My Year Off (4 page)

Boys: in the McCrum family, wherever you looked there were boys. The women seemed to produce nothing else; I have two brothers; my father would later become Head Master of Eton, the most famous boys’ school in the world, and I know that the world I’ve begun to describe here is a ‘boy’s world’. When I married Sarah my secret prayer was that, if we should have children, they should include a girl.

At Horris Hill (often known to its inmates, predictably enough, as ‘Horrid Hill’) I wrote my first novel in a Lyon Brand exercise book, a story of some one hundred pages in the Daphne du Maurier tradition about a gang of smugglers who came, as far as I can remember, to a sticky end at the Plymouth assizes. It was at this prep school that I had my first, and until my stroke my only, experience of hospital. In the autumn of 1964, when I was just eleven, I developed septicaemia in the forefinger of my right hand and was routinely treated with penicillin. The septicaemia spread rapidly and settled in the the ankle of my right leg, which became as painful and swollen as if I had suffered a sprained ankle. That, however, was not half the problem. The penicillin failed; the septicaemia raced through my body; I became seriously ill.

I was rushed to hospital in nearby Reading. The failure of the penicillin treatment meant that the ankle had to be ‘aspirated’ (i.e. drained) under general anaesthetic while the doctors found an antibiotic that was effective against the infection. Night after night I was
wheeled into the operating theatre, and once the danger was over I remained hospitalized for several weeks with my leg encased in plaster. Not until the plaster was removed would I know whether I was to be crippled for life with a ‘game leg’. As it turned out, I made a complete recovery, but I can still recall the shadow of potential disability looming as I rested at home (listening to Flanders and Swann on the family gramophone) while my parents tried bravely to prepare me for a life of physical restriction.

At thirteen, fully recovered, I cleared another academic hurdle and went to Sherborne School, in the midst of Thomas Hardy’s Wessex. The English boy’s education at prep and public school is a rite of passage that’s been described many times. I can add no thrilling detail to the shame, the cruelty and the indignity that has not already been told by others, except to observe that those horror-stories are all true, in my experience. By the age of sixteen I had galloped doggedly over these fences and got my scholarship in history to Corpus Christi College, Cambridge. Before I went to up to university, I spent eighteen months odd-jobbing (in England), drifting and travelling (in Europe), and ended up teaching English at Geelong Grammar School, in Victoria, Australia, where I learned more in one year than in the previous ten put together. After that I settled down for a while to three happy years at university, where I directed plays (including an adaptation of Flann O’Brien’s
At Swim-Two-Birds
, cheekily billed as a World Première) at the Edinburgh Fringe, wrote an unpublishable novel (moving from du Maurier to Beckett with none of the usual intervening stages either of wit or wisdom), achieved my degree, and secured a postgraduate Thouron scholarship to the University of
Pennsylvania in Philadelphia. My American year gave me an unconscious appetite for the United States that I was at pains subsequently to satisfy, and with happy consequences I could never have predicted.

Eventually, having recognized that I was not cut out for the groves of academe, or even the high tables of Oxbridge, I came home, and by some kind of fortune got a job, first as publicity assistant and then as in-house reader with the then independent publishers Chatto and Windus. I had been proud of my decision to look for postgraduate work in the United States, but in truth I was hardly deviating from a well-trodden academic racetrack. Even in London, the habits of school and university died hard. I sat in the library in my lunch hours and toiled away on another work of fiction, a perfectly dreadful comic novel, now happily lost, about a young man slaving away in a public library during his lunch hours. When I think of it today, I recall Dr Johnson’s famous put-down: ‘Your work is both good and original. Unfortunately, the part that’s good is not original, and the part that’s original is not good.’

Like almost everyone of my background and upbringing, the only unresolved questions of my twenties were: when, and to whom, would I get married? and what job would I get? These questions were both answered in April 1979, when I became engaged to my university girlfriend and was taken on as a senior commissioning editor with the publishers Faber & Faber. Thus, in the space of a few weeks, my course was set. After a number of false starts, I now published several works of fiction — from
In The Secret State
(1980) and
The Fabulous Englishman
(1984) to
Mainland
(1992),
Jubilee
(1994) and
Suspicion
(1996) — and also, from 1982 to 1986 collaborated with the renowned broadcaster Robert MacNeil
on a television history of our language,
The Story of English
.

Apart from my insignificant private struggle as a young writer in Westminster Public Library, mine was a quintessentially English upbringing of extreme security and considerable privilege. After one night in a hot, noisy, chaotic National Health Service ward of University College Hospital, I realized how much I’d come to take this sort of special treatment for granted. In the next hospital to which I would be transferred, I had a private room, the reward for twenty years of Faber-sponsored BUPA (British United Provident Association) private healthcare subscriptions. Later, as the days stretched to weeks, I discovered the limitations on BUPA’s healthcare package: the final weeks of my illness were devoted to a daily renegotiation of my right to health care as the hospital managers haggled over the cost of my room with chilly BUPA administrators, a quite different breed from the smiling and nurturing Florence Nightingales offered to the public in the television advertisements. (In the end, after some argy-bargy, BUPA came to honour their commitments.)

As I read over what I’ve just written, I’m struck by the way in which so much of my early life seems to point in some odd way towards the moment of my stroke. Of course, I know this is nonsense, that our fortune is tied up with fragility and contingency, and yet, there it is: my profound and inescapable sense of Fate, reinforced, I suppose, by surviving my stroke.

Fate, a concept familiar to the pre-modern mind, is no longer part of our everyday vocabulary and yet, even as I write this book, I cannot escape flirting with the idea that my stroke was an event that was somehow coming to me, that it was, in some inexplicable way, my destiny.
The irresistible allure of the grandiose explanation reminds me that, for all the astonishing technical advances of the twentieth century, we still possess an unquenchable instinct to make ourselves part of a story. It’s this that makes us human. Yet talk to any doctor in this vein and they will pooh-pooh such suggestions. Large or small, a stroke, they will say, is no more than the smallest physical malfunction, a wonky configuration of blood in a cerebral artery. This is the ‘insult’ to the miraculous and fascinating organ we call ‘the brain’.

After the first, immediate crisis, with which the National Health Service had coped superbly, I was moved, courtesy of BUPA, to a private room in the Nuffield Wing of the National Hospital for Neurology and Neurosurgery, Queen Square. The irony of my condition as a neurological patient was that I’d often watched the results of brain surgery from my office. The Queen Square headquarters of Faber & Faber overlook this world-famous hospital. For nearly twenty years, I’d stared out of my window at shaved and hideously scarred shuffling figures in pyjamas, like concentration-camp survivors, and wondered about their fate. For so long, I had faced this imposing red-brick façade across the square. It was strangely intriguing finally to be wheeled into its shabby, cavernous Victorian interior, as cool as a vintage wine cellar, though the unmistakable mixture of hospital
smells — hoovered carpet, disinfectant, wood polish and urine — is evocative only of disease, sickness and physical catastrophe. Now I was in the care of neurological experts for whom stroke was just the most common of the many possible illnesses of the brain.

So what is stroke? Strokes can be divided into two broad categories according to the type of pathological process involved: infarction related and haemorrhagic. The former, which accounts for about three-quarters of all strokes, involves processes similar to those underlying many heart-attacks. The other major cause of stroke is haemorrhage, which accounts for about 20 per cent of acute cerebrovascular events. Typically, an artery in the brain will burst. This will lead to a blood clot, which in turn may cut off the blood supply to part of the brain. In either case, one crucial question is: on which side of the brain did the event occur, left or right?

The two halves of the brain have different functions, and control different sides of the body. The right brain controls the movement on the left side, and is more specialised for creative functions such as visual—spatial analysis, some aspects of emotional processing and handling certain negative emotions, and musical perception. The left side, which holds sway over the right side of the body, is specialised for reading, writing, numeracy and language. In my case, the stroke occurred on the right side, thus affecting the left side of the body. The ‘insult’ was probably located in the basal ganglia, a motor part of the brain that is also closely associated with the frontal lobes which are themselves responsible for planning and reasoning and decision-making. The basal ganglia’s function is as a facilitator, a co-ordinator (Tourette’s syndrome in which actions occur without volition is a disorder of the basal ganglia). Much of this,
of course, is speculative: when it comes to the brain, the best doctors will admit that it is medicine’s dark side of the moon.

It’s the brain, or more accurately the central nervous system, that is threatened by stroke. In Britain, and in North America, the traditional term ‘stroke’ is slowly being replaced by ‘brain attack’, in the hope that new language will change our attitude towards the illness, and perhaps help modify our behaviour towards it (making us less complacent about it, and helping to improve survival rates). But even the new term ‘brain attack’ does not convey the whole story. A stroke is all to do with blood, or the absence of it. In medicine, ‘stroke’ is the description of an acute disturbance of the brain due to an interruption of the flow of the blood supply.

There are many different kinds of stroke, ranging from the most minor neurological episode — the transient ischemic attack (TIA), which can be so slight and quick that the sufferer is unaware of having had it, to the stroke which leaves the victim utterly unconscious. It’s worth making the point that a TIA can presage a larger stroke, and that if someone who suffers a TIA can see a doctor immediately, there are preventive measures that can dramatically reduce the risk of a subsequent and more severe assault on the brain. (In America, especially, some doctors are experimenting with the use of the drug tissue plasminogen activator, TPA; in Britain the only drugs used in TIA are aspirin, warfarin and persantin, and of these aspirin is by far the commonest.)

If you suffer a TIA you are thirteen times more likely to suffer a stroke in the following year. The signs of a TIA might include a mild slurring of speech or an unexplained transient weakness in an arm or leg. In such cases, the doctor’s attention will be focused on three
essential fields: first, the potential narrowing of arteries in the neck, from which bits of blood clot might break off and travel up to the brain; second, the possibility of clots in the heart; and third, the presence or absence of high blood pressure. Once these areas have been examined, the search will move to the the quality of the patient’s blood and the cell biology of the patient’s blood vessels. I was given the same three tests to determine what had happened to me. In my case, having passed them with flying colours, I was subjected to a closer and closer scrutiny of my blood. In the end, however, I was advised that, so far as could be determined after the fact, there was no treatment that would have prevented my stroke, and no certain explanation for why it had happened. Like most such episodes, it came out of the blue. I am occasionally asked if I am troubled by this, but the answer is, I’m not! (Life is too short.)

So, throughout my convalescence, I regularly gave blood, a procedure I came to dislike intensely. Once the doctors had ruled out the most common cause of stroke (smoking and high blood pressure), they began searching for more subtle causes. In recent years the scientific analysis of blood has become markedly more sophisticated. Perhaps I was suffering from Leiden Factor V? Was Lupus Anticoagulant to blame? I gave blood samples to, among others, a Dr Thomas, a Dr Cohen, a Dr Abraham, and finally to Professor Sam Machin, a no-nonsense haematologist of world renown. One of the many fears I encountered in the aftermath of my stroke was the anxiety that if Sarah and I were to have children I might somehow pass on the weakness in my brain. (Each of these excellent doctors assured me that this is quite impossible.)

During my year off I have turned repeatedly to
speculation about the genetic programming in my head that led up to that moment on 29 July. Was this simply a catastrophic version of a weakness that had already manifested itself in the lives of my ancestors? Did old Robert McCrum — who died in 1915 — die of stroke? I have, of course, no sure way of knowing (his death certificate refers simply to ‘respiratory failure’), and the experts scorn the notion that one can inherit such weakness. It is, perhaps, some comfort to know that he died old.

Stroke is seen as an old person’s illness for the obvious reason that, statistically speaking, the propensity to stroke increases with age. If, for example, you take a random group of a thousand Britons or Americans over the age of seventy-five, you will find that between twenty and thirty will suffer a stroke each year. (In the general population at large, the ratio is about 0.5–1.0 stroke per thousand population per annum.) Among old people many strokes are so small, and so few are the significant symptoms, that it can be almost impossible to determine what has taken place. When a series of very small strokes accumulates in this way, a general deterioration becomes evident over time: steps more hesitant, memory less reliable, handwriting less legible, movement less vigorous — the physical decline we associate with old age. In the end, an elderly person who has suffered in this way may well be simply carried off by a larger, and finally fatal, stroke. (Men and women beyond the age of seventy-five suffer ten times the incidence of strokes as those between fifty-five and fifty-nine.)