Part 4: Electric!

The two major problems with my left leg were my ankle and my hamstring. Both were completely non-responsive to my massive effort to move or tense them. As one might expect, trying to walk safely without fear of falling is linked intricately to the functioning of your ankle and hamstring. So that’s what we worked on. Many of the exercises focused on trying to ‘trick’ the muscle into remembering. The brain was there, the muscle was there, both were working, but they weren’t communicating; the messages were getting blocked along the way. We weren’t looking to hamstring curl 50kg, we were simply looking for the tiniest contraction (twitch) of the muscle. Once that one tiny contraction was achieved, it was just a question of doing it over and over again, eventually strengthening it to (perhaps) what it once was. Phillip was doing a lot of research and reading into electrical stimulation of muscles in rehabilitation, and he asked if we could try it (some people ‘don’t like current’). I was happy to.

The way we would use it was to attach the electrodes to the muscle with Phillip at the controls. We would count down and then try to time the electrical stimulation of the muscle with the stimulation coming from my brain, so that it seemed as though the messages from my brain were getting through to the muscle. Eventually we managed to get a contraction (very much a twitch) out of the hamstring without the use of the electrodes -that was the message getting through to the muscle. After that the hamstring got stronger relatively quickly. Soon Phillip was pushing down on my foot while I tried with all my might to do a hamstring curl, a massive departure from trying to initiate the tiniest of contractions.

The ankle was an entirely different matter, not co-operating at all. The problem with having a non-functioning ankle is that when you walk your toes drag because there is no dorsi-flexion. As a result, you have to walk in such a way that you bring your leg and foot ‘around’ instead of ‘through’ in doing a walking motion. If you’re wondering what dorsi-flexion is, it is when, if you are standing or sitting with both feet flat on the floor, you try to lift your foot off the ground as far as you can without your heels leaving the floor. That motion is very important for walking/running.

My ankle was not playing the game at all. This was highly significant to me because I still dearly wanted to run and participate in sport again. Without a (working) ankle this would probably be impossible. Phillip put together an ingenious little device that might give me a chance. Using the electrical stimulation device, he modified it so that a pressure sensor was placed underneath my foot in my shoe. Every time I lifted the foot to take a step the sensor would activate electrodes that were on my ankle in strategic positions. The ankle would then move in a ‘dorsi-active’ manner, and I would not drag my toes. So with this contraption attached to me I could achieve dorsi-flexion while walking. Not exactly the most convenient thing to have a battery powered electrode attached to your foot semi-permanently. Nevertheless, the device did have the effect of simulating a walking motion, and thereby perhaps reminding my ankle how it used to feel. One day I discovered that I could move my big toe. When I told Phillip this he almost jumped through the roof. He was happy to the point of laughter, whereas I thought that it was not such a big deal. He did however say that this meant that my ankle would ‘come back’. Of course, this was good news for me.

Phillip and I would practice stair climbing as well, albeit only one at a time. We started with the small stairs outside the ward reception, then graduated to using higher boxes in the therapy room.

Phil was (is) a really good guy and always seemed to be thinking about my case as he always had new ideas and thoughts about what we could try.

Klare Hein was my OT (Occupational Therapist). She was also pretty cool, a pretty woman about my age. The first thing she taught me to do was to get dressed. She told me that you always first dress/undress the affected side (the weak side), that way you are using you strong side in the best way. Hey, don’t laugh, getting dressed with one arm and one leg is a difficult task. The next port of call was to try to remember how to tie shoe laces, after the first day I could manage, even though my left hand was still quite spastic. We did a lot of physical stuff like throwing and catching a ball with my left arm. We also did mental tasks like puzzles and games that might incorporate my left side in some way as well as my mind. OTs generally try to make sure that you can do ‘normal’ everyday things like brush your teeth, dress yourself, etc. Klare did that no problem, she wasn’t particularly entertaining, but she did the job. Whereas Phillip’s passion and love for his job really shone through, I don’t think Klare had the same fire burning inside her. Not to say she was a bad therapist, though.

My speech therapist Danielle was brain crushingly irritating, although she was just trying to do her job. My speech had come back really fast after the strokes, I did not think that there was anything wrong with my speech, yet I needed this therapy. The most entertaining thing about my time with her was the fact that she had eloped and fell pregnant in the last few months. She wasn’t showing yet so it must have been quite recent. I always hoped she forgot about me. She always sat on chairs in the way that kids do; like when they sit on their own foot. One day she fell off onto the floor, it was pretty funny, sadly most of the others who witnessed it were either too brain-damaged or on too much medication to laugh. Shame, not a bad person, but that’s how it goes.

As I mentioned before, I was initially in the section of the centre for those with neck injuries. In a way I fitted in well because my injury seemed like it could easily be similar. Eventually they moved me to the ‘brain-injury' section. Now this was something to behold. Packed to the rim with loonies of every description. While I was here I started to realise that I was actually very lucky in that I was not more severely disabled than I was. I shared a room with the joy of joys, an Indian guy by the name of Shaun Johnson. Now, I hate to stereotype people, but hell, ‘Shaun Johnson’ is hardly a name you’d find on an Indian ballot paper. He was a seriously miserable bastard. Didn’t really complain much to the staff, but was always muttering something about ‘have you EVER had such a shit day in your life??’. He did have quite a story though. He was in a car accident and apparently had been declared dead on the scene. He wasn’t though, and lay in a coma for 3 months before waking up. He had spent the last 6 months or so at Riverfield.

There was a lady who came in who seemed seriously cooked, and she was, you could tell be the massive scar arcing across her shaven head. I couldn’t help but laugh sometimes. She would constantly ramble on not making any sense at all. At first I thought that she was perhaps just chatting away to herself in her home language, but after I asked one of the others he told me that she was just muttering nonsense in an array of sometimes indistinguishable languages. During exercises she would do completely random things like crack her knuckles and try to co-opt others into joining her (with the nurses scrambling to prevent this). Of course I felt sorry for her, but funny is funny.

Another lady there, Mrs White I felt really sorry for. She was very old and in bad shape. Her ankles and calves had swollen to the point that they didn’t look like they belonged to a human being anymore, and she was only ‘with us’ about half of the time. She would also do and say the most random things. During exercises one day she started begging and pleading profusely to be given….. ‘just one (gesturing with her finger) teaspoon, pleeeaaaaase’. Once given the spoon she was confused as to why she was given this thing. I felt really bad for her, she was on her way out. Her husband who also looked quite old used to visit her often, they would just sit quietly on one side of the room talking. My heart broke everyday for them.

The person I felt most sorry for was this young (20-25) guy from Mozambique. His name was Manguelle and he had been electrocuted while at work. He was severely, severely brain damaged. He could not really walk around without crashing into things or falling over, he was mostly tied with a sheet into his wheelchair. He always wore a nappy. He did not appear to have proper control over any of his limbs or his body, although they did seem functional at least. It was impossible to communicate with him and he barely understood instructions or greetings. At mealtimes he would have to be fed, and eventually his mouth held shut so that he did not spit out food. If left to his own devices he would simply make a massive mess through attempting to get the food into his mouth. For him I was so, so sorry. No-one came to visit him, no one ever asked about him, he was completely alone in a world which his damaged mind could no longer understand or make sense of.

Part 3: Riverfield

Sadly, Monday morning did not bring with it any moving toes, or any movement at all. This second stroke was much more severe and my left side was much worse than after the first stroke. That morning I had a (very uncomfortable) camera stuck down my throat so that a picture might be taken of the back of my heart. The picture revealed that I had a congenital malformation of the heart in that the foramen ovale did not close completely at birth. The doctors surmised that this was the reason that I ‘stroked’ (twice). Apparently, many people live with the same ‘defect’ their whole lives with no issues at all, but a small percentage experience problems. Surgery was immediately scheduled for the closure of the hole.

Luckily, these days, to do heart surgery one does not always have to open the chest cavity. My surgery was done almost remotely, via a special scope; through an artery in my groin area. Amazing really, that they could close the hole like that. I spent a lot of time in ICU that week, and a lot of time throwing up on nurses who were trying to feed me. I had a lot of family and friends visit me in ICU, the nurses seemed oblivious to the fact that there were visiting hours, which was nice of them. I guess it didn’t surprise me that I was surrounded by much older people in the ward, all recovering (trying to) from various serious ailments such as heart and/or brain surgery. One man across from me was in a lot of trouble. I’m not sure what all his problems were, but I knew that he had serious trouble urinating. Once while attempting to go in one of those bottles he took so long that he fell asleep while trying. He woke with a start only when he had spilt the contents of the bottle on himself. I felt so, so sorry for him and wondered if he had done bad things in his life to deserve to be where he was.

So now that my (ex) hole in the heart would not cause any more problems, the next task was to get going with some rehab. My mom did her research and found that the best place for me would be Riverfield Lodge near Fourways. I would have to go to a proper rehab centre as I required constant care from doctors and nurses and rehabilitation sessions numerous times a day from various specialists. I was given a private room, which was nice. There are not really wards as in a normal hospital – usually there would be a maximum of three in one room. The food was terrible, there’s no other way of putting it. The staff were not too bad, although the nurses at times did not seem to understand the severity of the paralyses in my left side.

A typical day would start with the nurses busting into my room at 5AM like the Gestapo on the Night of the Long Knives. Thankfully, they did not attempt to kill me, but rather proceeded to switch the lights on, rip my clothes off, stab me in the stomach (the only place this injection could be taken – apparently) with a ‘man-size’ orange syringe (a blood thinner and also the most painful injection I’ve ever had by a long stretch), then scrub me down to within an inch of my life, ask permission to wash my ‘private parts’, wash my private parts, dry me vigorously, and finally they would dress me. This whole process took less that 1 hour so by quarter to six in the morning I was lying in bed bathed, clothed, medicated, and ready for the day. It was astoundingly odd to me that this all HAD to happen before six in the morning, every morning. Eight o’clock was Exercises time for the whole wing (I was put in the ‘spinal injuries’ wing at first). Exercises was very basic stuff, VERY basic. Basic as in lift your foot off the ground and put it down 10 times, or roll your head from side to side. Or raise your arms and put them down 10 times. Everyone did what they could do, according to what their injury or disability allowed them to do.

After exercises it was time for breakfast. Usually there was at least pap (porridge made from maize meal) or some cereal, plus toast, coffee, tea, juice, and usually some other hot dish like mince or a strange ham type thing. It was pretty horrid. Depending on the schedule I would either have speech therapy, physiotherapy, or occupational therapy at various times during the day. In addition, a doctor would sometimes see me. Although I was to see a psychologist everyday, I saw her twice in total (once when I arrived and once when I left). Blood was also drawn daily by the Vampire. She called herself that, and I wasn’t arguing. The fact that the Vampire drew blood from about a 100 people per day did not seem to do anything for her needle-inserting skills and a visit from her usually left me looking like an addict that couldn’t find a vein. Anyone who knows me or has seen me knows that I am a very ‘veiny’ person –there is no shortage of veins to choose from. So there.

I was given an old wheelchair to get around in. I would put the left leg up on the plates, remove the right-hand plate and use my right leg to propel me along. It wasn’t exactly ideal, but better than lying in bed all day.

Phillip Avraam was my physio, and a really good guy with a massive passion for his work. Other patients there told me how when they arrived they could not walk or do much of anything, and how Phillip had helped them to progress to where they didn’t think was possible. So I was hopeful about working with Phillip. We started out very easy, just trying to stand. We then progressed to trying to walk with a staff (a long walking stick).

Eventually I was onto crutches, still not very steady at all though. In between all this we did special exercises to strengthen and ‘reconnect’ my brain to my left side. Eventually I could tense certain muscles in my legs, but others remained motionless no matter what. The best way to describe the feeling of not being able to move your arm or leg despite your brain telling them to is the idea of trying to make a phone call from a phone once its wire has been cut; it’s a feeling of impossibility. Nevertheless, we persisted on and on, not giving up. Eventually I was able to walk around relatively well with just one crutch, albeit not rock-solidly. We did a lot of work on my core to get things stable and assist the weakened left side. Eventually I was walking (limping) by myself, but I was far from steady and would always go slow, nervous of falling over. Being able to move around by myself was great though – at least I could go to the bathroom by myself without needing to ask for help. Once before I was that mobile I had asked for a bottle to pee in and had forgotten about it and spilled it on myself –sound familiar?