This is the design that I was working on five weeks ago, and that I was actually carrying with me in my bag when I had the stroke: a wee sweater in shades of natural Shetland, inspired by Aesop’s fable of the Tortoise and the Hare. I’ve been thinking a lot about this project, and about how appropriate it seems in my present situation. You will recall that the hare, (loud, over-confident, thinking it knows best), rushes ahead, tires, naps, and loses the race, whereas the tortoise, (slow, steadfast, assiduous) takes its time and wins. At the moment, I am trying very hard indeed to be the tortoise but unfortunately my personality is such that the hare often prevails.
Regarding my left arm, the hare in me feels that nothing is happening : I still cannot shrug my shoulders, nudge someone, or do the funky chicken. The tortoise keeps trying to remind me that each day the hair plaiting is just a little easier, and that it is brilliant I can knit and write at all, yet from time to time, the hare dominates in its obsession with these pointless and impossible gestures. And the hare often comes into play where walking is concerned. So impatient was I to get up and motor about by any means, that I’ve actually spent several weeks reinforcing some terrible physical habits, despite my physios’ best efforts. The situation is such that I must now expend my energy undoing the pernicious work of the hare through a more careful, focused and tortoise-like approach to mobility.
Last weekend, you may remember, I was walking with a springy toe-up leg brace and no other support. Yet my gait was, apparently, terrible: I accomplished a step by swinging my left leg out sideways from my hip, launching it forward by hoisting my whole trunk, and planting the leg, plank-like, a yard out in front of my right one. I could certainly move (and at surprising speed) but I was neither using or stimulating the correct muscles. I would clearly have ended up with a terrible limp and an award from the ministry of silly walks if I had carried on like that. This week, I went back to moving about slowly, supported by frames and sticks, and the physios have spent hours trying me out with different splints and braces –devices that do not keep my knee stiff as a board, and which encourage me to use the muscles that I can. Annoyingly, at the moment, there are not many of these to call on: the front of the hip and the quad both work a little, and this is good. However, the gigantic muscle inside my left arse cheek is not playing at all; nor is the hamstring, and there is not a single flicker of activity yet below the knee. I spend a lot of time trying to get my brain to “identify” the muscles that operate in various ways through moving the right leg, and to apply the same identification methods when attempting to move the left. The whole process is really difficult, tiring, and, indeed, often painful. But despite this, I enjoy my physio, look forward to it, and, when I’m on my own or with Tom, run through my exercises several times a day. The tortoise knows that it is important to work its hardest at those exercises that are the hardest, even though the hare only wants to perform those that it can already do well.
From the hare’s perspective, I have spent seven days going backwards. Last weekend, I moved independently and at speed: now I move hesitantly, slowly, while leaning on an elbow crutch. I will be honest and say that I am at times very frustrated with the tortoise’s approach: it is, quite simply, much more difficult trying to inch forward with muscles that cannot move, than it is to heave oneself about through the power of those that can. The deft and nimble hare also finds itself annoyed by the heavy hunk of meat that my left leg has now become. Teaching the left hand to move again was a very different matter. One could work hard at part of a gesture before accomplishing the whole, and every day brought the rewards of a visibly increased dexterity. But while a hand makes small and detailed movements, a leg makes giant, crude ones. I seem to spend an awful lot of time breaking down the components of a step, and working on those components in isolation. Yet, despite this focus on detail, in some ways the only way to take a step is to actually take one. And once a step is taken, those component movements seem to get lost in the continuum of motion itself. I hope I’m explaining this clearly: put simply, I find working on gait really hard because I can neither see nor feel whether the muscles are working or not, and because moving my leg also involves lumbering a whole heavy body about, rather than (as with the hand) developing a detailed and relatively independent action.
So I am working steadily like a tortoise and am, for the most part, maintaining the tortoise’s measured attitude to mobility. I take heart from the small improvements that I see, but, in the background, the impatient hare is becoming a little frustrated and frankly bored with what seems to it to be no progress at all. And, I am sorry to report that the know-it-all hare is also becoming bored with other aspects of its institutional recovery.
Now, I am not usually someone who bores easily: I can generally find something diverting in most activities or objects. Like many knitters, for example, I generally think of a long journey not as a hideous stretch of empty time but as a happy opportunity for more knitting. I have also found that, in many non-knitting-related contexts, knitting has nonetheless proved useful in its simple lessons of patience and forbearance. But despite these knitterly, or, perhaps, tortoise-like aspects of my personality, I am now really very bored indeed of medical professionals introducing themselves by asking me where I am, what the month and date is, and the time of day. Happily, folks, I am not confused. I am also exceedingly bored of the puzzles. To explain: two weeks after I had the stroke, I was introduced to the puzzles by a pleasant neuropsychologist who, in his dusty office, assessed my ability to draw a clock and geometric shapes of two and three dimensions. I had to name as many animals as I could in a minute, remember long lists of unconnected objects, count in multiples of seven, and identify the men I had “seen before” from a surreally brylcreemed line-up of 1950s faces. I rather enjoyed my time with this neuropsychologist, and was very happy to receive a clean bill of cognitive and communicative health. Despite this, since moving to my new institution, I spend disproportionate amounts of time puzzling it up to the max. Now, I understand that a key element of the rehabilitation programme is to assess each patient fully to ascertain which parts of the brain have or have not been injured. Believe me, myself and my brain are extremely grateful for the thorough nature of this system. The approach is, however, rather one-size-fits-all and, at its worst, also tends to heighten the sensation of being alienated and patronised that one already feels as a patient in an institution. I fear that my perhaps hare-like and certainly rather snippy academic nature means that I have limited tolerance for the puzzles: their quality, their sheer quantity, and their seemingly endless repetition. It has taken me five days of puzzling to complete the (to me) inane tasks that comprise the Chessington Neurological Assessment Battery — a Kafkaesque series of “tests” that build to the tortuous and pointless activity of constructing an unuseable coat hanger. I am dubious of the efficacy of any system that uses averages based on age range as a test of the patient’s ability, whether or not said test is forty years old and much of its equipment and activities arcane. Surely a more appropriate and accurate test of function would be to assess the patient against their abilities before they had a stroke? But perhaps (unlike, say, making a cup of tea), this is difficult to do with things cognitively associated. In any case, as I spend the precious free parts of my day reading, writing, and following Estonian knitting charts, I feel reasonably confident that my cognitive skills are pretty much at the level they were before all of this happened, and that this would be quite obvious to anyone who might happen to be passing.
All of this is, as I say, symptomatic of a perhaps unpleasantly hare-like attitude to certain aspects of rehabilitation, and I do not want to appear ungrateful. I am, indeed, extremely grateful for the combined professional efforts that are being put into making me well, and more beholden than I can really express to the good old NHS. Comments from Wendy and others about the comparative theraputic situation in the US has reinforced for me just how lucky I am to be where I am. But I wouldn’t be me if I didn’t gripe just a little about having to move more coloured blocks about or being asked to name yet another asparagus spear or pyramid; about the stool chart that is pinned to the bottom of my bed, or the part of my “care plan” that reads “Continent. Goal: to remain at this level.”
In my opinion, some of these hare-like qualities are indispensable in helping one to maintain a sense of control, identity and basic reality in what is a very unreal situation. The impatience characteristic of the hare can also be useful if it can be channeled and transformed into determination. But I think that frustration and boredom are generally pretty useless. In this context, they simply heighten the sense of being disempowered, which is never a good thing. One can really achieve a pleasant, zen-like calmness when one is working like the tortoise. With the slow, steady, and measured approach, one can take one’s time, one step at a time, thinking about stages in the process rather than the impossible hurdle, the bigger end in view. Yet while all of us, I imagine, find the tortoise a much more appealing figure, we may also admire the hare’s unrestrained energy and vim. I know that I do, and I would like to bring just a little of that vim to the long, tortoise-like labours that are still ahead of me. And I certainly have to retain the hare’s propensity to snooze.