Stroke recovery as a model for cities

Two years ago today, at a month shy of age 41, my life changed dramatically:  not long after 4pm I had a hemorrhagic stroke – a vein in the right side of my brain burst and began bleeding in my skull.  Within 10 minutes I had to lower myself to my floor so I wouldn’t fall.  I was unable to get to my phone to summon help and my left side was quickly paralyzed.  I wasn’t sure what was happening.  One thing I knew was I was likely to die if I didn’t get help.   Somehow I managed to live and fifteen hours later a worried friend came to my loft and found me curled up in a ball on my floor.

These past two years I’ve had an amazing recovery although I am still disabled and I still have setbacks (such as falling 2 weeks ago).  As I’ve worked to rebuild my left side I have thought how my process can be applied to cities such as St. Louis.

St. Louis, like many older cities, hemorrhaged population for decades. In the last decade (2000-2009) the population bleeding stopped but the total loss has been steep.  Like me, cities could no longer function as they had before.  Time to begin the urban therapy.

Two years ago I was left handed, now I’m right handed.  The portion of my brain that controlled the left side of my body was lost forever.  In therapy I learned I had to rewire my brain so the surviving cells would take on the function of controlling my left side.  At first I awkwardly used my right hand to eat and brush my teeth. Like cities that look back and think “if only” I thought I’d one day get back the full use of my left hand as a left handed person.  I was so wrong.  I do use my left hand now and I push myself to do as much as I can with it as I know that is the only way it will get stronger.

Cities have been in the same situation, a stroke of massive population job losses.  This lost left cities unable to function as they had before.  But our therapy for cities has been hoping they’d regain lost function.  As I know function does return.  I can walk again but I can’t run, skip or ride a bike – yet.

Cities need to start with the basics, one step at a time.  Cities need to examine what no longer works and what can come back first.  In stroke therapy they leg returns before the arm.  Fingers come back very late.  I can barely move my left ankle and I still can’t move my toes on my left foot.  Cities, I think, have been trying to move their big toe rather than get their leg back first.

The therapy I would suggest for cities is to focus on minimal basics needed to function, focus on what makes a city a city.  Walkable.  Parking is on the street or behind buildings. Density higher than the edge.

By design a core city is very different than the ex-urban fringe.  One is old and one is young.  Age does matter.  I’ve met older stroke survivors that have a harder time regaining function.  Another factor is how quickly you get help. Older cities that haven’t had help for a long time are more a challenge.

It has been a long & hard two years — considerable effort on my part as well as many others.  I have years of work remaining and so does St. Louis.

– Steve Patterson