Malcolm Bass is known for his exploratory climbs across the world, from remote Scottish winter routes to first ascents in Alaska, China, India and Pakistan. In August 2020, a life-threatening stroke left him hemiplegic and unable to use one side of his body, severely impacting his movement, sight, hearing and speech.

Suddenly confined to hospital and home with extremely limited physical capabilities, Malcolm struggled with basic everyday tasks and suffered mental health issues. Now, three years on and aged 58, he is regaining his independence, returning to work as a clinical psychologist and slowly venturing outdoors again with the help of his wife, Donna, and a supportive climbing community, which has raised over £60,000 to fund his continued recovery.

Although Malcolm maintains that climbing is now 'a thing of the past', his pre-stroke ticklist includes more than a lifetime's worth of significant climbs. Among his most notable achievements are an ascent of The Prey on the East Face of Mt Hunter in Alaska with Paul Figg in 2001, another first ascent with Paul of the west face of India's 6,780m Vasuki Parbat in 2010 (for which he was nominated for a Piolet D'Or award) and first ascents of Haizi Shan (5,800m, China, 2006, with Pat Deavoll) and Dunlung Kangri (6,365m, India, Paul Figg and Simon Yearsley, 2012).

In 2018, Malcolm made the first ascent of Janhukot (6,805m), a remote, unclimbed peak at the upper end of the Gangotri Glacier in the Garhwal Himalaya with Paul Figg and Guy Buckingham (UKC News). This was his last major expedition before his life-changing stroke in 2020. 

A stroke occurs when oxygen supply to the brain is cut off, whether through a blockage or bleed in the brain. Every year in the UK, 100,000 people are affected by stroke - that's one stroke occurring every five minutes. There are currently 1.3 million stroke survivors in the UK, many of whom suffer from lasting physical and emotional effects of brain injury.

During Stroke Awareness month this May, we sent Malcolm some questions about his recovery so far and what he's learnt along the way.

Since my stroke, the adventure zone has moved closer to home. 

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Can you describe the onset of the stroke and what you can remember of it?

I woke up at my best friend and climbing partner, Simon Yearsley's house and I remember feeling puzzled by how to tackle the challenges of getting out of bed and getting dressed. I got out of bed then staggered into the hall where I collapsed in the corner. Next thing I remember was Sarah, Simon's wife, arriving and looking at me with bewilderment and concern. I tried to get up off the floor but couldn't.

Sarah asked me if I was alright, I said 'Just leave me for a while, I'll be fine'. Fortunately, she didn't. She called Simon and between them they did the FAST test and realised I was having a stroke and called 999. My stroke was very serious and had they not reacted so quickly I would have died. All the time I was flopping around on the floor, my brain was being starved of oxygen and brain cells were dying.

How did the stroke affect you physically and mentally, and how did it impact your daily life?

In the immediate aftermath of my stroke, my brain swelled and as I am relatively young, there wasn't enough room in my skull for it. Donna got a call saying that I needed an operation to cut out part of my skull to allow my brain to swell otherwise I would die. After the operation I was in ICU for a few days, but was told that my cardiovascular fitness probably helped me recover. The stroke affected my whole left side. It had effectively gone—I couldn't swallow, walk, think clearly, or speak clearly and had blurred vision. I was incredibly confused. I got Donna to help me call climbing friends to put off planned climbing trips for a month or two until I recovered, little realising I wouldn't be going at all.

With part of my skull having been removed, I had to wear a helmet. It was quite something having just a flap of skin protecting the brain, and Donna hated cutting my hair with the wobbly bits so close to the scissors. However, I had an operation 9 months after my stroke to put in a designer piece of Italian porcelain where the skull had been removed…if La Sportiva made skull plates…

Now 2 years 10 months later, and after intensive (as far as my stroke fatigue allows) therapy I can walk with a person with me and with a stick up. My longest walk is a mile and that's a real stretch. I walk about 200-300m comfortably at the moment. But I have still no sensation down the left-hand side of my body. I can't feel when my left foot hits the ground. I have lost a quarter of my visual field in both eyes, have no use of my left arm or hand, and have huge balance issues. I can take a few paces without a stick with my physio supporting me under the armpits. I can't stand up or sit down from a chair without help, as my hamstring hasn't come back yet so I can't put my left leg into position and my balance is useless.

Because of my limitations, I need 24-hour daily care, but can live at home because of the support provided by my amazing partner Donna. However, I can't do anything independently – even get a cup of tea or fetch something for myself as I can't move around the house on my own. Another nice addition, which is not uncommon in stroke, is that I have developed epilepsy and have had a few major seizures, the last of which brought the air ambulance to the village. I missed all that excitement as I was unconscious.

I have trips to the nattily-named spasticity clinic for doses of botulism (botox), and I come out no more beautiful but with a more relaxed hand, which tends to tighten into a knot without the treatment.

When I first realised the extent of my stroke, which took about 3 months, I became very depressed, anxious and angry, but with good mental health care I have now recovered to my normal neurotic self.

Aspects of my pre-stroke daily life such as hill running, climbing and cycling now appear to be things of the past. Donna's daily life has been affected as much as mine. She was an excellent triathlete but hasn't been able to train since I returned home. We can't go away together in our van or anywhere really; we can't run and bike together, go surfing or even spend a day out as I get too tired for any of the normal things we used to do.

How have you been coping with these changes?

Despite all this Donna and I are working hard to build a life worth living with regular trips into the countryside with the mountain trike for short walks.

It has been a huge struggle for me to adjust to my post-stroke life psychologically and I have needed a lot of support, from NHS Mental Health services, from NHS and private physio and occupational therapists, from Donna, from friends and family, and from our wider sporting community and from the community in our village.

I don't like all the clatch I have to wear: a shoulder harness, as my shoulder has dropped out of its socket where the muscles have wasted; a foot-up splint or harness as the calf has shortened and my toes drop – one is a shoulder harness with a sort of elasticated suspender to my foot. I call this one my 'spastic elastic'. I have an ankle brace and hand splint. All these instruments of help and torture are another spur to recovery.

As a clinical psychologist, how has your professional background influenced your approach to dealing with the stroke and its aftermath? Has it made you think any differently about the impact of your work?

I have never worked clinically in the field of stroke or other neurological difficulties. Most of my clinical work has been in mental health rather than neurology. As a psychologist, I have felt very comfortable accessing mental health support. A stroke is a massive trauma, both life-threatening and life-changing and I think it is very important that stroke survivors be routinely provided with psychological support to help them recover from that trauma and adjust to post-stroke life. I have found neuropsychologists to be particularly helpful as they understand the biology of the neurological injury as well as the psychology of trauma and adjustment. I have accessed both talking therapies and drug treatment.

In my practice I have provided care for a lot of trauma survivors and I now realise as a recipient how important a long term, skilled therapeutic relationship is to recovery from trauma. This makes me proud of the work I have done in providing long-term therapy to survivors of trauma and grateful for the help I am receiving.

Has your experience as a mountaineer helped in any way, in terms of how you approach recovery or how you deal with the situation mentally?

I think my climbing years have helped me during this stressful time. During my climbing career, my friends and I encountered many unpleasant and threatening situations in the big mountains. Overcoming these difficulties gave me confidence in my ability to deal with difficult situations. This sense of agency is extremely helpful to me and is helping me deal with the many challenges of my recovery.

My many years of climbing have accentuated my natural boldness. Having faced the prospect of falling hundreds of metres down a big alpine face makes it easier to engage with the risk of falling over whilst doing my therapy around the physio plinth in my bedroom.

As an alpinist I trained assiduously for my big climbs. This experience of long-term structured training (often without any visible impact) has proved very helpful in enabling me to engage with the extremely slow and arduous process of physical rehab from stroke.

What strategies or therapies have you found helpful in your recovery process? Are there any exercises or techniques you can recommend for other stroke survivors?

In the past, I had two strategies in life – one of going for it blindly; and the other consulting an expert. Both of these still hold. I still try to do things that I can't do just to see if I can. Mostly though, I call in the experts. I am fortunate to have 4 sessions a week with a neuro-physiotherapist—she pushes me hard but understands my limitations. I have found hydrotherapy and swimming with her helpful for rehab and just for fun. I feel at my most able in the water, even though Donna is as damning about my swimming efforts now as she was before my stroke. Looking after my mental health by accessing mental health services has been invaluable in helping me maintain the gritty, optimistic mindset required to engage in challenging rehab tasks.  

I have some of my rehab sessions at a specialist rehabilitation centre, which is a gym-like environment with great equipment and expert physios and occupational therapists. Going there is incredibly tiring, but I find the atmosphere stimulating and motivating enough to push through the exhaustion of the journey and sessions.

I have found going outside every day, even if only for 15 minutes, very helpful. Getting an all-terrain wheelchair enabled us to get outdoors much more easily. The one we have is a mountain trike. Both of us used to spend the majority of our free time outdoors, so getting out to hear the birds sing and to sit under a tree is balm to our souls.

Exercise has always been my stress buster and I used to get loads. It's more difficult now, but I have some pedals that I can use from my wheelchair, and I go on them most days.

As every stroke is different, I am hesitant to recommend specific techniques apart from to 'mix it up' as stroke recovery is essentially brain recovery and brain training requires novelty.

How has your perspective on life changed since the stroke? Are there any new priorities or perspectives that have emerged as a result?

Unlike some, it seems that my road to enlightenment hasn't come from time in the intensive care unit. Neither my perspective nor my priorities have changed dramatically since my stroke. Before my stroke I felt that life was short, and I wanted to make the most of each and every day. I always felt an immense sense of urgency. Despite not having experienced an epiphany during or after my stroke, my perspective has changed in a couple of subtle ways: before my stroke, being an active alpinist was a large part of my identity. As participating in alpine climbing seems off the cards for the time being if not ever, I am adopting a new identity as a storyteller and mentor rather than an active participant. As such, it has become a key priority for me to finish the book I am writing.

In many ways my priorities have not changed. They remain: Love, laughter, nature, and adventure. I have always loved the possibility, uncertainty and challenge of adventure and I have spent much of my life seeking it. Since my stroke, the adventure zone has moved closer to home. Formerly I would need to spend several days on a mountain face to have an adventure. Now I find that walking up a little bank close to home provides the same uncertainty and challenge.

Have you encountered any unexpected challenges or difficulties during your recovery? How have you dealt with them?

Whilst I wasn't surprised by the grief that settled on me once I realised how much I had lost, I was surprised by the anxiety and irritability that I experienced; I had always been an independent and autonomous person, then I went to being frightened when Donna left the room for five minutes. I dealt with the anxiety and irritability by asking for and receiving mental health support. I have also been surprised at how fatigued I get since my stroke. I get exhausted very easily, physically, mentally and emotionally. I deal with this by carefully timetabling my activities and by taking regular rests on my bed throughout the day—usually 2 or 3 naps.

A strange thing called, in my case, Left Side Neglect has made life difficult. As the brain doesn't recognise my left side and I can't feel it, my centre line has moved to the right, making balance even more difficult and I don't really notice my left-hand side. I have had to work hard to learn to look left. Donna used to be able to stand to the left of to me and make faces and I wouldn't notice. I am not there yet, I often don't see where my left foot is going, but I am trying to focus more on my left. The centre line of my body having moved right makes balance difficult but again, with focus on the left I am slowly getting it to shift back to the centre.

The slow pace of functional recovery—tiny muscle by tiny muscle as they try to link with my brain—is also surprising. I am helped by reflecting on my somewhat glacial progress at sport climbing at Kilnsey. It would take me months to get up my Kilnsey projects, but with persistence I would eventually succeed.

How has your support network, including family, friends, and healthcare professionals, contributed to your recovery journey?

I am extremely lucky in having a loving network of people who support me in my recovery. Donna and my family have been brilliant. Donna does all my care and is the linchpin enabling me to live at home; she runs the house, does all our admin and supports everything I do including giving me additional therapy sessions. She also works part time and it's a daily struggle for her but her fitness before my stroke has helped her through. Support for her is support for me, as many of our friends understand.

Alpine climbing encourages the development of close bonds and my climbing friends have supported Donna and me in a variety of ways. They have done so much for us, for example, by helping Donna do things that are difficult on her own and giving her a couple of hours' break by looking after me.

My climbing friends also provide me with some adventure, by going to the climbing wall or doing challenge walks. These keep me motivated. The support of the wider climbing community has meant a lot to me all the messages of support are forwarded to me and each one gives me an enormous boost and helps me push on with my rehab.

Montane, Petzl and La Sportiva have generously continued to sponsor me through this difficult time, which has been a great psychological boost, and kept in touch to see how I am doing. They have also provided specialist kit to help my rehab. The Alpine Club organised a raffle with prizes donated by Petzl to raise funds for Move Mountains for Malcolm.

Without the specialist NHS and private physiotherapists and occupational therapists, I would not even be on my feet now. Their kindness and expertise have been vital in keeping me moving forward and we're having some fun along the way.

Donna's friends have rallied around both of us, from setting up MM4M, to a triathlete friend who is a physio giving me a year of free physio help and fun.

My professional colleagues at work (Tees, Esk and Wear Valleys NHS Trust) have been extremely supportive, enabling me to return to work in a very adapted and part-time role, which has really helped my identity and connectedness and helped me regain concentration and stamina.

Every single person who has offered me encouragement or a role in my new body and mind helps my recovery.

Tell us more about the #MoveMountainsforMalcolm campaign!

Donna's best friend Jo and her wife Lisa suggested a campaign to help us pay for the rehabilitation costs – which we would now not be able to afford. At first, we weren't sure about this, but they twisted our arms and soon they had set it up and co-opted my best mate Simon and his wife Sarah, my alpine climbing friend Guy Buckingham and his partner Emma Crome to run a GoFundMe campaign which they called Move Mountains for Malcolm (MM4M).

Due to their combined expertise and the generosity of so many people this is enabling us to continue the therapy that is so vital for my slow but steady recovery. We are extremely grateful for everyone who has donated and for those who have undertaken sponsored or other events. At the moment we are gearing up to cheer on Donna's amazing triathlon coach, Brian Welsh, who is competing in the solo category of Race Across America (RAAM), billed as the toughest bike race in the world, with Move Mountains for Malcolm as his named charity. This challenge we think vies in difficulty with a rather sociable and brilliant friend's recent sponsored year without alcohol.

What advice would you give to other stroke survivors who are facing similar challenges?

Every stroke is different, so I don't feel in a position to give specific advice. But I would say the following points might apply to most people:

Keep going with the rehab.

Try to keep connected to your communities.

Try to get outside every day.

Ask for help when you need it.

Either you or a friend should keep in touch with a real or virtual stroke community; you never know what you might learn, from a new exercise to new research or even a good bit of kit.

Set goals and just re-adjust if you don't reach them.

Try to have some fun or adventure.

You were fit and active before the stroke occurred. Have you learned anything about the underlying cause of your stroke, and what are some common misconceptions around strokes?

I was extremely fit and active before my stroke with no underlying health issues. My blood pressure was normal, and everything seemed fine. I was the fittest I had ever been, at the age of 56. My medical team could not discern any particular cause for my stroke. Sometimes these things just happen – it could have been a previous injury or a weak artery – who knows. Since the stroke we have encountered many people in the stroke community who are young, in their twenties and thirties, and who have been very fit and active.

Once you have had a stroke and perhaps been forced to be very inactive for a while, it's hard to keep as fit as one would like. It's a lazy assumption to think that stroke victims have not looked after themselves: this may not be the case.

What is your prognosis? How far might your physical abilities be able to recover?

Stroke is just weird. You normally don't get a prognosis about your recovery. The course of recovery from stroke is very unpredictable and sometimes people experience some physical recovery many years after the stroke. This means that in the long term, anything is possible, however I am still adjusting to the fact that I will continue to be severely impaired for some time to come.

What goals or aspirations do you have for the future? How are you working towards them?

I am very keen to regain the ability to walk first without assistance and finally without a stick. I call this 'free walking'. Alpinists have a credo about doing more with less: typically this means doing more with less equipment, however I want to do more with less active brain matter, and for me, less active brain matter means fewer functioning limbs.

I have some distance walking goals that I am working through leading to walking up Helvellyn, or even up a Munro in winter.  I also have in my list of goals climbing a Grade 1 gully. I would dearly love to gain some function in my left arm. I would like to continue to improve my climbing at the climbing wall; I would like to be able to climb without any direct assistance from another person. Another goal is to finish my book about my experiences caving, climbing and coming through stroke.

I am working towards these goals by doing seven sessions of formal physiotherapy per week plus additional daily exercises and therapy with Donna. I am goal orientated, so I have a goal map with incremental steps to my goals. One thing I have noticed now is that things always take longer to achieve than I anticipated.