At 43, Donal O'Kelly was a fit and apparently healthy barrister who neither drank nor smoked. Then he suffered a stroke without warning. Here is his graphic account.
A few years ago, I was the defending barrister in a burglary case in north London. I was cross- examining a police sergeant about his vigorous arrest of my entirely innocent client. He'd seen my entirely innocent client backing out of someone else's bathroom window and had jumped to the wrong conclusion, as policemen sometimes do. Mid-question, I suddenly felt a slight pain in the back of my neck. I paused for a moment, wondering what was happening. Then the lights went out.
I awoke a few minutes later, horizontal, unable to move and unable to speak. Although I had no idea what was going on, I realised it must be serious, as a paramedic was kneeling beside me, trying to reassure me it wasn't serious. I was stretchered into an ambulance and taken to the nearest hospital, the North Middlesex, a Victorian workhouse of a place that should have been pulled down years ago.
I was carried into casualty still wearing full battle dress - my barrister's wig, gown and the like - but I was incoherent. My words were slurred and just not coming out right. So I was unable to explain the eccentricities of court dress. The accident-and-emergency staff probably assumed I was a drunken actor. Or maybe a brief on a bender. In any event, I was left in a corner to sleep it off. It wasn't until my family turned up and explained I was a teetotal barrister that alternative diagnoses were considered.
Soon I felt that slight pain again and was suddenly unable to breathe. My limbs were seizing up. The medics gave me some oxygen, which eased my situation, but they took it away after a short while. I passed out again and this time was gone for days.
I awoke later in the week in intensive care. I tried to get out of bed but could not. I was paralysed on both sides, although feeling returned to my right side within the first few days. I still could not speak and my vision was blurred. Slowly I realised the doctors who deprived me of oxygen were trying to kill me. Not only that, but they had also murdered most of my family and friends and were planning to finish me off at the earliest opportunity. When I then saw my family and friends, all alive and well, I realised I had got it wrong somehow.
It was not until much later that I read paranoia was a frequent symptom after stroke. At the time, however, I remembered an old saying: "Just because you're paranoid, it doesn't mean they're not out to get you." I determined to be vigilant, just in case. I was very tired and very confused. It was as though my brain had closed down and I couldn't take on the extent of what had happened. Everything was such an effort, but I didn't realise how serious my situation was.
Later, in the third week, getting from the bed to the wheelchair was difficult but adventurous and fun. Never at that stage did I realise I might be a wheelchair user for the rest of my life. Even when the physiotherapist warned my friends I might never walk again, something in my head prevented me from believing it.
My swallowing mechanism had been badly affected and, after I had nearly choked myself to death, I was tubed up to a drip feed. In a particularly painful and disgusting procedure, a length of plastic with a bore no wider than a small rocket launcher was fed up my nose and down into my stomach. Pre-digested peach gunk of supposedly high nutritional value was slowly leaked into my system. In the following days, when well-wishers arrived bearing grapes and flowers, I would grimace, twitch and inevitably sneeze up the tube. I went though eight tube insertions before hay fever was diagnosed and flowers were banned.
Nobody knew why this had happened to me, and I'm still not clear. I was 43 years old, I was fit, not overweight, a vegetarian; I'd given up smoking and drinking six years previously. My blood pressure was normal, and I got plenty of rest and relaxation and played a bit of sport. The consultant neurologist said I was not the textbook candidate for a stroke but an angiogram, an X-ray photograph of my blood vessels, might provide the answer or at least some clues.
The nearest available angiogram machine was at St Bartholomew's Hospital, about eight miles away, in central London, and if I was willing to pay for the procedure it could be done immediately. I was naive enough to believe there was still a free health service in Britain, so I took my turn and waited six weeks before I could be properly diagnosed. It didn't really matter, because, as the neurologist said, I wasn't going anywhere in a hurry.
Time passed slowly. Three weeks into my recovery I wheeled to the gym for physiotherapy. Although you may think early intensive therapy is essential after a stroke, I was assigned just one session a week initially. It wasn't until a close friend got angry enough to demand more attention that my allocation was bumped up to four times a week. At this stage I was still emotionally labile - more often laughing uncontrollably but sometimes weeping inconsolably - and being curtained off because I may have been upsetting other patients.
There wasn't a stroke unit at the hospital. I was on an old-fashioned general medical ward with more than 20 beds. Most of the time we kept our spirits up with a mixture of camaraderie and graveyard humour.
The staff told me I must not try to walk unassisted; a nurse would help me. The ward was always so pressed for staff, however, that there was never any time to supervise me on walkies. One time I had a phone call. The student nurse who answered it unthinkingly called out to me to come and get the phone, and for the first time I walked the length of the ward unaided. None of the staff noticed until the rest of the patients burst into applause as I tottered to the phone.
Although the North Mid was solicitous for my welfare and probably overly protective, when I was transferred to Barts for the angiogram it was a different story. My notes had been lost in transit and staff there were unsure what I had been left to do on my own. The lot, I assured them: bath, shower, toilet, leave it to me. And they did. I was able to exploit my new-found freedom and before long was staggering about like an old drunk, unsteady, unbalanced and incontinent but moving and improving. The angiogram eventually got done - despite my sabotaging it several times by having laughing fits at the critical moments - but I'm still unclear about what caused my stroke back in June 1993.
I was discharged from hospital after two months and re-entered the world with no idea of what to expect.
My voice had completely gone, and as a barrister I felt this more acutely than most. The NHS voice therapist discharged me when I could just about croak and make myself understood. I sought further assistance privately, at University College London, where I worked with a sympathetic voice trainer for a further 12 months, singing and shouting like a lunatic. Although the NHS people were very kind, they didn't feel it was necessary or essential for me to walk or talk as I had before. Their low expectations were oppressive. Their goal was a very limited recovery. If I wanted a full recovery, I could do it in my own time and at my own expense.
And expensive it was. I soon exhausted my savings and had to rely on the charity of the Barristers' Benevolent Association to help me through. Family and friends helped out, but essentially I was on my own.
The advice and assistance I got from the professional carers were helpful but limited. Nobody wanted to discuss sex or sexual dysfunction, for example. My sexual appetite did not return immediately after the stroke, and this caused a few problems.
My partner and I eventually found out about an organisation in the UK that deals with this sort of difficulty, and we were able to get some assistance. For a long while it was a topic I was encouraged to ignore: apparently I should be grateful to be alive and not be fussing about the finer details. I was only able to get help because my partner and I were willing and able to spend the time and money to research what assistance was available.
I got back into office work five months after the stroke, and I was back into court after nine months. I remember being terrified the first time I tried to shuffle down Fleet Street. Everybody was walking so fast and confidently I felt sure I was going to be knocked over. I ended up clinging to a lamp post. It would be another two years before I would feel safe on the streets.
I was still emotionally labile and often prone to inappropriate and excessive laughter. One time I was representing the wife in divorce proceedings. I weigh in at just over six feet. M'learned friend for the husband was six feet eight.
Judge Williams, who was to hear the case, is a very pleasant and gentle man and a very good family lawyer, but sadly he is vertically challenged. He is about five feet tall. As the judge came into court, my extremely large opponent leaned down to me and whispered: "These little things are sent to try us." I could not stop laughing and had to be led away by the usher.
As a lawyer I was finding work more difficult than before. My ability to concentrate seemed to have declined, I was still occasionally tripping over my words and I was running out of steam in the afternoons. I'd also lost confidence, having been out of court for more than nine months. Eventually I found the stress and responsibility too much. I just wasn't enjoying it as I had in the past. I kept going for about 12 months, then, after much soul searching, decided to give up the law and look for something else.
It has not been easy.
My recovery hasn't been without its low points. The problems associated with having a stroke are enormous; the problems a younger stroke patient has are even greater. One moment you're in charge, then suddenly you lose all control, even over bodily functions. "Stroke shatters lives," says the advertising. My life has been shattered. It has been changed, changed utterly. Yet I have been lucky, very lucky.
Donal O'Kelly now works with the British charity Different Strokes.
• A stroke - medical name cerebrovascular accident - is caused by an interruption of the blood supply to part of the brain. The interruption is caused by a blockage of an artery supplying blood to the brain (cerebral thrombosis) or by a bleed into the brain from a burst blood vessel (cerebral haemorrhage).
• Of every 100,000 people in the Republic aged 45 or older, each year 375 have strokes. Younger people generally have a low incidence of stroke. Internationally, the incidence of cerebrovascular accidents remains steady, although death from the disease has been falling for some decades.
• The symptoms of stroke depend on what part of the brain loses its blood supply. In about 80 per cent of patients hemiplegia, or half-paralysis, results. This can cause loss of power in the arm, the leg or the side of the face.
Patients may also lose sensation on one side of their bodies, including losing their sense of where an arm or leg is positioned. They can have difficulty communicating, whether unable to express themselves or unable to understand what is being said to them. They may have difficulty swallowing and controlling their bladders, too.
• Donal O'Kelly gives a most graphic description of what it is like to have a stroke and then be on the sometimes long road to recovery. There is one big difference between treatment here and that available in Britain. The Republic has a dearth of comprehensive stroke units, which reduce death and disability from stroke by 25 per cent.