Desmond O’Neill: 50 shades of stroke

Desmond O'NeillLanguage in Ireland can be tricky and subtle, with many shades of meaning possible for even simple words such as “stroke,” as our minister for health discovered to his chagrin in the last few weeks. A coalition government of moderately right wing and moderately left wing parties assumed office in 2011 in financially difficult circumstances, and an entrepreneurial GP from the right, James Reilly, became senior minister for health, with two junior ministers from the left wing party.

Over the previous decade, fuelled by an active interdisciplinary Council on Stroke of the Irish Heart Foundation, there have been major developments in stroke services in Ireland from a dismal baseline. In an irony in terms of subsequent political developments, Reilly has proved an important advocate for ongoing development of stroke services in the face of widespread cut backs in the health services.

However, a very different form of “stroke” appeared recently on the landscape. In Irish politics, to “pull a stroke” is to engage in a mini Blitzkrieg of pork-barrel politics, with the dual aim of encouraging clientelism among constituents and discomfiting opponents (including often those on the same side in multi seat constituencies). It is a technique associated most closely with the main opposition party, and the incoming government had promised a departure from these bad old ways.

So, when two sites in the Minister’s constituency were added to a shortlist of primary care centres to be developed through public private initiative, there was considerable disquiet, and the junior minister with responsibility for primary care resigned, with concern over the additions to the list appearing to be a factor in her resignation. Even Reilly’s fellow GP and minister for transport, Leo Varadkar, noted that it “looked like” stroke politics.

This set the stage for any number of cartoons and punning headlines linking “stroke” politics and a medically qualified minister for health. The apex was a blindingly funny, and astonishingly medically apposite satire on stroke politics using the trope of acute stroke by Ireland’s leading humorist, Frank McNally. McNally was already celebrated for pieces such as his wonderful histories of Ireland in 100 Euphemisms, 100 Excuses, and 100 Insults.

True to an Irish tradition of humour that manages to be both gentle and biting at the same time, McNally posited “stroke politics” in the context of a health warning from the Irish Department of Health. The piece is a comic gem, and should carry a health warning for laughter related injury. Little translation is required—the universality of parliamentarian lifestyle may mean that it is redundant to explain that the Dáil bar is the bar in the Irish parliament.

While there may have been a little sensitivity in the ministerial office about levity associated with stroke, the Irish are sensible and humorous race, with a tolerance for an incisive and sometimes edgy humour, from GB Shaw on private medicine (The Doctor’s Dilemma) to Jonathan Swift on poverty (A Modest Proposal), and this creation is at one with the spirit of its illustrious predecessors.

As a stroke physician for many years, and with stroke affecting first degree relatives, my first reaction (after helpless laughter) was that all those affected by stroke, and all those working with stroke, must be deeply reassured that the modern terminology of assessment and management of stroke (including the FAST acronym) has so entered the public domain as to be deeply embedded in a humorous piece by a lay person, one of Ireland’s master humorists.

This is a tribute to the work of many involved in the Irish Council on Stroke (and funding of their advocacy by a philanthropic organisation, Atlantic Philanthropies) over 15 years that this revolution in awareness has taken place. McNally’s “stroke” of comic genius would have been appreciated by another great Irish humorist, Oscar Wilde: after all, there is only one thing worse than being talked about…

Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and founder Chair (1997-2009) of the Council of Stroke of the Irish Heart Foundation.