When the grim reaper tinkled my bell

ECG. Or possibly EKG depending on your taste

The tinkling of the mortality bell is an eerie sound. Neither frightening nor consoling. But certainly sobering.

For me, it came while I was thinking about something that occupies us all these days. That’s the devastating war being wreaked by Russia on an Eastern European country. What worried me most was that I couldn’t for the life of me remember the name of that country. 

I tried some other thoughts. My consternation deepened. I couldn’t remember the name of the great city in the east of the country being heroically defended against the invaders, among others by a friend of mine, whose name I’d forgotten too.  

I started testing my mind, like a man with a back injury testing his legs – “knees OK, ankles OK, but can I feel my toes?” 

There was information I could recall. I remembered Germany and its capital Berlin. But the name of the little town on the Rhine that had served as capital during the Cold War? Blowed if I could remember its name. 

I grabbed my phone and ran a search on ‘Russia at war’. There were lots of results, unsurprisingly, but what was this place that kept being mentioned? Ukraine? Never heard of it. 

Had I?

Could Russia have somehow got itself sucked into another war?

And yet, and yet, I had a nasty feeling that ‘Ukraine’ wasn’t really an unfamiliar word. Instead, it felt as though a great hole had opened in my mind and sucked in my previous familiarity with it. 

Which, obviously, was worrying.

But things were worse than I imagined. Talking a few minutes later with the daughter-in-law whose home near Madrid I was visiting on grandparenting duty, I realised that while I knew who she was, I couldn’t remember her name. Then my son started talking and, though I could recognise the sounds as English, I had no idea what he was saying. That wasn’t unprecedented, but this time I couldn't even understand the language. And when it was my turn, to speak, the horror deepened: I was producing words, but the wrong words, in the wrong order.

I’ve often been told I talk nonsense, but usually I’m accused of being incoherent in my thinking, rather than in my sentences. This time they were incomprehensible.

I still had enough presence of mind left to guess what was happening. You know the Stroke mnemonic? ‘FAST’? Face-Arms-Speech-Telephone? I checked my face in a mirror, I knew my speech wasn’t slurred, and my limbs were fine. So everything was fine on the first three letters, and I didn’t feel the need to use the fourth to call an ambulance. Which was just as well, since I’m not sure I could have made myself understood, especially in Spanish.

Then things began to improve. The words started to flow back. This daughter-in-law was Sheena. The son was Nicky. Bonn was the previous capital of the Federal Republic of Germany. It was indeed in Ukraine that the Russian Army was doing so much harm. Kharkiv was one of the cities putting up a valiant resistance. Among the many civilians helping that effort was my friend Alex.

The word ‘stroke’ was receding from my mind. In its place, though, I was thinking ‘Transient Ischemic Attack’ or ‘mini-stroke’. As the name implies, it passes leaving little or no permanent damage. But it is a powerful warning. 

One not to be ignored, my wife told me, in stern terms, when I phoned her later. The idea of several hours in a hospital emergency department, into the small hours of the morning, didn’t appeal. But she persuaded me that it wasn’t something I could sensibly avoid. So Nicky took me.

Badge of (hospital) confinement

I really can’t fault the Spanish public health service. The hospital gave me an ECG (which they annoyingly insisted on Americanising as EKG), a blood test, and a CAT scan. And then they flung still more resources at me. The Emergency doctor called me in and explained that she’d spoken to a neurologist and his view was that my symptoms strongly suggested a TIA. Not that they said ‘TIA’. This being Spain, they called it an AIT, for Ataque Isquémico Transitorio.

The upshot was that they kept me in overnight. The four-hour wait I’d dreaded turned into a fifteen-hour stay.

Stuck in a bed I didn’t want to occupy

I still can’t complain. A neurologist popped in next morning and ordered an ultrasound of my neck, to check the state of my carotid arteries. For good measure, they threw in a PCR Covid test. 

The neurologist popped back. Everything was clear – ECG (OK, OK, if you insist, EKG), CAT Scan, blood work, Ultrasound. He and his boss decided that I’d had indeed suffered a TIA (or AIT, if you prefer) but was at low risk of recurrence. They prescribed medications, including good old aspirin, to reduce the risk still further.

All this work was massively impressive, and I’m hugely grateful. Everywhere I met high professionalism and great dedication. What’s more, in this public hospital, I had nothing to pay.

On the other hand, the process was horrifically boring. I reckon that out of my fifteen hours in hospital, I spent thirteen waiting or, for too short a time, sleeping (boy, hospitals are noisy places). 

Bedside equipment including the monitor

They hooked me up to a monitor and a saline drip. It meant I couldn’t even get out of bed. Which was frustrating. I mean, after all, the transient attack had long since transitioned. It had revealed a long-term condition that needed managing, but right then, as I lay bored in bed, I was fine and there was no good health reason to stop me getting up. 

So I got up. When I couldn’t wait any longer for a toilet, I detached myself from the monitor and the drip and headed down the corridor. 

Now I like to think of myself as reasonably intelligent. It really disappoints me when I do something particularly stupid. Especially when I don’t even have the excuse that I was undergoing a dysfunction of the brain at the time, so instead it was all down to dysfunction of the mind.

I mean, those drips are called ‘intravenous’, right? I know that. That means they get stuck into blood vessels. So if you detach one without closing it off, and walk down a corridor, you’re going to leave a trail of blood the whole way. Fortunately, there was a cleaner working nearby, and she kindly agreed to clear up the mess. 

What a mess

That was the last time I got up on my own initiative. The nurse who hooked me back up to everything made that bountifully clear. Even when I went for the ultrasound, a short stroll down the corridors, a porter had to push me there and back in my bed.

But, hey, once you’ve been admitted, that’s it, you’re a patient in a bed, and in a bed you’ll stay, until a doctor says you can leave it. It doesn’t matter if you tell a nurse you’re fine. You have no authority over your inpatient status – or in-a-bed status – and nor does the nurse.

You can imagine the huge relief I felt once I was medically discharged and could get out of bed, officially and with permission. It was almost as good as emerging from the original TIA. 

Free at last

Not that things went back to the way they had been. Something had changed forever. From now on, I’m on medications to avoid a massively disabling attack. More generally, they help me cheat the grim reaper a little while longer. 

Ah, yes. That feels strongly like a premonition of mortality. That little tinkling bell, now ringing a little more insistently. An undoubtedly sobering sound.

At least, in better news, my PCR Covid test came back negative.