After a Stroke - bulletins and correspondence

On the morning of Saturday 23 November, 2024, I had a small stroke. Is it possible to describe the experience of a stroke? It’s much likelier that people will realise that they have recently had a stroke, but not that they are having one right now. The word “stroke” has always made me think that it arrives like a flash of lightning, even though I’ve long known this is certainly not the case. Its effects, I already knew, tend to paralyse parts of the body on one side rather than the other. In my case on that first morning, November 23, I became aware that I might have had a stroke when I realised my balance was highly problematic on getting out of bed - I immediately keeled over to the right - and more so when I found it impossible to swallow any of the pills I was currently taking. (It took me several hours - days - to understand that a stroke can especially paralyse the swallowing area of the mouth and throat.)

Thanks to Über, I was able, that same morning, to reach my local hospital, the North Middlesex, which I had already visited twice that week for what was soon recognised as atrial fibrillation. I chose Über because I was uncertain how serious my condition was, and because I knew Über - already having my address and having taken me from the North Middlesex to my home two evenings before -  would convey me to hospital quickly. In the event, by the time the Über arrived, I was so unsteady that I could not have made it across the road to the waiting car without the physical support of some kind passing pedestrians.

The North Middlesex Hospital is in the northwest London borough of Enfield. At the same time, my eldest sister, Marian, was in hospital in Tooting, in southwest London, with metastatic liver cancer, a condition far more complex and less hopeful than mine. In the weeks that followed, each of my three other siblings - Margaret (based in Edinburgh), Robert, and Jim (both based in northeast Essex) made several visits to both Marian and myself. As I collate these missives, I realise how very fortunate I am to have four kind, concerned, loyal, and good-humoured siblings. (I was equally fortunate in my friends, some of whom also made repeated visits to see me.) As I began to realise I was issuing the same reports to friends as family, I started simply to copy individual paragraphs and then whole messages. From Monday 25 November on, I tended to start the day with a group email to family and (an increasing number of) friends. I copy parts of my siblings’ replies here, simply to document how fortunate I am to have such family love. I, aged sixty-nine, am the youngest of the five; Marian, then aged eighty (and still living at the time of my writing this), is the eldest. Both my sisters have been in the medical profession, one as a physiotherapist, one as a nurse; one sister-in-law has also been a nurse. I have included some of the correspondence with my sister Marian to show that she was always in our thoughts, but have omitted  plenty, since her health issues are her own. But both of us were in National Health Service hospitals.

The A&E (Accident and Emergency) ward of the North Middlesex was quickly able (after a scan) to diagnose my condition as a small stroke. I was sent more or less immediately, by ambulance, to the stroke unit at UCLH (University College London Hospital), which some think Britain’s best: it’s in central London. From there, later that day, I called one longterm London friend, William Relton; he visited me the following day. Unfortunately, my telephone developed temporary problems soon after I called him. Only on the morning of Sunday 24,  was I able to inform my four siblings and other friends.

I am an inveterate correspondent. At first, after being admitted to hospital, I wrote separately to individual friends, but, especially as a widening number of friends made contact, I sent the same bulletin to all of them. What I share here are the reports I sent to my four siblings and an increasing number of friends from Sunday November 24, until I was released on New Year’s Eve - by which time I had spent time in three different hospital units.

As I hope these missives make clear, I was usually the healthiest person in each of the three stroke wards, and was aware of my good fortune by comparison to those in nearby beds. I don’t mean to claim I was unusually ill; I merely hope to shed light on some aspects of a stroke and of recovering from it. We hear much of how hard-pressed the National Health Service has become, but the only time this became evident to me during my five weeks and a half in its care was with ambulance service in taking me from one London hospital to another - two days later than originally hoped and in the early hours of the morning. In the six months after my leaving hospital, I have become more aware of financial shortages in the National Health service. At hospital level, however, I have intense gratitude and great admiration for the care I received.

Sunday 24 November

From Alastair, to siblings and to friends:-

A quick note, begin at 3am, to say that that, yesterday, I had what they (the medics) believe was a small stroke. No bleeding in the brain, and decent mobility of limbs, but NO ability to balance or swallow, plus (for most of yesterday afternoon and evening) an intense swimmingness of vision, which included inability to read and awkwardness in looking at faces. I can speak - but very throatily.

I made my way to North Middlesex Hospital yesterday at midday via Über. (As I think you all know, I had visited it twice that week, to address signs of atrial fibrillation.) They checked me carefully , and told me they thought it was a stroke with no signs of bleeding on the brain. They duly transferred me c.4pm to UCLH (University College London Hospital), which had a whole stroke unit. I think this is the branch near Russell Square rather than the one near Warren Street. Very good care, very kind people. Because of my inability to swallow, I could take no pills yesterday, so they are medicating me intravenously. My pulse is erratic, but, thanks to medication, seldom alarmingly high.

My phone buggered itself for all yesterday evening: I had already managed to call William - nice calm lucid conversation - but the phone problem promptly occurred before I could call you (family). Perhaps that coincided neatly with my vision problem. Anyway, I can’t tell you too forcibly what the inability to read was like for a logocentric person such as myself.

I have had short sleeps, and was so thrilled, in the early hours today, to find I could read AND that I could sort the phone. I’m still in the Stroke Ward’s admissions /emergency  area, and on a “stretcher” (with sides and wheels) rather than a bed. The staff treat me with intelligence - and I hope I’m a good and patient patient. Their main concern is to keep my heart rate (pulse) reasonable . I have some brief periods of tingling and head on the right side of my face which are, I’m told, consistent with a stroke, but none of which last long. I can stand to pee into a bottle, am unsure whether my ability to balance has improved, but am still removing saliva and sputum with tissues. My biggest fantasy is to drink some water followed by eating grapes and oranges, but these are still pipe dreams.

More later in the morning. William is organising some visitors for me, but I’m not sure my problems of throat and swallowing make me very keen on any visitor for more than a few minutes.  (And, my dears, I haven’t shaved since maybe Thursday. The horror, the horror.) Am wearing trousers but hospital smock/robe and hospital socks. More in due course - shall try to rest and sleep again now.

I’m often impressed by how public sound systems often play three different “musical” notes - often just electronic notes of equal length - that are big enough to serve as musical mnemonics. While I was writing this morning, the system attached to my pulse monitor kept playing three rising notes close together. I knew at once they were an orchestral phrase in Tchaikovsky, but which? Well, soon they led me into what I identify as the start of his “Suite no 3”. I wish my memory of the Balanchine ballet to that score were better. (I have known three-note figures on metros recall arias by Handel or Mozart. One friend in the 1990s said the Rome underground played the first three notes - descending - of the great Italian pop song “Volare”.)

0655

From brother Jim:-

When you can, please continue to report but, in the meantime, recover. Let your soul restore your brain’s ability to remember. If you can remember music and poetry, then perhaps your brain will remember how to swallow. Marian made Father use every sense of his body and mind to help recovery. I send all love.

0657

From sister Margaret:-

Dear Alastair. I am so very sorry to hear this and am wishing you all the very best of luck and good medical and nursing care for a very good recovery. How clever and brave of you to take yourself off to hospital and how good to hear you’ve been transferred to a stroke unit and that you’ve been in touch with William. XxxM

0711

From sister Margaret:

Hospitals often have policies re visitors and probably rest is important. Keep in touch if you can: does William have any of your siblings contact numbers? If you’re OK for visitors, I can visit on my visit to Marian. XxM

0819

From brother Jim:-

Pip and I are staying near Oxford. One or both of us can visit you today or tomorrow if a visit would help. I’d love to see you but only if it is of help. All of our love and (now) up to 100% sympathy.

0823

From sister Margaret:-

Interesting you mentioning these musical notes…. We used to be visited by a very colourful guy Alberto Massimo - …he would tell us such things often at length. Lots of love xxxM

0848

From sister Marian:-

Alastair I can only send love. My brain is muddled.

0850

From brother Jim:-

Tchaikovsky’s violin concerto works for me. And to you dear Marian: rest, sleep and fight, fight and fight again as you always have.

0851

From brother Jim:-

Let me know about visiting but only if it helps

0852

From Alastair, to siblings:-

Much love to you, Marian. I’m sorry we’re keeping London’s hospitals so busy .

0904

From sister Margaret and her husband Hamish:-

Xxxxxxx to you both. M&H

0904

From sister Marian:-

Dear Jim, I’m not sure fight is the right word as I lie here and have things done to me. Yesterday it was freezing in the hospital, today it’s hot. Love to you all, Marian

0918

From brother Robert.-

Dear Alastair,

I’m so sorry to read your news but admire your presence of mind to take yourself to hospital.  I hope that they get you into a proper bed soon.  The others have given you all the advice that I might have thought of. Music and poetry can be balm for the soul.

You may not be fighting, Marian, but you’re still full of spirit!

0925

From Alastair:-

Thank you! Much love to all.

Like Marian, I just lie here feeling passive. They recently took breakfast and lunch orders from neighbouring patients. Orange juice and fish and chips sound very exotic and fabulous when you can’t swallow.

Balance and swallowing remain chief problems for me - though vision has begun to swim again.

0934

From sister Marian:-

Alastair did you try 999?

1002

From Alastair, to siblings:-

No, because i didn’t realise how serious things were. Thank heavens for kind Über people and pedestrians.

1216

From sister Margaret:-

Oh Alastair, my admiration to you for your great presence of mind and courage. The general public, Über included, can really turn up trumps when needed. Lots and lots of love and hoping you get the best of care. XxxxM

1319

From Alastair, to siblings:-

My voice is very throaty. I’m in the Stroke Unit of the UCLH at Queens Square: emergency ward at present - they hope to move me into some quieter and more formal ward later today.

Jim, Pip, and William all visit today, though I fear it will be boring for them.

Just had MRI scan - to me not unpleasant after some of the avant-garde scores I have heard over the decades. From this, the MRI people confirm that this is a small stroke on the right side affecting part of the cerebellum and I forget what else. I will be here some days longer. On Tuesday, they will give me more blood-thinning medication. I have major balance problems, major swallowing problems, occasionally swimming vision, and minor blur of right eye/arm coordination.

1341

From Alastair:-

Am about to be moved to a proper ward. More anon.

1724

From sister Marian.-

It has been lovely seeing two brothers on  consecutive days. Tomorrow I have another radiotherapy appointment. I haven’t heard how Alastair is. Much love Marian xx

1727 hrs

From Alastair, to siblings:-

Jim and Pip just visited me in UCLH Queens Square. They will report to you all. William, who was here earlier, says I am very much myself. Main problems are balance and swallowing.

1740

From sister Marian:-

Same problem with balance but a different cause. I can swallow but I’m all over the place with balance. I am wishing you well, Alastair, with much love Marian xxx

1745

From sister Margaret (and her husband Hamish) to Marian and Alastair:-

So pleased J and P visited you. Wishing you both all the very very best and sending loads of love. XxxxM&H

1807 hrs

From Alastair, to siblings:-

Thank you all. People in my bay are eating dinner, which makes me jealous, since I can’t even drink water (literally can’t - I choke if I try), but not very jealous: it’s visibly hospital food.

1837

From sister Marian:-

I had some soup and something else.

It was lovely seeing both elder brothers on consecutive days. Alastair I am wishing well Love Marian xx

1839 hrs

From Alastair:-

Thank you! Oh soup! You know how to tempt a guy (a guy who cannot swallow).

1839

From Marian:-

🙏🤞🤗

1903

From brother Robert:-

Oh Alastair, not being able to swallow sounds awful.  I  hope that it comes back soon.  🤞

2237

From sister Margaret:-

Dear Marian and Alastair. I hope you both have a comfortable night. Lots of love Margaret

2342 hrs

From Alastair, to siblings and to friends:-

Thank you! I’m on an intravenous drip that purports to be hydrating me.

2345 hrs

From Alastair, to siblings and to friends:-

I’m now next door, in Bay 6 of the David Ferrier Ward. The other five here are very quiet but possibly less troubled than those in Bay 4 were.

Monday 25 November

0835 hrs

Group email from Alastair to friends as well as family:-

Good morning.

I’d say I am no better and no worse. The next change to treatment are expected tomorrow.

We all are very frequently asked to state our names and the date and where we are. Today, the 6am nu also asked me who is president of the United States.

“Biden,” I said.

She corrected me: “Trump.”

You may be sure I read the riot act as I corrected her and explained about the inauguration of any American president in January.

0846 hrs

From Marian:-

Well done - keep them on their toes.

A bit of blue sky this morning. No skudding angry clouds. Lying in my bed it’s much better than the grey of yesterday.

I hope I’m off to Sutton where radiotherapy is done soon.

It was lovely seeing family and friends over the weekend. A friend who was going to visit today isn’t because there is Covid in the family.

0846

From Alastair , to siblings and to friends:-

Big excitement. The swallowing experts will come in the next two hours. Some people wait for Godot, but I wait for swallowing experts.

I can’t see the sky, though I am now by the window.

0850

From brother Jim:-

Great news that there’s more than one! Who knew? As for Trump!!!!! I am still waiting to see if Biden will stand outside The Capital Buildings inciting everyone to moan a lot.

0858

From sister Marian:-

It will be interesting to see if all the previous presidents turn up for his inauguration.

0859

From Alastair:-

Absolutely

0900

From Alastair:-

Good luck with Further Radiotherapy, Marian.

0933

From sister-in-law Pip:-

Glad to hear treatments going ahead. Hope the standing experts are close behind the swallowing ones, Alastair 🤞🤞🤞🥰

1004 hrs

From Alastair , to siblings and to friends:-

The mobility experts came first. Albeit with their help, I could walk much more fluently than before, with a rhythm I didn’t have to intellectualise. They took me to the loo, where I also washed my face and hands.

The speech person is here, and soon will begin work on my swallowing. My voice is still very throaty, but I can speak faster and more naturally. More later when we hope she will have begun work on my swallowing.

1039

From brother Robert:-

👍🤞

1047

From sister Margaret:-

Good to hear things seem to be moving in the right direction. I had a giggle over the response to the President question. A friend has a Master’s degree in swallowing! All the very best to both of you and loads of love. XxxM

1200 hrs

From Alastair , to siblings and to friends:-

The swallowing/voice person tried me on swallowing both a teaspoonful of water and one of creamy raspberry yoghurt. Alas, neither was really successful, though I really tried and though the aftertaste of the yoghurt remains blissful. Probably they will feed up a tube my nose and throat now to make sure I get fed. It may also be used to photograph how my throat is functioning.

1241

From brother Robert:-

The ng tube doesn’t sound fun but let’s hope that they can improve things.

1541

From sister Marian:-

Alastair how are you?

1645 hrs

From Alastair, to siblings:-

I’m tired and miserable after too many tests and checkups and strangers earlier today. One medic tells me I have a chest infection. I think this is her mistake, but the backlog of saliva is now such that it may be hard to tell. They lost the cable to my phone when they moved my bed last night. They are about to feed me through the tube in my nose, but I won’t be able to taste anything.

1706

From sister Margaret:-

Very sorry to hear you’ve had a miserable day and I hope very much you haven’t got a chest infection. Is it the saliva that’s the problem: can they suction it away? (memories of old nursing days). Too bad they lost  your cable: can you get another? Glad you had some kind of wash but hope you get a shower or full wash soon. Present plans are that I get to London early Friday morning, hopefully to see Marian - and I can come up to visit you wherever you are. Have you had a shave yet? Happy to help you either whatever if you need it. Lots of love, Margaret

1808 hrs

From Alastair, to siblings:-

I had a shave yesterday. Apparently I do have pneumonia, which they are medicating. They recharged my phone for me; I will get Richard Fairman tomorrow to bring me a phone lead.

1814 hrs

From Alastair:-

It doesn’t feel like pneumonia!

1815 hrs

From Alastair:-

Two of the people in this bay are very hard to share with.

1819

From sister Marian:-

Pleased you are sorting your phone out.  It makes such a difference.

Are you responding to antibiotics? Or are even on them.

How does pneumonia feel?

I’m in a three bed bay, so far so good. 🤞🤞🙏

1825hrs

From Alastair:-

I am on antibiotics, and also on intravenous food that I can’t taste. I’m in a six-bed bay. We’re all over sixty but otherwise very mixed.

1836

From brother Jim:-

Good luck with your neighbours Alastair and I hope that you will soon recover the ability to swallow and get rid of food through a tube. Hopefully you will have earphones soon and you’ll be able to create your own sound bubble.

2020

From brother Robert:-

Oh Alastair, pneumonia on top of the other things.  We’re wondering if a physio might be able to help with some of the problems.

🤞🙏

Tuesday 26 November

0735

From Alastair, to siblings and other friends:-

Good morning.

Yesterday, they added pneumonia to my list of troubles; they also added a tube through my nose. Both depress me somewhat, I confess.

My voice is throatier than ever, with endless saliva making it harder to speak than before. I suspect that in other ways I’m improving, but the sustained inability to drink and eat is frustrating.

They want soon to restore the medication I had started to take last week for atrial fibrillation.

I don’t think a physio would help - it’s not pneumonia such as I remember it - but I see physios each morning anyway (for walking and balancing ) so will ask. Mainly now I hate being in the fourth day of being unable to swallow, of having endlessly to clear my throat and mouth of saliva, and (the second day) of having a tube through my nose. They’re monitoring me very carefully - moved my bed back to its earlier bay yesterday evening, during which we found my phone lead. Hurrah!

0739

From sister Margaret:-

Good! That’s one thing at least! XxM

0906

From brother Robert:-

Yes.  Let’s hope that your swallowing improves.

0912 hrs

From Alastair, to siblings and to friends:-

The most desirable thing in all creation is to drink (and swallow) pure cold water.

0915

From brother Robert.-

I really feel for you.

0924 hrs

From Alastair, to siblings and to friends:-

They want soon to restore the medication I had started to take last week for atrial fibrillation.

0951

From Jim from his daughter Meg, in turn from her friend Katherine:-

0954

From brother Jim:-

Dear Alastair the above message is from Meg’s friend who is a swallow physiotherapist. Google says that a SLT assessment is speech, language and communication skills assessment.

1001 hrs

From Alastair, to siblings and other friends:-

I saw a speech/language therapist yesterday and may see her again today. I can communicate as well as the increasing throatiness/saliva backlog permit. They will soon send a camera down my nostril and throat to inspect the swallowing problem.

1002 hrs

From Alastair:-

I seem to be walking a bit better than yesterday, which was in turn a big improvement from the day before, though the physiotherapists are so good I’m not sure if I could cope without them.

1004

From brother Robert:-

That’s good to hear.  👍😊

1308

From sister Margaret:-

XxxxxM

1343 hrs

From Alastair, to siblings and to friends:-

A camera did go down into my throat today, but the vocal cords are covered by layers of infected mucus: which is precisely how I sound, but which prevents the medics from investigating my inability to swallow.

1404

From sister Marian:-

Poor you.

I have been answering questions to do with possible discharge.

1405

From sister Marian:-

But I have told them Ed <Marian’s elder son> is the person with ideas.

1556

From brother Jim:-

Good luck with sorting out your infected mucus soon, Alastair. Much love to both of you

2052

From sister Margaret:-

Don’t read this if you don’t want to Alastair as I expect you have v g physios etc but  I was speaking to a friend, ex senior physio on neuro surgery, who talked about sitting upright or a bit forward or lying side to side to shift fluids, diaphragmatic breathing, bilateral breathing, postural drainage and suction to clear your mouth and trachea which she used a lot. She also talked quite a lots about swallowing hints. All the best. XxM

2109

From sister Marian:-

Thinking of you.

2133

From brother Jim:-

Thinking of you both and sending lots of love

2205

From sister Marian:-

Sleep well all

2206

From sister Margaret:-

Ditto and lots of love. XxxM

2315 hrs

From Alastair, to siblings and other friends:-

Quick update after almost four days of stroke and this hospital. Most patients here are in a worse way than I, and most of them are beyond all speech. One of them now - silent, elderly, but visited by devoted family every day - has what I think is a nebuliser for fifteen minutes four times a day: inconveniently noisy for the rest of us, but interesting to me as one of my physios is talking about giving me the same treatment. The thing is that it creates a fine mist which one breathes in. I hope this will work on me. Not much at present is loosening or drying the recurrent supply of mucus around my tongue and throat and vocal cords.

I have sat up for hours, I can sit up in bed: these things don’t bring me much change, though I’m happy to go on trying. I do wet some tissues and rinse my mouth with those now and then; this is slightly dangerous,  as  the mouth longs to swallow even a scintilla of this water, which it then rejects by choking  etc., but believe me it kinda helps, albeit briefly.

I also haven’t defecated since Saturday morning, but at least I am now walking better to the loo, at least sometimes. Also I am now in full pyjamas, which feel an improvement. (For the first three days, I was wearing a hospital gown and trousers and underpants.)

William and Richard Fairman, who both visited this afternoon, and Richard Jarman, who visited Monday afternoon, all say I am recognisably bright-eyed and humorous. Good to know but also something of a surprise to me.

Wednesday 27

0251 hrs

From Alastair:-

Drama! I was woken at 2.30am, taken for an X-ray, and returned. I think they want to check that the tubes entering me from my nose are in the right position.

0718

From sister Margaret:-

Sorry for this rather basic topic. Can you ask for something for your bowels Alastair? Lactulose is a good softener and Senior can be added as a stimulant or there is the combination Laxoberil which Marian was prescribed. Even if you are not eating, the bowels often need to move . Can you change position in bed? - as you don’t want bedsores. I intend visiting probably on Saturday. Would it be any help if I could manage any earlier? I hope v much physios can help soon.

Can you remind me again which hospital you are in?

How are you Marian?

0724

From sister Margaret:-

Stupid me: of course you can’t take medicine orally! Ask the staff.

0736

From sister Margaret:-

Does anyone do the laundry? I can bring down pyjamas and organize laundry. Xx

0737 hrs

From Alastair, to siblings:-

I’m in UCLH, University College London Hospital, widely thought to be our best, not that I chose it (I was transferred here on Saturday). They’re giving me plenty of medication by injection, plus liquid food and hydration. I am one of the more mobile and chatty patients on the ward. I don’t feel severely constipated, and there are signs that my bowels may move. More soon.

0741

From sister Margaret:-

Good, yes I understood it was meant to be a centre of excellence. XxM

0743 hrs

From Alastair:-

Yesterday I walked (with assistance) to and from the loo where I peed satisfactorily, washed somewhat, and tried opening bowels. It will happen.

I feel that the infection around my throat and lungs may no longer be infected - I mean that there is mucus etc but no longer yellow. Some of the walking is a remarkable improvement, not all. I am trying to cough, as this action itself helps, though I - once a world championship cougher, heaven knows - really can’t cough firmly at present.

0824

From brother Jim:-

Margaret, dear Alastair (our bright eyed and humorous brother) is in The David Ferrier Ward. It is on the third floor of The Chandler Wing of UCL Hospital, Queen Square, WC1N 3BG. It is the National Hospital for Neurology. Quite how you, Alastair, are remaining bright eyed and humorous is remarkable and no doubt exhausting but good for you. I am a huge fan of encouraging endomorphins to do their stuff. Laughter works better than anything to create them. Try watching Fawlty Towers or something like that. Anything to help endomorphin production. So: I said to the gym instructor: “Can you teach me to do the splits?” He asked:”How flexible are you?” I said: “Well, I can’t do Tuesdays “     

I went to the doctor and said ”I have hurt my arm in several places “ He said:” Well, don’t go there anymore “ Much love

0831

From brother Jim:-

Two kids were arrested yesterday. One was drinking battery acid and the other was eating fireworks. They charged one and let the other off.

0839

From brother Robert:-

🤣 groan! Groan!  Well done Jim.

Mary <Robert’s wife, trained as a nurse> asked similar questions to those Margaret raised, but I generally think that the medical stuff is outsi of my expertise and you’re we in the best place for medical care, Alastair.  I hope that they can help your swallowing problem soon.

0847

From sister Marian:-

I’m off to the Marsden Hospital soon for my radiotherapy penultimate treatment. It can make me feel unwell but not always. What happens then I have no idea.

0902

From brother Jim:-

Good luck Marian

0920 hrs

From Alastair:-

Much love, Marian - you’re always in our thoughts.

My agenda include such thrills as a nebuliser and the possibility of citrus smells.

0930 hrs

From Alastair, to siblings:-

I remember Marian’s once saying that, in her many years as a physio, she was always interested in helping stroke patients. The physios here are doing heroic work with my neighbour, a handsome senior man maybe in his seventies, who hasn’t spoken (and has rarely opened his eyes) for days. Very interesting. His three differently stylish daughters were all here yesterday afternoon - I wanted to tell them “You should see him at 3am, when he makes noises and does movements that you’d be impressed by, if only you could see him do them now.”

0933 hrs

From Alastair, to siblings:-

I’m on the nebuliser now.

1005

From Marian:-

I’m on my way to Sutton for radiotherapy. It takes half an hour +. A few minutes treatment then back again.

1007

From Robert, to Alastair:-

I hope that it helps clear your throat.  Would I be able to come and see you tomorrow?  If so, what are the visiting hours?

1008

From Marian:-

The driver and nurse accompaning me are two of the largest I have ever seen!!

1010

From Alastair, to siblings:-

Marian, I hope that is both funny and reassuring.

1021

From Alastair, to siblings:-

The visiting hours at the David Ferrier ward are 2-7pm. At present, you are advised to bring no food or drink, though heavens I long for (and am approaching) the day when that is no longer true!  UCLH is at Queen’s Square: nearest tube is Russell Square (Piccadilly Line).

1040

From Alastair, to siblings:-

I’ll just report that the speech therapists today brought FOAM from Lipton’s tea (peach flavour) and from Oasis citrus flavour. They reckoned that I swallowed just over 50%. I thought less. But the whole experiment was utter heaven.

I also liked the nebuliser.

Am trying, not very well, to cough and cough.

1214 hrs

From Alastair, to siblings:-

Apparently my pulse/heart-rate is high today, so they are not pushing other aspects of of physio.

1705

From Alastair, to siblings:-

I’m re-watching “The Crown” on my phone. So very remarkable and interesting, even after a third viewing.

1739

From Alastair, to siblings:-

My food all comes via tube without taste. I feel no serious hunger at all, but the therapy experiments with the froth of flavoured drinks are very intense experiences for me.

1815

From Alastair, to siblings:-

Froth is heaven.

I clean my teeth various ways, sometimes with a brush, sometimes with a finger. Toothpaste is of course major sensory overload - very delicious.

Thursday 28 November

From Alastair , to siblings:-

Good morning. Happy Thanksgiving!

Much of the day’s drama here occurs between 5.30am and 8.30am, even before the beloved therapists come, let alone before any visitors from the outside world.  So this morning I have walked with assistance to the loo (same ability to pee, same inability even to open bowels) and back; the balance problems are still present, but I can walk, at least with a nurse standing by. I then had my morning liquid feed and hydration, but now, at my request, have had a laxative added. Excitement! Plus other medication. My vocal cords remain coated by mucus/gunk, so I can only whisper.

Have also used toothpaste (heavenly flavour - pretty basic). Oh and my first go today at the nebuliser - so marvellous.

The therapists come soon. I am hoping for three visitors - Caroline Streatfeild c.1230, who is coming to UCLH for an outpatient appointment (she was treated for cancer here); brother Robert; my friend Fiona, who was at school with me in 1972-1973.

16.12

From Alastair, to siblings and to friends:-

The man (quite unconscious and largely immobile) next to me is being visited by his brother, who’s exclaiming “It’s not fair! Paul doesn’t smoke and he scarcely ever drinks. I can’t get out of bed in the morning without a can of Heineken and my sixth ciggie, but I don’t have anything wrong with me.”

Friday 29 November

0700

From Alastair, to siblings and other friends:-

Good morning! Today began at 6pm (not that I had slept much anyway) with (a) an accompanied walk to the shower (my balance still has bad moments), but (b) yes a SHOWER, albeit seated but naked oh joy and alone , with best of all (c) PINK GRAPEFRUIT GEL, which in terms of sensory overload is right up there with the foam of citrus juice and Liptons tea. Utter bliss, which I managed to spread everywhere, using it also as shampoo. Now, back in bed, the best thing is to run my hand through my (fairly untidy) hair and smell smell smell the wholly ravishing pink grapefruit gel. Some people like lowering taxes, some people insist on musical education for everyone, but for me it’s grapefruit shower gel that does it. I think it should be made universal, though i understand that there will be debate about this in the Himalayas and the Nile Valley.

0810 hrs

From Alastair, to siblings and to other friends:-

By 8am, we patients are almost exhausted. I have had one nebuliser (fabulous), various drug cocktails including laxatives (still ineffectual but it’s okay), blood-thinners, stuff to keep my heart-rate lower, and so on.

I now have to be very very strong as the breakfast people will bring TEA and TOAST and other thrills that I cannot take. You may have admired my self-control hitherto, but believe me when it comes to other people’s drinking the tea I crave, I reach new and dizzy peaks of heroism, especially when I can smell it.

0947

From Alastair, to siblings:-

Good if slightly scary news is that I am being prepared for transfer to my lovely previous hospital, the North Middlesex, its rehab unit. I know no timeframe, but at any rate this means they (like myself) are starting to see me as no longer one of the acute stroke patients that are the specialty of this hospital. I will keep you posted!

1420

From Alastair, to siblings:-

No signs of my being moved.

1723

From Alastair, to siblings:-

<attached to a YouTube video of “Kitty 3” from the Victoria Wood show”>

This is Kitty’s greatest. Everyone should know it off by heart. (“I thought Now what would the Queen Mum do? - So I just smiled and said ‘We shall have fog by teatime”) https://www.youtube.com/watch?v=bSYZSFiLKJY

1756

From Alastair, to siblings:-

Harry <younger son of my sister Marian> and Margaret <my second sister> came to see me: wonderfully welcome too.

1801

From Alastair , to siblings:-

Since then, I have had the joys of an enema, the second enema of my life. Well, it achieved what it wanted to achieve,  though not in a big way.  I still can’t swallow.

The woman opposite me is being difficult about the warm soup her daughter has lovingly made for her. My sentiments to her are less kind than they should be.

Saturday 30 November

0902 hrs

From Alastair , to siblings and friends:-

Currently, I’m still in the David Ferrier Ward of UCLH (University College London Hospital) at Queen Square. I will report if and when they transfer me.

Tha great excitement of last night was my enema. Having had laxatives over the previous twenty-four hours, I think it was fair to hope for more blasting results, but heigho, a little something did happen.

I was woken at 12 midnight for one X-ray and stayed awake till maybe 6am, during which I was taken for a second X-ray. The main object seems to be whether the tube down my nose (which I confess I loathe) is sufficiently far down for liquid food to be administered.

The most touching part of the night was with a pair of French African nurses who tried to insert, into my upper and outer hand, the needles that then can be used for injections, blood tests, etc. But as a third nurse gently said to me:- “You have become a pincushion.” (Say it with the emphasis on the final syllable). So everything - including my ardently anticipated trip to the shower with PINK GRAPEFRUIT GEL - is waiting for something else to happen.

Nonetheless a chap needs his thrills, so I have been taking small mouthfuls of Volvic water flavoured with lemon and lime - stuff I drink by the bottle anyway. Because I can’t swallow, this is always mildly perilous until I spit out all the blissful lemon-lime water - which (a) often makes me cough (something the medics like me to do) (b) leaves my mouth with a wonderful lemon-lime feeling that usually I take for granted but this week strikes me as nothing short of divine. More soon!

0942 hrs

From Alastair to siblings and friends:-

So the two ingredients of heaven on earth are:-

(A) Pink Grapefruit Shower Gel

(B) Volvic Touch of Lemon and Lime

There is nothing (else) I want for the rest of my life.

1207

From Alastair, attached to a video of himself in a nebuliser mask, to siblings and friends

Now you may perhaps not realise from this video that it portrays a man in a state of Nirvana equal to those achieved by Volvic lemon-lime tastelets or by Waitrose pink grapefruit shower gel, but live and learn! This is a man having his first nebuliser of the day. Usually, each will last fifteen minutes and there will be four in all. These transform the air, making it moist and even scented: it also makes deep breathing deeply rewarding. They’re on the noisy side, so I am probably the least popular chap in the bay while it lasts , but oh oh OH a chap does need his sublimity.

1248 hrs

From Alastair, to siblings and other friends:-

Sad news is that the nebuliser then came to en end. Good news is that I then remembered to shave.

0841

From brother Jim:-

I think that the nebuliser has something else in it. All this talk of Nirvana etc. - wacky backy or stronger. I think you are getting like John Mortimer’s description of Coleridge- “green around the gills and a stranger to the lavatory “! Much love

Sunday, 1 December

0839 hrs

Group email from Alastair to siblings and other friends:-

Good morning. Richard Fairman, friend of fifty-one years and a month, visited yesterday - his third visit in a week, bless him - this one at my obsessive request. Yes, reader, he brought

(a) Volvic Touch of lemon-and-lime

(b) Volvic Touch of Strawberry (Sugar Free)

(c) Lipton Peach Ice Tea at my request but also in the name of experiment

(d) Press Probiotic Water (Pomegranate and Raspberry)

(e) Press Probiotic Water (Mango and Pineapple).

Since I still can’t swallow, all I can do is rinse my mouth with each of these, but ah! what joy this brings me. My mouth tingles, again and again. Such are the rewards of Richard’s and my having being the two men of the five new classics students at Clare College, Cambridge, in October 1973.

No sleep last night for me - two or three of the six patients in my bay are in strange zones of speechlessness and delirium, with a lot of roaring and moaning. My bed is now is the fifth position it has had in seven days: the things they do with wheels and curtains at various times of day mean that lo! suddenly a new patient has materialised out of nowhere, while another whom I was getting to study with fascination has suddenly vanished.

Robert <brother> brought me P.G.Wodehouse (“Blandings Castle”), which is bringing a kind of bliss I had neglected for too many decades. And my friend Felicity sent me a single Scarlatti piano sonata, the kind of amazing seven-minute piece that transforms time and thought and place while you listen. The pianist was Yevgeny Sudbin (new to me); I went onto listen to it with other pianists too, all of them making me marvel at the music. Since Scarlatti (exact contemporary of Bach and Handel) tends to be one of the great composers one hears way too seldom, this was a mind-opening gift.

0841

From my sister Margaret:-

Good for Richard and other friends. XM

2112

From my brother Robert.-

I think the only Scarlatti I know is choral music; that’s all I can think of.

We’ve just been to a concert of Advent carols and hymns and other seasonal choral music sung by a choir from Woodbridge: Illuminati.  It was absolutely lovely.  I’ve not heard Oh Come Emmanuel in Latin before, though Mary tells me that she sang it in Latin at school.

Are you still in UCLH?

Tuesday 3 December

0808 hrs

Group email from Alastair to siblings and other friends:-

Good morning. My apologies for relatively long silence. Yesterday was enough to confuse anyway. Around 8pm, they were all ready to  transfer me to my other hospital - North Middlesex - but then didn’t. I forget why - I think because they are still bothered by my low oxygen.

I won’t say I haven’t slept, because I distinctly remember being woken by one of the many charming medics here whom I could have killed at the time.

At one time yesterday, I was told they had taken me off all antibiotics. This puzzled me, as nobody had told me I was clear of the lung infection (it has been called pneumonia, but not always). Earlier today, however, I was told I was being returned to antibiotics for that.

Welcome to life in hospital. Everyone is charming and kind to you, and everyone is grateful to you if you show signs of intelligence, but actually few people remember to tell you the important bits of your medical news when they are being decided. Possibly this is because, as with yesterday evening, the medical decision (to transfer me to North Middlesex Hospital) was postponed.

And truly it is hard to remember some things. I know I have once been brought to X-ray at midnight and again at 3.30am; someone asked me yesterday evening rather fiercely if I had been three times to X-Ray that day, to which I replied that, although I could remember being taken twice, I could not remember more than that.

Ah well. This morning, they took me very charmingly to X-Ray at 3am - in my bed, rather than in a wheelchair - all to no avail.  Although usually X-ray is manned at 3am, for some reason it was empty this time. I was returned to the ward, but I remembered at least to use the trip to check where everyone else now was. Paul, who was my largely lifeless neighbour in Bay 5 for three days before showing signs of improvement, is now is Bay 2.)

More later as I come to understand my situation. For example, I asked the nurse who just now took my blood pressure why the oxygen inhaler now fixed to my face comes with a six-inch (plastic) rectangular beard. She did give me the explanation. I have of course forgotten it.

There is more to say, but I’ll try to say in updates. It was lovely to see all FIVE of my visitors yesterday.

Victory! They have just removed my plastic white beard.

Hugs

Alastair

0823

From sister Margaret:-

Sounds grim: how you keep going amid all that I don’t know: well done you! All the very best and loads of love. Margaret xxxx

0846 hrs

From Alastair:-

PS. One reason I am unkeen on having visitors just now is that I have THREE different tubes feeding into or from my nose. The shame, my dears, the shame.

0922

From brother Jim:-

Courage, mon brave! Well done with dealing with all that.

1012

From sister Margaret:-

Courage indeed! XxxM

1134 hrs

From Alastair, to siblings and to other friends:-

These two photos show opposite ends of the same window in my hospital ward.  Read the request in purple (“Please keep window ledges free of items) and you know which end mine is.

1559

From brother Robert:-

How are things today, Alastair?  Are you still at UCL hospital?

Have you been able to shower in Pink Grapefruit gel?

1617 hrs

From Alastair:-

I’m hoping to shower and in Pink Grapefruit Gel - and to shave , MAYBE not in Pink Grapefruit Gel - later this afternoon.

For the third day running, I am having a good many silent hiccups, which aren’t painful but are a trouble, coming in spasms.

<My sister> Margaret, who could not have been kinder, was nonetheless (and rightly) cheered by how much better I seemed today - maybe you can ask her. We also had a better series of medics for Margaret (and me) to ask questions of than we did yesterday.

Progress: I have been opening my bowels, if not in any epic way, for a couple of days now. I never get to walk enough, but always now walk to the loo and back, slowly and strangely but not painfully.

And Chi, probably my favourite nurse, had just given me the nebuliser, for I think the third time today. We take our bliss where we find it; and we do.

Much love

A

1708hrs

From brother Jim:-

I will speak with Margaret and I send my love to both you and Marian.

Wednesday 4 December

0159 hrs

From Alastair:-

Off to North Middlesex Hospital at 2am! I’m not kidding.

0415 hrs

From brother Robert:-

Oh Alastair.  That’s dreadful!

Are you in North Middlesex Hospital now?  I hope you manage to get some rest.

I’m hoping to see you tomorrow.  Is there anything you’d like me to bring?

0442 hrs

From Alastair:-

The voyage was not without excitement and thrill.

The arrival was hilarious - I asked the two lovely ambulance people if I could walk with them, because I hadn’t done enough walking exercise in the last ten days - but we none of us had any idea how long and hard a walk it would be at 3.15am to find the Acute Stroke Unit. Fortunately, the ambulance woman and ambulance man were brilliant walkers, so we glided over even the sequences when I was almost permanently off kilter.

Now I am in a SINGLE ROOM! With private bathroom. I wonder what the view will be be.

Please bring any of these you can :-

    Lipton’s Peach Iced Tea;

    Lipton’s Lemon iced tea;

    Volvic Touch of Lemon & Lime

    Volvic Organic Black Tea Peach.

Now I will try to sleep.

0546 hrs

From sister Margaret:-

Well done Alastair and ambulance staff. I do hope you got and get done sleep now and hope very much the North Middlesex hospital is a much more conducive environment in which to recover. Gosh you’ve got to be fit to survive the NHS. XxxxM

0603 hrs

From brother Jim:-

Shuuuuuussssch

0742 hrs

From Alastair:

The voyage - London at its quietest , with Christmas decor everywhere - was just one first element of strong drama to the day.

I’ve told you of the hilarious arrival (starting at 3.15). The next stage of arrival - somehow it took them yonks to do an ECG of me - was dispiriting, but the two nurses (one male) were kind and good. Eventually, I was left alone, in my single room, whereupon I learnt how to find more or less everything (which had all been put out of the way) AND finding I could walk around my suite better than anticipated. A doctor came at maybe 4.30am and seemed to think that I was sane. Their issue is how quickly to release me: I can walk, after all. But at present I do need various medications that have to be injected into me somehow, along with liquid food and hydration. More later this morning when I meet another doctor.

Finally I managed ninety minutes sleep, and to feel the benefit, before being woken by a fabulously terrifying African staff nurse who shouts as nobody has done in my orbit for centuries. She looks at me - very directly and imperiously - as if deciding whether I would be best flayed, boiled, or casseroled, but she has soon learnt that I am the obedient type and we are now getting along okay.

More soon.

0801

From my sister Margaret, herself an experienced nurse:-

Magnificent: can picture her: BEHAVE! Hope you get lots of the 3 Rs : rest, rehab and recovery. XxM

Ambulance people sound wonderful.

0805

From my brother Jim:-

I don’t understand why she didn’t casserole you but pleased that your charm won her over. We are all hoping that the 3 R’s are the top priority now. Much love

0817 hrs

From Alastair to siblings:-

Reggae, Rumba, and Raspberry Margaritas for me!

From Jim Macaulay.-

Your R’s require a reassessment (say that carefully)

1036 hrs

From Alastair, to siblings:-

That tongue-twister makes me very throaty indeed.

1751

From Jim Macaulay.-

Pip and I are in London with Meg, James and Rosie on Sunday morning. Could Pip and I visit you on Sunday afternoon?

18.15

From Alastair:-

I’d adore that!

18.25

From Jim Macaulay:-

How are the mucus clearance, balance practice, and swallowing therapy going?

1855 hrs

From Alastair:-

I think it’s best if I keep you posted on all that - I think you know I generally do. Of course we work on it, but it’s hard for me to give a report on all the above when for various reasons (remember I slept less than two hours last night) I can’t report progress each day. Some things may not change for weeks in the future: we’re dealing with the inexplicable here. But I’m in good hands and like my therapists here.

1859

From my brother Jim:-

It’s great that you like your therapists.

1920

From my sister Margaret:-

Glad you like your therapists. XxM

2218 hrs

From my brother Robert:-

That’s really good to hear.  I’m not quite sure what time I’ll get there tomorrow.

Thursday 5 December

0215 hrs

From Alastair, replying to Robert:-

How are you getting here?

By all accounts, then allow another fifteen minutes for actually finding the entrance.

0731

From my sister Margaret:-

How are things in your new abode Alastair. And Marian , how are you? Lots of love to both. XxxxM

0749 hrs

From Alastair - group email to many friends as well as family:-

Good morning.

Somewhere amid the many interruptions of the hospital night, I managed to sleep an hour or two, but it feels a long time ago. Still, my evening shower was a thrill - I must have doused myself six times with Pink Grapefruit Shower Gel - and I have now almost forgotten the problem of discovering my bathroom had no towels. (It has them now.)

The hospital atmosphere here is very unlike UCLH. We stroke patients here are each in large single rooms with windows. Nurses or therapists or doctors or others all make dramatic entrances, even though sometimes the drama lies in its being a complete stranger this time, sometimes with all the proudly magical bearing and theatrical impact of a character from “King Solomon’s Mines”, who arrives to ask the same f*cking questions I get asked at least four times a day: What is your name, What is this place, What is the date including the year.

Things will doubtless keep changing , but just now - 7pm - my lungs feel free of infection and/or serious phlegm. The main irritation of the last four or more days has been a form of strong silent hiccups (or sometimes not so silent , but not with any hiccup sound, quite a lot of voice instead). The specialist doctor yesterday explained to me that this quite often accompanies the inability to swallow that I’ve had all along.

The physiotherapists I saw yesterday got me doing much more walking than I had done since my stroke, and allowing me to experiment with speed and changes of direction. I do sometimes make the oddest stumbles or refusals  or errors, but - baffled though I am - I try to carry on as quickly as I can. (Not so easy at age sixty-nine.). And they have got me into exercise games/tasks that really seem unworthy of a child of seven until you actually do them, when you find that walking this zigzag followed by walking over each of those three objects followed by stepping up into that little island, changing direction on it, and so on is all in fact of a technical difficulty you now rate far higher than any merely Olympic assignment. And you do it again and again , getting worse as often as you get better.

From the way the specialist and physiotherapists were talking, I understand that they are seriously hoping to put me in one of this hospital’s recuperation units. (NONE OF US KNOWS WHEN.) What’s going well for me is so obviously going well for me.

The speech therapist introduced herself yesterday, but could see I was zonked after a busy morning, so will be back today.

Richard Fairman and Richard Jarman (“Fairperson” and “Jarperson”) both visited yesterday, both full of news and plans but also wonderful at keeping their visits short. I love visitors more than most, but it is hard to explain how exhausting a hospital day can be. Nobody gives you a formal schedule, so that it is only later that you sometimes realise that that two-hour slot when you saw nobody and did nothing of interest was actually the one slot when you could have had some sleep. The lack of which - oh the anguish.

I am complaining more, which must mean I am getting better. Oh and probably the most depressing (if unsurprising) thing was the news from the specialist that the inability to swallow does not have a neat time pattern. It may last days,but it really may last months, and maybe more months.

Watch this space!

Much love

Alastair

1404

<from sister Margaret:-

How are you feeling about your new place, therapies etc. Alastair? sounds good that you are going to be worked quite hard. I am amazed at how well orientated you seem. My brain is still trying to get used to being back in Edinburgh. I’ve spent this morning decorating the church for Xmas , including Xmas tree etc. I managed to lob the fairy on top more easily than some years.

1406

From brother Robert:-

I’ve just left Alastair.  I arrived in the middle of a session with the speech therapist.  She is Irish and I think that she was trying to explore Alastair’s situation.  She spoke clearly to him and listened well.  She seemed very able and explained things well and gave him some exercises to do.

The room is a spacious one for a hospital, clean and orderly.

1408

From my sister Margaret:-

Sounds good. Great that you visited. XM

1450

From my sister Margaret:-

So good that the Richard’s are visiting: good for them: how kind.

Friday 6 December

From Alastair - group email to many friends as well as family:-

06.49. Good morning all. I will report later about yesterday, but certainly it was mainly a good day for me. My thoughts today are all with Marian and her transfer back home. Much love, Marian - keep us posted as best you are able.

09.29

From Alastair:-

1.And good morning. (The internet here seems to go through a blip every morning, but this morning’s is longer and blippier.) Blue, cloudless skies, sunshine making horizons matter. I’m seated by my window, facing (I think) south-west (the window faces southeast). I smell of Pink Grapefruit Gel from head to toe and am trying to work out which would be best, a world in which everybody smelt of Pink Grapefruit Gel or one in which only I smelt of Pink Grapefruit Gel. One of the major existential inquiries of our day, you must agree.

2.Yesterday’s speech therapist, Clíona, was excellent, testing and stretching me in various ways that tended to make me laugh in a positive way. How long can you make the sound Sss on one breath? How long the sound Zzzzzzz? (The latter uses the vocal cords, the former doesn’t.) How long can you sustain the vowel Aaaah? Despite my recurrent silent hiccups, I seemed to maintain each sound for upward of ten seconds, so hurrah.

Clíona also was the first to confirm that my love of rinsing my mouth with various flavours is actually a medically desirable thing. Before she came, I had even had some tea (thanks to the physiotherapist taking me to the patients’ kitchen) AND had tried some secret gargling. You can imagine that gargling feels a very healthy and important exercise when you can’t swallow , though only if your breath supply is in good order. When Clíona heard about it, she smiled approvingly before vetoing it because of the danger. Any liquid that might go down the wrong way can cause another lung infection - and lung infections are the chief dangers at this stage of recovery. (It’s by no means clear that I’m entirely rid of the last one, though much of the time it seems absent.)

As explained, the physios also came, testing me on all the things they felt I should be tested on for possible return to civvy life; I think I passed fairly well.

The main bore is that i have to spend hours of the day attached to one or more feed or whatever. I look up, and there is the Sword of Damocles above my head, or rather the plastic box suspended from the top of the mobile apparatus. At present I am reaping the benefits of liquid food Jevity (1.5 kcal), which looks like processed bananas but which of course I can’t taste. Also up there on the gibbet is a nearly empty bag of Compound Sodium Lactate. Later on, I will be injected with blood-thinners and more.

It is 9.15am: I await the marvellous physiotherapists and speech therapist. I’m less keen on the nurses here, but I see the structural problem : the architecture of the ward tends to make them not see the patients most of the time (we’re all in large single rooms), so that they forget that their calls to each other often feel jarringly loud to us, and indeed that any of their words to us would be more effective quiet rather than in their loud persuasive French-African genre, which still tends to rattle me as if awakening me from the dead.

Some wonderful visits yesterday : one from my eldest brother Robert, one (a complete surprise) from my old friend and student and critic-colleague Sophie Constanti (she and I go back to 1980), who has wonderful tales of her architect partner Paul and their now adult daughters Laurel and Emmeline and a recent visit to Cyprus (where her recently dead father began life). Her father had been in a Norfolk stroke unit at the end, so we compared notes at length, amid much laughter about much else. Interestingly, since I taught her dance history and started her career as a dance critic, we never spoke of dance once!

Now I shall go down the corridor with my gibbet and make some TEA. Tea is not a thrill in the league of the other flavours to those of us who cannot actually drink! -but it really does have a calming effect on the mouth.

Much love

A

0941

From my sister Margaret:-

Very glad it was mainly good for you yesterday. Thinking of you today Marian and hoping things go as easily as possible. Lots and lots of love to you both. XxxM

Saturday 7 December

08.42

From Alastair - group email to many friends as well as family:-

Good morning.

Yesterday was full of things that went well for me, I think. I walked more, both within the ward and downstairs outside the ward. I tried swallowing more ice crystals than before, apparently successfully all.  I did most of my walking without support and have become used to making my own way to the patients’ kitchen to make tea for myself. Since I still can’t drink and since the tea is one of the kinds I find dullest to the mouth, this is a peculiar exercise, but nonetheless I can feel the benefit of swilling a hot brew around my tongue and teeth and cheeks. I have made my first attempt excursion to the main hospital shop: I forgot to buy Earl Grey teabags etc, but it’s wonderful to have Colgate toothpaste now as well as to add a couple of new flavours to my catalogue (“Vitamin well, Hydrate - Vitamin C + D, Zinc + Biotin, rhubarb/strawberry” not to mention Lipton’s Raspberry Iced Tea).

I even managed to put in a few hours’ more work on Monday 9’s sellout “Nutcracker” event at New York City Center Studio 5 - this year’s insight event to show there is always more to say about “The Nutcracker” than anybody realised - this time going into unknown aspects of the amazing music and into three of the ballet’s solo male roles. Of course, all British “Nutcrackers” (except Matthew Bourne’s when well performed) are vile, so it is a nice paradox for me, here in London, to focus on the great Balanchine production over there.

William (Relton) came to visit me at 5pm: his first appearance at this hospital . Conversation ranged from British and American politics (never has either of us felt such despair for the future of the world) to travel and family, but there is no doubt that the most important event in the cosmos today is his debut performance at Snow White’s stepmother at the OSO Theatre Barnes. Let’s hope I’ll be able to see the performance for which I bought seats on December 20.

Much more important than all the above is how my eldest sister Marian is faring after courses of radiotherapy and other treatments. I could itemise everything about my own health and care that are frustrating and problematic, but I’m aware that basically I’m a healthy person coping healthily with a few blips.

Much love

A

Sunday 8 December

13.18

From Alastair - group email to many friends as well as family:-

Good afternoon.

I am the youngest of three strong-minded and clever brothers; and my father was the youngest of three strong-minded and clever brothers too, born between 1903 and 1909, farmers who each knew vast reams of poetry and history.  (There are and were clever and strong-minded sisters too, but let’s concentrate on the men just now.) Maybe around 1971, my father’s middle brother, perhaps the most brilliant of the three, had a serious stroke. My father was much affected - the two had often seen each other socially - and was a very good visiting friend to his brother; but my uncle never really recovered, and died, I think, in the late 1970s. Around 1981, my father (in his early seventies) had a medium stroke; but he’d learnt from having observed his brother. With my mother’s help, he determinedly fought his way back from a much more severe stroke than mine until, within six months of his stroke, he was driving and writing and playing golf again - all of which brought him great satisfaction for the next eleven years. Later, but only when he was in his eighties, various later strokes and T.I.A.s took their toll. He died in 1998 at age eighty-eight, in the fullness of time and surrounded by love.

So when several of you compliment me on my stoically positive attitude or whatever, I can tell you that I learnt it by observing my father. He, however, might put it differently. He had been a mainly strong and very healthy man, whereas I, the youngest of his five children, had more health problems when I was little than the rest of the family had ever known. My father, when he visited my bedroom, was rather embarrassed by his inability to help; and, though I think I knew he loved my spirit and cleverness, his embarrassment tended to register on me the wrong way. But this led to the best payoff line of my life. When he had his (?) 1981(?) stroke, I was maybe twenty-six, he seventy-two. I remember visiting him some five days after the stroke. He was doing his stroke exercises in their bed in their bedroom , and saying his five vowels -  “A-E-I-O-U” is a good exercise for those whose speech has been affected - and I just sat quietly with him for a while. Then he said “I keep thinking of you, when you were little. You were so ill, and you never complained. I’m trying to be like that now.” Well, my eyes filled then and they do now when I remember that: deeply moving.

Recovery doesn’t always feel like recovery (though, when I see how I can now walk out of the ward and take the lift down to the hospital shop, plodding rather than walking but nonetheless with no accompaniment and easily turning corners and changing speeds, I certainly do see I am recovering). On the one hand, I depend (somewhat) on a NG tube , which is fed into my stomach via my nose: that tube delivers food and some medication and hydration. On the other hand, fewer than 50% of medics can lodge the NG tube safely past my throat area. (And a couple of times I have accidentally rejected the NG tube, sometimes just by having a good cough, even when the tube has been in situ for days.) More often than not, the insertion of the NG tube - virtually undetectable when done by the right nurses - feels more often as if Europe’s main pipeline is being lowered into me, making contact along the way like ski-lifts or North Sea gas stations. I’m fairly stoical while all this happens, but what’s terrible, after I’ve been left alone with The Tube, is the discomfort caused by it, especially when the sense grows that its end hasn’t arrived in or near my stomach .

On the one hand, they don’t use the tube until I’ve been x-rayed. (I’ve had more X-rays for this in the last two weeks than in the rest of my life.) On the other, a hanging NG tube in my cavities tends to cause saliva, recreations, phlegm - all the stuff that I’ve been strongly warned could cause another lung infection and thus reverse all the other progress I’ve made.

So yesterday two NG tubes were inserted, at different points. It took an X-ray, after five hours, to establish that the first one hadn’t approached the stomach area enough. I lived with the second one for maybe eighty minutes, but by that point I just had to beg (or tell) fthem to remove it - the fairly tiny area affected had begun to feel like The Somme.

You see therefore that I can be as difficult a patient as anyone. Still, yesterday brought its pleasures - I really do walk by myself out of the ward and down to the main floor without fear or trouble now, and the thrill of my day is what to buy at W.H.Smiths (which forms of iced tea or flavoured water). How bonkers that tea and water that I CAN’T drink are so exquisite and exciting, but I bet no wine-taster gets thrills more intense than mine.

More anon tomorrow, I dare say. Much love to y’all,

A

Monday 9 December

09.17.

From Alastair - group email to many friends as well as family:-

Good morning from the Acute Stroke Unit, North Middlesex Hospital. And let me begin by establishing that the night nurse and I agreed last night that I am the healthiest and least acute patient in the ward.   

Yesterday evening, I began to absorb the amazing news of what’s going on in Syria - with its connections to (implications for) so many other countries - Russia, Ukraine, Iran, Iraq, Lebanon, and more. Even so, it had been a long day, so I ended it with sleep. Hurrah. This, however, is a hospital, so someone woke me before midnight - I really can’t remember why. Anyway, somehow this led to me sitting up on the side of my bed in the small hours (while sampling at least eight different flavours of water/tea type drink! AND while dealing with one attack of silent hiccups after another), listening with total fascination to podcasts on how the Syria situation has evolved over the years. I already knew from the “New York Times” that Assad had flown to Russia and that Russia had been unable to keep him in power because of its deeply awkward commitment to its invasion of Ukraine, but now I’m trying to understand a bit better how all this has been coming to pass. (And Trump’s new social-media announcement - characteristically Putinophile - that everyone should stay out of this local brouhaha makes it all the more fascinating.)

So I managed to spend yesterday without any NG-tube (my choice) and therefore without any liquid food. That was fine, as far as I was concerned. I’ve already asked for a nurse to try implanting a NG tube today - I’m ready. Let’s hope it works this time. But if not, today’s Monday return of physiotherapists and other medics should bring someone who can handle a NG tube for me.

Yesterday - no NG tubes, no liquid food - worked well. My brother Jim and his wife Pip (they will have been married fifty years next May) arrived as visitors in the late afternoon: maybe my most gratifying visit to date because they had seen me in so much worse form on previous visits. So of course I showed off, walking them around the ward, making tea for them in my patients’ kitchen, taking them downstairs and back. (Much more important, they told me all about our sister Marian, whom they had just visited in hospital in Tooting. She’s dealing with constant pain from tumours in her back and elsewhere, but with characteristic courage.)

There’s always another medical layer to existence. I’ve always had (literally) very thin skin, which seems to be growing thinner with age. At present, this means I’m looking like a pincushion, with marks left by the various blood tests and injections that have been taken. Yesterday, after my first walk downstairs, I realised that a cannula had become detached: the cannula (I hope I use the word correctly) is a single needle that feeds maybe four other needles - including blood tests, injections, hydrations, and more. It was hard for them to find any remaining skin area that would show a big vein. Well, they found it (photograph attached), but let’s hope it’s a long while till they have to find another. During the period when this one hadn’t yet been inserted, I became evidently more dehydrated - with bad effects everywhere.

Fortunately, the new cannula meant they could attach me to a zonking great Plastic Bag of Damocles, suspended from my portable (wheeled) gibbet, which has been hydrating me ever since. I wheeled it around with me when Pip and Jim were here. It probably helped to steady me a couple of times - though the main excitement of the past three days has been in discovering how easily I can now walk (well, plod) without support, including those little moments when we all recover balance without falling.

Onward! Much love

Alastair

Tuesday 10 December

0855

From Alastair - group email to many friends as well as family:-

Good morning.

1.The big event of yesterday came around 6.15pm when I was taken down for some endoscopy. It was explained to me that, first, a tube with camera would be lowered via my nose to see if my lungs etc. would permit a new NG tube. Since I had gone almost three days without food (très suffragette), I was quite keen on this.

Meanwhile, however, I had become neurotically convinced that my ongoing hiccups were related to some of the fluids in my system - not least the flavoured fluids I have so loved swilling around my mouth. So I sat there in my wheelchair in the endoscopy department (a basement, I think) trying hard to “hough” and hough and hough - big dry coughs that one hopes do move bits of fluid or mucus or saliva or gunk. Well, maybe they achieved something. After twenty minutes along came a good-tempered and good-humoured endoscopist - funny, bless him - who explained intelligently what they were going to do. I said I was all for it, but I would love it if some local anaesthetic were involved.

Guess what? It was. In fact, when I was taken through to the slab (my word, not theirs) , after much amusement about the TOTAL lack of visible veins in my arm and the TOTAL impossibility of ever being able to take any blood from me, they then ripped out the last cannula and inserted a new one (don’t ask - I didn’t), the two bits of local anaesthetic they applied to me (nostril and throat) soon had the effect of a lovely total anaesthetic. Half an hour later, I woke up , feeling fine, gradually aware that I now had a working tube down my nose again. I won’t say it’s invariably comfortable, but mainly it’s fine. Hurrah!

Nobody has yet told me how my lungs or vocal cords were looking, though.

2. Other good news had come that morning from physiotherapist Glenn, who claimed I had shown sufficient ability to balance etc., when showering standing up, to be allowed out into civilian life.

Actually, I have further skills to regain. In the afternoon, a second physio gave me some fairly intricate coordination exercises (walk successive zigzags, walk forward in steps that connect the toe to the heel, step up and down a single step with various elements of turning and retrograding) that showed me - in a good way- how much room for improvement there remains. That’s all fine; I enjoyed the exercises, and (mainly!) improved.

3. Still, my problem with swallowing remains. My impressive specialist, Dr Bhargava, took me through a couple of the possible solutions - I’m afraid I can’t now remember them in sufficient detail to explain anything to you - but please don’t assume that any transformation of my swallowing can be guaranteed in days or even weeks.

I hope to sound slightly more enlightened in the days to come! Meanwhile I have been attached to liquid food and to occasional hydration. In a couple of days I’m bound to be the fattest patient in the stroke unit.  But you knew that already.

Much love

Alastair

11.41

From my brother Robert:-

Thank you for the update; it sounds generally positive but I think you should take great care.  I think that it’s relatively early days.

Wednesday 11 December

09.21

From Alastair - group email to many friends as well as family:-

Good morning.

Yesterday, my niece and goddaughter Hannah arrived and surprised me with Pink Grapefruit Shower Gel WITH GINGER, with various new flavoured drinks, and with Matt Kennard’s fascinating new book “The Racket” about the global pervasiveness and influence of the American military (Hannah and I are the two most leftwing Macaulays by several light years). She also observed me through a fairly intensive therapy sessions (a) answering silly questions (b) swallowing ice crystals.

Later on, further physiotherapy sessions worked on more ice crystals to get me swallowing better and more frequently; and to be yet more coordinated and balanced in walking zigzags and single steps and toe-to-heel walking, and in balancing on one leg (even with eyes closed, at which I am hopeless).

All that is good news. Less good was the news that my swallowing problem is not something that can now be solved overnight. We are talking weeks at least. I will have further questions, but that’s a sobering place to end for now.

Love

Alastair

09.26

From my sister Margaret:

All the best Alastair. Trying to work in brief visit next week.

18.03

From my sister Margaret:-

I have a ticket down to London starting early Monday morning 16th Dec and hopefully will make my way up to visit you Alastair, then will head down to you Marian and return Thursday 19th. XM

Love to all from a frozen Edinburgh.

Tuesday 12

10.45

From Alastair - group email to many friends as well as family:-

Good morning from the Acute Stroke Unit of the North Middlesex Hospital. I’ve been afflicted by guilt: yes, as I reported yesterday, my niece Hannah on Tuesday brought me Pink Grapefruit Shower Gel with Ginger, but she ALSO brought me Pink Grapefruit Shower Gel with Basil. Only this morning did I remember to use it: it’s another total winner. What bliss in the morning at waking up whole zones of one’s inner and outer being.

Meanwhile my quest for flavoured drinks has brought me into the hallowed zones of Aqua Libra Sparkling Water Infused with  Cucumber Mint & Lime (also one infused with Raspberry & Blackcurrant; and another combining Blood Orange & Mango), Tango Apple, Volvic Touch of Summer Fruits…. I never imagined my mouth would be so very sensually responsive to such trite-seeming sources of paradise, but there you are: we take joy where we find it.

Other thrills yesterday included my first steps outside the hospital - with two physiotherapists. Yes, I crossed the zebra crossing; yes, I investigated which bus routes I might use; and so forth. My balance was not always impeccable amid this; but nobody else had to steady me; it was a lot to absorb; and so on.

Curiously, the day included two or three injections in my stomach. Do you remember having injections in your bottom? I had hundreds of those when I was little, but the bottom is evidently now a no-go zone. Tummies are in!

My specialist, Dr Bhargava, prepared me for the next stage in recuperation, namely the prospect of a “peg”. This means that, instead of depending on a NG tube through the nose for hydration and liquid food, I would receive food via some apparatus at the side of my stomach. This may occur next week. Don’t ask me the details yet.

Gradually, during the afternoon, it emerged more firmly that they are discussing moving me on. The choices are mainly to a rehabilitation unit in my neighbourhood or just to my home itself. The issues will concern self-feeding, self-hydrating, and managing medication. They’re evidently still deciding. I made clear I was keen to go home. We’ll see.

In the afternoon, Sally James Dickson visited me: the oldest or longest friend with whom I have never lost touch. We met at school, in September 1972; we even shared a flat for two years before her wedding in 1979. For my first year as a critic, I typed my reviews either on her typewriter or on that of her husband-to-be, Tim. This July, she came with me back to Felsted (our school) when I was asked to do the big speech day speech (to an audience of some eleven hundred people - scary or what?). So it is a friendship that has already run quite a gauntlet now. It did my heart good to have her here. Paradoxically, she said that I look very well, but then, paradoxically, so says everybody else too.

And maybe they’re right. In the evening, I managed to get an early night. Wonder of wonders, I slept an unbroken six hours. Just as well, since the hospital day started early today: it’s now 10, and I’m on my third nebuliser (each lasts fifteen minutes) and have lost count of the blood pressure tests. I could do with another sleep right now, but I’ll bet nobody’ll give me a chance until this evening.

Further adventures tomorrow! And much love

Alastair

19.38

From sister Margaret:-

All the best to you both. I have a ticket to London on Monday and hope to see you both, so please let me know Alastair of any change of residence as I would probably go from Kings Cross to you first.

20.25

From Alastair:-

I shall be at the North Middlesex, as far as I know. But I’m told that I’ll have a “peg” procedure that day, and therefore may be sleepy some of the time.

20.47

From sister Margaret:-

Oh yes! Gosh I remember PEGs but a while ago. Good luck!!

Friday 13 December

0908

From Alastair - group email to many friends as well as family:-

Good morning on Friday 13 December. There are various songs about Nelly or Elly The Elephant, but my generation’s went like this:

“Nelly the elephant packed her trunk

And said goodbye to the circus.

Off she went with a trumpety-trump,

Trump, trump, trump.”

Since I have been living for four days with a white tube that descends from my nose just past my groin, I have been feeling pretty damn Nelly. (But how I love the song’s premise that Nelly could pack her trunk anyway.) This morning, in between lathering myself with Radox Pink Grapefruit Gel With Ginger, I found myself singing (not very audibly) “Nelly the Elephant packed her trunk

And said goodbye to the circus.

Off she went to assassinate Trump,

Trump! Trump! Trump!”

That cheered me up a LOT.

My situation changes daily. Doubtless it will go on changing. The specialist in charge of me is Dr Bhargava, an impressive, authoritative, and experienced man, perhaps aged fifty: I spent all yesterday waiting for him to arrive , but it seems he was doing the big mid-month assessment of each of his patients, taking so long on Them that he never reached Me at all. (Remember, I am the healthiest person in the ward. And British hospitals do their best to try to get all their patients out of the ward for a night or two at Christmas, which must be steeply uphill work in many cases.)

Nonetheless he had begun his tour of the ward with a 10am discussion of all his patients with the physiotherapists and others, with the effect that two of them subsequently visited me with their accounts of What Dr Bhargavan Said. First, the date for my PEG procedure - fitting the Nelly NG feeding tube/whatever to my stomach rather than my nose - is Monday 16. (

Second, according to these physios, Dr Bhargava thinks that, when I leave hospital (probably some time before Christmas), I should not go to my own home but to a recuperation unit, because I should be near to medical aid and medication at that stage. I must admit, I immediately felt this to be right (grrr).

What we all hope can be done now, should God and Dr Bhargava approve, is for a camera to investigate all the mucus/phlegm/gunk that is still intermittently very evident around the top of my torso - around the trachea and vocal cords. This is what’s still limiting my voice. For weeks now, it’s just been sitting there like a cloud above my chest. If it gets out of hand, if could infect the chest lower down. Such a relatively tiny part of the physique.

My hiccups continue to come and go, but yesterday my physiotherapist Clíona and I realised that they very occasionally have an alarming capacity to stop me breathing in when I need to breathe in: I find myself locked, mercifully for only few seconds, until either the hiccup or the intake of breath wins. We plan to raise this with Godot - I mean Dr B. - when/if he appears today.

Other thrills yesterday included further injections to my stomach. Perhaps , because of waiting for Godot, I made only one descent out of the ward and down to the main ground floor of the hospital. To anybody civilised, the ground floor must seem banal - but to us patients it’sa rich bazaar…. because it contains the branch of W.H.Smith’s from which we buy our flavoured drinks.

It’s just past 9am. I am fully dressed in my armchair, redolent of Pink Grapefruit Gel, in old clothes generously lent me by my brother Jim. Let us hope the next three hours bring Godot Bhargava (whom I really admire) AND the physiotherapists. Hope springs eternal.

Love

A

Saturday 14.

09.46

From Alastair - group email to many friends as well as family:-

Good morning on Saturday 14. You could make a whole opera out of what happens in my hospital room each day, albeit one without any narrative impetus. From 7am onward, individuals burst in with tremendous panache, announcing who they are and mispronouncing who I am. Half of them have never entered this room before, half of them will never enter it again, but in they charge, with their various questions and announcements: “How do you stand the cold in this room?” “Your name is aLAStair MACaulay.” “Have you opened your bowels today?” I am especially fond of those who discuss what I like to drink and eat. And then they vanish, cheerfully prepared to terrorise some other patient whom they will never encounter more than once. You just have to love their chutzpah, applaud their aria, and enjoy them before they depart forever.

Yesterday, Friday 13, was a truly Godot today, since my hero Dr Bhargava did not materialise in the ward at all, let alone in my room. I assume this is because I’m the healthiest person here (and he saw everyone else on Thursday). Still, a person does feel slightly slighted.

Still, today is Saturday 14; it’s three weeks since I had my stroke on Saturday 23 November; I have spent the last ten nights in a large single room with capacious private bathroom. All this has been on the National Health, with nobody mentioning money to me in any form or on any level. My fantasies of assassinating anyone in charge of the healthcare system are zero. News of Luigi Mangione seems to come from the other side of the cosmos. <Mangione is the American who has been identified as the suspect in the December 4 killing of Brian Thompson, the CEO of United Healthcare.>

Jarperson (Richard Jarman) visited late yesterday afternoon when I was at my throatiest and hiccuppiest. He could understand me, but through what felt like ten inches of mucus and saliva and phlegm. They had actually medicated me against hiccups a little before his arrival. In consequence, I had hiccups throughout his visit and for the ensuing two hours.

This apart, he told me of his recent adventures in New York: in particular the Siena exhibition at the Met Museum and “Die Frau ohne schatten” at the Met Opera, but also an important negotiation with the Dance Division of the New York Public Library for the Performing Arts. Also last night he saw Stoppard’s “The Invention of Love” with Simon Russell Beale; he had a much better experience than my friend Alice, who, an SRB fan, saw SRB three nights earlier but found him off form. I reviewed the world premiere of “The Invention of Love” in 1997, and saw that original production at least twice more, before seeing three later productions from New York to Palermo. So you may imagine how much I long to have been there: it’s an imperfect yet great play, SRB is an imperfect yet sometimes great actor, and here am I stuck in hospital, ô rage ô désespoir.

Sarah Papineau, who has known me on both sides of the Atlantic for more decades than is polite to mention, has sent me an amazing box of goodies at the centre of which was Sonia Purnell’s “Kingmaker” biography of Pamela Churchill Harriman: an irresistible explosion of international politics, sex, money, that reappraises a woman who was long rubbished as just an ambitious floozy. How could I resist?

Well, one thing could slow my resistance: sleep. I am happy to announce that last night I slept for three hours and then for a further six hours. The world now takes on a more serene aura.

Marian, tell us your latest.

Much love

Alastair

13.30

From my sister Margaret:-

Glad you had a good sleep, Alastair, and that you have the entertainment of visitors but sympathise hugely with you over your hiccups, phlegm build up etc and missing out on NY theatre , general arts etc. Wishing you lots of courage and patience and love .

XxM

Sunday 15 December

09.23

From Alastair - group email to many friends as well as family:-

Good morning on Sunday 15 December. Cry freedom! Yesterday’s great adventure occurred when - brace yourselves - without telling or consulting anybody, I took an Über home, to my house in Bowes Park (N13).

I knew that the hospital would turn this venture into a much bigger logistical deal than it was, so it was one of those things I just had to do at the right time. Most afternoons, hospital allows you two or three hours when nobody attaches you to any tube or checks where you are. At 2pm, off I went to the ground floor, called an Über, and poop poop the open road!

The journey is twelve minutes door to door. Since I was sporting my Nelly-the-elephant white nasal tubing (as much of it tucked into my sweater as possible), I felt distinctly peculiar, but the driver behaved as if he had many such passengers a day.

Once home, I managed to check the heating. It had switched itself completely off anyway! (Don’t ask.) I climbed the stairs three or four times - no problem. I collected a few choice items: an electric toothbrush, a couple of books, a spare pair of shoes, a scarf, some spare underpants and vests, and so on. It was all so easy that, now I’m back in hospital, I’m fantasising of nipping back on sunny afternoons to do some gardening.

(“Glorious, stirring sight!” murmured Toad, never offering to move. “The poetry of motion! The real way to travel! The only way to travel! Here to-day--in next week to-morrow! Villages skipped, towns and cities jumped--always somebody else's horizon! O bliss! O poop-poop! O my! O my!”)

Back in hospital, nobody had missed me - I’d been gone less than two hours. It wasn’t long before one of those never-to-be-seen operatic characters burst into my room cheerfully announcing “What d’you want for dinner?” Now, it is over three weeks since I’ve had any dinner. I could have exploded at her. But no. I had sampled freedom, the open road, and home.

Much love

Alastair

0930

From my brother Jim:-

While I applaud your two hours of freedom and all that it has done to your confidence, please remember what happened to Toad. Much love, you reckless rooster, you!! Bravo!

0947

From sister Marian:-

I am staying where I am. I potter about. No helicopters today so far.  The sky is blue and the sun shining 🌞

0950

From sister Margaret:-

Love to both and  be CAREFUL. XxM

1005

From my brother Robert:-

Wowee Alastair!   What larks, what larks!  But while you’ve still got an ng tube, gardening is probably not advisable.  Our garden is pretty wet.

I’m pleased to hear you are pottering about, Marian.

There’s a grey sky here but our prunus sargentii and mahonia are flowering 😊

Monday 16 December

07.43

From Alastair - group email to many friends as well as family:-

Good morning on Monday 16. I have eight nephews and nieces I love, all adults and all parents themselves. Bless them, despite the other calls on their attention, they’ve all been in touch; and, though only one of them lives in London (outer London) (three of them live in Devon, Ireland, and Cardiff), three of them have managed to visit me. Yesterday, my niece Katie made her second visit to me (and, more important, to my sister Marian, who’s in hospital in Tooting and is weathering far tougher medical challenges than I). Katie, remembering the ward at UCLH I shared for eleven days, marvelled at the spaciousness of my current abode - large single room, commodious private bathroom - and gave me a good thumbnail description of how Marian is faring now that she, after weeks of radiotherapy and more, is bring given steroids again.

Otherwise Sunday 15 was desperately quiet. Today has been long flagged as the day when I’ll have my “PEG procedure” (“percutaneous endoscopic gastrostomy”, try saying it in one breath), whereby my food (still liquid, still untasted) will go direct into my stomach…. Really I don’t think I want to know any more about that, do you? I dare say I’ll be more curious After The Procedure. Anyway, since yesterday, people have kept popping in to tell me I’m not to eat (I can’t anyway), I’m not to drink (I can’t anyway), and then they keep me in mega-suspense by assuring me that nobody knows when The Procedure will occur. Somehow I have developed a notion that by the end of the day I will be twenty-five years old, with long blonde hair, and answering to the name of Clo-Clo. Let’s proceed to The Procedure!  Watch this space.

0840

From my sister Margaret:-

Am on the train to London arriving about 11.00 and plannned to visit you before Marian. Let me know if you are invisible because of PEG procedure. XM

09.20

From Alastair:-

I honestly don’t know when the Peg procedure will be, but possibly morning rather than afternoon

10.00

From Alastair:-

They confirm the procedure is likely to occur this morning. I am unlikely to be unconscious for long

10.07

From sister Margaret:-

OK : I’ll take Pot Luck. I can always explore your hospital emporium. XM

Good luck!

11.32

From Alastair:-

Am being taken down for The Procedure (11.30am)

13.20

From Alastair:-

I am returning to the ward!

13.38

<from sister Marian>

I hope to be discharged if the CT Scan 👌 and 👍

13.52

From brother Jim:-

Fingers crossed

14.57

From Alastair:-

Quick note to say that I was returned from unconsciousness and from the basement endoscopy section at 1.30pm - and who was waiting for me in my room but Margaret? Wonderful.

1505

From sister Marian:-

How and why uncomsciousness? I am waiting to be discharged. It’s all more complicated than I expected.

15.09

From Alastair:-

I was unconscious while they did a procedure on my stomach, Marian, so that now food goes straight to my stomach rather than by way of a NG tube in my nose.

15.32

From brother Jim:-

I hope that you are feeling OK, Alastair after the anaesthetist and PEG procedure. Good luck, Marian, with getting discharged. Much love to both.

16.58

Two different sorrows to report:-

My friends W and X had been desperately hoping for a grandchild from their beloved daughter Y. Y and her partner Z have had the child, a boy; W and X travelled to join them. But (W writes) “The baby is severely but not mortally ill. The brain is affected, alas, although exactly how remains to be seen. They are trying to control brain seizures and have lowered their intensity but not eliminated them so far. Y herself was hospitalized for a few days, but is out now. She is simply broken hearted still in shock, as who would not be, and very afraid of a disastrous long-term prognosis. Z is a pillar of gentle strength.”

And a different loss: the great critic Arlene Croce, to whom I owe so much, died this morning, aged ninety.

Tuesday 17 December

12.54

From Alastair - group email to many friends as well as family:-

Good afternoon on Tuesday 17. You will all be beside yourselves with excitement to know that yesterday, at 11.30am, I was wheeled down (with the help of the lift) to the endoscopy department (in the hospital basement) for my PEG procedure. (I can pronounce the three words Percutaneous Endoscopic Gastrostomy - though it’s tricky not to say Gastronomy instead - but for the life of me I can’t remember all three of them off by heart.) There was one hell of a lot of waiting , during which I was suddenly asked to sign various forms, presumably saying that anything that went wrong was all my fault, but which were largely just waiting-room tedium. (There’s nothing to read, for minutes. You even have to surrender your phone.)

The existence of a hospital patient is so largely passive that you lose the trick of any independent initiative. Down there in the endoscopy department, when someone asked me to get up and move myself onto a trolley, I was shocked, as if this was an unreasonable request in view of my intense incapacity. Then I was shocked again to realise that of course I could do that simple task perfectly easily.

Anyway, the surgeon and his colleagues introduced themselves (though in a manner that firmly implied I was just another supporting act to their immensely entertaining central act). The next thing I knew, it was 1.30pm and I was being wheeled back into my room here - where my beloved sister Margaret was waiting patiently, fresh from the train from Edinburgh.

Margaret is really a saint, though an exceptionally self-effacing one: she worked for decades as a health visitor and district nurse, but she also applies her mind to such vital non-medical matters as laundry, so she gathered together all the used shirts and underwear she could find, planning to pass it along the family line - mainly to another saint, my sister-in-law Mary, who will do the actual washing - and to return it to me tomorrow. Margaret, the second of us five Macaulay children and wife to the gallant Hamish, has returned to London more to help our eldest sister, Marian (first of the five). Marian’s existence with metastatic liver cancer has been far more complex and troubling than anything I’ve been through, though she - fifty years a physiotherapist - is, like Margaret, an exemplary patient. (A few of you have ticked me off roundly for having been so impatient a patient as to take an Über home on Saturday afternoon.) And Margaret effortlessly makes it her mission to come south to help us both.

I must say, these are the times when I’m moved to be part of a family. Sometimes weeks and months go by when I’m less in touch with my siblings than I am with my other friends - but put me in hospital and hey presto! sisters, brothers, sisters-in-law, nieces, nephews all come to lend support and concern. It’s moving; it even changes my sense of my place in the world.

Margaret then moved to visit Marian (and to stay in Marian’s house, in Wandsworth). I spent the evening quietly, slept maybe five hours, and then went on resting into the morning. Dr Bhargavan, visiting at 10am, was pleased to find my voice improved; Clíona, my wonderful speech therapist, gave me ice crystals to swallow - something I often do for her three times a day, five days a week - and at once said that these were my best swallows since she had met me two weeks ago.

Looking at the PEG is odd! (One has to roll up one’s upper garments to see it.) It’s like a big safety-pin bizarrely attached above my navel, but the feeding tube is attached to it too. It feels neither comfortable nor uncomfortable. Everything is operating as it should, though I miss the old hydrations, which seemed to pour cool water right next to my heart, whereas the new ones are at belly level.

Tomorrow they hope to send a camera down me to check all the gunk above my trachea that has been occluding my voice for three weeks. Dr Bhargavan and Clíona are as inclined to be optimistic as cautious medics can be. The results may affect whether I’m sent out to a recuperation unit before Christmas, but on that score I know nothing more.

Now, therefore, I shall shower myself in Pink Grapefruit Gel before descending to the metropolis of the ground floor - well, W.H.Smith - to restock my diminishing supply of Flavoured Fluids For The Non-Drinker. Such, such are the exhilarating highs of life in the Acute Stroke Unit.

Many thanks to all of you who’ve been sending messages. Please be sure that every word is eagerly received and fondly appreciated.

Much love

Alastair

Wednesday 18 December

08.42

Group email to many friends as well as family:-

Good morning on Wednesday 18. I attach two pics of beloved William Relton, who visited yesterday afternoon. Your task is to guess in which of the two he is giving us a very subtle foretaste of the stepmother in “Snow White” with which he is delighting the good people of Barnes. Richard Fairperson and I have seats for the Friday 20 performance, but we all admit I am unlikely to make it to Barnes in - heavens - two days’ time.

Bless him, he has sometimes been giving three performances a day, but he made time to cross London to this hospital in N18, his second visit here (and he visited me twice when I was in UCLH). He met my marvellous speech therapist Clíona, who, always intelligent and always clear, took us through what she hopes will be achieved by the on-camera investigation of my throat via my nose. I confess I felt somewhat alarmed when she mentioned the possibility that some damage to my vocal cords will be permanent, but I accept that they have to investigate every aspects and possibility. Her best hopes are that they will film me (within my throat area) swallowing an ice crystal and then a little amount of water.

This is a short bulletin. I have managed quite a bit of sleep in the last twelve hours, though I remain baffled as to why they chose to wake me at 4.45am to take my blood pressure. Next to events in Syria, Berlin, Moscow, Paris, the Acute Stroke Unit of North Middlesex Hospital is not too seismic. Thanks for following.

Much love

Alastair

08.30

From Margaret:-

Alastair , I see you are having an investigation today . I had planned to visit you maybe 11.30/12 midday ( difficult to judge times) but is it best I abandon that plan?

Your investigation could take a while. Mx

08.32

From Alastair:-

Jim also hopes to come maybe around 1230. I know nothing more about today’s throatoscopy than you, but my own guess is that it will be very local and without anaesthetic.

0835

From sister Margaret:-

I’ll let you know. First morning of care resuming here for Marian then Ed is involved with Hospice assessment midday after which he returns to Kent so I’ll liaise with him first. Mx

10.41

From Alastair:-

Come whenever you want, Margaret. The throat-oscopy will be local, in this very room, at 2pm.

16.48

From Alastair:-

Requests have been overwhelming for photos of William as the stepmother in “Snow White”. As yet I have none, but here are pics of the DOUBLE role he played at the same venue’s “Jack and the Beanstalk” (Jack’s mother and I forget what shameless villainness).

19.19

From Jim Macaulay:-

It was good to see Alastair’s progress. The major ones are: Alastair can now reverse swallow to some extent which enables the spitting out of phlegm/ mucus- 10 days ago this wasn’t possible. Alastair can walk (balance) well which again is an improvement worth noting. I also am impressed with the amount of reading that Alastair is achieving. I just hope that the staff remember that sleep is vital to good brain recovery and stop waking him up at 4.00am to take a blood pressure reading which could wait until 6.30am. The endoscopy showed that the right side of Alastair’s throat/voacal chords etc. is weaker than the left. This results in air escaping incorrectly through the vocal cords creating a slightly raspy sound. The strength imbalance to that area means that the chords do not seal correctly thus protecting the trachea when swallowing. The speech therapist was really pleased with the endoscopy and what it told her.

Thursday 19 December

11.56

From brother Jim:-

The hospital has just phoned me to inform us that Alastair is due to move today(time not determined yet) to The Magnolia Unit, St. Michael’s Centre, Enfield, EN2 0JB. Tel: 02087025690. Anyone planning a visit today needs to check his location before visiting because the hospital couldn’t specify a time for the location change.

From sister Margaret:-

12.08

Thanks Jim. I hope the Magnolia Unit is comfortable and gives good care and rehab.

12.12

From Alastair - group email to many friends as well as family:-

Good afternoon on Thursday 19 December. Yesterday , Wednesday, brought four visitors - all siblings: my sister Margaret (no 2 of us five) from 10 till maybe 12.30, my brother Jim (no 4) from around 12.30 till maybe 2.30 (they overlapped briefly), and then our brother Robert (no 3) and his wife Mary from maybe 3 to 4. Wonderful to see each of them.

In the middle of all this, a marvellous team of two women came with my speech therapist Clíona to send a camera down my nose to inspect my throat - what I call a throatoscopy. I then was asked to swallow, to cough, to swallow, and so on. Jim (who was present) and the three women could watch the enlarged results on screen. Next I swallowed single teaspoonfuls of milk dyed pale blue; and then to cough and to swallow. And so on to strawberry-flavoured yogurt (oh the bliss to the alienated mouth!). They made all this interesting and amusing; and I’m a good sport, I do all these tests as full-out as I can, though I’m here to admit my swallowing powers still leave much to be desired. Jim, a better observer than I, flatteringly sent this report to our siblings that evening:

“It was good to see Alastair’s progress. The major ones are: Alastair can now reverse swallow to some extent which enables the spitting out of phlegm/ mucus- 10 days ago this wasn’t possible. Alastair can walk (balance) well, which again is an improvement worth noting. I also am impressed with the amount of reading that Alastair is achieving. I just hope that the staff remember that sleep is vital to good brain recovery and stop waking him up at 4.00am to take a blood pressure reading which could wait until 6.30am. The endoscopy showed that the right side of Alastair’s throat/vocal cords etc. is weaker than the left. This results in air escaping incorrectly through the vocal cords creating a slightly raspy sound. The strength imbalance to that area means that the chords do not seal correctly thus protecting the trachea when swallowing. The speech therapist” (Clíona) “was really pleased with the endoscopy and what it told her.”

I add that, when I asked if they would now recommend exercising the “vocal folds” (their expression) to achieve greater parity, they said no, their prime task at this stage was simply to improve my swallowing. With luck, much else falls into place around that. But they seemed pleased with the progress I’ve made, slow though it often seems to me.

In the evening I remembered the virtues of sleep and an early night, so I tucked myself up under two hospital blankets and was asleep, the lights at their lowest; some time well before 8pm. Need I tell you that I was then woken maybe three times between 11 and 3? For some reason there had developed a blockage in the package of liquid food that hangs fatefully above my bed (the Pack of Damocles): the night staff took it upon themselves noisily to rectify this, often leaving on the lights while they vacated the room for half an hour.

Ah well: I can look upon that (wearily) now, because this morning has changed everything yet again. My niece and goddaughter Hannah (the second of Robert’s three daughters) came to join me for an hour, during which one and then another member of the medical team entered to announce that I was probably , that I was probably, no, finally that I was definitely being moved to a Rehabilitation Unit (“Magnolia”) today: when we do not know.  Hannah left me to pack for this excitement. My nephew David (Jim’s son) is due to arrive early this afternoon - though whether I will be here then we know not. As I have said before, watch this space.

Much love

Alastair

<1219>

<from Margaret>

Good luck Alastair. I hope your new place gives good rehab. I seem to remember you’ve got stuff in most cupboards so worth a double check that things don’t get left behind. Xxxx and hoping you get more uninterrupted sleep amongst the magnolias. XxxM

21.49

From Margaret:-

Sorry to hear about this, Jim but v glad you have help for this now. A friend of ours has had this machine to overcome his sleep apnoea for a good few years and I believe it is v beneficial. Hoping Pip can cope with it.

Friday 20 December

<1446>

<from Alastair - group email to many friends as well as family>

Good afternoon on Friday 20 December. You will remember that, having had a stroke on the morning of Saturday 23 November, I spent the eleven nights of November 23-December 3 in University College London €Hospital and the fifteen nights of December 4-18 in North Middlesex Hospital, in each case in the Acute Stroke Unit. In UCLH, I was always in one six-bed bay or another; in North Middlesex, I was in the same single room, with spacious  private bathroom. In both places, I soon felt I was the healthiest person there.

So yesterday afternoon I was transferred to Magnolia Unit. Where is Magnolia Unit ? You may well ask. Even the driver got lost. We were stuck in so many traffic jams that I became convinced Magnolia was way north of the Shetland Islands, I’ve still no clue of its postal address, and, when I asked for the wi-fi half an hour after arrival, they calmly told me it had broken down and there would be none until tomorrow. Truly it felt as if someone had found a good way to wipe me off the record and off the map: address unknown, WiFi lost.

But I think we’re somewhere in very north Enfield. (My house is near the southern edge of Enfield.) Magnolia, which I think is a rehabilitation unit, is one of a small village of hospital-connected buildings, though I think they are not connected to one specific hospital. (Medics here ask me which hospital I came from, so I deduce that patients are brought here from multiple medical locations.

My bay has four beds, with so far one or even two of them left unoccupied. Again, I’m much the healthiest person in the bay, and much the youngest.  The two men currently sharing this bay with me are scarcely distinguishable from their bedclothes: they lie there immobile most of the time, incapable of sitting up unassisted. As in UCLH, some of the dementia cases are pathos itself; one man - whose first language seems to be English, spoken with a southern African accent I’d say - will be quiet and immobile for hours before suddenly emitting very theatrical and very loud roars of “God almighty!” or (equally histrionic) “It doesn’t matter”, both of which seem prompted only by his subconscious, never by anything here. But there are many professional actors who lack his command of voice: maximum vibrato effortlessly deployed, way more than an octave in range, easy range between forte and piano. (He’s just broken into song while I’ve been writing.) One man here, probably in his eighties, is being visited by his wonderful wife: he only joined us at 5am this morning, but I’d already realised he was sane and lucid before she materialised. Today is their sixty-first wedding anniversary. “And we still love each other,” she adds tenderly - which I well believe from watching them: he is so much more focused when he’s talking to her, and she’s the warmest, kindest person we see.

What else? There’s no WiFi until well after Christmas, but I’m hoping I can send this by paying. Although official permission has not yet been given, it looks as if I can go stay with brother Jim and his wife Pip from the afternoon of the 24th till the second half of the 26th, as long as I can show on Monday 23 that I have mastered how to administer my own liquid feed.

I have been given new swallowing exercises for the coming weekend, with the prospect of further ones on Monday 23. I’ve done a little balancing on each foot, and some walking up and down (a very few stairs). It’s possible I may be able to walk out to a SHOP; I’m sure it will feel like the whole of Oxford Street combined. This place really shows you the less glamorous side of the National Health Service, but I am learning from it.

Much love

Alastair

Saturday 21 December

09.49

<from Alastair - group email to many friends as well as family>

So this is a dull weekend in the dull Magnolia Unit, but not entirely dull for me, because I have much to learn. I can only be released on Tuesday 24, for forty-eight hours, but only if (a) I have mastered the art of injecting myself with liquid food - more complex than you might imagine (b) I have mastered the yet more elaborate art of administering three kinds of medication, each of which are pills that require to be crushed with mortar and pestle.

Meanwhile before then I have to do the following swallowing exercises (try them too):-

1. Masako (Tongue Holding). Bite your tongue with your teeth; then swallow gently (much harder than you might anticipate), making sure your tongue is still between your teeth. Do this five times, relaxing after each one.

2. Effortful Swallow. Swallow with a lot of effort, squeezing the muscles in your tongue and throat. IMAGINE THAT YIU HAVE A GOLF BALL IN YOUR THROAT THAT YOU ARE TRYING TO SWALLOW. Make this swallow as long as possible , keeping it strong and effortful. Do this five times, relaxing after each swallow..

3. Effortful Pitch Glide. Say “aaaah” or “eeee” sound from a low pitch to a high pitch. THEN do a good strong swallow. Breathe out and relax. Do this five times.

Now do all these exercises three times a day (my speech therapist proposes five times).

Okay?

The two elderly men with whom I’m sharing this bay are still immobile and silent much of the time, but David comes to life when his wonderful wife of sixty-one years visits; and today I hope she will be delighted to see how much more animated he is. William, the black African with the startlingly theatrical voice (Gielgud and Olivier could compete to produce some of his vocal effects), is seldom in the same world as the rest of us. Just now, he’s singing quietly, a slow melody that nobody else can recognise: his characteristic vibrato throbs away , so that , like everything from his throat, it all sounds deeply emotional even if I suspect it’s just nonsense to him.

We continue - shockingly, I think - to have no WiFi here (none until well after Christmas). So now I shall wrap up warm and walk out to a local café (maybe ten minutes’ walk) to send this life-changingly important missive to all of you.

Love

Alastair

17.14

From Margaret:-

Well done Alastair, you have a tough number to cope with  and I admire your ability to assess the situation and make the best of it. Wish I could visit you. Do hope you master the PEG and get to Jim’s for Christmas. We have been having a joyful, interesting and active day at Ruthie and Ollie’s lochside civil Partnership ceremony for which it stayed dry, followed by soup and cheese etc at Peggy’s, then a long moorland walk and now a restaurant meal a couple of villages away. XxM

Sunday 22 December

08.44

From sister Margaret:-

Hope you learn to manage the PEG. It can be useful if the staff write down the instructions and get you your practice in front of them. Will try and send photos. XxxxxM

13.27

<from Alastair>

Good afternoon on Sunday 22. Here, when I visit a local cafe to use its internet, I order a cup of tea or coffee. Officially I can’t swallow tea or coffee, but on Friday I discovered I could actually swallow a little coffee, while yesterday I found I could happily gulp down a couple of cups of tea (once in the morning, once in the afternoon). Progress! Now I’m back at the same café, with my first cup of tea beside me. Back in the ward, I’ve also learnt that I can drink sparkling water. Again, progress!

I finished Sonia Purnell’s “Kingmaker”, her 450-page biography of Pamela Harriman Churchill, an amazing subject. “Pamela” was a British/born woman of many lovers whom many people refused to take seriously - her husbands included Winston Churchill’s son Randolph; her lovers included the broadcaster Ed Murrow, Gianni Agnelli the head of Fiat, Aly Khan, one of the Rothschilds, and dozens more (a great many of whom truly wanted to marry her and/or felt she was the love of their lives) - but who ended up not just being Bill Clinton’s choice as American ambassador to France but instrumental in the Dayton Agreement between Bosnia and adjacent countries, seen by some as the last successful intervention by America acting as the world’s policeman. As a young British aristocrat in the 1930s, she was the kind of whom Nancy Mitford spoke condescendingly; in the 1940s and 1950s, Winston and Clementine Churchill evidently were far fonder of her as their daughter-in-law (even after divorce) - and she of them - than of their son her husband the unspeakable Randolph; between the 1940s and 1970s, the list of her lovers and the apartments and money they spent on her is staggering; as a leading figure in American and global politics in the 1980s and 1990s, she became industrious, galvanising, vital, while deploying only ever better her tremendous qualities and quantities of charm.

Now I’m back reading “The Swerve- How the Renaissance Began”, Stephen Greenblatt’s account of how the Renaissance began with the rediscovery of Lucretius (Roman proponent of Epicurean philosophy), a book I began in February but which I’ve been meaning to finish. It’s an astoundingly multifaceted (and highly readab that includes a grasp of the libraries and learning and scribes of mediaeval Europe, the cultural effects of early mediaeval Christianity upon the mind and the character of secular life in an era dominated by Church thinking, the subversiveness (and nature) of Epicureanism…. Oh I’m not doing it any justice at all, but it’s deeply fascinating and mind-opening.

Back in my bay, David (surely in his eighties at least) has been visited by his wife, son, and daughter - a wonderful family to

observe, all so close and warm. The black African man I named as William turns out to be Llewellyn Williams. We hear that his grandson will visit him on Christmas Day. Today, he is largely in self-pitying mode, his voice throbbing as he proclaims (to the ward at large) “Infection is no respecter of persons!” “Think twice, think twice”, “Look at me, look at what I’ve come to. Did almighty! Hardly any skin and bone!” They haven’t been able to find his son.

I’ve been spending time on slowly acquiring the skills to inject myself with liquid food and medication via my PEG: needed if I am to be allowed to spend forty-eight hours over Christmas with Jim and Pip. At first, so many stages of the procedures seemed insuperably elaborate, but now I’ve almost mastered it. I just hope they set out in writing exactly what I should administer at 8am, 11am, 2pm, 5pm, and 8pm - different each time. It seems to me that I’m injecting about ten gallons of various kinds of liquid into myself five times a day, so don’t be surprised if I soon look like a whale. The hard thing is suddenly to change gears from reading about Petrarch and mediaeval libraries, or about Elie de Rothschild’s jealous wife, to slowly injecting these gooey quantities of gunk into my midriff.

I started today with three visitors - Sally and Tim Dickson at 9.40, my niece Hannah at 10.10. Sally and I met at school in 1972, Tim in maybe 1977. Last night, they were at a dinner (just twelve people) for our old friend Honor’s seventieth birthday, to which I’d been invited: it meant so much to hear all about it - Honor, whom I met at Cambridge when I was eighteen, is in such a good place in her life. Hannah and I have had crushes on each other since before she could speak:  I love now asking her about her politics and her three daughters, who are all at school. (Since Sally and Tim have three daughters, all now married, I now wish they’d overlapped.) Her first cousin and near-contemporary Katie wrote to me last week “I was wondering what I might need to do to get near the leftwing branch of the Macaulays?” - referring succinctly to Hannah and myself as the family’s lefties. I’ve spent days thinking about how best to reply!

Much love,

Alastair

Monday 23 December

18.21

From Alastair - group email to many friends as well as family:-

Good afternoon on Monday 23. I should have known there would be a price to pay for those unofficial cups of tea. Being honest by nature, I told various of the therapists here that I had been going out to a local café. It turns out that this was a very serious risk, or rather that they want it to appear very serious. Literally, I had to sign a form saying that I knew the risk I was running , because technically people in my condition who drink even tea unsupervised run the risk of “aspirating”, that is, imbibing something that might go down the wrong way.

Well, what the hell: I signed. Yet it then turned out that they’re secretly delighted I had the cup of tea! - as I’m accelerating a process that would otherwise have been delayed by the weekend and then Christmas. So they then examined me drinking liquids with various head positions AND tested me spooning a whole minitub of delicious custard into my mouth. Tomorrow I’m being started on toast! Ah the rewards of illicit behaviour.

Tomorrow, I go to stay with brother Jim and his wife Pip for forty-eight hours. For this, I have undergone training so intensive that you’d think I were being prepared for a month-long assault course. Do you remember my PEG? I’ve had it for a week - yes, seems like a year, I know. Well, my PEG is now the conduit through which I inject myself with both liquid food and medication - really a somewhat gruesome process: the food five times a day.

But tarry a little! It turns out that each nurse has her own way of administering the medication (do you mix the separate pills before crushing them?) and is intolerant of other methods. This morning, the occupational therapist firmly told me she preferred the first, if slowest, of the methods I had been taught. Meanwhile nobody has yet given me a written list of which medications I am to take when. All will be made clear in the fullness of time, but one does wish time were a tad less full when such clarity is achieved.

So I finished Stephen Greenblatt’s brilliant “The Swerve” about the rediscovery of Lucretius helping to trigger the Renaissance, with an amazing emphasis on erotic love amid expositions of natural physics. And now I’m about to start (or recommence) Colm Toibín’s “The Magician”, his “novel” about Thomas Mann (Germany and German culture, sexuality and bisexuality, changes in world society between 1891 and 1950). Really the great discovery of staying here at Magnolia Unit is that being deprived of internet has been a true pleasure, because it’s given me the time to, and to read in peace and quiet at length.

The two other men in my bay grow steadily less alike, though they both lack any control of their legs and they are both way more elderly than I. The increasingly demented Llewellyn Williams, it had emerged, is from Jamaica. He spent all this morning in positively religious mode (“Thank you, God, you’re great. I follow you every inch of the way. gracias. He has told me, he has written it down for me, he will keep me in his hand all the days of my life. He created the world and all that there in is. I thank you, God.”) This afternoon, he suddenly changed gear (“They take away the call button. Murderers! The worst: murderers! Destruction!”).

In complete contrast is eighty-nine year old David Holmes, who comes into focus when his lovely wife arrives, usually twice a day for a couple of hours. Last night, when she left, he murmured to her: “Love you, sweetheart. These aren’t just words”. (This after sixty-one years of marriage.) They scarcely stop speaking when they’re together: they exchange news of their neighbours, of their two children, of the magazines he’s reading (“Private Eye”, “The Oldie”), and more.

I’ll try to write again before Christmas, but in case we miss each other at this crowded time of year, have a merry one.

Much love

Alastair

19.14

From brother Jim:-

I am sure that you will manage your food procedures well. What I need to be shown is what to do if you secretly or openly choke and then aspirate. How do I help you recover?

1951

From Alastair:-

Excellent question. So we can ask it together while you’re here.

Tuesday 24 December

17.26

From brother Robert:-

We’re peeling carrots, preparing potatoes and Brussels sprouts.  I’m doing a fruit salad and Mary’s doing a chocolate roulade.  Rachel’s just come home from a day on duty; it’s a rather nice way to spend Christmas Eve.

With Mary’s and my Best Wishes to you all for a Merry Christmas.

22.21

From Alastair - group email to many friends as well as family:-

Good evening on Tuesday 24 - Christmas Eve. Although there were several “Will this show ever get on the road?” moments - the (really affable and kind) nurses and therapists who were meant to prepare me for leaving hospital for two days underprepared me in some ways and over prepared me in others - I’m happy to say brother Jim collected me at 1pm and that, after he had checked everything with those nurses and therapists, we had a wonderfully smooth journey to further Essex, reaching it in beautiful sunny weather by 3pm. We took a detour to the most beautiful part of the farm, the view north over the river Stour, and then came home to his home, Primrose Hall, where Pip soon joined us.

I had a brief slumber before joining a family FaceTime with sister Marian (in London) with her son Harry, daughter-in-law Katherine, and children Isla and Oliver, in which we talked the family talk that families should talk: Marian’s collection of nativity scenes, the gel in Oliver’s hair. A little later, we had another FaceTime to Yorkshire, to Jim’s son David, and his children Johnny and Molly. (His wife Sophie was busy, but we’ll catch her tomorrow.) What could be more Christmassy? Well, we then watched the Nine Lessons and Carols service from King’s Cambridge. I told Jim and Pip how my friend Ros Sulcas and her husband Chris, both native South Africans, had moved to New York where they had their daughters , but then had decided, when the daughters were maybe very early teens, to relocate to London, maybe around 2011. After a few months, when Ros was revisiting New York, she brought the daughter who was missing New York most, who told me over afternoon tea “New York is COOL.” A few months after that, I visited them in their London house one evening. When I asked that daughter if she still pined for New York, she said “No. Christmas carols has changed EVERYTHING.”

On that note, I wish you a merry one from my bed at Primrose Hall.

Much love and many merries,

Alastair

2239

From brother Jim:-

Alastair is expert at the administration of his food and hydration routine. It has to be repeated 5 times each day. Slightly more exciting is that he can carefully swallow soft non-structured food such as a small amount of mashed up fish pie. The trick for him is to remember to turn his head to the right as he swallows. That simple move aids the vocal cords to meet correctly thus reducing the risk of food going down his trachea. A small amount of fish pie and two cups of tea were all swallowed without mishap. Alastair can go up and down stairs with ease but I think that he will get annoyed with me soon because I insist on being downhill from him as he does so. Hopefully an undisturbed 8-hours of sleep will do him good. I hope that everyone has a very happy Christmas.

Christmas Day

07.20

From brother Robert:-

Merry Christmas to you all 🥂

07.22

From sister Margaret:-

Happy Festivities to all. Xx

08.44

From sister Margaret:-

Well done Jim and Alastair: all the best, enjoy your day. And love and all the best to all the family. XxM

08.45

From Alastair - group email to many friends as well as family:-

Merry Christmas! I’m still in my pyjamas, but have injected myself with my meds and with my liquid feed while listening to the “Ab Fab” “Reunion” on Radio 4. It’s a pervasively grey day here at Primrose, but it’s lovely to be here. Jim popped in to remind me - compassionately - of the people in the ward I’d be sharing with otherwise!

Much love

Alastair

23.33

From Alastair - group email to many friends as well as family:-

And yes: it came to pass - I ate (and loved) a puréed version of Christmas lunch, turkey and bread sauce and potatoes and Brussels sprouts. And subsequently a puréed version of profiteroles, too, which took more careful swallowing but oh the bliss. Jim and Pip took me to their daughter Katie’s for lunch: Katie, her husband Rob, their daughter Ella, and Rob’s mother Jen - always moving to have three generations gathered together at Christmas - all ate (while successfully sharing with Ella advice about eating at least one Brussels sprout), and shared the jokes and tonguetwisters and riddles in our Christmas carols. Katie and family live half an hour by car from Primrose; after I began to fade, I was back asleep in bed here (after taking my meds and my feed), before 6pm.

I’ve just woken for another hour (in time for more meds and more feed). I should have mentioned listening to Tchaikovsky’s violin concerto on the way to Katie’s. My two brothers were both farmers who knew Beethoven symphonies by heart (so thoroughly that they could run through them while ploughing the fields), but - although I knew Jim loved Tchaikovsky - I didn’t know that Jim was steeped in this violin concerto, with which I became fascinated while I was at school. He said a few words about what he thinks it’s “about” (and about what it was about for Tchaikovsky), which gave me a wonderful focus as we both listened to it in silence (Pip was already at Katie’s, helping with food). With many composers, we needn’t spend much time on what their music “means”, and in particular what they wanted to “say”; but much of Tchaikovsky’s music comes from a place that makes us ask both what it means to us and what it meant to him.

For those many of us who missed William as Snow White’s misunderstood Stepmother in “Snow White” this year, he is sharing the following photographs. We can only be awestr by the artistic majesty of his interpretation and live in hope that 2025 brings us something equally wondrous.

Thursday 26 December

22.47

From Alastair - group email to many friends as well as family:-

Good evening on Thursday 26, Boxing Day. Brother Jim drove me back this afternoon to this Magnolia Rehabilitation Unit. I must say it’s felt a lot stranger to be back here again than it felt to leave on Tuesday, even though several people have smiled happily to see me back today.

Probably this is because I made big advances while at Primrose. Between Tuesday evening and lunch today, I ate several mouthfuls each of fish pie, of a purée of the main Christmas lunch, and then of profiteroles, of various kinds of relatively soft cheese; and of champagne we well as tea and coffee. Apparently I have much more colour in my face; and I negotiated a big staircase multiple times. Oh, and I spoke to sister Marian, who is as toughly resilient as can be, wryly humorous about her two sons taking charge and about her grandson Oliver (Oliver) having his hair upright with gel.

So it’s strange to be back in the quiet deadness of the ward. The empty bed in my bay is no longer empty, though the (relatively young, somewhat mobile) man occupying it has not spoken a word. Llewellyn has been mainly silent, though very occasionally holds forth in his singularly theatrical way. David Holmes (aged eighty-nine), as fragile as when I left on Tuesday, was happy to welcome me back. He somehow amplified his final phone conversation with his wife; I’m as touched as before to hear the devotion between them, after sixty-one years of marriage.

Friday 27 December

07.47

From sister Margaret:-

It’s great to hear you improved such a lot when at Primrose. I can well imagine that it seems v strange to return to Magnolia and not v easy maybe: tricky also around this holiday time. Am wishing you all the very best. Lots of love, Margaret

08.48

From brother Robert:-

You have improved a lot by the sound of it.  How is your voice and the phlegm problem?

Lots of love,

Robert

10.02

From Alastair - group email:-

It has already been noted that I have gained weight over Christmas. Those profiteroles….

I am the worst judge of my voice and even of my phlegm. Let’s wait to see whether medics today or on Monday have anything useful to say. I’ve only been here eight nights, though, and I’m not sure I’ve seen a proper doctor since I arrived. (The sisters and staff nurses are all Impressive, if not always comprehensible to my Anglo-Saxon ear. My favourite but least comprehensible staff nurse has just assured me I’m “doing great”.) We’ll see.

11.51

From Alastair - group email:-

My speech therapist tells me I will be released on Tuesday 31. She then gave a pile of vocal and breathing exercises that I are way, way, beyond my capacity now or then.

Also I’m being put on level 4 food for swallowing.

From brother Jim:-

What does level 4 for swallowing actually mean? It was just great to have you at Primrose.

From Alastair:-

Level 4 means I can eat lasagne but not pasta.

20.12

From Alastair - group email to many friends as well as family:-

Good evening on Friday 27. The new fourth man in my “bay” is Polish, apparently without any English words at all, and therefore is a peculiar presence: occasionally noisy on the phone or with visitors, mainly silent and indeed mainly motionless, though he does have the use of his legs (with zimmer frame) and is probably at least a decade younger than myself.

My main news is that my speech and language therapist - apparently the main arbiter of my destiny in this Magnolia rehabilitation unit - has begun announcing that I should depart on Tuesday 31. Tuesday is her own last day at work that week, so that’s the last day when I should reap the rewards of her instruction. Whether I reaping those rewards is another matter: she likes me to sing a sustained vocal note for fifteen seconds or more, which I simply can’t do (I don’t think my lungs were ever good that way).

But I’ve stopped taking food in liquid form, though the food I’ve been eating is only up to level 4. (Lasagne is level 4, but pasta - level 6 - is currently beyond me. Ah the lure of upper levels as yet to be attained!) I must admit the bread I was given along with my delicious soup tonight was distinctly on the hard side - probably level 6 or upwards, a real challenge.

Richard Fairperson visited this afternoon for ninety minutes, bless him: it was his second visit to Magnolia - and Magnolia is not an easy place to reach by public transport. Who would have thunk it when we first met on our first day at Cambridge in October 1973?

On Sunday afternoon, I may try to take another Über to my house. I’m invited to dine with friends on New Year’s Eve in Vauxhall, friends who always have the best food ever - but you’ll be amazed/disappointed/relieved to hear that I’m instead going to spend the evening in bed at home. Much love,

Alastair

Saturday, 28 December

07.40

From sister Margaret:-

It’s good to hear you’re still making progress Alastair. I admire your fortitude but it can’t be easy. Good for Richard to visit you: just so kind. I wonder how you feel about going home?? Will you get any follow up??  Sending lots of love. M

08.18

From Alastair - group email to many friends

as well as family:-

I assume that many outpatients visits to hospital lie ahead. But being in control of my own time will be a joy. I suppose there will be problems - yesterday the connection to my Peg broke, which caused hours of incidental trouble - but I’m tired of being told six different ways of managing my flushes and my meds by six different nurses.

Level 4 means porridge or weetabix but not corn flakes

08.49

From sister Margaret:-

Yes I can empathise with wanting to be in control of things yourself. Hope it all goes well. Porridge is meant to be better for you than cornflakes I think specially if you make from oatmeal. All the best. Off for a Ukrainian lunch today. X

22.31

From Alastair - group email to many friends as well as family:-

This morning‘s first drama was about our purportedly Polish colleague refusing to eat hospital breakfast when his medications must be taken with food. The staff nurse had to call his son, who speaks English, to explain in his language to him that he, the patient, must eat food with his meds. All this before 9am.

Twelve hours later, we established that his language was Spanish ! - though I would guess an offbeat dialect of Spanish, as it doesn’t sound like any Spanish I’ve heard. (He’s talking it right now, very loudly, despite two of the bay’s other patients being fast asleep.)

It’s been a bad day for the rest of the bay. Llewellyn Williams, our Jamaican colleague, has veered between loud obscenities when the nurses have rebuked him for spitting on his sheets and floor; he was fast asleep when his grandson came to visit (the grandson didn’t seem too eager to waken him). This evening, he’s suddenly been very frail and alarmed of voice (two adjectives seldom applied to him before), as if both scared and dangerously weakened. The eighty-nine-year-old David Holmes has his wonderful wife devotedly in attendance much of the time between 1pm and 7pm,

but, despite the delight he takes in her, I worry that he’s losing strength rather than gaining it.

I therefore am the exception to the rule, since it’s increasingly said that I’ll be released on Tuesday 31. I’m given “real” food - but am healthy enough to find most Level 4 hospital food (all that I’m officially allowed) repulsive : it’s as if the “puréeingprocess systematically deletes all the texture and flavour out of every kind of food. This evening’s meal was so beyond-bland, so much an earthworm’s idea of human food, that I took two tiny mouthfuls before leaving the rest well alone, then charged off to the nearest Italian restaurant (ZaZa - Authentically Italian), where in delight I treated myself to risotto followed by berry panna cotta. I am now a more radiant and less aggrieved version of my former self.

Earlier in the afternoon, my niece Hannah had brought her elder and younger daughters, Lauren and Pippa. I gave them a tour of this largely quiet and somnolent recuperation unit; chatted away (or asked) about school; chatted about family; and learnt how to play Magnetism, one of those games that anyone can learn without humiliation. Only when they’d left did I remember that I should have shown them the procedure that would have surely fascinated them - my mid-afternoon injection of my own midriff (via Peg) with water (“flush”) followed by liquid feed followed by more water/flush. As far as I can tell, the liquid feed is now wholly redundant, but I’m still being given it (am still administering it to myself), though now only twice a day , until the medics are all assured it serves no further function.

I did begin to ask Lauren and Pippa about their understanding of what it is to have a stroke, and yet I don’t think they learnt anything useful about the subject from me. Above all, I still don’t know why I had one. I had (I thought) just achieved a good balance of medication for atrial fibrillation on November 22, the day before the stroke, and was starting to feel better than I had for weeks; I hadn’t drunk any alcohol for the previous four days (and no alcohol at all the previous week either). What can one say except moan “It’s not FAIR”? Heigho.

Sunday, 29 December

07.40

From sister Margaret:-

Yes, Alastair, have you asked the Drs ,

though perhaps the senior ones are off, just now, as to any reason why you had a stroke?

Shame you don’t enjoy bland, puréed food : glad you enjoyed the risotto and panna  cotta.

We had lunch with our Ukrainian friends yesterday which didn’t include their usual dumplings but their special wheat, fruit and nut dish (somehow a special part of their identity), Hannah’s version of a thinnish Bortsch, then meat….

11.53

From brother Jim:-

Dear Alastair, you are missed at Primrose. I trust that you are fastidiously following your vocal exercises. Where are you going for lunch?

21.10

From Alastair, group email to siblings and many friends.-

Good evening on Sunday 29. I ended last night by moaning “It’s not FAIR.” Today, I remembered that, exactly a month before (November 28), when I was still a patient in the stroke unit at University College Hospital London, I’d been in a bed next to a tall Englishman who never spoke and seldom moved. His brother, visiting that day, suddenly exclaimed “It’s not fair! Paul doesn’t smoke and he scarcely ever drinks. I can’t get out of bed in the morning without a can of Heineken and my sixth ciggie, but I don’t have anything wrong with me.”

I must be getting better because everything about hospital life is driving me nuts. Never mind: I took an Über this afternoon to my house, depositing all the books I’d finished here. Wonderful to see the flowers in my front garden: I attach a photo of the viburnum bodnantens with its fragrant white-pink clusters of bloom in the dead of winter - and I wish I’d photographed the winter jasmine (yellow), too.

I finished Colm Tóibín’s “The Magician”, but haven’t finished making up my mind about it. It’s painstakingly historical fiction that on the one hand gives us a huge amount of biographical detail about the life and work of bisexual novelist Thomas Mann while on the other entering, remarkably sensitively, into Mann’s nervous system and private thoughts. Both those sides are admirably done: I’m never inclined to doubt Tóibín’s envisioning of Mann’s private life. But in “The Master”, where Tóibín takes the same approach to Henry James, there are scenes of haunting force - whereas here there aren’t.

And now I’m on Orlando Figes’s “The Europeans”, which is history rather than fiction, yet really very close. The three central characters, from the mid-nineteenth century, are the star soprano Pauline Viardot-Garcia, her husband Louis Viardot (a writer and ,director), and the novelist-playwright Ivan Turgenev, who was in love with her (and portrayed her and him as Natalia and Rakitin in his wonderful play “A Month in the Country” (so much better and more multifaceted than Frederick Ashton’s exquisite but too-sentimental ballet adaptation). Since Viardot-García mattered greatly to Rossini, Meyerbeer, Berlioz, George Sand, Chopin, Brahms, Gounod, Saint-Saëns, Tchaikovsky, the whole milieu excites me.

Hospital dinner level 4 reached a new low this evening with salmon that looked as if it had been made from mould. The salmon and the two vegetables had all been arranged neatly to share the same plate like differently coloured slices of a single wet cake. I tried two small mouthfuls and bolted off to the same Italian as last night. Unfortunately the authorities here noted my absence and interrogated me on my return. “What did you eat?” When I said “Penne all’ arrabbiata,” there was a hissing intake of breath as if I’d said Swordfish Baked In Cocaine.

21.37

From sister Margaret:-

Are you watching the The Christmas Lectures BBC 4 : they are about swallowing etc this evening .

Monday 30 December

0800

From Alastair:-

Margaret, I never answered your question about my asking the senior doctors about why I had a stroke. No, I haven’t. I haven’t seen a senior doctor since maybe December 18. I wonder if I will see one today or tomorrow before being (I hope) released.

But I’m guessing that the atrial fibrillation I’d been having earlier in November and possibly the medication I’d been given to fix that were central factors. As you know, we have strokes on the Macaulay side of the family; we also have atrial fibrillation on the Craig side…. It’s odd that my stroke happened the day after I felt my new regime of medication had done the trick for my atrial fibrillation, but I dare say they were all connected.

08.13

From Margaret:-

Yes, interesting. I get the link to atrial fibrillation and I gather the Gemmills were prone to ‘bad hearts’. so maybe strokes. Father’s and Uncle David’s I always wondered were linked more to pretty heavy smoking and in uncle David’s case, alcohol.

13.05

From Alastair, to siblings:-

I have been upgraded to Level 7 swallowing, which includes everything, though I suspect I shall be cautious for a while. (But I just had fish and chips, which went fine.)

And I’m being released tomorrow at 1pm; the hospital is ordering an Über for me. I should get home at 1.30.

Then I’ll meet William for a late lunch at 3 in the West End.

Then (declining one very kind dinner invitation) I’ll come home and hope to be asleep in bed long before the New Year.

13.56

From brother Robert:-

That’s wonderful news and you seem to be making excellent progress now.  What happens to the peg?

14.12

From Alastair to siblings>

The peg will remain, we hope unused, for maybe three more weeks.

14.39

From brother Jim:-

Bravo Alastair!

15.25

From sister Margaret:-

Very good, Alastair: all the best.

20.46

From Alastair to many friends as well as siblings:-

Good evening on Monday 30. I’ve been upgraded to Level 7 swallowing. It took a few further questions before I established that this means I’m allowed to eat and swallow anything - steak, pizza.

And I’ll be released tomorrow at 1pm: the hospital is ordering the Über to take me home. How will the outer world seem after more than five weeks?

Tuesday 31 - New Year’s Eve

0909

From Alastair to siblings:-

I’m still due to go home at 1pm, but I find (not for the first or second time) that I’ve been receiving conflicting information about my Peg, my feeds, and my meds. My speech therapist - really the one in charge of me here - says I should go on taking the same meds (with “flushes” of purified water before and after) as I did over Christmas, all via the Peg. But having to take liquid “feed” is now a thing of the past; I’m eating and drinking plenty enough.

The remaining mystery is about my peg being rotated, as I was told two weeks ago it should be this week. My speech therapist is taking advice on this.

09.40

From sister Margaret:-

All the very best Alastair. Re your PEG I remember Mr Peg , the supervisory PEG man visiting you and saying once a week you should try and pull it gently in  and out a bit and also rotate it, and clean the area of insertion which seems to ring a bell with what we had to do with them at work (Mary will be more up with it than I). Also he said not to clamp the tube, though he said most people will say you should but he said two problems with PEG tubes were the tube itself wearing through or something like that and it blocking, hence flushing and not clamping he said but you maybe will be told otherwise.

09.46

From Alastair:-

I remember Mr Peg saying that, but I want someone to show me how or to supervise me the first time.

10.19

From Margaret:-

Quite right. I’d insist both in hospital and in the community.

10.48

From brother Robert:-

All the best, Alastair; I’m sure that Margaret’s advice is spot on.

17.39

From brother Jim:-

Happy New Year to one and all!

22.53

From Alastair - to many friends as well as siblings>

Here’s a short list of activities that are probably inadvisable within the first five hours of release after thirty-seven days in hospital when recovering from a stroke:-

1. Thirty minutes after returning home (via Über, kindly arranged by the hospital), taking a twelve-minute walk to the shops, five minutes’ shopping there, taking the tube to the West End, and twenty more minutes’ shopping.

2. A light two-course almost two-hour restaurant lunch with my old friend William Relton, including a champagne cocktail and a glass of house red.

3. Another hour’s shopping in the West End, with shopping filling two fairly heavy bags (fruit, wine, cereal, milk).

4. A journey back on the Piccadilly Line, including walks up and down staircases - with both hands laden with aforesaid shopping and therefore not holding rails or bannisters as stroke patients are invariably advised.

Yes, reader, I happily did all the above, of course. I mean to sound neither defiant nor smug when I say I’m feeling just fine. I’m on my way to bed soon, hoping to be fast asleep before midnight.

My thanks to so many of you for being such good correspondents during the recent weeks. Some of you are in your twenties, some of you in your eighties, some were at school with me, some have only met me in the last five years (since I returned from living in New York). Obviously I’m especially endebted to the nephew who wrote “Changes you may have missed on your stay.

“Remember when talking to strangers.

“The sky has changed to green and the new monarch is called Bob.

“People may be shy in bringing these facts up, so it's important to begin conversations with them to get it out of the way.”

But I also thank the old friend who replies to my missive of Sunday 29 December, “I can give you a recipe for Swordfish baked in  cocaine.”

They tell me it may be six months before I have full control of my voice, but I must say it held up fairly well during today’s lunch with William. I was advised in December to cancel (or postpone) my March trip to New York, but when I next see a specialist in January I’ll ask if that holds true, since I see to be recovering way faster than anticipated. I’ll also learn in January whether I have to go on administering a few feeds and medications via Peg (this morning, the medics were still contradicting one another about this) - and when my Peg can be removed. I’ll also be asking the specialist about the aftermath of a stroke. I’ve been given vocal and physical exercises to do, but they’re on the simple side: should I try going further along those lines?

I’ve also been made aware of people who, my age, have had worse strokes than mine and/or have been more traumatised than I. Not to mention people who are living with far greater pain and/or grief than I. So, despite all the weeks of stress and even if it sounds bonkers, I do feel lucky. As I’ve said, all the many friends and relatives who made contact with me - all of you - are part of my good luck. Here’s to a very Happy New Year for all of us and all of you. Much love

Alastair