have never been big on Postponing Gratification, and  in that way I suppose I am terribly American. 

        But now it’s different. I’m not going to live another fifty years, and probably not even  another twenty-five: I want to take maximum advantage of what’s left, and go out with a feeling that I’ve had a really great run.           

  
Gather ye rosebuds while ye may, old time is still a-flying

And this same flower that smiles today tomorrow will be dying.

Will these profound insights have any practical impact on my behavior? 

For the fact of my mortality, the answer is probably no. I’ve always been a grasshopper, not an ant.
But the knowledge that the brain can be manipulated is quite a different story. The event with my thumb gave me a fundamentally different insight into the workings of the mind. It made me think that Yes We Can—even if President Obama thinks  that we cannot. (And it reminded me of those incredible stories in the newspapers about  thought-control experiments, in which participants accomplish various tasks just by ordering them to be done with their thoughts.) 

The physical therapist  regularly makes reference to the thumb event, and  her reminders have the practical effect of making me try tell myself ,”Do it!”. The hand or leg  says no no no no; and then it obeys my order. (I have to admit that on my bad days the hand or leg obdurately says “NO!!” and “no” is the last word.) 

But  mostly my new watchword is “yet,” as in, “I can’t do that….yet..”  

 Those three little letters make all the difference..            
Weekends are a slow time in rehab.. The PT staff does not work; the PT room, with all its ladders, etc., is locked and the patients go into a state of suspended animation, waiting for the staff to return on Monday

 Isn’t this a questionable practice?  The patients are here every day: shouldn’t the staff be around to help? Why not stagger the work week?

The PT girl’s answer  is that it can’t be done.

 “This is a public hospital, “she says, “and we bargained for double pay on Sundays and time and- a-half on Saturday. The hospital can’t afford us on the weekend; and so the PT room is closed.”
 It makes no sense for the patients; but I guess it’s great for Family Values.

 I spent Saturday and Sunday writing my journal, pretending to exercise, and fiddling around.. A wonderful aunt told me once that I should never “kill time” because time is all we have, but this weekend felt an awful lot like killing time.

There are 45 beds on this floor, and about half of the patients are completely bedridden. I see them only by sneaking glances into their rooms as I shamble down the hall; they look to be pretty far gone and I quickly avert my eyes.

Of the remaining half, about half are embedded in wheelchairs of one kind or another:  motorized or not, outfitted with special devices like arm lifts and leg holders, especially constructed to accommodate one-sided patients.  I never would have thought there could be so many kinds of wheelchairs.
That means there are only about a half dozen patients on the floor who are really ambulatory –if I dare to call myself really ambulatory. (The PT girl told me I am an exceptional case: almost no one arrives at Fernand  Widal  already able to walk.) 

When I got here, I would have thought that it might be possible to develop a certain camaraderie with at least a few of my fellow patients. After all, we’ve all been hit by the same enemy; we’re all going to be here for a long time, we’re all quite separated from our friends and family.
 But the rule around here seems to be to Keep To Yourself. (Contrast the vibes in the busses in Paris, which have ads that encourage people to talk to their fellow passengers, to be “convivial” and friendly.  And the suggestion is often followed!)

I am reminded of my grandmother, who spent her last years in a facility that was, I suppose, much like this one. Towards the end I asked her what it was like to live in a home for the aged  (My grandmother died at 96.) and she answered that it was generally not too bad, but, she said, “The worst part is that there’s no one to talk to.  The residents are pretty much ga-ga, and the only people with whom I can have an intelligent conversation are the doctors, who tend to be too busy.”

Is it my fault, for not trying? I don’t think so. I’m certainly a yakker, and no one could say that I haven’t made a good-faith effort, and I don’t mean by talking about Kirkegaardian despair or Mimi in La Boheme.  l have tried to talk about subjects I know we have in common, like the hospital food and  the regulations that govern us; l have tried to talk about and Our Strokes.
Those who can are sometimes willing to talk about their strokes. But the conversations seem forced and distant: it seems that most people really do not want to talk about anything  with their fellow patients, it seems that they would rather be left alone.

 In spite of the fact that the ambulatory patients on the ward see each other many times a day -- in the PT Room, in the Ergo room, in the lunchroom--no one -- no one! – has initiated any conversation with me, and several people have responded to my conversational sorties with angry dirty looks, and have walked away without answering. 

It’s as if we’re people who meet in a bordello, or at the abortionist’s. We talk cordially  to the person with whom the business is to be conducted; we treat each other  as impersonally  as strangers on the Metro. 

It’s kind of spooky, especially here in France where people tend to be chatty, especially when they hear my American accent.

 I have met one person with whom I have something in common.  He’s an Argentine composer, about my age, who does seem to know about Mimi and who can talk intelligently about Vargas Llosa  and Cortazar and Borges. He is willing to permit occasional conversation.

But still.  Mostly my fellow patients seem like damaged, ghostly figures, flickering in and out of focus, only partially  present. They seem to be distantly, galactically absent – and that includes the cultured and courteous composer.

Life in the rehab is no fun, there are no two ways about it.  If you want a good piece of advice from the inside, Keep Out. The conversation with your dreary brother-in-law, dull as it might be, is bound to be spicier than the conversation in the hospital. And for sure, so is the food. 

That having been said, I have found one person with whom I can talk. M. Carreau is a retired night-shift postal clerk, a guy who, like me, likes to laugh, likes to cook and likes to shoot the breeze. (Interestingly enough, he has also read extensively –Hemingway, Steinbeck, all the French greats.)
Carreau told me about his stroke; he told me about his trips to America (his daughter was married in Las Vegas); he told me about his video collection of 200 movies, old and new.

“That’s terrific,” I said. “I was thinking the other day that I feel like Marlon Brando at the end of The Godfather: I just want to sit back quietly and watch the tomatoes grow. I was trying to remember, was that Godfather I, II or III?”

“That was the first one,” Carreau said, not missing a beat. “The second and third are more about Michael Coleone, played by Robert DiNiro. Brando is the star of number one, not numbers two or three.”

 Carreau is 72.  He’s a little guy with many missing teeth, a big pot belly and a funny way of talking; he slurs his speech (as we all do) and he talks quite indistinctly, which means that he is  sometimes a little hard for a foreigner like me to understand.  He looks like one of those people one sees on the street: quite short and toothless, mostly bald and badly-shaven, marginally competent . He looks like a person who is of no interest to anyone except his nearest and dearest.

 But looks are deceiving. Carreau’s thought process is entirely  unimpaired and his life experiences are noteworthy: he has run in five marathons (!); he is an avid sportsman, and he talks knowledgeably about wild mushrooms, his former membership in the Communist Party and his travels in America. He quotes Faancois I and Henri IV;  he even speaks a few garbled words of English, which I can never understand and whose  mispronunciations  send us both into gales of laughter.

Conversation with Carreau is a welcome note of normalcy, here in the silent and isolated world of the Magic Mountain.

 Which reminds me. Maybe I’ll re-tackle Thomas Mann, if I ever finish War and Peace. 
Which is probably not going to happen.  Doesn’t it go on forever, like this endless rehab?

 

CHAPTER VII 
I think I’ve finally figured out  what  Ergotherapy is. In English it’s called Occupational Therapy and the World Federation of Occupational Therapists provides the following definition: 

Occupational therapy is as a profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment to better support participation.
Occupational therapists use careful analysis of physical, environmental, psychosocial, mental, spiritual, political and cultural factors to identify barriers to occupation. Occupational therapy draws from the fields of medicine, psychology, sociology, anthropology, and many other disciplines in developing its knowledge base

That’s a long-winded way of saying  that occupational therapy is aimed at helping patients solve specific  problems in the real world. It is different from physical therapy, which  is aimed exclusively at the restoration of the patient’s muscular and physiological deficits, unrelated to one activity or another. 
The occupational therapist  conventionally works in rehab centers; but she may also be called upon to work outside the hospital. She may be called upon to insure, for example, that a patient’s living environment  is properly secured, with railings on the stairs, no-slip surfaces in the bathroom and kitchen cabinets that are accessible to a person confined to a wheelchair. 

The stroke I suffered did not affect my cognition.  In my case, therefore, Myriam the occupational therapist’s responsibility has been to help me accomplish certain specifically defined  tasks, like putting a peg in a board, a cube in a box or a small wooden cylinder in a basket, that I no longer have the ability to do alone. (Carreau, who also has no intellectual deficit  --far from it --, has nevertheless  lost the ability to write. Myriam is teaching him  how to form letters.) 

Putting cubes in a box is not an intellectual task (to say the least); but it does involve problem solving. This “work” is  thus quite different from the work that  I do with the PT girl, which almost invariably involves simple manipulation of my leg or arm or hand, unrelated to any particular task—and conventionally with  no use of supplementary gadgetry, games or devices.( “Try to stand on your right leg with your left leg out behind. Bend the knee; then straighten it up. Perform that act ten times.”) 
In the Ergo room, therefore, I practice opening my fingers to reach for a desired object (fairly difficult); clutching the object (ditto);  lifting my wrist –no shoulders, please-- to place the object in a new location  (very tough) before releasing it and moving  the hand back to take another block or peg (fairly easy).
The tasks that Myriam assigns me are designed to re-train a set of muscles rather than to re-train the cognitive areas of the brain. (Forty minutes of putting pegs in a box does not put a serious strain on the centers of higher learning.) 

Myriam’s work with me is exclusively manual, and in that sense it is similar to PT. But with patients who have experienced a loss of cognition, her work is far more sophisticated
Some people, for example, have lost their ability to reason: Myriam works with them on simple games of logic. 

Others have lost their memory or their ability to deal in an ordinary way with the world around them. For these patients, she might design an exercise in which they have to look up a name in the telephone book,  or play word or memory games designed to re-educate the brain in what it once knew cognitively, which was to remember and to think in an orderly way. 

Some people have lost all sense of one side of their bodies, and only put lipstick on the right side.  Myriam helps them find their own bodies, or perhaps helps them distinguish left from right, or perhaps to recognize the inside from the outside of a shirt or a pair of pants. (A stroke is always a vicious, and often a lethal, event. See below).

One patient here was asked on admission, “Do you know what year we’re in” and he answered “2012.” A month later, he’s much better—but he still has lots of trouble finding certain words, and any slightly complicated question throws him for a loop. He works with the ergotherapist on memory games and newspaper reading.  (Carreau was asked to name the President of France and he looked at the interviewer as if the interviewer was nuts to be asking such a stupid question. “Louis XIV,” he responded,  “Who do you think  is the President of France?”) 

For me, and because I’m in France, a necessary part of occupational therapy is –making food!. And so next week, I’m going to make a quiche. 

Why quiche? The easy answer is that I’m doing a quiche because I didn’t want to make an apple pie, which would have involved the complicated tasks of peeling apples, kneading dough and placing the slices carefully in a pattern. (It’s not that I feared the difficult tasks: it’s just that I don’t particularly like apple pie.) 

So the decision came down to quiche, which involves making the dough, slicing and dicing the bacon, grating the cheese, slicing some onion and combining all the ingredients into  some semblance of real food . 

Can  I do it?  Will it be edible? Stay tuned! 

Today in PT I played a kind of soccer game with Carreau. We kicked the ball back and forth a bit, but I was laughing so hard at the vision of these two old codgers playing a game of soccer, Carreau dragging behind him a portable drip device on a seven-foot standard to “cleanse his urine”   (he has a prostate infection) and me tottering from one foot to the other, that I could hardly see, let alone kick the ball.

 Carreau is a load of laughs. He and I had a great time, and so did our audience, which consisted of a very beautiful black woman  whose warm and rich laughter often fills the PT room with sunshine and flowers .  
I won the soccer game, 10-6. I don’t know which one of us won the beautiful lady’s heart, but I’m sure it was me. I’m a lot cuter than Carreau.. 
That having been said,  make no mistake about it: a stroke is a brutal experience and many of its survivors might just as well be dead. A cousin of one of my friends had a stroke at age 50; today, one year later, he’s in an institution, he still can’t talk, he apparently can’t read, and he can scarcely move. He has refused to do any further PT, apparently because he has concluded that the PT isn’t helping. And where can he go from here? His productive life seems to be over, thank you Mr. Stroke 

I see these horror stories in every room here in the rehab center. The person in the room next to mine –a young man, probably no older than forty--is alive, but barely: he is wholly bedridden and I have never seen him move. He is fed by a tube and he never even seems to open his eyes; he appears to be in a “persistent vegetative state.” 

I talked this morning with a patient from Laos. He had the terrible misfortune to be struck by a hemorrhage  rather than by the more usual, and typically less deadly,  blood clot, which is what I had.  After the stroke, he spent several weeks in a coma; he had an operation to relieve the pressure on his brain caused by the hemorrhage, and when he finally awoke, he could not speak, he could not see, and  he could not recognize his closest relatives.  He told me that he had been a millimeter away from dying. 

Today, a year later, he speaks relatively clearly; his thought processes seem relatively coherent (not entirely, but relatively); and he can move pretty well—not perfectly, by any means, but pretty well. He is 52 years old; he has spent a year in rehab, and he is going home tomorrow. He is still a very damaged person. 

I could go on. A woman I know could never was able to say anything but doh-doh-doh-doh after her stroke and spent the rest of her life –which was measured in years rather than  months-- in a wheelchair. Another woman can get around, but needs to be guided constantly by her husband. She can talk, but she speaks so slowly that conversation with her is tedious; she can understand, but she seems to be mostly absent.

Who gets strokes? As deadly and cold-blooded as a rattlesnake, as mindless as a shark or a crocodile, a stroke makes no distinctions as to its victims. Young or old, rich or poor, men or women, healthy people like me or sickly diabetics who smoke and drink whiskey, anyone can be struck and anyone can die or be incapacitated by a stroke. The general rule is that younger and healthier is better, but the doctor tells me that she knows a man who ran eleven marathons and then had a stroke at an early age and a woman who  smoked a pack of cigarettes every day of her life and died at the age of 90. Wikipedia  says strokes can occur in fetuses. 

And there’s no rule about where a blood clot will travel. If it happens to wander to a critical area of the brain, you’ve bought the farm; if it blocks a less-dangerous artery, you’re only slightly or briefly incapacitated -- like me. (Don’t conclude that my situation is a cake-walk. I can still walk only a few hundred yards and my right arm is still mostly useless. And that is a whole month after the event!) 
But the doctors tell me that good heath definitely does make a difference in rate of recovery. Assuming a relatively benign clot, a person who doesn’t smoke, an athlete, a young person with a good attitude and a strong body, even an older person  (like me or Carreau) who is in good health, stands a better chance of a quick and complete recovery than a smoker or a sedentary diabetic, or a person with uncorrected high blood pressure. 

Good health can’t prevent a stroke—even a lethal stroke. But if by chance you survive the initial blow –and survival is largely a matter of chance— and if by chance the blow is not too heavy, as in my case-- it’s better by far to be in good health, in order to have a speedy and complete recovery.
It’s a little like predestination. Good works do not determine whether or not you are saved, because that decision is made by God without human intervention, but you should perform Good Works as an outer sign of inner grace.

Or so thought the early Protestants. I myself, as a devotee of the Grand WooWoo, don’t place much stock in Protestantism, or Good Works as a sign of anything. Salmon is better than roast beef because it is better than roast beef, period, and it has nothing to do with preventing  a stroke—which it won’t do in any case. 

But I do believe that the great WooWoo, (which is another way of saying the luck of the draw) determines who does and who does not get a stroke, and where the blood clot settles, and whether it’s a fatal event or not. You can eat all the salmon in the Pacific Northwest and still croak from a stroke, but if you make it through the initial episode, and if that episode is not too grave, you’ll probably get better, faster, if you’ve previously been eating a healthy diet.

Moral: lead a healthy life! Salmon is good for you! Eat more fish, they feed themselves! 

 

CHAPTER VIII

 

Thursday is Rounds day at the hospital. Every Thursday, the doctors, the PT staff, the Ergotherapists, the relevant nurses and a bevy of medical students conduct a Regal Processional to the patients in their rooms, and after a detailed examination,  the doctor and his team make the essential treatment decisions that will govern the patient’s life for the following week.

 

Every second week, Rounds are conducted by the head of the service himself. As  I knew Dr. Yelnik  by reputation to be a highly respected clinician, I awaited his visit fully dressed and all adrenelined-up: I had carefully practiced my walking and my hand movements, and  when I stood before him and his staff, I was loaded for bear.

 

Dr. Yelnik’s examination was, as I had anticipated, extremely thorough. He moved my right hand and fingers; he asked me to make faces; he asked me to make more faces; he watched my still pathetic, but improving, walk.

 

When he had finished, I popped the question.

 

“I think I’m ready to leave,” I said. “I think the rest of my rehabilitation can be conducted on an out-patient basis. I think I no longer need to be tying up one of your beds.”

 

Doctor Yelnik  looked  mildly surprised: I think he had expected me to remain in rehab for at least another week, maybe two.

 

He looked around the room for reactions.

 

Silence.

 

He thought for a moment, stroking his chin in an appropriately professorial manner.

 

Then he pronounced his judgment:

 

 “All things considered,” he said, “I am inclined to agree. If the proper arrangements can be made, I think it is appropriate for Mr. Padnos to be discharged.”

 

I had been granted a reprieve.

 

With consummate dignity, the great man and his entourage then formally gathered their robes and  removed themselves from my room, much like a Cardinal at the termination of High Mass or the Supreme Court at the end of the session.

 

“Au revoir, M. Padnos.”

 

 “Au revoir, Monsieur.”  (Doctors are called “Monsieur”  in France.)

 

And that was it.

 

Several days later, after the appropriate arrangements had been made—mostly by Mme. Tessier, the Assistante Sociale, who courageously braved a filthy day of slush, cold and rain in Paris to install me in my seat in the train --which was an hour late, requiring us to stand in the freezing  yuk for an extra hour-- I left Fernand Widal -- I hope, forever. It was on the afternoon of December 20, one month and three days after my stroke. Phase One of my recovery was over.

 

And what is my judgment about this awful event, and the treatment I have received to recover from it?

 

With the exception of the surly behavior of a couple of the orderlies, I rank my experience 100 on a scale of 100. (Orderlies  can be surly anywhere. They are low paid and they work hard.. The vast majority of the staff was kind and helpful, orderlies included.)

 

The French medical system is ranked by the UN as the best in the world. The treatment I experienced in the two hospitals was top-notch; I could not have received better treatment if I had been the richest man in the world.

 

No, that’s probably not true: I might have had better food.

 

But I might not  have had better food. I have a friend who believes that there is a school somewhere that teaches cooks from all over the world to make hospital food, i.e., food that is tasteless, mushy and extremely nourishing. Even if I had been rich, I’d probably still be complaining about the food.

 

Apart from the cuisine, I am not sure by what standards a non-expert patient like me can reasonably  judge a hospital.

 

To judge by competence of medical care, Lariboisiere and Fernard  Widal feel to me like 100%, if not more.

 

Considering such intangibles as respect for the patient’s privacy, courteously cutting  the patient’s food (we’re all pretty one-handed here), remembering to give and attach the patients bibs (we’re also pretty messy eaters): also 100%, although, as I say, a few of the orderlies are sometimes short-tempered with the patients, and sometimes they forget the bibs, or a patient’s dietary preferences.

 

The quality of the rooms?  100% on cleanliness and order; 100% on décor. The rooms were thoroughly  cleaned and mopped every day; my bed was changed every day; my rooms in the two hospitals here have seemed identical to the room I once  had at the Mt. Auburn Hospital in Cambridge, which is the only other hospital I have ever experienced, and  Mt. Auburn is thought to be one of America’s best hospitals.

 

Overall score for Lariboisiere and  Fernard Widal? 100%.

 

Thank you, French medical system; thank you Dr. Yelnik, thank you Frederic The Great, thank you Myriam the ergotherapist, thank you Cyrielle the PT girl, thank you Mme. Tissier, the Assistante  Sociale who successfully intervened with the French bureaucracy on my behalf and then accompanied me, uncomplainingly, to the train, through slush and snow: I couldn’t have done it without you;  you’ve been wonderful, wonderful, wonderful. Merci mille fois.

 

*              *                   *

 

I do not pretend to be an expert on medical economics, but I cannot close this diary without a brief comment on the finances of this adventure.

 

I have just completed a month in the hospital, with consultations with specialists, several MRIs, many blood tests, heart scans and other procedures too numerous to mention.  I have been medicated and vaccinated; I have been interrogated, palpated and osculated.

 

And the cost of this elaborate care?  Zero. That is the French medical system.

 

It is true that the cost before the stroke was not quite zero. Because I have no work history here, I have to pay a small annual sum that is calculated on the basis of my income, which I have to prove to the French authorities by showing my American tax return. And because the French government system only covers some of the costs of care (although for this event I will get 100% coverage) I have subscribed, as do most French people, to a private supplemental program called a mutuelle for about 100€ --$130--a month.  The mutuelles are extremely competitive; I picked mine quite carefully to get the maximum coverage at the minimum cost.

 

So my cost, on an annualized basis, is about 1500€-- roughly $2000..

 

And if  this event had happened to me in America?  I shudder to think..

 

Every American can and will  tell his or her own health horror stories, but I probably can’t do better than to tell a story I heard  recently from a California tourist who was in Paris for the holidays.

 

“I’m in Kaiser Perrmanente, in San Diego,”  Steve told me, “and my wife and I (Steve is 61) pay about $1200 a month in premiums. Our premiums have just gone up 60%, and we have a $3000 deductible, which means that a hospital stay like yours would cost a minimum of $3000. Plus our monthly payments, which come out to about $15,000 a year.”

 

“So on an annualized basis, a stay like yours would have cost us about $18,000.”

 

“Kaiser is a so-called ‘private socialized medicine.’ That means that the plan owns all the hospitals, and the doctors are on salary. The care it is good care, but it is pretty bare-bones. 

 

“Many people in California are in much more expensive plans, and many people are in no plan at all.

 

“American health care is a disaster; and everybody knows it has to change.”

 

For a person in France, these figures  are mind-boggling. They basically mean that only the rich can afford good care; they basically mean that much of the population must go untreated, or get second-rate care..

 

I wonder what would happen to M. Carreau in the United States.

 

A $3000 deductible? Carreau lives in subsidized housing.  He most assuredly doesn’t have $3000 --and he couldn’t pay that sum for heath care if he did.

 

$15,000 per year health insurance payments? That would be his entire pension. If he had to spend it on health care premiums, he couldn’t eat or pay his rent.

 

In France, Carreau’s health care was free, and he got exactly the same treatment as I did.

 

In the US, were it not for Medicare, which  is only available to the elderly, Carreau would get screwed.

 

In France, Carreau , and  other patients much younger than he, gEt first-class health care--free.

 

I find it hard to understand why the French system is wrong.

 

That is, I can’t see why Carreau, a retired postal clerk, or the pathetic young man in the bed next to mine at Lariboisiere, shouldn’t  get the same treatment that I get, as a retired lawyer.

 

 

President Obama and Sen. Baucus decreed, to my mind preposterously, that the French system would be excluded from any consideration when the new health care bill was being hammered out. The Republicans were even worse: they wouldn’t even support a tiny public option –i.e., a mini--version of the French system--as part of the overall program; and President Obama capitulated to their demands, as far as we know,  without a fight.

 

America used to be the greatest country in the world: an innovator in science, in technology, in education and most of all, in democracy.

 

Something terrible has happened to our country, when it is common knowledge that I am a lucky man to have had a stroke in a foreign country rather than at home.

 

I am an American, and I’m proud of it.  But I am not proud of how my country  treats its aged and infirm, and that’s the category to which I now belong.

 

I regret to say it, but I’m happy that I live in France

 

 

Chapter IX

 

In  the tiny barber shop in Vaison-la-Romaine a few days after my release, I waited my turn for a haircut  (after six weeks un-shorn I had begun to look like The Ancient Mariner) and I noticed that the only other customer had a cane like mine.

 

“Stroke?” I asked him. (A cane and a limp gives you  a lot of freedom to talk with strangers; the man’s one-sided gimp looked a lot like mine).

 

“Yes, in 2009,”  he answered.  “I spent about two months in the ICU and then another six months in rehab.”

 

“Good God,” I said. “Eight months in the hospital! I was in for a month and  three days and I thought I’d go nuts!”

 

The man shrugged.  “You do what you have to do.  I see that you can already do lots of things that I still can’t do.  I can’t move my hand the way you do, and your gait is a lot steadier than mine.  You should feel lucky.”

 

The barber chimed in. “My first wife had a stroke when she was 38,” he said. “The doctors thought it was because she had been on the pill for too long.  She was in the hospital and rehab for about a year, and when she came out she was in a wheelchair for another year. Even today, twenty years later, she walks with a limp and doesn’t have the full use of her right hand.”

 

Three people with direct experience of a stroke in a tiny barber shop in a small city in the South of France!  Stroke is everywhere!

 

Stroke is a brutal, viciousl event, and it is, in fact, ubiquitous.. It is the leading cause of disability in the world and the second cause of death  --after heart attacks—in the US and Western Europe.

 

It is also a horrendous personal experience. It takes a fully functioning, normal and lively human being, a person in the fullness of life-- and in an instant—one instant!-- turns him or her into a crippled, a vegetable—or a corpse. It turns strong men into pathetic weaklings; it turns beautiful women into haggard, haunted hags. It makes people lose their minds; it makes people unable to speak; it makes people incontinent or wheelchair-bound or devoid of strength or energy. It turns bright, lively human beings into that   category that we all dread: pathetic, helpless patients.

 

I am one of the lucky victims. I never was incontinent, I never lost my ability to speak, I never had any cognitive deficiency.

 

It could have been much, much worse, and I thank the Great WooWoo that I missed the bullet. I only have a limp and a slightly disabled arm, and even those disabilities are temporary.

 

 

What now?

 

I am going to need months of rehabilitative therapy to regain full use of my right arm

and leg; I am going to need months of convalescence to get back my strength, because  I am much, much weaker than I was before the stroke. (I guess it’s understandable: my left side has to do double work, as it is doing things that used to be done with the help of the right side –like typing. And I’m necessarily tired because every step requires the left side to drag along with it the more-or-less dead weight of half of my body, which remains largely incapacitated.)

 

That having been said, the fact remains that I can still type; that I can walk around; and that  I can still think straight—although  a lot of  my friends that think I never could  think straight and that the stroke has not improved my thought process one iota.

 

The fact is that I’m a lucky guy, and not a single day passes when I don’t know it.

 

One month in the hospital? Poof, an instant of time

 

A few months of rehab with a physical therapist? A bagatelle.

 

An extra hour of sleep every night?  A pleasure for my friends, who doubtless will be happy for the silence.

 

I close with one final thank you  to the doctors and the staff at Lariboisiere and Fernard Widal; and with a super-big hug and thank you to the many friends from all over the world who have been kind enough to read this journal and to send me good wishes, encouragement, cheering messages—and even compliments on my one-handed writing! 

 

It’s now been two months since I was knocked to the floor of my friends’ apartment by a stroke. The stroke left me unable to stand up, unable to get into or out of out of bed without help and unable to move my right arm, hand or fingers—at all. It led to a month in the hospital.

It has now been one month since I was released from the hospital. Helped and guided by the hospital’s Assistante Social, I took a taxi to the Gare de Lyon and tottered slowly and unsteadily towards the TGV, a new cane clutched firmly in my left hand, and headed back, I thought, to my normal life.

Because I was a little wary of being alone, and because the hospital had strongly encouraged me to find a place to stay with friends or relatives, I headed to a friend’s house near Avignon, a kind of way-station between the sheltered universe of the hospital and my own house not far from Aix-en-Provence.

My friend Gene was phenomenally generous and kind. He met me at the door to the train (I was exceedingly glad to see him!) and immediately took charge of me and my suitcase. He gave me his son’s bed –Alex was relegated to a sofa--, and he didn’t complain when my hesitant, tap-tap-tapping through the outdoor market in Vaison-la-Romaine transformed his normal buzz-saw of activity into a slow-motion crawl.

Similarly, my son, who gave up his own life for ten days to help me settle into my own place, displayed Job-like patience as he watched, doubtless with inner trepidation but with complete outer calm, as I spilled my food, asked for help with the simplest kitchen tasks and tried to ride my bike.

The bike event was a disaster. Although I moved very carefully as I raised myself up onto the seat, I miscalculated my balance and ended up violating, for the first (and until then, the only) time, a cardinal rule of the hospital, Do Not Fall. I lost my bearings and crashed down to the ground, totally helpless: like the gigantic bug in Kafka’s Metamorphoses, I lay flat on my back with my arms and legs waving in the air, desperately trying to put myself to rights.

And at that very moment, my son magically appeared at my side.

No one ever wants to be helpless; no father ever wants to appear helpless before his son, even a son as unequivocally kindly and concerned as mine. (“Dad, think what would happen if you fell and broke your hip! You’re nuts to be trying to ride a bike! Take your time! You’re doing fine, don’t be in such a rush!”)

Falling off my bike was a very, very bad moment. It told me that I was most assuredly not “cured;” it told me that, even though I was beginning to feel reasonably normal, in fact I was in a seriously, even in a dangerously, diminished state. It made me understand that it was now mandatory for me to move very cautiously.

Add to my shaky equilibrium was the fact that the slightest effort left me exhausted.

The doctors tell me that a stroke -- even a relatively “light” stroke like mine--  is a brutal attack on the body. They say that the body needs an enormous  amount of energy to repair the damage: it doesn’t have a lot  of energy left over for bike-riding or other frivolous activities.

In fact I had a rough time with ordinary household tasks, like emptying the cooking water from a pot of pasta (too heavy). And I dribbled my food (in the hospital they give you a bib); and I was constantly dropping and breaking things, like plates and glasses.

I was beginning to see myself as a complete incompetent. And that incompetence began to take an emotional toll.

Apparently Depression is one of the predictable consequences of a stroke, which I suppose is not surprising. After living through a near-death experience,  the stroke victim awakes to discover that he can’t walk, talk, eat or even swallow the way he used to—and his equilibrium is so shattered that he falls off his bike! No wonder he’s depressed.

But depression is not my default state. Even before the stroke, I knew that at the end of the day-- even at the end of a horrendous day-- there’s really only one important question, and that question isn’t related to the anguished state of one’s poor, wounded psyche but rather to the critical issue of What’s For Dinner. If you spend too much time moping, you’ll forget to buy the Arborio for the risotto, and you’ll end up munching on a cheese sandwich. That’s really depressing!

Still, I can’t deny that the after-effects of a stroke are much more persistent and debilitating than I had anticipated. After the hospital, whether your stay has lasted a week or many months, you still face a long, rocky, uphill climb,  and there will be many falls, emotional or physical or both,  before you can resume your normal life. (Gabrielle Giffords, take note.)

The truth of my situation is that it will be a long time – the doctors estimate six months to a year—before I’m fully recovered.

And the truth of my situation is that during that time, I’ve got to live my life, insofar as possible, as if I were already fully recovered.

That means that I’ve got to resume my photography, I’ve got to jump-start my social life, I’ve got to start to look for a new woman. And I’ve got to decide on dinner.

None of that can happen if I just sit around feeling sorry for myself.  And so I’ve concluded that I have to dust myself off and move on. (“And anyway,” said one friend, “maybe you’ll learn something new. What do you think can you learn from being one-armed?”)

It’s certainly true that two months after the event, I still have only limited use of my right arm. And it’s true that I am still quite weak, and I walk with a pronounced (although ever-decreasing) limp.

But the fact is that I can walk, and I can usually walk for considerable distances without feeling at all tired.

And I no longer need a cane.

And I can move my right hand and fingers almost normally; and I can raise my right hand to eye level, and counting; and I can cook and drive and clean the house almost as well as I could before the accident. (My housekeeping before the stroke was not exactly meticulous. I think I need to hire a maid.)

I can even ride my bike for short distances —if I’m very careful, if I stay out of traffic and if I go very, very slowly. (But wait for the next chapter.)

And there’s no doubt that I am much less tired, even after considerable effort, than I was a week ago.  I now do things automatically that seemed, only a week ago, to require a major effort of will, like going up or down a flight of stairs.

I am also keenly aware of the fact that I am in far better shape than most stroke victims.

That is, I’m not incontinent; I did not lose my cognitive faculties; I never had any speech loss, and because I’m left-handed, I didn’t have to re-learn how to write.

Nor did I end up, after a year of re-hab (!), permanently confined to a wheel chair, like the 22 year old daughter of a friend, or with a loss of vision in one eye, like the 37 year old daughter of the très symathique fishmonger in the market in Aix.

Although it seems difficult to measure actual change (I still limp: how long will that go on?) it is clear that things are improving. A week ago, I had to decline several invitations in Paris because the trip seemed like an impossible effort; I have now bought a train ticket for Paris and (with my heart only a little in my mouth), I have arranged a full schedule of events.

The bogeyman of depression seriously spooked me for about three weeks-- and the fall from the bike didn’t help.  I was constantly tearful and upset; everything seemed like a huge effort; I yearned for the comfort of my warm and snuggly bed.

I was never “Half in love with easeful death,”  but I must admit that the phrase did come to mind.

And then suddenly, from one day to the next, the depression was gone. I was still limping and dropping glasses and dribbling my dinner, but it no longer upset me. If broken wine glasses were the (temporary) legacy of a stroke, I’d have to live with broken wine glasses; if I  was going to slobber my soup, I might as well buy some extra laundry soap and slobber with a couple of laughs. And maybe I’ll wear a bib.

As for the wine glasses, The Great Woo-Woo easily solved that problem. With predictable prescience, she invented a fabulous institution called “The Yard Sale,” and last weekend I found five (very nice) glasses for 2€, (about $2. 50)— and I  realized that I probably didn’t need to have an emotional crisis over $2.50.

I close with a few words about my friends.

When I was in the hospital, it seemed that all of Paris turned out to see me: Moroccan friends, people from the South visiting Paris, neighbors and even a visiting American, in town for the holidays, who came to bring me a set of keys I had left in my friends’ apartment. (We talked at length about health care in America.)

The response to my diary has been phenomenal. I’ve heard from high school friends, magically transmogrified by the passage of half a century from gawky teenagers into dignified grandparents; I’ve heard from a Catholic priest in Indiana who once rented my Paris apartment; I’ve heard from a French professor in Seoul who writes me, in a jumble of magnificent Franglais, to tell me that he loves my writing, my photographs and the idiotic internet jokes I send him by e-mail.

All of these friends are a tonic for the recovering stroke victim. After all, with so many good wishes flowing in my direction from so many diverse quarters, who am I to complain? I have to get well so as not to disappoint my friends!

It’s now been a month since I left the hospital, and my recovery is proceeding slowly and uneventfully—although there are occasional setbacks, like the fall from the bike. (Even the fall had its positive side: I learned to listen respectfully to doctors orders, and not to assume that I Know Better.)

The one-month anniversary—two months after the actual event-- seems like an appropriate time to put my Stroke Diary quietly to bed.

I began the diary in the hospital as a kind of occupational therapy; at the end, a lot of people have read it as a first-person report from the world of the handicapped and disabled, a world they will (hopefully) never experience first-hand.

If all goes well, it’s a world I will soon be leaving –thanks in part to my friends’ kind words and support.

I’ll be glad to return to the world of the able-bodied. I can report from The Other Side that living as a handicapped person – and more specifically as a handicapped person who apparently missed an encounter with The Last Goodby by only a millimeter or two—is no fun whatsoever, even for a person who had the good sense to have had his stroke in Paris and not in the USA or (God forbid!) in Cuba or elsewhere in the Third World.

If you have a choice, you should tell the Man In Charge that you’ve decided, after all, to skip the interesting challenges of a stroke. In all likelihood, spending a day with the grandchildren, or taking photographs of Cuba or store windows, or just sitting and smelling the flowers, is a more amusing way to while away your leisure hours.

At least that’s the way it looks from the South of France—from whence I send love and amazing thank you’s to everyone who has been kind enough to suffer through this ghastly event with me.

You’ve been wonderful!  The Great Woo-Woo and I thank you from the bottom of our garlic-ridden, olive-oil drenched, noisy and disorganized Provencal hearts. And we lift our Yard Sale wine glasses in a toast to your health. May it last forever and a day.

 Most important of all: may you never, Oh Never, have to write your own version of this diary.

 

 

 

 

Nov 17, the one-year anniversary date of my personal Big Bang, seems like an appropriate time to take a post-stroke snapshot.

 

I’ve come a long way from that night a year ago spent on the cold floor of my friends’ apartment in Paris, my right side completely paralyzed, unable to leverage myself up into my low-lying bed.

A year later, after a month in the hospital and a year of physical therapy, I think it’s fair to say that there is no way for a stranger to know that I’ve had a stroke. That is, I have no speech impediment, I have full motion of all my limbs, I ride my bike all over Paris (and have not had a fall for many months) and I usually don’t even have a trace of a limp.

 

To the outside world, I have made a 100% recovery.

BUT

From my point of view, my recovery is not quite that great.

I usually don’t walk with a limp; but if I’m tired, I limp.  And if I’m very tired, I lurch. On some days –like yesterday—   I lurch a lot.

 

My balance is still shaky. I usually walk correctly, but sometimes I have to concentrate to keep myself on an even keel. Sometimes I feel really, really dizzy.

On the edges of my mobility – lifting my right hand to reach an object behind my neck, for example—I am not fully recovered. I work diligently on these problems in physical therapy, which I still attend three times a week.

 

Fatigue is a lingering problem. Sometimes I am very, very tired. (Everyone gets tired, but the fatigue following a stroke is different. That fatigue is severe and constant, a leaden weight that you drag behind you like an anvil, everywhere you go.)

 

But I am unquestionably getting better.  I am now no more tired than other people my age; I usually walk normally, and the other day I amazed myself by swimming the full length of the local (Olympic size) swimming pool.

 

Swimming feels like an astonishing achievement. It requires the use of every muscle in the body; it requires the co-ordination of an arm and a leg which until recently were wholly paralyzed.

To make these formerly lifeless limbs stretch, kick and move in a coordinated effort seemed miraculous, and I was thrilled when I finished my lap. (Six months or so ago, when I tried to take a few strokes in the hospital pool in Cavaillon, I could only thrash about clumsily, gasping for breath and clutching for the safety bar on the edge of the pool.  Swimming the full length of a large pool seemed like a laughably impossible goal.)

 

I crossed another line late this summer when I suddenly found myself able to walk perfectly normally; that is, moving at a goodly clip with no limp whatsoever.

I couldn’t do it for very long: I soon settled back to my usual plodding, somewhat dizzy, pace.

But for a few minutes that day, I did walk perfectly. And it seems that that “few minutes” grows by a few minutes every day or at least every week. If I’m not tired, I can walk quickly and without a limp, i.e. perfectly normally.

 

Progress from a stroke seems glacially slow: two steps forward, one and a half steps back. Sometimes I seem to go for a long period without any progress at all. Indeed on some days, it feels as if I am slipping backwards. 

The therapist tells me that this irregular progress is par for the course. Stroke victims recover, if at all, by fits and starts; sometimes, for long periods, they don’t progress at all. During those periods of apparent stagnation, it requires an act of faith to believe that any further advances are possible. I try to keep the faith.

 

And what have I learned from this horrific experience?

First, I have discovered what the doctors call “the plasticity of the brain.”

That means that the brain has an amazing—perhaps a not yet fully understood but certainly amazing— ability to learn new things or to re-learn old things, like swimming and walking normally.

The seminal moment for me in this voyage of discovery was the incident with my thumb, when the physical therapist in the hospital told me to make a certain movement with my then-completely inert thumb, and after a dozen tries, the thumb suddenly came alive.

I looked at the thumb with amazement.  “But you said no a dozen times,” I said to my thumb, “and now you say, Oh, OK, if you insist.”

 

From this miracle I learned –and this rule is now graven in my mind like a marble etching: — The Answer Is Not No. The Answer Is Not Yet.

 

I now believe that if I set my mind to it, I can do almost anything. (Hence, a recent beginning at learning Danish, a language I had previously thought impenetrable.)

A second lesson – and this one is not so easy to put into practice—is that regular, relatively vigorous physical activity is the key to physical health.

 

As an intellectual construct, everyone knows that we are supposed to Use It Or Lose It. But for people who might be called “Older,” —a category into which I apparently now fall— intellectually knowing the rule is not the same thing as putting it into regular, daily action.

Older people –stroke victims or not – are inclined to take it easy, to rest on their laurels (or lack thereof), to relax with a good book. (Think of the aging Marlon Brando dozing peacefully under his tomato vines in Godfather II.)

 

We are tired. Many of us disappear into “rest homes.”  We don’t want to risk falling, or hurting an arthritic joint, or breaking a bone.

 

It requires an effort to get up and bike around Paris, especially when the weather is too cold – or too hot, or too wet, or too something-else. We all have a million reasons to stay quietly at home: to pay bills, to do the laundry, to catch up on the news from Libya, to answer the e-mails.

But I have learned that it’s an effort that I have to make.

 

And so I get out and around, on my bike and on my feet, every single day, with no exceptions, for at least an hour.

 

Stroke victims often get seriously depressed. Whether a person is surrounded by a loving family or lives alone as I do, progress from a stroke is maddeningly slow. It involves occasional tiny advances followed by many weeks or months of stagnation. For even the sunniest personality, the process is necessarily discouraging.

 

I have met countless people who have told me about a formerly dynamic father/mother/brother/sister who had a stroke and then spent the rest of his/her life dully nodding off in a wheelchair/sofa/armchair.

I understand those stories. It’s hard work to get better, and I, too, hear the siren call of Depression.

“Give up,” it says. “Sit still. You’ve gone as far as you can go.”

 

But for me, depression is not the answer. Depression is death, and I’ve got a long way to go before I’m ready to begin my descent down that dark and dreary road.

A stroke is a vicious event. It happens in an instant; the recovery, if any, takes place asymptotically: no matter how much progress you make, you never reach your goal of 100% recovery — but you keep trying.

*         *              *

I made an appointment a month or so ago for a check-up at Lariboisiere, the hospital to which I was taken after the stroke.

 

I spent an entire day being probed, tested, examined and studied by every kind of machine known to modern medicine.  I had my blood pressure tested, I had an MRI and a Doppler, I watched my heart going boom-boom-boom on a TV screen and I listened to the blood coursing through my veins.

At the end of a long day, I had my exit interview with the doctor.

 

“Your health is excellent,” the doctor informed me. “You need to keep up the good work.”

“I understand that people who have had a stroke are at an increased risk for a second stroke. Does that apply to me?”

The doctor glanced at his papers.

“I’ve given you a prescription to lower your blood pressure, which is not especially high, and another to reduce your cholesterol, which is well within normal limits. And you need to keep taking your daily aspirin.

 

“You tell me that you are quite faithful about taking these medicines.  If that’s true, and if you keep up your exercises, I’d say you are at less risk of another stroke than a normal person of your age.”

I smiled, and the doctor stood up and extended his hand.

 

“From a neurological point of view,” he said, “I’m ready to sign off on your case. You do not need any further neurological follow-up.”

 

That was the best news I had for a long, long time.

 

Feeling terrific, I jumped on my bike and headed off for the pool. I still had work to do, and the hour was getting late.