Prognosis Read online

  Anger was something I would learn to live with, something I would hate myself for, something that would drive away those closest to me, that would strangle nearly every intimate relationship I ever had. Anger was the acid that would eat away at the people I loved. It was the reason I would spend many years alone, although that was the least of my worries then.

  I was depressed. My life was stuck inside a chink in a wall that stretched out before me. The only way forward was through a long black tunnel burrowed into infinity. I couldn’t escape, so I settled in and made it my home. I lay on my sofa inside my tunnel. If it were not for the dogs, I would never have dragged myself up. I would have stayed on that sofa, closed my eyes, and waited until time stopped.

  Depression is the soulmate of brain damage, although no one told me so. Frankly, I had no good reason to live. The life ahead of me was terrifying. A life of disability checks, years spent trapped inside my house until it was taken from me because I couldn’t afford the mortgage payments, lying on that sofa, unable to think, unable to remember, unable to work. I should have seen a psychiatrist. I should have sought help. But I lacked the insight to realize that. I didn’t see another specialist about my head injury or any of its manifold consequences for nine more years. The hospital neurologist had left me with an intense dislike for members of the medical profession; I was completely without hope.

  I had lost my father, lost my mind, lost my self. What else was left for me to lose but George and Bess? I trifled with the idea of suicide but stopped when I thought of the dogs. I had a responsibility to them. No matter how miserable I was, I pledged to keep myself alive for the rest of their lives. Then, I decided, I would permit myself to die. And even that idea was daunting. I was no longer competent enough to know how to kill myself. Something would go terribly wrong. I would nearly die but not quite. I would lose the use of my legs or some such thing. It did not even occur to me that it was the same fear I had about helping my father die.

  My own death was beyond me. In the absence of antidepressants and psychiatrists, I drank. Every day. Around half a bottle of wine, sometimes more. They say that alcohol causes depression, but they ought not generalize. It may not have been the wisest coping mechanism, but alcohol made life tolerable.

  In the months after my accident, I heard nothing at all from my mother. What did she think had happened to me? Did she care? I could not believe she’d abandoned me. And then, after a while, I could. I had disconnected my phone, but she knew where I lived, and her apartment was only a fifteen-minute drive away.

  My relationship with my mother had always been brittle.

  When I was twelve, I showed her a short story I had written. I did quite well at English in school and loved to write. She was an English teacher, and I trusted her opinion. She handed my story back to me and said, “Well, I don’t think you’re going to make much of a writer.”

  I was fourteen when my mother admitted she had never wanted a daughter. She had just attended a parent-teacher night at my high school, where most of the teachers had described me as “naughty” or “disruptive.”

  “All I wanted was two boys,” she said, when she finally calmed down.

  “Why?” I asked.

  “Boys are easier and I like them more.”

  “Well, I’m sorry I’m not a boy,” I said.

  “I lost a baby,” she said. “I never told you that before.”

  “Where?” I had visions of her leaving it somewhere and forgetting about it.

  “Before you were born. I’m certain it was a boy. We were going to call him Matthew.”

  I looked at her but didn’t speak.

  “But you made your father happy! He wanted a girl.”

  That same year, a couple of months later, my mother told me she thought it would be best if I never had children of my own. “I just don’t think you’d make much of a mother,” she said, exhaling slowly.

  At the time, I said nothing. But I filed those remarks away in a drawer of my brain marked “Things I Learned from My Mother.” The accident seemed to leave that part intact.

  I grew to suspect that my mother wanted to be the only female in my father’s life. Perhaps she considered me competition. I wondered whether she had overheard him, weeks before he died, telling me that I had always been the most precious thing in his life, that he loved no one more than me. It was a time when my mother liked to listen in on our conversations. A time when she worried I might help my father die.

  I certainly wasn’t blameless in our relationship dynamic. From the time I was thirteen, I realized I had a unique ability to needle my mother. Sometimes all it took to get her to snap was a look from me. I had a combustible power over my mother, and I used it whenever I wanted a reaction.

  Once, Edward punched me in the face. It was after we had been together a couple of years and a male colleague had turned up at our place drunk, shouting into the intercom that he was in love with me. Edward assumed I had led him on. His fist smashed my face, and I fell onto the corner of our glass coffee table. I ended up with a black eye and a bruised chest. The next time Edward saw my mother, he apologized to her and told her he had no idea what had come over him.

  “Don’t worry, Edward,” she said. “I’ve been wanting to do that for years.”

  My mother’s hostility frightened me. Weeks before my father died, I held his hand and sobbed.

  “What will happen to me?” I asked him.

  “Don’t worry, Pod, you’ll be fine. You’re the strongest one in this family. Easily! And Mum will take care of you. Of course she will.”

  “But she is only ever nice to me when you’re around!”

  “I know,” he said. “I do. I know exactly what she’s like. But this will be different.”

  My mother never came to visit after my accident. I continued to stare into the pockmark on the wall, reliving my father’s last months, tears racing down my cheeks. I had lost my mind. There was nothing left but the halfway state between sleep and waking. George and Bess huddled alongside me until my crying finally stopped.

  3

  BUILDING A NEW BRAIN (PART ONE)

  One morning I entered my study. It was likely about two months after my accident, but I cannot be sure. Like many head-injured people, my serial memory is terrible, and I struggle with timings and chronology. I had decided to finish my PhD. I refused to believe I was incapable of doing so. A voice inside my head had spoken: I can’t continue to live like this. I can’t waste my life. I must do whatever it takes to get my old life back.

  My study had been sealed up since my accident, and the carpet reeked. The room had served as George’s toilet when I spent too long at the office—his way of letting me know about work-life balance. I yanked open the window to air the room.

  Towers of photocopied books and articles smothered my desk. Glancing at the books, I didn’t recognize any of them. How did they get here? Were they library books? Was I amassing a giant fine for not returning them? I removed books from the pile, studied their spines, and was relieved to discover they weren’t library books. They belonged to me. I picked one from the top of the pile and held it in both hands. It didn’t look even vaguely familiar. On the spine of the book was the word “Japan.” My PhD topic focused on Singapore, Thailand, and the Philippines. What was a book about Japan doing there?

  In the middle of my desk, surrounded by papers and notebooks and pencils and highlighter pens, sat my computer and keyboard. I stared at the computer, trying to remember how to turn it on. I ran my fingers around it, exploring the contours of the monitor before realizing the hard drive was housed in another large box at my feet. The on switch was down there. I knelt down, switched on my hard drive, and waited for my computer to boot up. Sweeping the books and papers to one side, I opened a file named PhD v1. Bess burrowed into the space beneath the desk and settled at my feet. George curled up on the landing, aloof. My study was his toilet, not his bedroom.

  Inside the file there was a folder titled Methodolo
gy, which seemed like a good place to start, although I had no idea what the word meant. Was it the opening chapter? I wasn’t sure. I had no recollection of writing it. Forcing myself to concentrate produced a sensation inside my skull like someone using an angle grinder on the back of my head.

  I opened the document and studied the words. What was a “hypothesis”? I wondered. I turned to the Oxford English Dictionary my father gave me for my thirteenth birthday. He had also given me the two-volume Shorter Oxford English Dictionary for my birthday the year before he died, but the print was tiny and there were way too many words for me to be able to find anything. After a struggle, I found the H’s but couldn’t find “hypothesis.” Goose bumps spread down both my arms. I had written something that didn’t make sense. What was I thinking? What did it mean? Did I write this?

  I closed the document and burst into tears. Things were worse than I thought. Much worse. I tried to calm myself and opened another file titled Introduction. My eyes drifted along each line of text, hopping from word to word, but my brain registered nothing. My thesis was concerned with “The Influence of Culture Upon Administrative Practice in Singapore, Thailand, and the Philippines.” I remembered the three countries but had forgotten the rest of the title until I saw the words written in black marker across the top of a manila folder. I cradled my head in my hands and strained to remember any details about the time I’d spent in Southeast Asia three and a half years earlier. I pinched the skin on my leg, hard, thinking that what I needed was to wake up, to concentrate. I slapped my leg. No matter what I did I couldn’t seem to turn on my brain. Its power had been drained. I gripped my desk with my fingers and forced myself to concentrate. A memory of getting food poisoning from a raw piece of chicken in the Philippines came to me. And I knew I’d befriended a Sri Lankan engineering student whose grandmother kept an elephant. I recalled writing a letter to my father each week, telling him what I had been doing, describing everything that I thought might interest him. He had still seemed healthy then, oblivious to the tumor taking root inside him.

  My body trembled. The prognosis had been right. I could see my future, spread out in front of me like a frayed, dusty carpet. I would fester at home on the sofa until the dogs grew old and died. Then a friend, who happened to be a vet, would euthanize me. I would lie down on a Formica table in her surgery, and she would stroke my cheek, say goodbye, and this hell would be over. I comforted myself with my plan. It would take around a decade to execute, but it was a plan all the same. I turned off my computer and retreated to the sofa and the sanctuary of my pockmark.

  On his deathbed, after I had broken down and told him I would not survive without him, my father squeezed my hand and said, “You’re clever, Pod. No one can ever take that away from you. You will be fine, whatever happens.” But something had happened, something my father could never have foreseen, and I was no longer fine. I turned this thought over and over in my head like a hard clump of soil.

  The next day, fueled by thoughts of my father, I resolved to try again. Confined to his sickbed, he had made a valiant attempt to finish the book he was writing. Some years earlier on a visit to the British Museum, he had discovered the handwritten journals of Robert Brown, the young botanist who had been part of the voyage on the first circumnavigation of Australia. HMS Investigator set sail in 1801, and Robert Brown’s brief over the journey was to collect scientific specimens, including plants, insects, birds, and rocks. My father had decided to annotate Brown’s diaries, adding notes and interpretations, breathing new life into material that might otherwise have been lost. He had spent two years on the book before he became ill. In the end it was a useful distraction, something to keep him from thinking about dying.

  I brought a laptop home from work and tried propping him up with pillows from the bedrooms and the sitting room. No matter how many pillows we used, how many positions we tried, he could never get comfortable enough to use the keyboard. It was easier for him to work with a pad and pencil. Pain hijacked his every movement. Bone cancer, the doctor warned us but not him, is one of the most painful ways to die. He eventually left his notepad on his bedside table, knowing he would never be able to finish.6

  I thought of my father as I stood outside the study. He would expect me to sit down at my desk and work for as long as it took to resume a normal life. That’s what he would do if he were in my position. I summoned all my strength and reentered my study.

  The room was tidy and smelled as fresh as it ever would. I had a vague recollection of cleaning the room and airing it the day before. I took an article from the top of the pile of photocopies, placed it in front of me, and attempted to read: “The Dynamic Interplay between Employees’ Feedback-Seeking Strategies and Supervisors’ Delivery of Performance Feedback.” Was that even English? What on earth did it mean? I refused to believe that title made sense to a person with a healthy brain, let alone someone like me. I spent a good twenty minutes trying to unscramble the meaning of the title before burying the article at the bottom of the pile and choosing another. The next one was “Intraorganizational Structural Variation: Application of the Bureaucratic Model.” I shuddered. Who wrote this crap? Worse, who read it? People like the person I used to be? That was a scary thought. Who was I?

  I searched the pile for another. And another. Finally, I found one with a title I could understand: “The Filipino Family.” It took me an hour to grasp the first sentence.

  I devoted the entire day to interpreting a single paragraph. I read it, and I read it again, again, and again. Then I read it aloud. Again and again and again. Bess wagged her tail, and I felt it thump against my foot. She thought I was talking to her. I had not talked to anyone other than George and Bess for a very long time, and my voice sounded strange. It echoed inside my skull and made my head ache. From time to time as I read, I uttered words that did not appear on the printed page. Rogue words that came out of nowhere and made no sense.

  Eventually, I seemed to grasp the meaning of the first eight lines. Like most introductory paragraphs in journal articles, all it stated was the purpose of the research and its scope. It would be a good day, a wonderful day, if I managed to read the first photocopied page of that article. Before the accident I read a book a day, two on a good day. Now I would settle for a page. I concentrated so hard my hands began to shake. Bess licked my toes as a gesture of encouragement. It was too hard. I threw the article on the floor, buried my head in my hands, and sobbed, again.

  In my study the next day, my brain felt like it had been scooped out with an ice-cream spoon and replaced with porridge. Nothing worked, and my vocabulary had been scrubbed clean. Each sentence contained words I didn’t recognize, words I couldn’t understand. English was like a foreign language. I kept the dictionary close by, but looking up a word took an eternity, and even then there was no guarantee I would find it. I saw it on the page of the article, but I couldn’t find it inside the dictionary. On occasions, I couldn’t even find the right letter in the dictionary to correspond with the first letter of the word I didn’t understand. Tiny particles of sweat formed along my hairline. I flicked through the dictionary, and the sweat began to trickle down the sides of my face. Thinking provoked pain. I slammed the dictionary shut and attempted to calm myself by stroking the top of Bess’s head.

  Rebuilding my vocabulary turned out to be harder than I’d hoped it would be. I decided I would attempt to work five hours each day, seven days a week, for as long as was necessary. It wasn’t as if I had anything better to do. I recorded the meaning of every word I didn’t recognize in an empty notebook. It didn’t take long before I ran out of pages. At the end of each day I studied those words and attempted to remember their meanings. By the next morning, I would, without fail, recognize the words but not remember what they meant. The cells in two parts of my brain had died, and the pathways connecting the neurons had become obsolete. It would take a considerable amount of time and effort before new pathways began to form.

  MRI technology has
shown that the brains of head-injured people work significantly harder than those of non-head-injured folk to solve even the most basic problems, or to retrieve memories. My brain felt like an old, rickety bicycle I was trying to ride up a steep hill. Every yard or two, I was forced to stop, catch my breath, and gather my strength so I could creep forward another yard.

  After a couple of months, I decided to attempt to make notes about each article on a writing pad. I had forgotten how to type, and writing anything on the computer took forever—studying the keyboard in search of the correct keys. But I could still write by hand. That much I hadn’t forgotten, although I had a tendency to write sentences that included words I didn’t plan on, words that belonged in different sentences than the ones I was writing, or words that belonged in sentences on completely different topics.

  I hoped to find and record the salient points of a journal article. But as I read I was unable to siphon off the key points from the padding. Everything seemed vital. I could barely read, much less skim, and I was distracted by everything. I copied the words verbatim from the page to my notebook. At first, I noticed mistakes. I stared intently at each word I had written. It took all my effort to subdue the thrashing sensation inside my head. I sobbed and tried again. I wrote the first sentence a second time and compared my writing with the author’s words. There appeared to be no mistakes, and they seemed to match. My head throbbed. Yet it was the first time that I had been able to concentrate since my accident some four months earlier. It was a tiny step, but it felt like progress.

  I didn’t know this at the time, but the part of my brain that took the brunt of the impact during my accident was my left parietal lobe, in the area of the junction with the temporal lobe, which is known as the “language zone.” Damage to that region can cause a range of different problems related to language, to expressing oneself through words and word finding. It may also disrupt the ability to understand spoken and written language. I experienced challenges comprehending written English for a couple of years after my accident, and to this day I struggle to understand spoken English in university lectures or when talking to an expert about something with which I’m unfamiliar. My best chance of absorbing new information is through reading. Sometimes that works, sometimes it doesn’t, and I will read and reread whatever it is until the penny finally drops. Word finding, spelling, syntax, grammar, and vocabulary confound me. The condition is known as “dysphasia.” The sheer force of impact of my head on that rock had produced a reverberation known as a “contrecoup,” which had damaged my right parietal lobe. Networks within the right parietal lobe determine the ability to draw, to create things, and our visuospatial orientation.