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Chronically Upbeat

After a Stroke, a Song?

Author and TV producer Richard M. Cohen writes about living with a chronic illness.

Harvey Alter's voice suggests a man in search of his song. His speech has a musical tone, but at some moments the words themselves seem computer-generated, intended simply to spit out thoughts that make sense. His deeply human laugh begins in his belly when he strains to say something he knows is funny. But this is a vast improvement. For Harvey, a 62-year-old criminologist, there used to be only silence.

His journey began one day in 2003. Harvey was in his Greenwich Village apartment, putting the leash on his dog in preparation for their ritual morning stroll around the neighborhood. "Suddenly, I was disoriented and felt dizzy," he remembers. "I stumbled and tried to gain control, but couldn't." Harvey was having a stroke.

Each year, about 795,000 Americans suffer a stroke, and more than 143,000 of those people die. But even for survivors, stroke puts everything they know at risk—their identity and skills, their dreams. Harvey's very ability to think, all that rests in his mind, was in peril that day.

There were workmen in the apartment when it happened. "I tried to say, 'Help me,' but my speech was gone," Harvey recalls. "I tried to say, 'Call 911,'" he says. "I pointed to the phone. I think there was desperation in my eyes." It seemed to take forever to convince the workmen, who spoke only Spanish, to do something. Anything. At first, they thought he was crazy.

Harvey thought of the warning signs of a stroke in progress: a drooping mouth, uncontrolled movement in the arms, unintelligible speech. How in the world did he know that? "I give credit to the media, the talk shows," Harvey says now. "They have taken time to explain this stuff to us." Recognizing the signs of stroke in himself, Harvey felt powerless. "I thought I was going to die," he recalls. "To me, that loss of control meant that it was a stroke, which equaled death." At the time, his partner was out of town. Harvey had no advocate—he was alone.

But in a way, each stroke sufferer is alone, he says emotionally: "So many of us have gone into the Valley of Death. Many of our brethren did not get out. I am singing to you now, trying to spread the word." He pauses. Like many people who have experienced stroke, Harvey has aphasia: a compromised ability to make sense of and process words. Though some people do recover from this condition, for many it becomes a lifelong struggle. "I live in the country of Aphasia," Harvey says. "There is no return. Once you are there, you're there."

There are two kinds of stroke, ischemic (a clot) and hemorrhagic (bleeding). Harvey had a clot that blocked the blood flow in the left side of his brain. This caused paralysis on the right side of his body. His face drooped on that side. And because the brain's language center is located on the left, Harvey had difficulty stringing words together. Mostly, out of frustration, Harvey said "no."

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