Thursday, 30 December 2010

Stroke Diary (17): Signing Off

I hope this will be my last Stroke Diary, since on the 23rd. December I was discharged by my consultant. There are no guarantees. The stroke was without cause and having had one, it's more likely I'll have another. But for now, it's over.
I don't have a firm diagnosis. The consultant wasn't able to commit to Reversible Cerebral Vasoconstriction Syndrome (RCVS) but he did concede that I have a brain that 'tends toward vasoconstriction', which amounts to much the same thing.
I was taken aback by the results of my last CT Scan, which showed the area of brain damage. I thought I'd had a tiny bleed, so was shocked to see a dead, white area in the cerebellum, the size of a fifty pence coin. It's hard to accept that it will never recover; we're used to things healing. I've been left with problems with balance and fine-motor coordination, made worse when I'm tired, so I'm glad I don't work as a bomb disposal expert. The literature suggests I might also expect problems with working memory and processing information. And I thought it was just the new job!
I parted with the consultant on good terms; we shook hands, past tensions forgiven. It was Christmas and I could have some champagne. I could also be insured for overseas travel. There are two things which will never be resolved, so maybe it's enough to leave them behind here: I shouldn't have been left on an acute ward for five days without seeing a specialist and I shouldn't have experienced the confusion and delays that were attributed to the link with Queens Medical Centre. One minor thing still puzzles me, that hospital wards don't think they need to provide a hairdryer. Even if I buy one for both wards, would they offer them to patients? When I asked, it was as if I had requested a hedge trimmer.
Thank you for reading this Stroke Diary and particular thanks to Peter Levine for linking my blog to his: The Stroke Recovery Blog. For a short time I had many more readers in the USA than I could ever have expected due to this generous link. If you have recently had a stroke, or if you are still on the road to recovery, I wish you well.

Saturday, 27 November 2010

The Hunting Party

This is my second novel, written while I was still with Charlie Viney's Agency. It was Charlie's idea that I try writing historical fiction. He suggested the true story of Winifred, the Countess of Nithsdale's rescue of her husband William from the Tower of London, the night before his execution for his part in the failed Jacobite rebellion of 1715. Since it's a true story, it's really fictionalised biography rather than a novel.
I enjoyed the research but historical fiction is not a genre I read, so writing the novel didn't come easily. I remain fond of Winifred and several agents have shown interest. It's currently on the long-list for the UK Authors Opening Pages Competition.
The Hunting Party will be discussed on December 15th. at 8 pm on the on-line book group for completed but yet to be published novels. If you want to read the novel and take part in the discussion visit

Saturday Night

My Saturday nights are a joy. Friday is the one night I go out, still being on adrenalin from the week and Sunday night is shrouded in gloom due to the imminent arrival of Monday morning.
The evening kicks off with Strictly Come Dancing, a glass of wine and if I'm lucky a log fire. I've come back to Strictly after boycotting them for sacking Arlene Phillips. The success of programmes like this depends on honest judging by people who know what they're talking about, which is why I like Craig's comments. I'm annoyed by Anne Widdecombe and her primary-school 'clever' answering back. She'll never be funny, nor should she try to be, having spent years as an unpopular but serious politician. It reminds me of George Galloway on Big Brother. Why do they do it? And another thing...after years of haranguing from Gok, Trinny and Susannah about the importance of a good bra, can the Rt. Hon. AW be the only one not to have got the message? I'm also cross about Pamela Stephenson for claiming to be a 'serious' psychologist. I wonder how her clients feel about her now?
Next comes Merlin, an inoffensive drama with two nice looking young men in the lead roles. It has the same plot every week which goes something like this: the king, Luther, suspects someone of using magic in Camelot where it's been banned. Merlin (doing work experience as the young Arthur's servant) secretly uses magic to sort everything out and peace is restored.
After that it's a quick flick over to the X-Factor to cheer on Mary (bosomy club singer, who'd be better doing a bit of jazz) before Wallender (the Swedish version) on BBC4, although recently it was no-lips Branagh in the English version. I was surprised to recognise some of the police officers from the Swedish version moonlighting as crooks in the English version.
Meanwhile, I have my laptop on my knee, checking e-mails, posting on Facebook and sometimes writing my blog. It's called multi-tasking or 'not paying attention'.

Saturday, 30 October 2010

Stroke Diary 16: Endings and Beginnings

It's never a good idea to start a new job less than three months post-stroke unless it involves shorter hours and a more gentle pace than your old one. But my stroke occurred three weeks after I was offered a more senior post in another local authority and only a few days days after I had resigned. I knew it would be hard but starting my new job on time and in reasonably good health became a personal goal. Besides, I had been told that my cerebellar bleed was Very Minor and really, not worth troubling about overly much.
I've now spent two weeks in my new job and life is achieving some equilibrium. The last week in my former Psychology Service drew deeply on my physical and emotional reserves. Clearing out 21 years of junk against a rapidly diminishing window of time resulted in some long days and the farewells, formal and informal, meant facing up to the consequences of the decision I had made pre-stroke; to leave behind a supportive team, an established role and close friendships. And how would I cope in the leafy suburbs and villages of rural Leicestershire, away from the chaotic but positive energy of a multi-cultural city?
With the inevitable lack of sleep over the weekend, it was a zombie who turned up at County Hall on the 18th. October. No one seemed to notice that it wasn't me and I got through each day with a fixed smile and glassy eyes, experiencing a sense of unreality (I'm only a visitor here) with waves of loss for everything familiar and known. I'd been honest with my new employers that I am, despite appearances, still recuperating from a stroke and this had been sensitively acknowleged in my induction. But a stroke is a stroke, no matter how minor and by the end of the first week my brain was protesting. I had head pains and a numbness in my lips, worrying symptoms that I had ignored in the few days prior to my cerebellar bleed in July. A brain scan had already been organised for the folllowing Tuesday, so there was nothing to do except wait. I've since had the scan and have heard nothing, so I'm assuming everything is okay.
I don't know how other stroke patients feel but for me it's as if I have little control over whether I have another stroke or not. There are no risk factors to manage, such as smoking, drinking or using illegal substances, I have no medication to take and a scan will reveal little unless I've already had another bleed. I try to pay closer attention to my body, particularly the goblin with a hammer that now lives at the base of my skull but since there isn't much I can do, it's best to try and forget about it.
The second week has come to an end and I am already feeling established and purposeful at work. With every loss there are gains. In my new world there isn't a long hours culture and I have been shocked to see the inside of my own home by 5.30 almost every evening. I can already see the strengths of the Psychology Service I have joined. I can feel the return of my motivation to finish my current novel instead of staring at undemanding TV every evening and I'm ready to get my diary out to see my friends.

Wednesday, 6 October 2010

Stroke Diary (15): High heels and the Backwash

I'm coming to the end of my second week of working full time. It was a struggle at first and I made optimistic promises to myself to have a proper break at lunchtime (even to try and catch forty winks). Of course I haven't done any such thing but I've managed not to work late...except for last night. It's going well but I have to remind myself that I'm not doing normal duties. It looks like I will finish almost everything before I leave on October 15th. but I have needed every moment. Things do take me longer. But my biggest achievement was to brave high heels and to risk the backwash at the hairdresser. At last, a fabulous head massage and no wet face and soaking sleeves.
I was told by my stroke consultant that the backwash would be okay, at my long awaited out-patients appointment last week. For those of you with an interest, the backwash is no problem for someone with my type of stroke, so it's worth asking.
The outpatients appointment went better than expected, even though I must have seemed intimidating, sitting with an open notebook, pen poised, frowning at him over the top of my glasses. I was given plenty of time and was able to talk through possible causes. It looks like Reversible Cerebral Vasoconstriction Syndrome is worth pursuing. I'll have another scan and a further outpatients appointment in December. Meanwhile the consultant is going to do some homework, as by his own admission, he knows very little about it.
He seemed aware of my concerns about my treatment. I wondered if he had read the blog but didn't dare ask. We settled on blaming Queens Medical Centre. It's always useful to have a third party to blame, it saves everyone getting defensive. It was typical of QMC that there was still no feedback from the scan taken on 4th. August. In their defence, the consultant felt that had there been anything to report (a need for surgery or some other intervention) we would have heard from them. I don't believe that is a good enough reason for taking two months to respond.
We also talked about my dissatisfaction with my discharge and follow up; that I had been left without information and guidance. I always try to bring solutions rather than problems, so for my next outpatients appointment I'll prepare a list of the sort of information I needed, which might form the basis of a leaflet to give to patients (how annoying is that!). I also pointed out that while the Stroke Association website is excellent, it's very thin on information about bleeds. So I got a lot off my chest and went away feeling that I had been heard, even though I might get nominated for 'Irritating Patient of the Year'.
I am happy with my progress. I still have problems with balance and being in crowded, noisy places. My head still hurts at times (although I learned that the brain itself cannot be the source of the pain) and I process information more slowly. But the 'fuzzy head' feeling has gone and even the persistent and common stroke survivors' problem of tiredness is less of a drag than it was. I have been very lucky.

Thursday, 23 September 2010

Jingle Hell

I saw my first Christmas tree today. It was 24 degrees outside and the customers at the Premier Inn coffee shop were in short-sleeved shirts and cut-offs. Pride of place in the entrance hall was given to a decorated tree, advertising the festive season (only three months to go!).
The charity shops are displaying cards in their windows, the newspapers are full of adverts for Christmas dining and supermarkets are already stocking Christmas biscuits, sweets and snacks, exactly the same as those available in the other aisles but wrapped in red and green with holly, berries and bows. The department stores are helpfully corralling a load of tat into a designated area, marked 'Gifts' where Halloween, Bonfire Night and Christmas vie with each other to empty the customers' wallets.
I am aware of the arguments, which are similar to the 'farmers in Scotland' reasons for not staying on British Summer Time all year. For those of you unfamiliar with this, the debate runs that it would be so dark in Scotland in the morning that the farmers wouldn't be able to feed their animals. So we all have to suffer miserable, dark nights for what feels like most of the year.
The 'Christmas in September' justification says that customers, particularly women, like to plan ahead and have their shopping done, presents wrapped and cards posted by the end of November. Those with families overseas need to get cards and parcels posted even earlier. If customers didn't want to shop early, the Christmas goods wouldn't shift, would they? We all have to 'enjoy' Christmas for three months, so that the super-organised amongst us can feel smug in December.
Well, excuse me but aren't presents available all year? The Post Office runs all year. Food, in ordinary packaging, is available all year. We don't eat the packaging. Trust me, shortbread tastes the same, however it's wrapped. I don't have a simple answer to the cards and wrapping paper dilemma but if it's so important, these could be bought cheaply in the January sales.
Let's reclaim the autumn and fight to hold back the Christmas tide! The way to achieve this is passive resistance. Don't buy anything 'Christmassy' until December. Women, let's join the men and shop on Christmas eve. If the stock doesn't shift the shops will stop displaying it. Be honest, that half-price tin of sweets is always gone by the end of October. And that's the whole point...we then have to buy another.

Sunday, 12 September 2010

Stroke Diary (14): Back to Work

Monday 6th. September:
I once worked alongside a teacher in a small special school for children with learning difficulties. She had recurrent breast cancer but twice had made it back to work. I asked her how she was feeling and she told me that returning to the school had been her target, her goal, the thing that kept her going through the bad times. I couldn't understand this. Her class were exhausting, the school was tatty and the staff didn't seem to be an inspiring bunch. I couldn't imagine anything more desirable than not being at work, being free to choose how to spend each day and not having to face getting up on dark, winter mornings. But then I was a mother of three young children, struggling to balance home and work and not that confident about my success as an educational psychologist. I had no idea how important work can become for the mature woman, once children have left home and competence and confidence in the workplace becomes a mantle of respect and wisdom.
So I was relieved to return to work on an agreed plan of half days and very reduced duties but even then, by lunchtime each day my brain was shouting that it had had enough, it needed to go home and lie down. I didn't achieve a great deal. I managed to clear my e-mails, attend a couple of meetings and give some informal supervision. I couldn't have made any school visits or delivered training, so I am far from fit. My workplace is unique and I am aware that for many stroke patients, a return to work after six weeks would be impossible due to unreasonable demands and pressure from employers. I have been allowed to take my time and through the week I felt myself change from 'sick person' to competent member of a community with a shared purpose. The conversations about how I was feeling dropped away and I was consulted, sometimes apologetically, about real issues. Next week, I'll be more focused and tackle the pile of tasks, already comfortingly tagged with 'to do' post-it notes.
The best thing about this week's recovery is that my head is feeling less thick and fuzzy. Either that or I'm simply getting used to it. I can still get dizzy and my balance isn't good but I think these problems are going to need some kind of programme (Pilates? Tai-Chi?) rather than natural recovery. I had no problem with the three flights of stairs up to my office but after one unsteady moment, I had to be strict with myself about holding onto the bannister (difficult when carrying a mug of coffee AND a piece of cake).
My outpatient's appointment is scheduled for the end of the month. I am supposed to have another CT scan before this but I have had no word. My G.P has been chasing it up and she telephoned to say that the consultant was (roll of drums)...'waiting for QMC'. I wonder if this is code for 'I forgot all about it'.
My next Stroke Diary post will follow this appointment. It marks the start of my quest to find out what happened to me. I am not anticipating any enthusiasm or collaboration in this from the consultant and I am expecting to be told that I have to accept that the stroke was 'just one of those things.' I'm not going to accept this.

Saturday, 4 September 2010

Stroke Diary (13): Almost There

Monday 30th. August:
Are you sure you're ready to go back to work? I'm often asked this question but it's a hard one to answer. How would I know? Some days this week, my last week of sick leave before my planned return to work, I'm almost 'back to normal' on the outside. Inside, I still have a 'thick head', an experience I was frequently promised by my teachers in Scotland but until now I've been lucky enough to avoid.
On Wednesday morning I go to two libraries, searching unsuccessfully for the books I need for the next book group meeting. I visit Costa for a coffee and then a friend calls in for lunch.
On Friday morning I manage the city centre for the first time since the stroke. I park in John Lewis, walk to an appointment in Hotel Street, have a coffee and finish with a small wander in the Highcross shopping centre. And another friend comes for lunch.
I reason that if my mornings can be as busy as this, then I can manage a morning at work. But other days are different. I now seem to have a built-in monitor for 'over-doing it' when tiredness and headache get the better of me. On Saturday, I do almost nothing and it feels like one of the first days after my discharge from hospital. At night I'm still troubled by pains in the back of my head and I'm still munching paracetemol through the day. I do want to go back to work. The longer I'm away the more daunting it seems and I need several weeks to prepare a handover before I leave. I'll let the G.P have the final say next Monday.
I love Autumn. I like the clothes and the weather is often calm and mellow with just a small bite in the early mornings to let you know that winter's on its way. We have a beautiful early autumn week and teacher friends are beside themselves with rage at being back at work after the unfairness of our dark, sodden August. I take walks along the towpath, each time venturing further out past the mellow red brick of the Victorian canal bridges, noticing spiders' webs caught in the low sunshine and the leaves just turning into their ancient tapestry colours. Twice this week I walk with a friend to the Kings Lock Tea Room, only accessible from the towpath and have coffee in the garden that overlooks the water meadows. The wasps are a problem but we let them have some jam and they leave us alone. Somehow, the distant view of the sheds of Fosse Park, an out of town shopping centre and the dominance of the pylons shouldering Leicester's power into the city, makes this unexpected oasis seem even more remote.
In town I revel in the quiet of Leicester's back lanes, bathed in early morning sunshine, the children back at school and their parents still too exhausted to venture out. I'm the only customer in Cafe Mbriki and spend a relaxed forty five minutes with my coffee and a newspaper. Since the stroke, I've been reading a daily newspaper and many magazines and I've become aware of how many articles in the review sections are about the same people or event, with almost the same content. These are always linked to a book or a television programme. Clearly, publicists are doing a good job.
I manage to get a copy of J.G Ballards's Empire of the Sun, which we're reading for book group along with his second novel, The Drowned World. I find that one of the best things about being in a book group is having to read novels outside my circle of preferred authors. I'm only on page 77 but I'm not keen on his style. Because it's his own story, it has the reported feel of a diary with too much detail that would be of interest to a small boy but with an overlay of adult interpretation and awareness. I will persist, however as I'm forming ideas about the impact of war on the next generation, with reference to my own peer group, the much-criticised 'having it all' Baby Boomers.
So far I've made a good recovery due to normal healing processes but now I need to work specifically on my balance. It is much better, but I still have 'whoops' moments when I stand up suddenly or stop in mid-track. Thanks to a friend's generosity, I now have a gym ball to balance on while watching T.V. I'll report on progress.
I haven't managed to make a start back with my own novel and I wonder what that's about? Maybe next week, when I'm at work, motivation will kick back in. It's ridiculous but I feel too busy. My days are taken up with walks and visits, a sleep in the afternoon, some cooking and any old rubbish on T.V. (usually involving reconstruction of some sort: houses, faces, bodies). And this blog! Something will have to go.

Sunday, 29 August 2010

Stroke Diary (12): Not There Yet

Monday 23rd. August: This morning I'm back at the G.P after a bad night. Once again, I'd had pains in the back of my head, presumably from the cerebellum, making it hard to get comfortable. Call me old fashioned but I'm used to being able to rest the back of my head on a pillow. 'Try sleeping face down', my husband helpfully suggested. The consultation with the doctor was pre-arranged to decide whether I was ready to go back to work but given the head pains, I was signed off for another two weeks, with a phased return from September 6th. She asks if I'm depressed. I think not, although I'm not exactly cheerful.
Through the week, I have contact with my boss and do some planning, which makes work seem very close but also possible. I'll be going back to the city service on reduced hours and with a limited workload. The focus of my remaining five weeks will be to tie everything up before I leave around mid-October.
There's good news. My project is going ahead, several wonderful colleagues having stepped in to make sure it happens. I am relieved and deeply grateful but immediately want to interfere with how exactly they're going to deliver. I have a half hour conversation with one of these saints, going over the details. I know I'm not 'letting go' at all.
This week would have been our beach week in Sri Lanka, where we would have met up with our youngest son. This realisation brings feelings of regret and loss but his e-mails describe his stay in a forest monastery, which was no doubt a more improving experience than a hedonistic week on the beach with us. One of the monks he stayed with contacted me a while back asking to be my friend on Facebook.
It's autumn already and I'm not sorry. We have heavy rain overnight and through the day and it fits my mood. It seems more comfortable to be relatively inactive at home and to sleep in the afternoon, when it's pouring with rain outside. But I do see friends, driving myself to Queens Road for lunch in the busy new bistro. Another friend takes me to Palmer's Garden Centre for coffee and we enjoy the 'caravan roof experience' as rain beats down on the conservatory. The coffee at Palmer's was unexpectedly good. The very best thing about this sick leave is how much I've seen of family and friends and the contact I've had from old friends, some neglected for years. I don't think it was a lesson I particularly needed to learn; I already knew it was important and that I was remiss but the demands of my work and the novel writing often made regular contact difficult. Perhaps next summer I'll have a 'stay-cation' and do it all again.
I'm reading The Glass Room by Simon Mawer, short-listed for the Man Booker in 2009. It was recommended by my 82 year old mother. I'm surprised, as there's so much sex in it and I know she doesn't usually like this. We go to Darlington for two days to see my parents, so I get the chance to ask her. She says the sex is well written and feels natural and in context and she's right. It's a terrific book; one of those I can't wait to get back to and the characters pre-occupy me even when I'm not reading. I wonder why it didn't win. The actual winner, Wolf Hall, glowers at me from a shelf, heavy and unread and I've yet to meet anyone who got past the first few chapters (apart from my mother).
The plan is to get back to my own novel next week. I imagine my characters trapped mid-sentence, just where I left them before my stroke. I wonder how I'll feel about them when I wake them up. Will they still be the same people or will they have changed?

Monday, 23 August 2010

Stroke Diary (11): Ongoing Recovery

16th. August: The second week of recovery at home doesn't begin well. I have severe head pains through the night and wonder if I should go to A&E. I end up back at the G.P on Monday morning but there are no neurological signs of a further stroke, so I go home and have a Very Quiet Day. I might have overdone things at the weekend as I'd felt so well on Sunday, the day had felt almost 'normal'. I'd helped with some gardening, we'd had a walk, I even cooked dinner and I hadn't needed a rest. Since recovery isn't going to be linear, it would really help to have some guidance on what is normal and what isn't.
I have to start listening to my brain and when it hurts, I think it means I've done too much or it needs more water. I reduce the number of visits to one a day and allow for a long rest after lunch. I can sleep for a couple of hours in the afternoon and still sleep at night. I've read that tiredness is a common side effect of a stroke.
Despite the poor start, progress is obvious. I do have fewer headaches and by the end of the week I've driven to a shopping centre and have filled up the car with petrol. I notice how hard it is to filter out competing sounds outside and that I can concentrate on only one thing at a time. I find it tiring to listen to too much conversation. Oh no, I've been left with a male brain!
I have the medical for my new job, obviously a bit more serious than it might otherwise have been. But it doesn't amount to much, more of a chat really and I'm out in twenty minutes. It doesn't look as though any 'adjustments' will be needed. I think I'll have to be a bit careful in secondary schools at lesson changeover times (to avoid being trampled underfoot) and plan my days carefully at first so that I'm not rushing from one thing to another but otherwise, six weeks from now I can't imagine I'll have too many problems. I walk to the railway station to get a taxi home and am hit by a wall of weariness.
One of the changes I want to make is to avoid rushing to the supermarket at nine on a Sunday morning, so I explore Ocado and compose my first shopping list, which I manage to save under the imaginative heading 'Morag's list.' It takes me about one and a half hours, longer than the supermarket but now I have a list I should speed up, unless I get distracted by all the recipes and special offers. It's delivered on Saturday night and I'm pleased that they promise to take away all the carrier bags next time. I have shopped by internet before but the excessive use of bags put me off. I discover that I'm no good at estimating metric weights when I receive a huge box of washing powder. Being raised on imperial measures, the difference between 500g and 1000g, for example, isn't something I can easily visualise. For some reason, I seem to have ordered two packs of minted lamb meatballs. Oh well, at least there are no substitutions. I'll get better at it.
I promise myself that when the insurance money arrives for the cancelled holiday, I'll treat myself to a new computer. I only do three things in a day on my computer; e-mails, Facebook and my blog but it can take hours because of internet problems. It's the one area of my life where 'slow' isn't positive.

Sunday, 22 August 2010

Stroke Diary (10): 'and the hardest part... letting go, not taking part', as Coldplay sang on X&Y. To borrow another phrase, this time from the author Margaret Cezair-Thompson, I have to 'small-up' my life. By the time a week has passed since my discharge from hospital, I'm learning to manage this recovery thing. My friends and work colleagues keep me in mind and I have many visits. We go for walks or coffee and they generously bring meals for the freezer, cake or gifts. But I'm learning that I can manage about an hour at most, that outings and visits must be balanced with rest and that if I achieve one task or job in a day, then I'm doing well.
Letting go of work is the hardest thing. I have to accept that a project close to my heart may have to be abandoned because I'm not there to steer it. I can't influence the decision. It's theirs to make and mine to accept. What's clear is that I'm not going to be back to help with it. The headaches persist and finally, I check in with the G.P. She's clear that a return to work, four weeks after the 'event', is being over optimistic.
But I am making progress. By the end of the week, I've abandoned my stick and I think I'm walking almost normally. There are definite periods when the buzzing in my head has lifted. I take a taxi to a pre-arranged appointment with my beauty therapist. Why cancel? The need is desperate. The taxi drops me half an hour early and I'm made tea and taken to the relaxation room, where I recline on a day bed and watch the sparkling lights in the ceiling. I've never had time to use the relaxation room before. But I'm worried how the back of my head feels when I'm flat on the table.
The next day I go to the hairdresser, again for a pre-arranged appointment and after checking on the internet, I don't use the backwash since there is a link between the backwash and stroke. I kneel on the chair and lean forward over the sink. My face and sleeves get soaked and I miss the head massage. Some advice, specific to cerebellar haemorrhage, would help so much. I don't know if I should even be doing these things, particularly as another bleed might leave me seriously impaired.
I speak to the secretary of one of the consultants. She doesn't know if there's anything to report from 'Nottingham'. I say that I feel I've been abandoned without advice and guidance. I can feel my frustration and anger rise and I waste hours mentally drafting a letter of complaint. I have to reign in my outrage as I can feel the harmful stress levels. I've always believed I deal with stress well but that's intellectually. Who knows what's been going on physiologically? I decide to use my feelings to improve my blog, even if no one ever reads it and I'll aim to make the best use of my outpatient's appointment, when it comes. Complaining will only make the medics defensive and I need them 'on-side'.
I investigate the link between vaccinations and stroke on the internet and there doesn't seem to be anything but I'm not convinced as both arms still ache from the jabs I had on the day of the stroke. I also find some potential leads to account for my own stroke; AVM or Arteriovenous Malformation or a condition called Reversible Cerebral Vasoconstriction Syndrome.
When my children were small, I had a tendency towards hypochondria. I couldn't imagine them growing up without me and this made me fearful about my health. I dealt with it using strategies based on cognitive behaviour therapy (CBT) and I may have become too dismissive. I now know there were warning signs I shouldn't have ignored.
In the first week home I gain 3.5 lbs. in weight, which is half a pound a day. A friend points out I've got bigger things to worry about but at this rate, I'll be huge in a matter of weeks. The main problem is a lack of exercise but one thing is certain, I'll have to 'small-up' my portions as well.

Saturday, 21 August 2010

Stroke Diary (9): On the Mend

7th. August: Getting up takes forever. Our solution to my balance problems is to bring one of the garden chairs into the shower. It takes up most of the space but works. I manage to wash and dry my hair (a hairdryer at last!). The garden chair is replaced the next day by a picnic box. We are nothing if not resourceful. Each step of the getting up process seems to require long intervals of staring out of the window. Is this what is meant by loss of motivation? I'll have to work on my 'bustle' if I'm going to get back to work any time soon
I pretend to be Virginia Wolf and 'sort the flowers' which have been rammed somewhat haphazardly into various vases. I salvage what I can and create two displays. Flower arranging was the only badge I got at Brownies although I may, on reflection, have also managed to pass parcel wrapping. Both skills have stood me in good stead and I wonder what other key life skills I might have acquired had I not wasted my energy annoying Brown Owl.
My daughter and partner arrive for the weekend and on Sunday we try 'going out' and visit the Botanic Garden for lunch. I manage a short walk with the support of an elbow and my stick. It's a beautiful day and the garden is busy with visitors looking at the sculptures but I don't take much in because I'm concentrating on managing. My walking is improving but I really want to know when my head will return to normal.
My first task on Monday morning (9th. August) is to look at my e-mails. I delete 30/36, most of them links to Facebook. I must have ticked a box which notifies me by e-mail when a friend has posted on Facebook but I find it annoying. I'll see those messages when I choose to look on Facebook.
My second task is to do some research on cerebellar haemorrhage. I have left hospital with no information on steps to aid recovery, what is normal and how to get help if I need it. The Stroke Association website is helpful but I learn that only 1/10 strokes are haemorrhagic and a small number of those occur in the cerebellum. What I read on other sites isn't encouraging. I get the impression I'm lucky to have survived. Perhaps there's not much information on recovery because not many people need it.
I telephone the secretary of the consultant who discharged me to see if there's any news from QMC. I'm still hanging on to the belief that something of importance might have been discovered on that last scan, the one that went in the post. She doesn't work on Mondays.
A friend comes for lunch and we walk to the shops. I feel vulnerable around traffic because it's hard to focus on too many things at once. If a car is doing anything unexpected, like parking on the pavement just ahead, I have to stop and wait until they've finished. The rest of the time I sleep.

Friday, 20 August 2010

Stroke Diary (8): Caring for the Aged

'Shoot me before I get there' is the often heard plea from those in their robust, active-retired 60's, 70's or 80's. The trouble is we become aged incrementally and once there, decisions about what happens to us will fall to our relatives.
I have had close contact with a few ill, confused, very elderly women while in hospital and wanted to blog about this seperately as I have a lot to say (as ever!).
Firstly, I saw none of the neglect of elderly patients in hospital that has preoccupied the media. Particularly during the five days I spent on an acute ward, I watched and heard the nurses take painstaking care with elderly women who needed to be cleaned up, who had bed sores, who were incontinent and who were unable to feed themselves. My opinion from this limited sample of five days is that the women who were being cared for at home by a series of carers were in a worse state than those from care homes. In both hospitals, the LRI and Leicester General, no woman was ever left unfed or left soiled for any length of time.
I found it difficult to be the sole cognitively aware patient on the ward. I would have liked to have been more helpful but I'd had a stroke and it was hard for me to stop a determined patient from trying to get out of bed and escape, or to retrieve her dropped call button, to answer her repetitive questions or to call the nurse when she needed to go to the toilet. The confused elderly need more human contact than they currently get. I'm not saying it's the job of highly qualified nurses to spend their time watching old people but I'm told there are many people 'out there' who are looking for voluntary work and perhaps this may be a role for volunteers.
The confused, aged patient is rarely able to sleep, is not able to read or watch television because they are agitated. Their agitation stems from anxiety, which leads to repetitive questioning and stereotypical behaviour such as folding, sifting, sorting or hand-rubbing.
I was struck by the similarity with the behaviour of young children with autism and I feel there is much to be shared in terms of strategies. The elderly people I met would have benefitted from visual systems, for example photographs, symbols or objects e.g 'night/day','toilet','bed' to support their understanding. A visual timetable would also help, so that the sequence of the day can be made clear e.g 'first lunch (symbol), then visiting time (symbol'). Choice boards would be a good idea. 'Do you want tea (object/symbol) or coffee (object/symbol)?'
Elderly people need someone to listen to what they mean. Amidst the repetitive questions and comments without any obvious context, something is being communicated. But it needs an adult with time to sit, listen and make a guess. To help with the agitation, these patients need someone to show them pictures, to play simple games or puzzles with them, to help bring them out of their inner preoccupation. Everyone needs to avoid the relentless, forced jocularity which is often the way they are spoken to. There isn't much humour in being 95. The elderly patients didn't get the joke and nor did I.
Incontinent patients, like children who aren't yet toilet trained, need a regular toileting schedule. This wouldn't prevent all accidents but might cut down on the frequent need for cleaning-up that I observed. This would be time consuming but it could easily become just another regular procedure such as taking patients' blood pressure.
I shared some great moments with my aged companions. I enjoyed hearing their feisty answers to the competency tests ('you can stick your tongue out all you like, when's your birthday?') and struggled myself to remember the date of the end of WWII. I enjoyed sharing, at second hand, the devotion of long-term partners and their children, in particular a tiny, aged couple who couldn't bear to be separated by her illness. When he left with their children, she made repeated attempts to get off the ward using her mobile tray for support, so that she could follow him.
Every one had a complex personal story. I heard one old lady tell the staff that she had heard her baby cry after its birth and then she was told he had died. She never saw or held the baby. Being in hospital triggered this memory. Perhaps she had never spoken of it before.
I enjoyed their refusal to comply, to be meek and accepting. I watched one old lady refuse food from a spoon, then finish the meal herself as soon as the nurse was called away.
But I was relieved to get away. I found the constant worry of monitoring my companions too much. They needed more help. I was advised to draw my curtains around me, so that I couldn't see what was happening and I'm sorry to say that in the end, I did.

Thursday, 19 August 2010

Stroke Diary (7): Going Home

My sister, a G.P with two children who are junior doctors, once said 'never fall ill in the first week of August'. This week is junior doctor changeover week across the whole country, where they all move around posts. There's another week later in the year but since I don't know when it is, this isn't much use as a warning. On the 3rd. August, the consultant said I could go home once the Physios had checked my mobility on stairs and walking outside. I brought up the scan I was expecting. He couldn't find any mention of it in the notes so either the junior doctor hadn't written it up, hadn't actioned it or both (see Stroke Diary 6 on the importance of accurate file notes if you're an educational psychologist). We couldn't check with him as he'd already moved on. I don't know what went wrong but a nurse tells me that the scan has now been organised.
The following morning I have another CT Angiogram and on 5th. August I'm told by the consultant that 'Nottingham' (oh no!) have to see a CD of the results. I could go home but it would be better to stay around and find out what they've got to say. On Friday 6th., I eagerly await the ward round. At last, there will be some results. I need to know for myself but I'll also be able to answer some of the questions of friends and family. But when the consultant checks in the file, there's nothing. The (new) junior doctor is asked and I hear her say she sent the CD by post instead of by courier 'because she didn't think it was important.'
People new in post will make mistakes and have to be supported but I hope I'll never hear a new educational psychologist say within earshot of a child, parent or teacher that any part of their concern 'isn't important'. I could get very angry but I know the stress won't do me any good. It is, however, a mistake too far.
During these last four days, I am visited by friends who bring creative gifts, fruit (always in short supply in hospital) and magazines that I'd never have thought of choosing myself and which don't require much concentration. They take me for walks along the corridors with my stick. My gait is wide-legged, like a toddler and my head feels like it's trapped in a wind tunnel. I'm okay as long as I can hold on to the hand rails along every corridor. My husband sensibly visits when no one else is coming and he walks with me outside. My youngest son telephones from India, keen to come home. He had been texting but none of my replies had reached him. Although my husband and his older brother and sister had been keeping him up to date it's important that we talk and he hears for himself that I'm not much different.
The ward has a visit from a petting dog. While he's lovely, a dog is not high on my personal list of ward visitors. A beauty therapist with hot wax, tweezers and skills in stroke-compliant Indian Head Massage would rank a little higher. To signal my intention not to stick around much longer, I start to wear clothes instead of pyjamas, which further confuses my ward companions who think I'm a member of staff.
The Physios finish their assessment and I'm discharged. Driving home, the world seems smaller and more grey. In the house, things lie exactly where I last put them down and in my work bag, I find my mouldy packed lunch box from 22nd. July. But it's wonderful to relax without the company of the confused elderly, to watch television and (very early) to settle into my own, warm bed. My view of the NHS? Everyone works very hard, everyone is kind but lines of communication need some attention.

Wednesday, 18 August 2010

Stroke Diary (6): The Stroke Unit

On Monday 2nd. August I meet another group of professionals, the Occupational Therapists. I'm invited to Breakfast Club, where the patients make tea, toast and wash up. Fortunately, I'm fine at all of this. I'd really like an assessment of my writing and I.T skills but I guess I can sort that out for myself at home. The O.T's and Physios are kind, enthusiastic and fun and it's good to have hot toast and apricot jam instead of cold, chewy toast and marmalade. I am a little uncomfortable being assessed, even though there are lots of jokes and laughter, and I resolve to review policy on observations of children once I'm back at work. I wonder what children who are old enough to be aware that they're being observed feel about it? I remember observing a four year old with autism at his playgroup. I followed him around the activities with a clipboard, recording his attempts at social interaction and his use of language. I turned round to find him following me with a clipboard, carefully making marks on paper and wearing a pair of toy glasses from the dressing up box. Touche!
I meet four different consultants while I'm on the Stroke Unit and each has a slightly different take on my case. I'm warned there may be no answers, that my cerebellar haemorrhage may be 'just one of those things'. That will be difficult to accept. I want an answer. If I don't know why it happened then how can I prevent another?
The ward round has a standard format. The consultants are usually very busy, having rushed from a meeting or an urgent case and are dependent upon a junior doctor to interpret the file notes from any previous consultation. They're also able to refer to a computer on a trolley which shows them the patients' brain scans. I'd love to see my own brain but I don't ask. They seem so busy, I don't want to hold things up. I'm reminded of the importance of a good file note, which should include a very brief summary of any conversation and a few clear action points. I'll go back over this with my current team and hopefully my new team.
I ask again about whether there are any results from 'Nottingham' and the junior doctor is asked to chase this up. Later in the day, I'm told that another CT Angiogram has been organised.
I'm not too well. I have headaches and nausea and I feel ill all day. If I turn my head sharply the world spins like a top. I report this but the consultants don't seem worried. It's like watching the stewards on a flight. If they're still walking up the aisle, serving coffee and chatting during tubulance then nothing can be wrong, can it? If the consultants aren't worried, then I won't be either. Maybe this is 'normal'?
Apart from Breakfast Club and the excitement of the ward round I sleep. I wake and find a friend from work has left me a book. It's by a Jamaican author, Margaret Cezair-Thompson and is her first novel. Once I'm feeling better I'm quickly absorbed by it. In The Pirate's Daughter, she skillfully creates the world of Jamaica in the 1950's to the 1970's, weaving historical events and the lives of real people into an intriguing fictional plot.
My young 'ward-mate' makes a fantastic recovery and is soon ready to go home. I'm delighted for her but envious. I remind myself that she's probably twenty years younger than me. I'm left with three confused, elderly women. The fact that they're all probably forty years older than me makes my stroke seem more abhorrent. Despite the posters on the corridor that say stroke can happen at any age, there isn't much evidence of this on the wards.

Monday, 16 August 2010

Stroke Diary (5) : The Stroke Unit

Friday 30th. July: Ward 8 of the Stroke Unit was a very different place from an acute ward. I arrived late to a quiet, darkened, sleeping environment. I noticed that one of the nurses was a nun, wearing a wimple identical to the headscarf worn by the muslim nurses. Religious women have always covered their heads, I thought.
At breakfast, I hankered for the bran flakes and banana offered at the LRI. The only wholegrain cereal on offer was Weetabix, which required immediate sitting up and alertness to avoid a soggy mess.
The others in the four bedded ward were two elderly women and one young girl, who seemed very ill. On the first morning I met Professor R (no first names here) who gave me practical advice about a phased return to work and when I could expect to drive again. I explained my jobs dilemma and he reassured me that I would be well enough to take up my new post. I tell him about the CT Angiogram, taken two days before and that I'm 'waiting on results' from QMC. He doesn't seem aware of this and says that they have all the facilities to do their own tests and have a direct computer link with QMC. So why did I spend five days in the LRI?
I start Physiotherapy. The Physios all seem to be tall, slim, good looking and shining with health, like an advert for Switzerland or Nike. My walking and balance skills are assessed and I go to the Physiotherapists 'gym' session, which is a circuit of mobility and hand-eye coordination activities. I'm not too bad at the hand-eye stuff but rubbish at the mobility tasks, particularly weaving between cones. I'd certainly be picked out by the police for a breath test if I was spotted walking from my car.
In the afternoon, it's visiting time. Friends and family bring the outside with them and the ward is transformed from it's habitual quiet, somnolent state. I think about how much the cards, flowers, visits, texts and phone calls have mattered to me. I resolve to try to be more caring in future. A nurse comes onto the ward and says my mother has telephoned. I can see she's laughing and I can imagine why.
Then it's the weekend and not much happens medically. The ritual of meals becomes important as the staff who bring around the tea, who take orders for food and who serve the meals seem to have more time to talk. From this, I learn that the focus of everyone on the staff is the move of the entire Stroke Unit to the LRI next week. It seems that long term working relationships are to be disrupted and it has been hard to organise work rotas around the move. This is the only time I see any person, staff or patient, show any emotion.
My eldest son comes for the weekend and makes himself useful at home by running errands and visiting me on Saturday afternoon. One of the few benefits of my situation is to have a 'one to one' with my son and I don't waste it. The next day, I am struck by the incongruity of the partnerships that can arise from hospital visiting as my son, my sister and a work colleague share a conversation around my bed.
Around ward routines and visiting, I sleep or read. My companions are not able to watch television, so ours is thankfully off. I can't imagine watching a whole programme as I did last Sunday. In some respects I'm improving but in the brain department things seem to be worse.

Sunday, 15 August 2010

Stroke Diary (4): Yet More Waiting for QMC

Now it's Wednesday 28th. July. I am left out of the ward round and no one makes eye contact. I'm an embarrassment, a shadow sitting by the window. I start to cry. I am truly miserable but also deeply frustrated. I'm a person who makes things happen. I'm good at 'kicking ass' on behalf of others. I can't believe the inaction, the poor co-ordination, the lack of energy that is the hallmark of my treatment so far. I ask a nurse if anyone is chasing up my scan? I want the telephone number of the person at QMC who is managing my case. 'I'll ring him myself', I threaten between sobs. They're desperately busy with some very sick old women who've arrived in a bad state but my distress brings some action.
A doctor appears, previously met on A&E. He's surprised I remember his name but I point out, a little sharply, that there's nothing wrong with my cognitive functions. He's clearly embarrassed that I'm still on Ward 16 and tells me he'll chase up the scan. He also says that 'nothing magic' will happen at the Stroke Unit but I'll at least get some Pysiotherapy and should get a better night's sleep. I wonder what he's getting at. Is it a warning about the Stroke Unit (don't expect much) or is he trying to make me feel better about the time I've languished on an acute ward.
I tell him about the headache at night and the nausea and he finds me some pillows. These are like gold dust. When I've asked the nurses, I've been told there are none.
I feel hopeful that I might now see some co-ordination but in the afternoon, an ambulance arrives to take me to the Stroke Unit at Leicester General. I should have allowed them to take me but I argued that I couldn't possibly go now, I was waiting for a CT Angiogram. The ambulance driver finds a nurse who explained to me, as if I was indeed cognitively impaired, that I'd had all the tests I needed, I could go. I insisted that a doctor (always pull rank) had told me that the warlords in Nottingham had requested another scan. She checked. It seems there had been a problem with my notes.
By late afternoon, I'd been wheeled back through the corridors and lifts to Radiography. I waited outside the scan room with a couple of teenage girls, the one on the trolley had taken an odd turn when they were out shopping, the other was her friend. We all sit and text. No one speaks. I noticed some pillows tucked onto a shelf and make a note to tell them back on the ward.
There is uncertainty that my canula, the awful plastic device they put into the back of your hand before any operation, will work since it was fitted in A&E several days ago and has been roughly treated by me, in my fumbled attempts to wash and dress. Thankfully, it works. I felt the dye swoosh around my veins and a prickle in my groin and my brain as it reached its target.
Later, the same doctor appears to explain that a CD of the scan has been sent to 'Nottingham' and we could expect the results tomorrow. And tomorrow, I would definitely move to the Stroke Unit.
On Thursday 29th. July, a week after the stroke, I arrive at last on the Stroke Unit after midnight. But I spend the entire day on Ward 16. An orderly teases me, because I read the Times every day. She thinks I'm pretending. I'm now a fixture, an institution.
A doctor finds me and says that 'Nottingham' can't read the CD. It's a software problem. I despair of this link with QMC. It hasn't worked for me and has prevented appropriate action. Looking at the problem from a management perspective, it's obvious that the consultation model has failed because I'm no one's responsiblity. If I was actually a patient at QMC, they would have made decisions quickly because I would have been blocking up one of their beds. In Leicester, the doctors felt no responsibility for me because I wasn't their patient.
I have not been able to organise visitors apart from my husband for a couple of days as I couldn't be sure where I would be, so I spend my time sleeping, reading and staring out the window. People say to me it would 'drive them mad' but when you're very ill, many hours can pass doing very little. Think of when you have had a bad flu and take to your bed with only Radio 4 for company. The day passes in a fog of half-remembered programmes.
That night, a Stroke consultant appears. He's the first I've met and his presence is due to a chance encounter downstairs with another doctor. He assesses me, doing the now familiar neurological tests and takes a brief history. He says he'll move me that night. The nurses say it could be any time, so I go to bed as usual. About 12.30 a.m the ambulance arrives. I'm wrapped in blankets and wheeled through the deserted hospital, past the shuttered WRVS shop and cafe, to the outside. Outside smells so raw. On the drive to the Stroke Unit, the paramedic asks me what I do 'in the real world' and tells me about his child who has seen a county educational psychologist. She's done a good job, he says. I'm pleased to be spoken to like a person rather than a patient and to hear this good report about my new team. I try to adjust my features into 'professional mode' but actually I'm exhausted.

Stroke Diary (3): Still Waiting for QMC

There is no news from Queens Medical Centre. Yesterday was Sunday, the doctors re-assure me on their ward round. Everyone will be back at work today, so we should hear something. What is the social etiquette of a ward round or nurse changeover? Should you, as patient, make eye contact, smile and nod as you are discussed? Or even chip in? Or is it more polite to stare out of the window, pretending not to hear, until you are spoken to?
Now I'm no longer on a drip, I manage a shower. It requires military planning and feels chaotic and painstakingly slow. When I drop something, the world spins when I bend to pick it up. But it's also blissful to sit down under a stream of warm water, to feel my skin prickle and relax, to smell my own, chosen bathroom lotions. It feels like an achievement. I also start going to the toilet independently, planning my route down the ward, staking out the hand holds before I set off. I crave fruit and think about mango and avocado salad with prawns. I wonder what Jamie Oliver would do with hospital food. Is there really a need for a three-course hot meal twice a day? Does anyone still eat like that?
I sit in my chair by the window, staring at the Connect Four tower that I can see from my office but from the other side. I ring work and tell them what's happened, I speak to my secretary and cancel appointments. It doesn't seem real. My mobile phone is heavy with texts. It's a struggle to answer them all. I sleep and sleep. At the end of the day, there is no word from QMC. The other patients come and go, the very elderly returned to their half-lives, the suicides restored to the life they don't want, the chronic alcoholics wasting the lives they have, the mentally unstable unwittingly destroying the lives of those who care for them.
I'm visited by Hospital Radio. I choose Ruby Tuesday by Melanie for the request show that night. Listening to Hospital Radio is free and I hear my request, 'for Morag, on Ward 16'. My TV money has run out and I'm reluctant to buy more because I'm moving on aren't I?
On Tuesday morning I hear from QMC. The doctors tell me there's nothing urgent to be done (which I guess means it's not an aneurism) but they want another scan done, this time a CT Angiogram. I can't move to the Stroke Unit until the scan has been taken. I have to wait. This is actually nonsense. I could have moved to the Stroke Unit and the scan could have been done there but I don't know this yet.
Another big step forward today; I manage to wash my hair. It's hard to believe but there's no hairdryer on the ward. I'm not allowed to use my own (brought with all my possessions in the suitcase) because patients 'musn't use their own electrical equipment'. I understand this, I know about PAT testing, but it's hard to understand that no one has thought that women patients will need a hairdryer. Here's a tip, if you're having a stroke, go to the hairdressers the day before (and get your legs waxed- those hairy legs matter to you, if not to anyone else). The matron at boarding school talked a lot of sense when she explained that clean pants were necessary every day because if we were run over by a bus, she wouldn't be shamed at the hospital.
Another patient was told off for charging her mobile phone so after dark, when the night shift starts, I secretly charge mine, hiding the charger behind the curtains. I also start to sabotage the persistent fans. Such minor rule-breaking brings a certain satisfaction.
In the event, my hair dried like a bush but the friends that visited in the afternoon were too polite to comment. They brought fruit and magazines and I let them see me walk. We talked about the nurses. Revenge is sweet.
I telephoned my potential new employer and relayed what I'd been told; the bleed is small, it might never happen again, I should make a full recovery. Since I haven't yet seen a specialist, this is only somebody's guesswork but I don't know enough to question. It's what I want to hear. She is kind, re-assuring and we agree to speak again.
By 'lights out' (optimistic since whenever a new patient appears they go back on again) I still haven't had my CT scan. That night I start to feel nauseous and the headache starts. I worry that the bleed has started again.

Stroke Diary (2): Waiting for QMC

Ward 16 was an acute ward, not somewhere patients were expected to linger. Day and night, patients arrived, were assessed and were moved on, which meant that the traffic was continuous and sleep was impossible but the interest level for an observer like me was high. Sick people arrived with their distraught families and I could listen in to what had happened and the talk of the nurses and doctors. Curtains provide only an illusion of privacy. I had no idea how sick I was. In fact, my condition was poor. I'd managed a wash by the bed but I needed help to get to the toilet. If I tried to walk alone, I swayed like a drunk and was at risk of toppling over. My head felt tight and heavy, like I'd suffered the worst flu. But I texted friends, pleased I could still do so, I slept a great deal and when awake, I eavesdropped. It was shocking but funny to hear confused, elderly Asian ladies, who otherwise needed an interpreter, telling the nurses to 'fuck off'. I also overheard a spectacular row between a teenage girl and her mother. The girl had rung one family member in the morning, to let them know she was being discharged. The message had got confused and poor mum arrived late in the afternoon, without a car, carrying a bag of things her daughter might need overnight. The air was blue.
My stay had started energetically, with an MRI scan first thing on Sunday morning 25th. July. I was impressed, recalling Gerry Robinson's television series on the NHS and how critical he had been that facilities stood idle in the evenings and at weekends. The porter was a young man who told me how he had to be busy, how he hated standing around waiting for patients. He helped me complete a questionnaire outside the scan room and I noticed that his reading skills weren't that great. On the way back to the ward, he and another porter complained above me and around me about their working conditions. I wanted to say to the lad that maybe he was lucky to have a job. He should hold onto it, see where it might lead.
Being wheeled around the hospital made me think of the many times I had energetically patrolled these corridors and drummed my toes impatiently outside the lifts, when I was the educational psychologist for the hospital school. I was glad it was the holidays. I wouldn't bump into any teachers. I didn't want to explain; not yet.
The MRI scan was less frightening than I'd expected. I was very aware of the radiographer's breath, perhaps because my sense of smell had been affected but once inside the tunnel, I found that there was a re-assuring periscope arrangement where I could see him (but not smell him). I had headphones, which played music and an alarm button if I panicked. It was noisy, exactly like a washing machine and the music didn't mask the sound but I found it helped to try and match the length of the tracks to the noise. So if the radiographer said 'here's another scan. It's very noisy and will last for four and a half minutes', I thought of it as one and a half tracks. When I came out, I suggested to the radiographer that he try to pair the length of the tracks to the scans but I don't think he got it.
Back on the ward I'd been joined by a woman I vaguely recognised. I thought she might have been on some training I'd given a few weeks before. Her husband sat with her for a while then left. The rest of the patients were elderly women or very sick Asian ladies, who all seemed to have sons who might have been models. The absence of affection struck me. No one kissed or hugged their women when they left.
It was the end of Nil By Mouth and I over-optimistically ordered lunch which I couldn't eat. But a cup of tea was wonderful. At visiting time my daughter and husband arrived and our talk was cheerful, as it so often is in hospital. I explained that I was on my way either to Queens Medical Centre (QMC) or the Stroke Unit at Leicester General. I wouldn't be on Ward 16 long. We were just 'waiting' on word from QMC.
My daughter had rushed from her home in north London as soon as she'd heard and I think it was a relief to her to see that I looked the same and could talk normally. My husband had had the task of telephoning family and friends and amidst the widespread shock, everyone wanted answers, 'how could this happen?' I had my own worries. I was between two jobs. I had resigned from one and had not yet signed a contract for the other. I was expected to deliver three days of training in early September. I had left so much work undone, including a half finished chapter of my novel. The holiday would have to be cancelled; we wouldn't be able to see our youngest son in Sri Lanka. The ordinary turn of life had been interrupted. I'd been brought to a full stop.
Later that night my husband brought the entire contents of the shower and my dressing table in a suitcase in the hope that 'some of it would do'. The senior nurse on duty sat with me for a while and told me about his family, his working hours, his staffing problems. I switched on my professional 'listening face'. I worked out how to put money into my personal T.V and watched the first episode of the new Sherlock Holmes. Later, that would seem like a heroic level of concentration. My brain was still swelling.
Meanwhile, the fans roared and open windows spilled cold night air across me as I shivered in my hard, pillowless bed. The other patients came and went. The friendly lady opposite disappeared in the middle of the night and I woke to a whole new set of companions.

Saturday, 14 August 2010

Stroke Diary (1)

On Thursday 22nd. July I had a stroke. In the morning I'd had some vaccinations for our holiday in Sri Lanka on August 12th. but otherwise it was a normal day. Although it was the school holidays, I had seen a small child at home, as a statutory report was required. The visit had been stressful as the child ran around the room,snatched my glasses, threw things. The parents had seemed reluctant to intervene, perhaps intimidated by having a professional in their home. The father sat on the floor watching me and I was aware that every time I leaned forward, either to pick up something the child had thrown or to arrange some toys on the coffee table, he was getting an eyeful of cleavage. As it was a muslim household, I felt concerned that there might be a complaint about my dress. I also managed to fit in a visit to my hairdresser at lunchtime, to have my fringe trimmed. So it was busy, but not unusually so. By early evening I felt tired and a litle unwell but thought it was a reaction to the vaccinations.
At around 7 pm, I had a severe headache. It was sudden and felt like a vice. With hindsight, I think I felt a hot rush at the base of my skull. The headache was not unusual, I'd had a few as severe in the past. I waited for it to settle and then I started to feel sick. I tried to get to the bathroom but couldn't make my legs work properly. The world spun and I couldn't stay upright. I was sick for 12 hours, unable to move from the bed. In the morning, we rang the G.P and over the telephone, I was precribed some anti-sickness medication. At this point, the vaccinations were still in the frame.
By Saturday morning, although the sickness had stopped, I was no better and we called the out of hours doctor. We were told we were number 25 on the list for a home visit. They rang back and asked to speak to me and I gave a detailed account of what had happened. An appointment was made for me at the Urgent Cases Centre (a G.P. practice) at the Leicester Royal Infirmary. I was reluctant to go as I had to get up, shower and dress but I managed this and was driven in the back of the car to the hospital. I needed a wheelchair to get to the Urgent Cases Centre and found the wait to be seen intolerable. A television on the wall droned with the sound of motor racing and the hot waiting room seemed full of well, lively people. But the doctor was thorough. He took a full history and did some neurological tests. He looked at me and said, 'forget the vaccinations, I think you've had a stroke.'
After that it was A&E, where a CT scan confirmed his diagnosis. I remember the doctor breaking the news. I'd had a bleed in the brain, in the cerebellum. I'd like to say that I was aware of the implications but I think I must have been too ill to care. It seemed more important, right then, to find somewhere warm and sleep. Left alone, we talked about the other patients; middle-aged women who'd had a 'funny turn', the breaks and fractures and those comatose from alcohol.Within a couple of hours I was on a holding ward, freezing cold, asking for blankets. Although the weather had been hot, it was evening and all the windows were open and the air conditioning roared above me. My husband went home to get my night things and my companions were an Asian lady, her husband and a tall, handsome son who spent his time texting. Late at night, clutching my blankets, I was transferred to a wheelchair and moved to Ward 16, my home for the next 5 days. My journey through the quiet hospital, was accompanied by the relentless banter between the nurse and the porter that both excluded me, yet required me to be an amused audience. This model of interaction was the standard fare of life on the wards.
On Ward 16, quickly taking in the open windows, the fans whirring, the patients lying under a single sheet, I clung onto my blankets. My boarding school training clicked in; hoard, hoard, hoard. For the first time I heard the magic letters 'QMC'. They want you to lie flat, a nurse told me, snatching away my pillow. No one explained and I didn't ask but QMC (Queens Medical Centre) were clearly in charge. I am Nil By Mouth. I don't care. I would never eat again.

Sunday, 27 June 2010

Just Desert(ed)

The hottest Sunday afternoon of the year so far and roads are deserted. I turn into the supermarket car park and draw up right outside the entrance. The cool of the air conditioning slices through me. I snatch the few things I need from the empty aisles and pass through the checkout in minutes. As I leave I notice the petrol forecourt, usually deep with queuing cars, has space at every pump.
I cross over to Fosse Park, our 'out of town' shopping centre, named in respect for the Roman legions who once tramped the Fosse Way. Normally, at half past three on a Sunday afternoon, the shopping centre resounds with the tramp of shoppers and the clash of tills. Today, only two elderly people wait in line for coffee at M&S. In the food hall, I am directed to a till where the cashier yawns with boredom.
I am interested in the World Cup. Honestly, I am. I'm desperate for England to stay in the tournament, so that I can experience more Sunday afternoons like this.Right now it's 2:1 to Germany, so come on England, help me out here! If you don't go through, I won't have another afternoon like this until the Wimbledon men's final.

Saturday, 29 May 2010

Birmingham Book Festival: The Spring Thing

The day started out quite well; the normally crowded two-carriage train from the Fens to Birmingham was waiting at Leicester station and there were plenty of seats. Things took a wrong turn when the first taxi driver at New Street station denied all knowledge of the Birmingham Conservatoire and asked me to leave the cab. The second driver was more patient, asking another driver for directions and gently explaining to me when we arrived at the Conservatoire that I hadn't needed a taxi at all as we were just at the top end of New Street. But it was cold and pouring with rain and had I walked, I would have been soaked through which would not have done at all as the Adrian Boult Hall was freezing. It puzzles me that the event organisers did not give more thought to the well-being of the audience, or delegates, or whatever we were. The tickets were expensive, yet the toilets were blocked, there was no lunch and the queues for coffee were long. Worst of all, two of the 'headline' acts had cancelled. A nightmare for the organisers, certainly and they had done well to find replacements but I would have liked to have known, so that I could have made a choice whether it was worth going at all. For me, a wasted day is worse than a wasted ticket, especially as trains, taxis, lunch add extra cost.
During the first session, I became sure about my ability (or lack of) to process aural information. This was a persistent problem for me at school but I have only recently become aware of the problem again at Writers' Club where members read their scripts aloud. I can only process what I'm hearing if I visualize the words and then 'read' them in my mind, which is hard work. Consequently I stop listening. As a psychologist, I pose three hypotheses for this problem: a slight miswiring in the brain, a lack of experience of being read to as a child and a difficulty controlling my own thoughts, which tend to crowd in if my eyes aren't occupied. I suspect there is a problem in all three areas but the latter is the worst offender. During aural processing I start to 'ruminate', which can be more colloquially described as 'wool gathering.' Gradually, my mood darkened, so that by the time we broke for lunch it was close to its' 'Black Death' phase. I had tried to listen to some pleasant readings from some no-doubt well written books but I realised that there is absolutely nothing new to say about the process of writing. With minor variations, it's a fairly samey process for everyone. What also deeply irritates is hearing about the trials and tribulations of authors who have all day to write. What can possibly be useful or worthwhile about having to listen once more to the 'tyranny' of getting up in the morning to face the keyboard, the excitement of the postman, the staring out of the window, the guilt over not starting to write until three o'clock in the afternoon. I say to them, 'get over it'! Many of us fight to squeeze writing into corners of our lives but still think of ourselves as writers. P.D James worked full time as a civil servant until she retired.
I went for lunch in a dark, brutal shopping mall cynically called 'Paradise Forum.' I haven't tried Nando's before but their mushroom and halloumi cheese wrap was delicious; warm and spicy and mood enhancing. Outside the mall, the rain had stopped and I knew where I was. To my left, the Birmingham Central Library and facing me the art gallery. I was feeling better; still grey but reflective. I was a student in Birmingham in 1975 and the Central Library had been my safe haven in a city that was reeling from the New Street bombings. At the time, I hadn't noticed that the architecture of the library was so grim, even though I was in deep culture shock from having left behind the ancient streets and crashing, north sea beaches of St. Andrews to learn how to teach in Birmingham schools, where our tutors told us there was nothing they could say about behaviour management, it was 'sink or swim'. I sank.
I did go back after lunch to hear Stuart Maconie, as his radio show with Mark Radcliffe is my companion when I'm working in the evenings. He was a good raconteur, full of stories and humour and not much about the writing process, except the advice to be on your own, watch, listen and make notes.
After that I left, taking my visual processing skills first to a cafe, where the people interacting around me were ten times more interesting than anything I had heard during the day and then across to the art gallery 'disguising misery as aesthetic appreciation' (Salley Vickers: Dancing Backwards). I'm ashamed to say that I didn't stay for Carol Ann Duffy but with my new understanding, what was the point? I own a book of her poetry I can read whenever I like. Besides, I couldn't wait to get home to my warm house, my flushing toilet and my own novel.

Monday, 17 May 2010

Night Train

Here's the autobiographical piece I read at Short Fuse this month:

Night Train

Somehow I’d only made the connection between paedophiles and girls. This was 1969 and I was fifteen. With my younger brother, I’d taken the overnight sleeper from Glasgow to Kings Cross many times before. Our compact cabin was like a doll’s house, everything miniaturised and tucked away. We lay awake and heard the stations announced to empty, echoing platforms as we rocked and jolted through the night: Edinburgh, Newcastle, Crewe. In the grey light of early morning, tea and digestive biscuits were brought to our cabin by a steward in a white jacket. We would roll up the blinds and watch the countryside emerge from the mist.
It was just before Christmas and the taxi ranks in Glasgow had queues that were long and slow. We needed to cross to the other side of the city to catch our train and as time crept by I was afraid we would miss it. It was dark and late. In a crowded, busy station, we were alone.
I asked my eleven year old brother to stand at one taxi rank, while I stood in the other line on the opposite side of the concourse. It was risky but he was always visible, even if we couldn’t communicate except by hand signal. Separately, we stood twice the chance of getting a taxi I explained, sending him off alone.
After about twenty minutes, when my line seemed to have grown no shorter, he waved to me, beckoning, a man at his side.
‘He’s got us a taxi,’ my brother called out as I staggered across, dragging our heavy suitcases.
I thanked the man, grateful for the kindness of a stranger. But glancing out of the rear window as our cab pulled out of the station, I saw him climb into the next taxi. I felt immediately afraid. He might be following us.
At Glasgow Central, his cab pulled up behind ours and although I tried to walk fast, he caught up. He appeared normal, even kind and fatherly but I didn’t want any more help. He ignored my protests and picked up our suitcases, carrying them to the ticket barrier. At last, I thought, he can’t come any further. But the ticket inspector made the natural assumption that the man was our father and waved him through. Would children today have protested? I hope so. I hope they would have shouted, ‘he’s not with us, he’s not our father!’ In the fifties and sixties, children like us were brought up to be compliant, not to question adults or make a fuss. Children like us would certainly have died of politeness, given the chance.
He can only come with us to the train door, I thought, trying to push down my panic as he carried our cases down the platform, my brother chattering comfortably at his side. The steward won’t let him on without a ticket. He did. The man, this intruder, insisted on carrying our cases onto the train and into the compartment. By now I was very anxious and certain that he wasn’t safe. I realised he was one of the ‘strangers’ I had been warned about for years but even then, I thought I must be the likely focus of his interest.
He sat down on the bed next to my brother and looked at his watch. ‘I bet you two are hungry,’ he said cheerfully. ‘There’s plenty of time before the train leaves. Why don’t I take your brother away with me to get some fish and chips?’ He leaned across and touched my brother’s cheek.
My brother looked at me, keen for my approval. At that moment I understood. If I let him go I would never see him again. In a split second I became an adult. Anger swelled in my chest. He had no right to harm us. I pressed the bell for the steward, praying he would come quickly. If we were left alone for any longer, I might not be able to stop him taking my brother by force. He could kill us both, to stop me telling.
The steward came at once, filling the doorway with authority and re-assurance. I can’t recall the words I used but I know I told him that the man was a stranger and that I wanted him to leave us alone. He was escorted from the train, leaving without remorse or explanation and waved goodbye to us as he passed our window.
I did tell my parents but they took no action. Perhaps I downplayed the story to protect my brother as he had no understanding of how vulnerable we had been. Or perhaps I felt responsible for putting him at risk and was afraid of criticism. When I think about that night, I know I almost let him go.
Now, I wish our story had been reported as the man might well have been caught. He will almost certainly have tried again and may have been successful. I know I saved my brother’s life and possibly my own but for a moment, our future had hung precariously in my hands. I made the right choice. That I might have got it wrong is the stuff of sleepless nights.

Sunday, 25 April 2010

A Little Nerd Music

Yesterday, I went alone to see 'I am Love' at our new Phoenix Square digital media centre (or cinema). I thought it was incredible; the filming was fabulous and caught the oppressive, formality of a wealthy Italian family with great authenticity. Much of the first fifteen minutes or so focused on the house, as if the family were just bit players. The stilted mausoleum of the palazzio was contrasted with the sensual fecundity of the garden/farm in the mountains, where the affair happens.
Afterwards the place was buzzing, so I decided to stick around for a bowl of pasta and a glass of wine. The next film started at eight, so I was soon left alone, the sole customer. Around me, a band were setting up for a gig. I thought I'd stay a bit longer and maybe hear some of the music and the musicians themselves seemed worth a bit of scrutiny. There was a tall one with a ponytail. So far so good. But what was this? A boy of about seventeen assembled a drumkit and then two guys who could have been Ph.D students studying physics, set up three AppleMac laptops. It was like Kraftwerk but scruffier: check shirts over t-shirts that had seen better days and chins struggling to establish a healthy beard. I wasn't going to stay and listen to laptops. I paid my bill and left.

Sunday, 21 March 2010

Incredible Acts of Kindness

The woman stops and rolls down her car window. Oh no, what now, I think.
'Do you want my car park ticket? It's got a couple of hours left.' I accept, graciously. This is the second time this has happened to me. The first time was in a dark multi-storey, with heavy, low ceilings. I was alone. A man ran towards me, his hand raised. I froze. 'Take my ticket,' he panted, 'I've paid for too many hours.'
I have experienced many of these small, inexplicable acts of kindness, particularly from women when my children were small. The passenger on the train who fetched drinks for us when I couldn't leave three children alone and go to the buffet, the strangers who helped me on and off buses, the people who returned dropped toys and the woman who found and looked after a child I had lost at the American Adventure Theme Park. The most amazing example I witnessed was on a bus in Manchester and it followed a completely explicable act of cruelty. I wrote a poem about this for the recent Big Issue poetry competition. Needless to say it didn't win but here it is anyway:

Manchester Heroine

I am impatient,
with a driver who speaks no English,
with a man who eats a burger,
with the boy whose ipod whistles.
I am impatient when the bus halts,
too long.

A man tries to buy a ticket from
our driver, who speaks no English.
We wait, stilled,
hit by invective, then silence.
The driver cannot move.
He is diminished.

A woman stands, walks to the front,
touches his arm, soothes with words.
He was drunk.
It's not your fault.
Take your time.
We can wait.

She apologises for Manchester,
for us, the passengers on this bus,
the number 43 for West Didsbury
and Northenden. We smile, proud.
No longer impatient.
Not now.

I wish I'd had the courage to be that woman.

Saturday, 13 March 2010

Stupid Boy

There was a mum, a dad and two little children, one a baby in a highchair, the other a little boy about three years old. I'd already exchanged a smile with the mum as she spooned goo into the baby's mouth. I didn't see her leave the table but she must have taken the baby to change its nappy. Something about the dad's tone made me glance across. 'You stupid, stupid little boy' he hissed. The child had spilt his father's coffee. The dad noticed me watching but continued his lecture, lowering his voice. The child's face crumpled and he cried, head in hands. When mum came back, the child didn't lift his head from the table.
Come on mum, I urged her silently, please repair this. Instead she listened to dad's complaints about the child and ignored the boy. The waitress heard the story too, dad sneaking a look at me to guage my reaction.
Roll the tape on twenty years. Dad will despair of his son. 'He's a great lad but no ambition. Doesn't have a clue what he wants to do with his life.' Well, that's because he's stupid, Stupid.

Sunday, 7 March 2010

The Hammam

The Marketing Department at Rituals may well have made a mistake, linking their latest product line to the Hammam, a Turkish bath. I went to a Hammam in Wadi Musa, Jordan, at Christmas and the experience was as far from our 'pampering' spa days as an hour on a rugby field is to an aerobics class.
I chose the women-only Hammam, not because I'm a prude but I thought that if there was going to be embarrassment or worse, humiliation, in the bare-naked department I would rather deal with it in front of my own gender. The staff were plump women in black swimsuits who ordered us about with single-word commands normally reserved for dogs. I sat where I was told, on a hard bench in a room full of steam; 'sit!', 'wait!'. The other punters were vague, pink shapes in the mist and as I peered at their vapourous gestures, I understood that I should first try the sauna, once there was a space, then sluice myself with what I hoped was warm water. I hadn't managed to get to the water bit when somebody grabbed my arm and I was taken to another room where bodies on slabs, not unlike gravestones, were being vigorously scrubbed by the attendants. One beckoned cheerfully and pointed to a vacant slab.
'Lie down!' I climbed on with difficulty and lay on my back, the hard stone pressing into the back of my skull. The attendant scoured my face with a rough cloth, soaked in something that smelt of Vim. Stupidly, I had kept my make-up on. I hadn't been washed like this since I was a child and my mother was fed-up. I had forgotten how it felt, that particularly ferocious scrub unique to mothers who are at the end of their tether. After my face, all my other parts followed. 'Turn over!' Do you remember when you last had your bum washed by someone else?
'Get down!' I heaved myself off the slab. Another hand led me through the steam and I stood gasping as I was doused in cold water. More hands. 'Come!' Another room, another slab. Now the oils. No! Not through my hair! Too late. The oils smelt like fly spray. I was pummelled, squeezed and pinched, as if by bullying hands in a school playground. My legs and arms were pulled into positions they hadn't seen since I was six months old and could suck my own toes.
'Finished!' I was pulled off the table and wrapped in a towel. Pushed through a door I stood, blinking, in front of a quiet group of women sipping herbal tea. 'This way!' Back in the changing room, I sat blinking on a wooden bench. I couldn't get dry. The oil clung to my skin and hair and no matter how hard I towelled my skin, it stayed wet. My clothes had to be peeled back on. There was a hairdryer but my hair was so tangled, my brush shed bristles in despair. Looking like Worzel Gummage, I slid onto a bench amongst the other women to drink my tea. They murmured softly to each other in German, calm and relaxed. One of them turned to me and smiled, her eyes scanning my disarray. 'First time?'

Wednesday, 3 March 2010

My working life (2)

Right now I'm troubled by a six year old who is about to be permanently excluded (expelled) from school. He was excluded from another school when he was four. What is an educational psychologist to do? Running off isn't allowed. I have to try and hold everyone's distress; the school who are coping with staff and children being hurt on a daily basis and the parents who cannot bear the rejection of their little boy. It's really too late. There is a sense of failure and defeat all round. I am the still voice at the centre; I listen, I advise but there is little I can do to prevent this. The school have had much advice from teacher support services, the child has generous support from the local authority and I try to help the school and the parents but the answer lies in getting rid of this child's 'ghosts' from the nursery. Here is a ferocious, angry little boy who has to control everything and everyone around him through verbal and physical aggression. He cannot allow himself to be a child; being little and vulnerable is a terrifying place to be. When he's angry with his mother, his voice becomes hard and cold, he calls her by her first name and says she's 'stupid'. He moves like a tornado and his reach is like quicksilver. I have asked for help from Child and Adolescent Mental Health Services (CAMHS) but there is a long waiting list. The parents and child need lengthy, quiet, calm work on their relationship. While this happens, the child needs education in a small, nurturing class where he can safely practice the art of childhood. And pigs might fly.

Monday, 22 February 2010

Book Group

It's that time again, the night before book group. Normally I'm in the shameful position of not having finished the book but due to a bout of winter vomiting virus yesterday and taking a recuperative day off work today, I have actually read the whole of Stieg Larsson's The Girl with the Dragon Tattoo. I was absorbed by it once I got over the clumsy writing and sloppy editing, which just underscores the power of a great plot. Did I mention the information dumping? I don't think I'll read another.
I've found ways around not having finished the book. I read the first and last chapters and a few in the middle, then print a couple of reviews off the internet. Usually, I can blag my way through the evening, since our group can be distracted by the wine, the food and other pressing matters and we have to remind ourselves that there is a book to discuss. I'm usually reading something else and find it hard to tear myself away to read the book group choice. Why make the effort? Without the group, there's so much fiction I wouldn't have tried because it's outside my comfort zone. Even if I don't finish a book in time for the meeting, I almost always finish it later. And we laugh.

Wednesday, 17 February 2010

My Working Life (1)

I don't write much about my working life but since work is where I spend most of my time, that's about to change. It's half term this week, so the schools are closed but it's still busy. This afternoon I visited a family to discuss my statutory advice or 'Appendix D' which is a detailed report educational psychologists write on children who are undergoing a legal multi-professional assessment of special educational needs.
In the small living room there were five children, the autistic child I was assessing, two little girls under three and two boys, one about three and the other about eight. The television was on and a neighbour was visiting. We spent about an hour and a half going through my report in detail, with everyone chipping in. This is normal, except that quite often there can be dogs as well.
We got the work done and I had a cup of coffee before I left. Life is great!

Sunday, 14 February 2010

Writing on a shoestring

Is it possible to write a novel without any time? I can confirm that it is absolutely possible but a publishable novel? I'll let you know. Firstly, lets dispense with the myths. The first one that's trotted out is the 'getting up at dawn' scenario. If you don't sleep well, that's an impossibility. Dawn may well be when you're just getting off to sleep. But I do know writers who've done it. The second myth is that you can write at work (when the boss isn't looking). Again, I've met writers who do this but if you have a fast-paced job, it's impossible. Here's what works for me, written as a list because very busy people make lists, which is pretty annoying I agree:

1) make contact with your novel every day. This is an old chestnut but worthwhile, even if all you do is read through what you wrote the day before. This keeps your characters at the forefront of your mind and you can mentally write the next scene, work out tricky plot situations or even map out a whole chapter while you're driving, shopping, standing at the photocopier or struggling to remain conscious in a meeting. The disadvantage is that the written version is never as good as the one you 'wrote' in your head. Road safety is another disadvantage. I get so absorbed that I miss junctions or even forget where I'm going. Once, I drove quite a way to Manchester before I remembered I was meant to be driving to Darlington.

2) read lots of fiction. By all means enjoy the book but try to notice stylistic devices, interesting vocabulary and ways the plot is driven forward and shamelessly copy them. Everyone does it, nothing is original, just watch out for plagiarism.

3) avoid television unless you're brain dead at the end of the week. Something has to go and there's truly nothing on.

4) only allow yourself to look at your e-mails and Facebook after you've done your writing. This tip was given to me by Martin Bedford, one of my tutors at Manchester University. Thanks Martin.

5) keep up with friends, family, shopping, holidays, meals out, films, theatre, walks. Live a life. If you don't, what on earth will you write about?

6) carry a notebook and write down overheard dialogue and scenes you observe. You'll at least feel like a writer and restaurants will think you're a critic.

7) if all else fails write about the thing that robs you of your time, whether it's work, children or elderly parents. Keep a diary. Remember, life is art. A teaching assistant and a parent are jointly publishing the home/school diary that went back and forth between them every day for all of a child's primary education. The child has autism. Publishers are fighting over the book. Of course they are.

8) if you have to take a break from the novel (it's Christmas, you have flu, you're on holiday) try not to make it too long. From my experience, getting back to writing after a break can be very difficult.

9) don't worry about how or when you write. I've heard a lot of published authors speak and they're as lazy as the rest of us.

Good luck!