What my stroke taught me

At the age of 60, I had a stroke. There were plenty of warning signs, but I blithely ignored them. Before the stroke, I had been a high-functioning advocate. The stroke left me debilitated, both physically and cognitively. It was, without doubt, the single most traumatic event of my life thus far.

Four months later, I have largely — but by no means completely — recovered. Those four months have left me with ample time to reflect on the stroke. Here are nine things that I learnt from the experience. 

1. A stroke occurs when blood stops flowing to a part of the brain. The term “brain attack” conveys just the right level of aggression, with its implied juxtaposition to a “heart attack”. Though few people would use the possessive case in the context of a heart attack, it is common to hear people refer to “my stroke”. This suggests an element of chumminess (“I had my stroke last year”), as if a stroke were something akin to a favourite pet. There is nothing chummy about a stroke.  The term “brain attack” amply reflects the dualism that is part of our everyday thinking: heart versus brain; emotional versus rational; affective versus cognitive. But whereas it’s possible to refer with some wistfulness to a broken heart, nobody refers with longing to a broken brain.
2. When something goes wrong with one’s heart, it’s relatively easy to know what the problem is (though it may be difficult to fix). But when something goes wrong with one’s brain, it is immensely difficult to know what has gone wrong. That is because, on a physical level, the human brain is a complex mass of synaptic connections and neuromuscular junctions. Repairing the brain is akin to repairing an aircraft while it’s in flight. After I had the stroke, I was told repeatedly about the plasticity of the human brain and the establishment of neural pathways. To my amazement, it is all true. I have been astonished by the capacity of the human brain to heal, learn and grow. It’s a slow process, but the marvel is that the process happens at all. 
3. When I was recovering from the stroke, I underwent an intensive period of rehabilitation at Vincent Pallotti Hospital. I was one of the lucky ones: I survived the stroke. Many others are not so lucky. Those who survive are often left bedridden, unable to feed themselves or to perform bodily functions unaided. I have kept in contact with some of those patients, but not nearly as many as I should have. I do not know where most of them ended up. And I do not know the answer to the question that troubled me so in rehabilitation: what happens when the medical aid stops paying?
4. In rehabilitation, I experienced a sense of community that I have never experienced before. I spoke to people I would never otherwise have spoken to, and in many cases I struck up a genuine connection with them. There was an identity of purpose (to get well) and a sense of pulling together in support of that purpose. When one patient managed to stand up and walk his first steps in rehab, those watching cheered spontaneously. This is community in the most genuine sense. It is bewildering to think that to experience that sense of community again I may have to get sick.
5. After I had the stroke, I became immensely sensitive to people treating me as if I were an idiot. I wanted to respond: I am not stupid; I have suffered a brain trauma. I’m embarrassed to say that there were occasions when I did respond in that way. Closely allied to this was the development of various coping mechanisms to mask the fact that I had suffered a stroke. I wish that people would treat me as if they were behind a veil of ignorance regarding whether I was or was not recovering from a stroke. That would dispense with the feigned concern as well as the tendency to talk to me as if I were a moron.
6. It is the uncertainty that caused me the most anxiety. The question I kept asking myself in the immediate aftermath of the stroke was: will I ever recover? And neither I nor my medical advisers knew the answer. It is profoundly unsettling knowing that you have suffered a traumatic brain injury and not knowing whether you will ever get better. In my case, I remember making a deliberate decision that I was going to get better. I made the decision when I was in rehab, and it was probably the most significant decision I’ve ever made. Once that decision had been taken, it was “just” a question of implementing it — as difficult as the recovery process was (and still is).
7. As important as it is, the desire to recover from a stroke is insufficient by itself. During the recovery process, I was struck by how much I needed the support and encouragement of friends and family. I searched for a sign — any sign — that they thought I was recovering. As US academic Jill Taylor put it after her stroke: “Recovery, however you define it, is not something you can do alone, and my recovery was completely influenced by everyone around me. I desperately needed people to treat me as though I would recover completely. Regardless of whether it takes three months, two years, 20 years or a lifetime, I needed people to have faith in my continued ability to learn, heal and grow.”
8. It took several months after the stroke for my brain to start functioning again. As the doctors put it with delicious understatement, I was experiencing some “cognitive fallout”. To combat the fallout, I did lots of occupational therapy. This required me to play games that I had not played since I was a child. The games were extraordinarily useful in bringing my cognitive functions back to life. And it set me wondering: why do we devote so much time to physical exercise and almost no time to cognitive exercise? After a certain age, most of us have no cognitive conditioning at all. It seems counterintuitive to spend as much time as we do in the gym, yet devote almost no time to developing our most important organ: the brain.
9. The most important thing I learnt from the stroke was to value every day. Most mornings when I wake up, I’m just thrilled that I have woken up at all. This is something that can be appreciated only by those who have stared into the abyss and managed to step back. In my moments of despair (of which there were many), I wondered whether I would ever see the sun set over the ocean again. Being and non-being; existence and non-existence; life and death — these are the fine lines we draw as we try to find a comfortable spot to watch the sunset.

• Alfred Cockrell SC is a practising advocate and a member of the Cape Bar.