Kaleidoscope of a Stroke Survivor

By Dr. George Jacob

When life is overshadowed by dark clouds of crisis, one can realize that ‘things could have been worse’, by being thankful for silver linings.
Dr. George Jacob was born in Quilon, now, Kollam, in Kerala, India on October 6th, 1965. He is the oldest of four children born to his parents, the late Mr. E.V. Jacob, a seafood exporter and Mrs. Elizabeth Jacob, who was a lecturer in Zoology at St. Teresa’s College, Cochin, at that time. He passed MBBS from Medical College, Kottayam, Kerala, India in 1990, and later M.S (General Surgery) from the same college in 1996. He then started his career as a surgeon in a busy Department of Surgical Gastroenterology, which functioned in three major hospitals in the private sector in Cochin. Ten years later, at 39, just as he was beginning to realize his passion as a surgeon, he su¬ ered a massive stroke that paralyzed the left side, wreaking his surgical career in the process. This ‘bolt from the blue’, necessitated change of vocation from that of a surgeon to that of an Intensivist in the Surgical ICU, where he works as Senior Specialist. Having lost the sense of direction in life, at least momentarily, he took to writing. He found a new avenue to express himself, through the unfamiliar world of letters, exchanging his scalpel for the pen, in the process. His new-found passion had him contribute in various sections of the national daily, the New Indian Express.

• Language: English
• Publisher: Notion Press
• Release date: Nov 27, 2013
• ISBN: 9789383416523

Book preview

Kaleidoscope of

a Stroke Survivor

Dr. George Jacob

Notion Press

5 Muthu Kalathy Street, Triplicane,

Chennai - 600 005

First Published by Notion Press 2013

Copyright © George Jacob 2013

All Rights Reserved.

ISBN: 978-93-83416-52-3

This book has been published in good faith that the work of the author is original. All efforts have been taken to make the material error-free. However, the author and the publisher disclaim the responsibility.

No part of this book may be used, reproduced in any manner whatsoever without written permission from the author, except in the case of brief quotations embodied in critical articles and reviews.

Dedicated to all who helped me back on my feet when I fell

Preface

As a 39-year-old, my life was fairly a Sunday afternoon stroll in the park. I was a not-a-bad surgeon by then, working within the environs of the abdomen of patients, performing complicated surgical procedures. I was trained to be a ‘gastrosurgeon’ as surgeons operating on the organs within the abdomen are called. I trained under one of the most accomplished gastrosurgeons of the country, Dr. H. Ramesh, in whose unit I joined as a surgical toddler, after completing my masters in General Surgery. I was married to one of my classmates I had met during my medical course. She later went on to become an anesthesiologist. I was a proud father to two wonderful girls. I was blessed with my mother, who chose to stay with me (to bless my girls with her presence as a caring, and sometimes over-caring grandmother). I was also lucky to be in the company of a group of people and their families that made up my siblings. At work, my colleagues were my family. I couldn’t ask for more then. On January 14, 2005, things changed abruptly. A stroke paralyzed the left side of my body. I was operating at that time. That bolt from the blue ‘wreaked’ my surgical career, as also my life, in almost all its aspects – physically, which the world saw, spiritually, emotionally and mentally, which the world never saw in their immensity and significance and probably would never will. Those were left to me to be fought alone and to content with. Life had taken a completely different route, a route where many seemingly unseen and formidable battles had to be fought and won to progress through life, which had by then become a grind. As dark clouds formed a canopy above me, shutting out light, I had only my memory, which, mercifully, God chose to spare the ravages of the stroke. In my memory lived many events and ‘episodes’ that had happened in my life. Each one offered to me a different and distinct color, as one would see through a kaleidoscope. These distinct colors, the many events that had occurred much before my stroke, arrayed themselves to decorate my world, now immersed in darkness. These distinctly colorful events made up my dreams while all else seemed to fade around me, in my hour of darkness. These colors have been collected together as within a kaleidoscope in this book Kaleidoscope of a Stroke Survivor, besides these memories of days gone by, I have included chapters like ‘ICU-an inside story’ and ‘the noble act of organ donation’, both as a tribute to the science that had molded me into a doctor and also for the purpose of public education. Through this compilation, I wish to tell every stroke victim that ‘all is not lost’. To drive home this fact a few episodes that colorfully happened after the stroke have also been included, as also some musings on subjects that bothered me most like ‘yes, we must’, ‘the fading song of the willow and the leather’, ‘unable to rest when God did’ ‘hartals, the scourge of Kerala’ and many others, to all those who might be going through my similar situation. I would like to tell them through this that ‘things could have been worse’. Hope the book will serve its purpose.

Acknowledgments

An attempt to thank people, who helped me make this venture a reality, would result in a chapter in itself, and a long one at that. But it would be gross ingratitude if I fail to mention some of them.

My classmates at the medical college, Kottayam, got together to form a ‘Yahoo group’, years after completing our course, to later switch to a ‘Google’ group’. In this site, old friends residing and working in various continents in their respective specialties in medicine met daily to exchange pleasantries. Every topic under the sun was discussed and debated on zealously. Music clips from the YouTube were exchanged. Photographs and recipes were shared. Tales of day-to-day life and experiences at our respective workplaces were discussed in a generally warm-hearted and humorous banter. It is here, probably for the first time ever, that I posted some of the chapters contained in this book. I must thank my friends, unbiased and honest ‘reviewers’ of my articles, who never thought for a second time about calling a ‘spade’, a ‘spade’. They contributed by infusing in me the drive to write more and more on various events that happened after our batch graduated from the medical college and various events that took place in the campus while we were students. I must thank each one of them, who, in fact form characters in certain chapters, with nicknames, of course, for bearing with my eccentricities and ‘leg-pulling’ with patience and the right spirit, as only true friends can.

My thanks to a lot of my colleagues at the hospital I work in, who goaded me, sometimes even ‘arm-twisted’ me (as would be appropriate to say) ‘to write something and publish’. Some of them are Dr. Suresh, my orthopedic colleague, Dr. Gigy, my best friend and my treating neurologist, Ms. Zyleshia, my friend and clinical psychologist. I am not forgetting to mention my boss, Dr. H. Ramesh, that diehard taskmaster, who always have been breathing down on me saying ‘do something’, incessantly.

After my life changed its course drastically after the stroke that hit me out of the blue, I, somehow, took to writing. I realized my ‘covert’ capability to write, which suddenly seemed to be uncovered by the stroke. It all happened with the publication of a letter to the editor in the local edition of the national daily, ‘the New Indian Express’. (It was about the reckless drivers of the private buses plying on the roads of Cochin. Publication of my letters to the editor, at one time, became a daily affair.) Gradually, I graduated from letters to ‘view-points’ and often to opinions, columns in the ‘citizen journalism’, ‘readers’ opinion’, all in the same newspaper. For this, I need to thank Mr. George Abraham, the then Deputy Resident Editor of the paper, whose magnanimity to publish my humble contributions, in fact, served as a catalyst to reinforce the writer in me. Mr. Shevlin Sebastian, the Principal correspondent of the paper, helped by following up my publications in the newspaper and also by ‘coaching’ me to write better. Both of them together helped a ‘toddler’, who laboriously and circumspectly plodded through an unfamiliar world of the letters.

It would be unfair if I Don’t thank my wife, mother and children, to whom I used to reveal some of these chapters, soon after their creation. Their criticisms, sometimes blunt and rude, but always honest and well-meant, stood me in good stead.

How can I forget Professor Mrs. Betty Kurian, who was magnanimous enough to edit these ‘raw’ chapters by pruning and budding as only she can?

A book would not be a possibility without a publisher. To Notion Press, I say a hearty ‘thank you’.

Contents

Title

Copyright

Dedication

Preface

Acknowledgments

I The Stroke and After – A Bit Adventuristic

When Realization Dawned

Write Stuff

Visiting a Friend in a Town Untouched by Time

Unwinding Beside the Chalakudy

The Potter and the Clay

A Punctured Morning

The Way I Refused to Show My Friend

Onam by the Lake

Of Girl Power and Straightened Hair

Nightmare of Dressing Up

Thanks to Ayurveda

Garderner at His Pruning Best

Dr. Sunny

‘Bring the Wheelchair’

Bear Hug After the Benediction

Amma at Dwaraka

A Promise I Could Not Keep

Moses Built the Ark

Invasion of ‘Dwaraka’

In a Pant with No Button

II School and Childhood

Waiting in Queue for Big-B

They Were More Than ‘Servants’ to Us

The Unending Race

The Land of Rivulets, Tilapia and Palms

The Entire School and Nature and Me

That Long-Lost Christmas

Retired Colonel and Loose Brief Strings

Red Stripes on the Calf

Rebecca’s Well

Plagiaristic Grandson

‘Non-Existant’ Uncle

Mobbed!

Bakery on Three Wheels

Bethel’s Choir

Biriyani At A Price

Combatting the Eight-Legged Terror

Debacle Than a Debate

‘Earaly’, Pallichal Road, Cochin –

Floppy Hat, Rifle, Boating and Movies

Grandma Intuition

Grandpa’s Flowery Largess

III A Teenager in College

That Girl In Blue

Girls Really Did Make Me Nervous Then

IV As Medical Student

Alarm and Coffeemaker – Two In One

Courtship with Official ‘Sanction’

Disastrous – ‘Do You Need Anything, Sir?’

Down the Memory Lane

Downcast!

Eidelweisse, Eidelwiesse

Even Beggars Can Be Choosers, Sometimes

I Didn’t Want to Meet My Friend That Day

Lest We Miss the Train

Lost in the Forest

My Best Teacher

Olympics with a Difference

Safe With Her Grandparents At Last

Spiderman on ‘Field Work’

Too Shocking for a House Surgeon

Treading Down Edward VII’s Path

Walks to Church on Sundays

V A Doctor, Adult and Family Man – At Last?

An Unyielding Wedding Cake

Appam First, Check-In Later

Better Late Than Never

Blue Potty and Rosa Rio

Chugging Along the Konkan

Edge of the World

Hangman in the ICU

Hero No.

Honeymoon at the Hospital

How Could I Complain?

KL7/X-259

Needle-Vending Machine

Painfully Grim Maundy Thursday

A Remorseful Battle

Shock in Mid-Air

Slipping Through My Fingers

That Incident Irked My Mother-In-Law

The Day I Wished Never Dawned

The Longest Sermon Ever

VI Thinking Out Loud

Unable to Rest When God Did

Fading Song of Willow and Leather

Alcoholism – Truths and Myths

Bypassing Safe Travel

Hartals – The Scourge of Kerala

ICU – The Inside Story

Independent, Yet Not Free

Kerala Must ‘Emerge’ From and Despite a Lot of Muck

Need to Call Hartal Against Hartal

The Noble Act of Organ Donation

The King Who Swore Never to Return

Yes, We Must

VII Afterword

Things Could Have Been Worse

I

The Stroke and After – A Bit Adventuristic

Even though I walk through the valley of the shadow

of death, I shall fear no evil.

–psalm 23:4

When Realization Dawned

It was another day in the office on January 14, 2005. As a surgeon, it was another day in the operating theater at P.V.S. Memorial hospital, Cochin, where also I was working during those days, in addition to Lakeshore Hospital, in the same city. That day I was supposed to do an anterior resection, combined with hysterectomy for a locally advanced rectal cancer. As always, whenever I was called upon to operate within the confines of a female pelvis (surgically, that is), I was a bit nervous and uncomfortable, probably because the eternal fright of the gynecologist for those ureters while doing hysterectomy might have rubbed off on me as a student, somewhere along the line, while doing the medical course. I started operating early morning and went on until afternoon. I felt more tired than usual, which I thought was due to the stress and strain of doing an operation, which I was not comfortable with, by default. While having lunch with my colleague, after the operation, she noticed that I had facial palsy (weakness of one side of face) on my left side. Not bothering much about it, tired and dazed, I walked up to the surgical ICU. The nurses at their working station said ‘don’t make fun of us’, which I think now, was their response to the facial palsy I was having and a limp I might have had at that time, which I don’t recollect now of having had. Having passed the nursing station, I fell down with a thud, which I thought then resulted by tripping on a telephone wire or some other thing on the floor. Anyway, the nurses took great pains to pick me up and lay me on a cot. Deciding to investigate the matter, they checked my blood sugar, to rule out hypoglycemia as the cause of my fall. Having ruled that out, they rushed to the medical ICU, which existed right opposite the surgical ICU, where a senior gastroenterologist was taking rounds. They sought his services to tend on me. He came over and immediately diagnosed that I’ve had a stroke, as I had a leftward gaze, to which I protested. I could not imagine at that time that I could have a stroke (I was all along expecting a coronary event, which I was sure would get me someday, going by my family history of the same); I noticed that he was calling my neurologist friend, against which I protested even more vehemently (not against the choice of the person, but against all that could follow such a step). Giving up my attempts, I pleaded with him not to inform my wife about the events, who on that day was working at Lakeshore Hospital, whatever happened. After a while, I felt a sharp pain of a needle piercing one of my groins, to which I woke up to find myself on the table of an angiography suite, with bright round lights staring down on me, with my neurologist friend standing next to me, trying to calm me down and asking me not to move. Somewhere in my dwindling consciousness, I recognized the voice of the cardiologist of a nearby hospital, run by the Catholic order, and through the conversations going on, I came to realize that an angiography was about to be performed on me. The cardiologist told me about the warm feeling that I might experience inside by cranium and not to move at all.

After a while, I felt a sharp pain deep in my pelvis, which I imagined was a Foley catheter crossing my bulbar urethra; I thanked God for not allowing that sensitive procedure (catheterizing my bladder) from taking place at the hospital where I worked. I did not care at that time about the procedure that was taking place, which I imagined was being performed by some inconsequential nun and not by a nurse of my hospital, at whose face I would have to look on the next day. A sharp pain on my left forearm woke me up, to find my wife sitting next to me, trying to evaluate my response to pain. Looking around, I found myself on one among many beds in a room, which I soon realized was an ICU. Through the corner of my eye, I could see a priest, wearing that colorful outfit which only priests are supposed to adorn, holding a chalice, accompanied by a nun, one on each side, one of them holding a lighted candle, and the other, a shining cross. To my great terror and fright, I found they were approaching me. The priest commanded, ‘son, George, open your mouth’, which I obeyed. I imagined at that time that I had landed myself in a grave situation, and that the disease to which I had fallen, whatever it might be, would end my life soon, and that my family would have given up on me, and hence the reason for this priestly visit. Approaching me was certain death, which I imagined. The priest was carrying the ‘last sacrament’ to my ‘deathbed’! I opened my mouth to receive that little soft stuff, which had no particular taste other than that of impending death, lest St. Peter deny me entry at those pearly gates, if I happened to head that way. A dull pain inside my head again woke me up. In the background, I heard the voice of a senior anesthesiologist of Lakeshore Hospital making a suggestion ‘it could be rabies’ and the voice of my boss at a distance complimenting her for that ‘good’ suggestion. ‘Rabies’! That meant 100% mortality. I was disturbed and when my wife asked me how they diagnosed rabies, I replied, ‘by picking up Negri bodies on brain biopsy at Mannoothy’. I was almost sure that I was suffering from rabies, and went back to daze with a sense of defeat and panic, imagining the ENT surgeons would jump on me any time to perform a trans-sphenoidal brain biopsy to confirm rabies; I dozed off again. ‘George, take deep breath’, that order by a voice loaded with command and one which meant business, that familiar voice of the head of anesthesiology of Lakeshore Hospital woke me up this time. Opening my eyes, through clouded vision, above the oxygen mask on my face, I could see my siblings, who were all abroad, around my bed. Much to my relief, that I was still alive, I shook hands with them. After awhile, I noticed my mother walking in toward my bed, carrying my two daughters, with terror on their faces, probably at having seen their father with a large oxygen mask and the Ryles tube going down through his nose. This time, I began to cry, which was immediately stopped by a stern order by my aunt, who accompanied my mother.

When I came to myself, someone explained to me (I don’t exactly remember who) all that had taken place. When realization dawned,

I realized that a dissection had occurred on the internal carotid artery of my right side, and that a thrombus generated from the dissection had clogged my right middle cerebral artery that caused a large infarct inside the right side of my brain, causing dense hemiplegia of my left side, paralyzing that side and my career as a surgeon, and that many CT scans and a cerebral angiography were required to diagnose that, and that I was subjected to intra-arterial injection of rTPA, a surgical procedure in the form of a decompressing cranioplasty and four days on ventilator to take care of the malignant cerebral edema caused by that large infarct, all planned and executed mainly by my boss, along with the chief of anesthesiology of Lakeshore Hospital, my neurologist friend, and many others, including God, as the result of which I am now able to sit in front of this computer to type this.

I also realized that rules within the ICU should be modified regarding the rite of providing the ‘last sacrament’ and even bedside prayers, as it could convey wrong impressions to the really sick, but conscious patients, who could have awareness.

I also felt care providers within the ICU should exercise restraint and caution while communicating with each other, as one day, a poor patient panicked by wrongly imagining that he was dying of rabies. These are lessons that have come in quite handy to me, especially now that I’m involved in critical care, spending many hours in the ICU more than surgery, a change imposed upon me by the thrombus that decided to get stuck in my middle cerebral artery.

I also realized that there were a lot of silver linings decorating the dark cloud that had darkened my life. What if the effects of the stroke had surfaced elsewhere, like when I was driving on the highway, instead of falling down within the safe confines of an ICU? What if that thrombus had decided to block the middle cerebral on the left side, causing a right-sided hemiplegia, with its associated disabilities, the worse of them being aphasia (inability to speak) and inability to write? What if the coronaries decided to play up badly, as I had feared all along, instead of the cerebrals? What if I were not fortunate enough to have supporting colleagues and family? What if I had no job, which came to me on a silver platter after I returned from my physiotherapy? What if God had decided not to be by my bed during those days of crisis?

Write Stuff

The days immediately following my stroke on January 14, 2005, generally centered on waking in the mornings to days full of terrible anxieties and baseless worries. These affected my functioning as a human being, from leaving for the strenuous work in the stressful environs of the ICU, coming back home, tired and spent, to crash into bed after a bath to wash off the microbes from the ICU that would have clung on to me, to wake up to place myself in front of the TV to watch my favorite musical ‘reality shows’, then to proceed to family prayer and dinner and then to kiss the day goodbye by crashing into the all-embracing arms of my bed yet again.

One morning, while going through the local edition of a national daily (a newspaper), an activity that I rarely indulged in until then, contributions from readers in the form of suggestions through letters against the growing menace of reckless driving by private buses in Cochin, which claimed many a life on the city’s streets, caught my attention. I e-mailed a letter to the newspaper. A few days later, lo and behold, the letter with my name was published. This truly was an exhilarating experience for me; I walked through the rest of the day with my chin up. From that day, my days began by reading that newspaper from page to page. I began to send letters to the editor of the newspaper daily, without fail, on subjects that touched a whole range of issues. My excitement grew as a large number of my letters continued to be published, something that caught the attention of my colleagues, relatives and friends. It seemed as though I had found another area to express myself, when the possibility of expressing myself as a surgeon looked rather bleak. To add to the variety, an article of mine that talked about the noble act of organ donation was also published, as was an article in the ‘time-out’ section of that paper that described the war my mother had to wage against terror that appeared in the form of a spider, all by herself. My letters, I realized, had started failing to strike right chords with the editor, and their publication in the newspaper dwindled for a considerable length of time, which bothered me. I sent a letter to the editor asking him whether my letters were being received and if there has been a change of address to e-mail them. In the process, I introduced myself as a surgeon whose career has been ‘wrecked’ by a stroke and that I was hoping to find expression through writing. A few days later, I had a call from a Principal correspondent of that paper that he wanted to do a feature on me, to which I agreed. On the appointed day, he arrived at my home to interview me. He told how the editor was impressed by the word ‘wrecked’ that I had used in my letter to him. The interview centered on my stroke, my newfound passion in writing and how I coped with the disease. After a few days, the feature on me titled ‘Write-Stuff’, which also carried my photograph, was published in the newspaper. To a person like me who was naïve to the world of letters, I felt like a celebrity! A lot of letters from other readers of the paper expressed their thoughts on my story. Most of them appreciated the way I stood up to adversity. The incident that ‘wrecked’ me was now helping me to stand up on a terrain that was foreign to me – that of the world of letters. Days were no longer a dull drab. What I lost on the operating table seemingly was being rediscovered on my computer keyboard.

Visiting a Friend in a

Town Untouched by Time

One of my classmates, who