Stroke Symptoms and Effect

THE PAINLESS CONUNDRUM

It happened while the 4400 was replaying on Sky+ at 6.55pm on 14th September 2007. Painless and, initially for me at least, with no apparent effect.

I am a tour operator, guide/driving a seven seat Mercedes on trips throughout the Highlands of Scotland. These can be long days including driving up to four hundred miles with a very early start and arriving home quite late in the day.

On this particular day, it was short and easy. I had been guiding two United States’ ladies who were particularly interested in Scotland’s history. We visited Cawdor Castle and then went on to the thirteenth century Beauly Priory, the Storehouse of Foulis on the Cromarty Firth and ended the day at North Kessock watching for dolphins.

One of the ladies, Valerie, smoked and as I sat in the car with the other lady, Christine, we were generally discussing the world and life. She told me that she had suffered a stroke about a year previously and had treated this as a warning to improve her lifestyle.

She said that she had hardly been able to speak and I said that I would never have known that from talking to her. She said that if I’d known her before the stroke then I would now be able to tell that she did not speak as clearly as before.

Christine said that her friend had taken on board what had happened to her and had begun to lose weight, losing more than four stone (56lb) over the past year, although she was still struggling to give up smoking.

I told Christine that I had given up smoking twenty years previously and had made a decision to lose weight during early May 2007. Between 11th May and that day, the 14th September, I had lost two stone and six pounds (34lbs), but that I had also been recently diagnosed with atrial fibrillation, an occasional fluttering of the upper chamber of the heart and this was now under treatment.

^{The conversation eventually drifted away from health and back
to the natural history of the Beauly and Moray Firths. We crossed the Kessock
Bridge and I left them at their hotel. I was home by about 5.30pm.
Atrial fibrillation can cause strokes because the erratic
beat of the upper chamber can cause the lower chamber to create a stronger than
normal beat. This can create a clot which can then reach the brain and cause a
stroke or brain attack, which it is sometimes called.
It is therefore somewhat remarkable that, never having
previously discussed the possibility of a stroke with anyone except my doctor
and wife during a drug change, at 6.55pm that evening after a glass of wine and
very nice meal of chicken with rice, I should experience a stroke attack.
I can still remember almost every detail of the event,
although I was not immediately aware that anything had happened to me. There was
no pain at all and I may not have realised that anything had transpired if it
had not been for my wife, Wendy. I wonder when I may have become aware of it if
I had been living on my own. The only immediate effect was to render me
instantly speechless.
I remember looking away from the television towards our
wonderful picture window which has panoramic views over Loch Ness. With such a
vista in one’s home, it would not be abnormal for me to look at the view, even
with an interesting programme on the TV.
Something, however, struck Wendy as odd as I seemed to go a
little “blank” and she asked me if I was “all right”.
Now I really was aware that something was unusual. I sort of
wanted to say that I was OK, but nothing came out. I couldn’t even seem to
contemplate speaking. It was quite extraordinary really.
Wendy said that my face then showed a puzzled expression.
Having found myself incapable of expressing myself verbally in any shape or
form, I was puzzled as anyone would be!
Wendy got up and come over to where I was sitting and asked
me again if I was OK and I remember opening my mouth to speak, but nothing came
out. I wanted to say that I was fine, but I could not get my mouth to issue the
words. It was as if the words themselves had vanished from my cerebral
dictionary. I couldn’t say them because I didn’t know how to form them, yet I
knew what I wanted to say. My brain seemed to be unaffected in that regard.
This went on for perhaps a minute. Then I signalled that I
wanted a pen and paper and Wendy brought me the ubiquitous Post-it-pad.}^{I took the pen and decided that she needed to know that I
understood her. So I wrote, “The”.
I still have it. It was the most perfectly constructed “The”.
It sat in the top left of the paper in perfectly normal handwriting. The word
“The”, but I couldn’t write the next word which I believe was to be “4400”.

Why I should want to write “The 4400” when I really wanted to
say that I could understand her is a mystery, because the programme we had been
watching was sitting on “pause”. Wendy had frozen the programme within a matter
of seconds after realising that something was wrong.
Never mind, I took the pen, and a sensible centimetre or so
to the right of the word “The” I decided to write that I could understand her
perfectly.
Without more than a smidgeon of hesitation I wrote clearly
and precisely, in my very best flowing handwriting, the word “The”!
Now I knew something was badly wrong!
On that same piece of paper I wrote “The” twice more, then
decided that I needed to start again. I began a new piece of paper and tried
with all my might to write something other than “the”. Eventually I got out a
squiggle which looks a little like the word, “Other” and I think this was a
combination of my brain telling me to write
“understand”
while my motor systems continued to consider that it was absolutely vital that I
continue to write the word “the”. I did manage “thee” once as well. My
born-again Christian sisters would probably have considered that to be divine
intervention!
By now Wendy had told me that she was calling NHS24, a
government emergency system which must be used outside of normal doctors’
working hours.
I could hear her talking to them and she was struggling to
get over to them that our address would be difficult to find.
Our house is perched on the side of Loch Ness, some four
hundred feet (125m) above the loch and three hundred feet above the main A82
road between Fort William and Inverness. We are located just outside the village
of Drumnadrochit, which, back in 1980, I had turned into the monster capital of
the world when I set up the Loch Ness Monster Exhibition.
Between the main road and our house is a hundred yards of
tarmac strip running up through a field at a gradient of about one in five. This
is followed by a one in six gradient of dirt track with a double S-bend. The
narrow road then suffers further sclerosis as it squeezes past a neighbours
garage and then follows a three hundred yard meandering path to the house,
ending with a downward one in six slope with a sheer drop of a hundred feet or
more on one side, then, like a continuing nightmare, it ends with yet another
S-bend and tiny turning area by the house.
Suddenly I realised that the laptop was sitting nearby on a
coffee table. I signalled Wendy to bring it to me as, somehow, I knew that my IT
abilities could not be affected by whatever was happening to me. I had heard
Wendy say “stroke” to NHS24 and I realised she must be right.
I opened and switched on the laptop without problem so my
motor responses were apparently normal.
I double-clicked Word so, yet again, no problem with a double
click.
Word opened and I decided to type “I can understand you”.
I am a touch typist and expected to type those few words in a
matter of two or three seconds, but I couldn’t make anything at all come on to
the screen. I didn’t know how to type the words I wanted to say.
My mind screamed at me, “This is crazy. Of course I must be
able to type. I’d pressed the on/off button OK, I had double clicked the Word
logo, I must be able to hit the keys and make something appear on
the screen.”
I looked away from the screen and deliberately looked down at
the keyboard and hit the individual keys:
“I can I understu”.
The “u” was unimportant as by the time I had almost finished “understand” Wendy
said, “You can understand me”.

Success, but what an effort. I continued to type without
looking at the screen and this is the exact transcript of that page:

I can I understu
I need you to ask questions
Hospital tab
The cptr to hosp to just as
We need A to the to permanent to need until recover.
New tab
atenolol

My objective was to try to get Wendy to ask me questions to
which I could respond with a yes or no, thumbs up or thumbs down, nod or shake.

I also wanted my tablets to be ready to take with me to the
hospital.
I felt, after this success using the keyboard, that it was
important to take the computer, abbreviated to “cptr” to the hospital so that I
would have a method of communicating with the doctors if needs be. The sentences
above were truncated, of course, once my meaning had been got across they did
not need to be completed.
The cryptic reference to “A” was me already thinking about
the business. We needed to get Alison, one of my guides, to take on the business
permanently until I would be able to recover. I was already aware that I would
be out of action for months and the worry was creeping in that I may never speak
again. Also I did not want to let any of my passengers down, some had booked
months in advance on trips of a lifetime.
I was also concerned about what had caused this. Could it be
the new tablet, the very tablet which was supposed to ease my atrial
fibrillation? The atenolol?
Then a thumping at the door and the ambulance crew had
arrived.}