‘Well, something,’ the neurologist called to tell me the following day, ‘has sent your cholesterol through the roof.’ Instead of twenty milligrams of Lipitor, I should double the dose to bring it down as quickly as possible. After speaking with him, I remembered that, fifteen years ago, in England, my GP had said that my cholesterol was a little high. I paid it no mind, moved to a different part of London, signed on with another doctor. As far as I could recall, my cholesterol had never been tested again. Until now. Now I’d joined the great American statin-dependent democracy of high cholesterol, was being welcomed into the community of stroke victims as featured in a clutch of nicely produced brochures.
They made depressing reading, these brochures. In a friendly way they showed people of both sexes and many races going about their fulfilling post-stroke lives. These people, regardless of their race or sex, were overwhelmingly old and white-haired, and the advice — a walk is good exercise, pruning trees in the garden can be aerobically helpful — applied to a demographic to which I did not belong. Even as I rejected the proffered kinship, however, I remembered something that had happened nine months previously. I’d been sitting in a café when my left thumb and forefinger went completely numb. It had been freezing outside, but, looking back, this numbness had nothing to do with the temperature: it was absolute. Not just numb or cold, more like dead. This only lasted a couple of minutes and I soon forgot about it. On a couple of other occasions my vision had gone sort of sparkly and bleached out, but these episodes were so fleeting that I forgot about them too. Such things, I read now, might have been transient ischemic attacks: so brief they were difficult even to register until something more extreme occurred to give them definition and meaning. Until then they had nothing in common with anything you might ever think of as stroke-related.
Back in London, I often used to bump into the writer Gilbert Adair on Portobello Road, both before his stroke (always smoking, never healthy-looking) and after, when he was, as he put it, ‘sadly diminished.’ I last saw him, shuffling around with a friend, struggling to remember who I was, a couple of months before he died in December 2011, aged sixty-six. Gilbert was stroke-brochure material, had led a perfect stroke-conducive life. I may have been unlucky to have had a stroke at all, but it was a stroke of luck that I’d had such a mild one. Within forty-eight hours there was almost no physical difference between how I’d felt before and how I was afterwards. I was able to play Ping-Pong on Friday and Saturday (a very good workout for the eyes, one that persuaded me there was still some slight vision loss between 10:00 p.m. and midnight in the clock-dial scheme of things). On Monday I was playing tennis again. Apart from being at increased risk of another stroke I was fine — but psychologically I was conscious that the ground could open Adair-ishly beneath my feet at any moment. Every time I got out of the bath I worried that the giddy rush of blood from — or is it to? — the head might be the bow-wave of an approaching stroke. I was scared of bending down — and I was worried, constantly, about my brain.
There had certainly been some cognitive impairment — but Jessica insisted that this had occurred before the stroke. I used to pride myself on my sense of direction, but that had long gone south, or maybe north or east. I had trouble concentrating, but that too had been going on for ages — I put it down to the Internet, not to my brain blowing a fuse or springing a leak. So, no, nothing had gone permanently wrong in my head, or at least nothing had gone wrong that had not been in the process of going wrong for a while — but I now regarded that head and the brain snuggled warmly inside it in a new and vulnerable way. I’d been looking forward to signing up for a Medical Marijuana card in L.A., but the prospect of smoking pot (smoking in the healthy Californian sense of vaporizing) now seemed quite dreadful. While marijuana might meliorate the symptoms of some conditions, it seemed guaranteed to send the stroke victim spinning into an epic bummer in which you fixated either on the stroke you’d just had or the one that could blow your brain apart at any moment, that might be brought on by worrying about it. That was the thing about all this: it was a brain thing, and I loved my brain and the way it had been going about its business so gamely for more than half a century. Let’s say you have something wrong with your liver or heart. Terrible news. But if you’re lucky, if you get another one and take the right medication, you’ll be back to your old self again. But with the brain, the one you were born with either works or it goes wrong and you start sliding away from yourself. Even if a better, cleverer brain — a brainier brain — had been available for transplant, I wouldn’t have traded in the addled one I had for anyone else’s. And although the problem, we’d quickly discovered, wasn’t in my eyes, that’s where it had manifested itself — and I loved my eyes too, especially here in southern California, where half of the reason for living, possibly all of it, was to see and be seen. I loved seeing the ocean and the sunlight and the gorgeous, tanned, fat-free, screen-tested bodies as they muscled and jogged along the beach, adorned with zero-cholesterol tattoos of Maori designs and lines from Infinite Jest. But also there, down by the beach, were the homeless and the half-mad, men and women whose brains had been torn apart by drugs or had gradually come undone because of some undiagnosed fault in the wiring.
A week after the stroke we bought a car, a Prius that had belonged to a friend who had recently died. Almost exactly a year earlier we’d had dinner with her husband while he was in London. When he got back to L.A. his wife (who, until a few weeks previously, when she’d started to feel tired all the time, was much fitter and more energetic than him) was diagnosed with cancer. We saw them both when we visited in May; she seemed to be doing well with chemo — and then, in October, she died. Another friend, in London, had died last spring after years of cancer treatment, remission and recurrence. They were both in their forties. My parents, by contrast, had lived very long lives. My dad soldiered on till his ninetieth birthday — to the day, exactly — in spite of a diet dedicated solely to increasing the chances of a stroke, cancer or heart attack. It’s a shame that he wasn’t around to enjoy the exquisite comedy of his healthy-eating son having a stroke at fifty-five.
In almost every respect life continued unchanged, except that I had to cut out the twice-baked hazelnut croissants and I was often unable to play tennis because of pulled muscles, which took ages to heal — a side-effect of Lipitor or a main-effect of middle age? I didn’t know, but, in keeping with the advice in the brochure, I was getting plenty of other exercise, was constantly out on my bike, in the amazing light and weather. How long would you need to live here to start taking that for granted? Longer, if you’re from England, than one lifetime, even one as lengthy as my dad’s.
I was ready to write off the stroke as an inexplicable happening — and so was the neurologist — a new one — whom I went to see three months later, by which time my cholesterol was down to exactly where it was supposed to be. But doctors don’t like mysteries, are reluctant to surrender to the inexplicable, and he proposed referring me up to another level of expertise: still another neurologist, who specialised in strokes. What did I think of that? Well, shortly after I’d started playing Ping-Pong again I’d mentioned to a friend whose father had suffered a series of strokes that I still had what I guessed was about a 2-percent vision loss on my left-hand side.