Fallen: A Trauma, a Marriage, and the Transformative Power of Music (15 page)

AUG 6/08

CT OF THE HEAD

COMPARISON:
CT
— July 28, 2008, 8:02 pm

FINDINGS
:

Left-sided craniectomy is again noted, with brain herniation through the bony defect, which has marginally increased in size when compared to previous films. The right frontal
EVD
has been removed, without any evidence of acute hemorrhage.

Extensive bifrontal and left temporal contusions continue to evolve, with no new hemorrhage.

Tentorial subdural hemorrhage is largely resolving, and has become hypodense and shifted to occupy the posterior aspect of the left cerebral hemisphere. It only measures approximately 5 mm and exerts only minimal mass effect.

The size of the ventricles is essentially unchanged.

THE TWO HEMISPHERES
of the cerebrum are covered in a gray-matter cortex, and each hemisphere is divided into four sections: the frontal lobe, the temporal lobe, the parietal lobe, and the occipital lobe. Within the complex microscopic neural grids of these lobes, thought is translated from an internal symphony of neurobiological electricity to an external world of action and language. I parse my way through Simon’s
CT
scan the way I once did through Milton’s
Paradise Lost
.
Brain herniation through the bony defect
means that the cerebral tissue of the left hemisphere has continued to swell outside the hole where Simon’s skull was removed, and the brain could be damaged by this contact.
Mass effect
refers to the amount the brain has shifted as a result of an increase in volume caused by the bleeding and swelling. The
tentorium,
or the tent of the cerebellum, is an extension of dura mater that separates the cerebellum from the occipital lobes. That the hemorrhage there is resolving and that there are no new hemorrhages are good signs.

The extensive bifrontal and temporal contusions are the areas doctors continue to refer to as “mushy.” I have been given a diagram of the brain with bullet-point lists of each lobe’s specific functions. The frontal lobe has a long list, covering a variety of functions and personality traits. Higher functions, we are told—executive functions: the frontal lobes do the work that separates humans from beasts. The list for the temporal lobe is shorter but more critical: memory, hearing, language. I do not like the phrase “continue to evolve,” but no one can offer an explanation as to what that means exactly. The important thing, I am told repeatedly, is that there is nothing in this new
CT
scan to indicate that further surgery is necessary.

The doctor agrees to reduce the morphine to an only-as-needed prescription.

The diagram we were given appears on the following page.

Parietal Lobe · intellect · sense of touch · differentiation of size, shape & color · spatial perception · visual perception · muscle tone, strength & sensation Occipital Lobe · vision Cerebellum · balance · coordination

Frontal Lobe · initiation · planning/anticipation · follow-through · impulsivity · judgment · reasoning · abstract thinking · smell · motor planning · personality · emotionality · speaking · integration of thought and emotion · self-monitoring

Temporal Lobe · memory · hearing · understanding language Brain Stem · breathing · heart rate · blood pressure · movement & sensation for head, neck, eyes, hearing · relays messages for other movements and sensations

In addition, we are also given a second, more colorful picture in which the various functions of the brain are represented as a cadre of phone-wielding, paper-sorting office workers. Accompanying this picture is a description of how the brain functions, using the analogy of a company. The frontal and temporal lobes, the explanation goes, are the vice presidents. There are many vice presidents, all of whom are constantly receiving information from the rest of the company, and their job is to analyze this feedback, and to use this analysis to inform their judgments and decision making. In addition to this data gathering, the vice presidents of the frontal lobes are responsible for initiating activity, one of the most critical functions performed independently of other brain areas.

The parietal lobe houses the managers, each manager running his or her own department: the mechanics of speech department, a language department, a motor department, a spatial reasoning department, a music department. The managers are in regular communication with one another, as well as with the vice presidents.

At the bottom of both the brain and the corporate food chains are the workers. They are largely unaware of the vice president’s big-picture plan. They have straightforward jobs, which they do day in and day out. They remind us when to get a drink of water. They help us stay alert when necessary and, afterward, lull us to sleep so that we can recharge. They express our basic emotions and are responsible for unconscious physical reactions such as the crimson blush when we are embarrassed, the increase in our pulse rate after a fright, the open-mouthed yawn before bedtime, the sneeze after a sniff of allspice, and the tears that flow when we are sad.

In a brain injury, it is as if someone has been fired and the overall efficiency of the company is compromised.
A primary purpose of rehabilitation is to find out who got fired and who is still on the job,
the explanation reads,
so messages can be re-routed and the company can become more and more efficient again.
I read this description over many times, and each time my heart thrills at the words
re-routed
and
efficient
; perhaps healing from a head injury is also an opportunity to pare off all extraneous diversions and reduce the bureaucratic white noise of the brain.

Despite what I perceive to be the optimistic implications of this explanation of brain function, I find the corporate analogy unsettling. The cultural expression of neuroscience reflects the culture the brain exists in; our thinking about thinking provides an interesting window into the time in which we are thinking. If Simon were awake, this would be an interesting point of departure for a conversation we might have: how using the corporate structure of a company to understand our brain so aptly reflects our time.

FRANZ JOSEPH GALL
was born in the mid-eighteenth century and became a doctor and an anatomist during a time in Europe when physical features such as facial structure were strongly associated with temperament and moral character. He theorized that development of specific areas of the brain would result in a corresponding development in the cranial cavity and that much could be learned about a person’s nature by palpating the bumps and depressions of the overlying skull. People with bulging eyes, Gall contended, possessed strong verbal memory. Those with skull prominence over the ear were excessively destructive and suited for work as, say, executioners. The area on the forehead touched or rubbed by poets during the act of writing represented “ideality.” Gall called his theory
phrenology,
and he claimed to be able to identify and localize twenty-seven discrete human faculties, including acquisitiveness, vanity, veneration, wisdom, passion, pride, affection, arrogance, ambition, and a sense of satire, all of which he placed on a detailed map of the human cortex. His ideas were largely rejected by the scientific community of the day but found enormous popularity in the larger culture.
The Constitution of Man,
published in 1827 by George Combe, an intellectual descendent of Gall’s, sold over 100,000 copies; at the time only the Bible and Paul Bunyan’s
Pilgrim’s Progress
were more popular.

The European science community strove to distance itself from Gall’s pseudoscience while still embracing the notion of localized function. It was Paul Broca, a highly esteemed French scientist and physician, who made the correlation between a lesion on the left frontal lobe and a patient’s inability to speak. Despite widely diverging methodologies, Broca and the phrenologists came to a similar conclusion, locating the ability to articulate language within the frontal lobe. This area of the left hemisphere is still known as Broca’s area, the primary speech center of the brain.

Paul Broca’s localization legacy carried down through the nineteenth and twentieth centuries. During this time, the field of neuroscience accumulated an immense wealth of data by studying the brain at increasingly greater microscopic levels, breaking down the anatomical, physiological, and biochemical organization of single neurons. It is this legacy that is largely responsible for the first diagram we are given, with its carefully mapped out and segregated regions in the brain.

A DOCTOR ON
the ward shows Marc and Lorna the actual
CT
scan, pointing to the areas where the damage is most severe.

“But,” he says, “you can see there is also damage here”—he points—“and here and here.” His finger skates over the entirety of the image of Simon’s brain.

“Basically everywhere?” Simon’s dad asks.

“Basically everywhere, yes. But this area, here, for example”—he points to a smudgy spot on the right frontal lobe—“is midway between two important areas. So, damage there? We don’t exactly know what it will mean.”

IT IS NOT
a comfortable thing, thinking about thinking—akin to attempting to tear the wings off butterflies. In the two hundred plus years since the end of the Enlightenment, neuroscientists have tried to pin down our butterfly thoughts, the how and where and why of them. In direct opposition to the Enlightenment’s Doctrine of Equipotentiality, much of the best-known and most influential research of the twentieth century followed in Broca’s footsteps. Groundbreaking systems neurophysiologist Miguel Nicolelis refers to this lineage of neuroanatomists as
localizationists
. In the localizationists’ framework, the neuron is the single functional unit in the brain; these scientists have worked, and worked brilliantly, to create a map of the brain, placing functions such as language, movement, and creativity in very precise sections of the gray matter’s walnutlike folds and fissures. Over the past two centuries, opposition to this idea has been sporadic but passionate. Scientists such as Marie-Jean-Pierre Flourens, Camillo Golgi, the Canadian psychologist Donald Hebb, and, most recently, Miguel Nicolelis himself—a renegade group that Nicolelis refers to as the
distributionists
—have argued that the functioning of the brain is a dynamic interplay of all its billions of microscopic parts and that brain function can only be understood if we look at ensembles or networks of neurons acting in concert, not just at isolated areas of the brain. The dissection of a single ant, the distributionists’ paradigm implies, will not provide sufficient insight into the daily complexity of the colony. You can’t pluck a single feather, they tell us, and unravel the fluid mathematical abstractions of the shifting, kaleidoscopic flight pattern of a flock of starlings. You can’t study a drop of water and claim to understand the sea.

AUGUST 7, DAY 17

Long-term care facility? I can’t believe it, Beau. It was such a busy day yesterday, but after everyone left and the evening breeze blew into your room, you seemed to wake up. I told you, as I wetted your dry, chapped lips, that when you were better, some evening soon, we would sit outside at sunrise and eat big chunks of cheddar cheese and drink cold beer and you, in answer, made the rock ’n’ roll sign of the beast. You have a new bed that lowers way down so I can pull the cot right beside you and we can sleep next to each other. Every time I drifted asleep last night, you tugged at my pillow until I woke up.

LARGELY BECAUSE OF
the legacy of Paul Broca and the ensuing dominance of the localizationists’ framework, it has long been believed that language and analytical thought are the domain of the left hemisphere while music and creative expression reside in the right. But more recently, neurobiologists have demonstrated that there is no such strict separation between the processing of language and of music. They have shown not only that there is considerable overlap between the cortical networks responsible for language and music, but that the musical elements (such as rhythm and intonation) in speech play a pivotal role in the acquisition of language: music making implicitly fosters the brain’s language network. Given this new research, it is likely that, as both Darwin and Jean-Jacques Rousseau proposed, music was ancient humans’ first form of communication, that it is the evolutionary predecessor of speech and remains today a living, breathing, cacophonous bedrock fossil of humanity’s varied languages. It is entirely possible that humanity was sharing thoughts, information, and emotion through rhythms and vocalizations long before we even had the word to name it: song.