Four years ago, Richard Gray suffered a catastrophic stroke that left him bedbound and unable to speak. His filmmaker wife Fiona Lloyd-Davies set about recording his recovery in extraordinary detail, and now her footage has been made into a BBCHorizon film.
Were you with Richard when he had his stroke?
No, I’d been out for the evening, and returned late to find Richard lying on our bed in the foetal position, clutching his head, saying “stop this f–ing pain”.
We went to A&E and while he was waiting to be seen, he slowly slipped into unconsciousness. The doctor said that I should call his children in New Zealand; it was clear that he was in serious danger of dying. His scan was sent to King’s College Hospital in London and we found out that he’d had a catastrophic haemorrhage in his brain, bleeding both inside and on the surface. The following morning, he had a large section of the left side of his skull removed in order to allow the brain to swell. They only removed the bone – not the brain itself – but when the swelling went down two or three weeks later, atmospheric pressure had pushed his brain into the right side of his skull, making it look as if half of his brain was missing.
In what ways did the stroke affect Richard?
For the first week, he barely moved at all. There were some promising signs a week or so later, when he said a few words, but he soon regressed again, possibly because the swelling in the brain had begun to reduce and the blood wasn’t flowing so easily. Three weeks after his stroke, Richard couldn’t speak, he had no movement on his right side and he was severely cognitively impaired. But you get these little glimmers of hope. I brought Richard’s military medals in to the hospital [Richard is a retired Colonel in the New Zealand infantry, and a former UN peacekeeper in Sarajevo, Bosnia], and he reacted in a way that made me think he knew what he was looking at. These moments are so important. It can be bleak, but you have to believe that the person you love is still there.
How did Richard begin to recover?
Initially, things were slow. He’d be hoisted out in a chair for half an hour or so, but he couldn’t do much more than that. Eight months after the stroke, he started to eat solid food, which was a massive step forward. He also had a cranioplasty operation to replace the missing part of his skull with a titanium plate, and that really helped – he was much more engaged in his recovery, and the next day he was able to move his right leg a little. We were lucky that Richard was medically stable after his stroke – he didn’t have any fits, which are always a concern after a brain injury. But it was only when we got him to the Raphael Hospital [which specialises in the neurorehabilitation of adults] that he really started to get better, slowly learning how to walk again. You realise just how complex the act of walking is – most of us take it completely for granted.
What was the most memorable moment for you during Richard’s recovery?
Richard loves animals, and when he came face-to-face with a horse during one of the therapy sessions he had his first emotional, spontaneous reaction since his stroke. That was a really special moment; you could see his spirits lift. There was also a moment when we were on a jetty and he decided to spin around in his wheelchair. I was having a heart attack as I thought he was going to fall in the water, but he just thought it was funny. It felt like I was getting my old Richard back.
Your film explores the idea of neuroplasticity. What is this?
It’s the ability of the brain to change and repair itself. Before Richard’s stroke, I’d heard about this in the context of London taxi drivers, who have to pass a test called ‘the Knowledge’ before qualifying. This involves memorising routes along London’s 25,000 streets, and neuroscientists have shown that it actually increases the size of part of the hippocampus – a region of the brain involved in memory and navigation. The brain can adapt and improve its functioning through repeated exercises and tasks. I held onto this idea when Richard became ill – it gave me hope that Richard might be able to recover.
How important was neuroplasticity for Richard’s recovery?
It was absolutely key – without this ability of the brain, Richard wouldn’t have recovered. But it also needs to be married to therapy and stimulation. The plasticity gives the potential for recovery, but it’s not going to be fulfilled unless you have the right intensity, regularity and quality of therapy.
As scientists learn more about the brain’s ability to change, it’s affecting the choices that surgeons make, too. Ranjeev Bhangoo, the surgeon who performed the life-saving operation to remove Richard’s skull, talks about finding a balance between removing enough of the clot to allow Richard to survive, but at the same time removing as little as possible so that the rest of the brain is given the maximum potential to recover. Surgeons have this incredibly difficult challenge to find the right balance between the two, as quickly as possible. “Time is brain”, they say.
How is Richard doing now?
He’s amazing. He does physio once a week, exercises on his own every day, and he’s having speech and language therapy twice a week, so his speech is improving dramatically. He’s also started to do some basic reading. He has a better understanding of his impairments now, so there are challenges, but he’s an incredibly resilient person. Getting better is hard work, and I so admire the amount of effort he puts in to everyday things like putting his shoe on or getting up from a chair. I just feel so thankful and fortunate to have him with me.
What do you hope people will take from watching your film?
Never give up hope. A couple months after Richard’s stroke, I was sitting in the hospital corridor crying, and one of the nursing assistants came up to me after her shift and showed me a video of another stroke patient who had recovered. She could just have gone home, but she gave me that moment of her time and generosity. If there’s someone out there who’s in a similar position to Richard, or is looking after someone who’s had a stroke, then I hope this film will also give them hope. Ten months after his stroke, I was told that Richard had plateaued and should go to a care home. But I could see that the spark was still there. Sometimes, amazing things can happen.