Fallen: A Trauma, a Marriage, and the Transformative Power of Music (22 page)

“Tissue loss, extensive enceph-al-o-mal-a-cic changes,” I read out loud, stumbling over the excess of vowels. “That’s not good, right?” By now I understand that it is impossible for damaged or destroyed neurons to heal or regenerate. The injured or absent areas will remain that way.

“No, it’s not good,” Dr. Yao says. “But clinically, day to day, Simon is improving, and that is good. That is where we will take our cues.”

“He’s sleepy right now, but, you know, he doesn’t feel any gaps in his thinking.”

“Well, that,” Dr. Yao answers predictably, “is symptomatic of a brain injury. It is common not to feel like there is anything wrong.”

I
don’t see any major gaps in his thinking. This is what I want to say but don’t. And now that Simon is less confined to bed and awake more, it is no longer entirely true. There are differences. The focus he requires to make his therapy session appointments precludes any other form of interaction, and if someone tries to engage him briefly in conversation, he is often preoccupied and impatient, impulsively driving off in his electric wheelchair midsentence. He likes to drive the chair fast, the New Driver sign dangling precariously off the headrest, and his solution to hallway traffic jams is generally to speed up and barge through. He worries incessantly about each new step he takes with Sean and Melissa, and it is difficult, if not impossible, for him to take a mental break. He often has problems with the proper sequencing of events: if ten small steps are needed to solve a given problem, he might start on step one but then leap ahead to nine or ten right away. There are occasional and surprising gaps in the logic of his everyday thinking, more evident at the end of the day when he is tired.

“Before his accident Simon was extremely bright and quick...,” I say, letting my sentence trail off, unsure of how to frame my question. Unsure, exactly, what my question is. “He’s in the
OT
room, picking up pennies, and his hand is getting better but how...” I stumble again, afraid that the hot tears, always so close to the surface, will boil over. Deep breath. I focus on Dr. Yao’s shoes: ruby red with a blocky, tapered heel. As always, they match her purse, and, as always, I find them elegant, enviable, and grounding. Another deep breath. “How do you heal executive functions?” I ask. “How do you heal thinking?”

“There are no blueprints,” Dr. Yao says. “The brain’s ability to heal is contingent on its ability to make new connections.”

This makes sense and is surprisingly comforting. Simon’s great gift, as a musical improviser, is his ability to make spontaneous and often startling new connections over the course of just a five-minute song. So, I tell myself, despite the mushy frontal lobes and the missing bits of the left temporal lobe, there is the possibility of continued healing. For his thinking, at least, if not for his right ear. With Simon defying so many of the doctors’ predictions, I have been holding out for the possibility of healing in his right ear. This
CT
scan shows, however, that one of the many fractures—through occipital, temporal, and sphenoid bones—starts at the back of Simon’s skull, near the top of the spinal cord, and traverses through the temporal bone, across the canal of the carotid artery, and through the semicircular canal of the inner ear and the cochlea, ending close to the Eustachian tube. There is no need, Dr. Yao asserts, for further exploration. Damage to the structures of the inner ear does indeed mean the hearing loss is permanent.

ARMED WITH THESE
CT
results, Simon and I take the
GF
Strong transport bus back to
VGH
for an afternoon appointment with Dr. Haw. I saw Dr. Haw only once in the early days of
ICU
. He was surrounded by students and other doctors engaged in their early-morning rounds, and we had only the briefest exchange before he pressed on. Simon, of course, has no recollection of him, but this is the man who has been inside Simon’s head. Dr. Haw has seen the folds and fissures of Simon’s cerebral cortex, touched the living tissue that has, throughout his life, defined his particular Simon-ness.

“It is a pleasure to meet you, sir,” Simon says, extending his right hand.

“And a pleasure to meet you.” Dr. Haw grips Simon’s hand. “When we first were introduced, you were more than halfway through death’s door. I’m glad you’ve returned.”

“Me too,” Simon says. “Thank you.”

“Thank you,” I echo, acutely aware of the feebleness of my language. Only an hour before, I said thank you to the woman at Starbucks when she handed me an Earl Grey tea. Thank you is not enough to offer Dr. Haw, but at the moment, it is all I have.

The room is small, the narrow space between Dr. Haw’s desk and the wall behind us underscoring how cumbersome the electric wheelchair is. I push chairs into the far back corner so that Simon can squeeze in as Dr. Haw settles himself behind his desk. He is a short man with a kind and serious face. The office walls are hung with various degrees bearing his full name—Dr. Charles Sung Haw—and I am charmed by the verbal suggestion of musicality, the hint of humor, in his name; I imagine I can see this in his face, too.

Dr. Haw asks a few questions and patiently answers ours, and then we discuss when the large section of skull bone still missing from the left side of Simon’s head will be replaced. Dr. Haw wants to replace the bone flap as soon as possible, but two things need to happen before he can proceed: the open and miserable pressure sore on the back of Simon’s head will have to heal entirely, and one of the drugs Simon is currently on—heparin, a blood thinner used to prevent the blood clots that spinal cord injury patients are susceptible to in the first few months after their injuries—will have to be completely out of his system.

“Perhaps we’ll be ready for surgery in four to six weeks,” Dr. Haw concludes as he walks us to the door.

“Thank you,” Simon says again and, again, I echo it.
Thank you.

A week later we return to
VGH
, this time for an appointment with Dr. Dvorak, the surgeon who operated on Simon’s back. I have not met Dr. Dvorak, only his assistant, Dr. King. At the time of Simon’s spinal cord surgery, the head
ICU
doctor assured me Dr. Dvorak was, if not the best, one of the best spinal cord surgeons in the country.

We follow a receptionist to an examination room where we wait, busying ourselves by studying the large diagram of the spinal cord hanging on the back wall. Soon we are joined by a doctor who looks too young to have achieved the status of best spinal cord surgeon in the country.

“I’m Dr. Cabot,” he says, shaking Simon’s hand. He turns and shakes my hand. “I don’t know if you remember me? I was the doctor in the
ICU
the first few nights Simon was there. I remember you both and”—he turns back to Simon—“it is just outstanding to meet you now. You’ve come a long way since that time.”

He explains that he will do a brief physical exam, and then Dr. Dvorak will be by to discuss the results of Simon’s most recent
X
-rays. We discuss Simon’s dizziness, which is still a significant issue, and he asks a few general questions before instructing Simon to raise and lower his arms and to flex and extend and squeeze his hands, much the same way that Sean did.

“Outstanding,” Dr. Cabot repeats, over and over, as Simon executes each movement. “This is outstanding.”

“My physio is helping me move to a manual chair,” Simon says, taking the opportunity for a much-deserved brag. “Wheeling is hard for the left side, but he thinks I can build up the strength.”

“It’s outstanding. This—things like this—it’s why I wanted to become a doctor,” Dr. Cabot says, both palms open, gesturing toward Simon. “I’m going to get Dr. Dvorak now.”

A few minutes later they both return. Dr. Dvorak has a friendly face and a largesse in his physical stature that seems to easily accommodate the mantle of one of Canada’s top spinal cord surgeons.

“It’s a pleasure,” he says, shaking both our hands. He explains briefly the placement of the rods in Simon’s spine. The most recent
X
-rays look good, and there are no new developments or problems. When Simon asks what kind of healing he can expect, Dr. Dvorak says that now, only time can tell.

“But you have certainly defied our previous expectations. You know, there was serious talk at a certain point when you were in
ICU
of not even doing the spinal cord surgery, the expectation that you would live being so low.” Dr. Dvorak smiles a wide-open grin. “I’m certainly happy that we made the decision to proceed when we did.”

“Me too,” Simon says. Once again we both offer up our thin, insufficient thank-you’s and agree to book follow-up appointments at Dr. Dvorak’s new location at the soon-to-be-opened Blusson Spinal Cord Centre.

As they both exit the room, Dr. Dvorak turns to Dr. Cabot. “Holy cow,” he says. “It’s unbelievable.”

“I like that Dr. Dvorak,” Simon says as the door closes behind them. “He looks just like Bobby Orr.”

I BUY A
paperback copy of Norman Doidge’s
The Brain That Changes Itself,
my heart quickening as I read the preface: “This book is about the revolutionary discovery that the human brain can change itself, as told through the stories of the scientists, doctors, and patients who have together brought about these astonishing transformations.”

This book becomes my new bible. I carry it with me, returning to different, specific passages, over and over again, the pages quickly becoming soft and slippery.

Since the beginning of modern science, the dominant governing metaphor for brain function, Doidge explains, was one of a “glorious machine,” and although machines were capable of many extraordinary feats, their core properties and capacities were fixed and unchanging. In this paradigm adult brains were “hardwired”; the various components of the brain were designed to perform specific functions; if the brain sustained any type of injury or damage, it was assumed to be permanent. Even a healthy brain, within this framework, could not be improved through intense physical or mental activity.

In his book, Doidge sets out to show how limiting and erroneous the machine metaphor is. Rather, the intricate neural circuitry of the brain has the potential to be highly fluid, malleable, constantly rearranging and reorganizing its pathways. The brain—that creative sculptor of reality—has the capacity to change its own structure and functioning through the thoughts it thinks and the actions it takes. In making his argument for the brain’s “plastic” quality, Doidge relates several breathtaking stories: a man, blind since birth, who regains functional vision through a device placed on his tongue; a young woman, born with only one cerebral hemisphere, who is an active member of her family and community; a man cured of chronic pain in his phantom limb by an ingenious and inexpensive mirror-and-box invention. An elderly poet and teacher who, after a massive stroke in his brain stem, recovers sufficiently to return to his previous life, teaching, remarrying, and dying years later while hiking in Bogatá. I read these stories over and over again, trying to learn the language of neuroplasticity. I read these stories over and over and discover the exact thing that I had been so afraid of during the time in
ICU
: Hope.

FRIENDS OF DANNY’S
parents were killed traveling from Nelson to Vancouver. The side of a mountain shook loose and landed on the stretch of road their car zipped along.

“
That
was an accident,” Danny tells me. According to Danny, what happened to
him
—a missed landing in a bike jump—was not an accident. “It was stupid,” he says. “There was this moment and I should have pulled the front wheel up. I knew I should pull it up. But I didn’t. It’s my fault.”

I hear in his words that he lives this fraction of a second over and over again. In flight. Creating his own breeze in the hot blue air of a breathtakingly average summer day.

“Everyone freaked out when I landed,” he tells me. “Even though I couldn’t move, I had to talk them through calling my mom. Getting an ambulance.”

Over and over again. The inhale. The moment of suspension. The brief but glorious tricking of gravity. The slight shifts in body weight. Forward. Backward. The rubber of the front tire, touching down. Exhale. Wrong. The twisting catastrophe that lies ahead.

Over and over. He practices it over and over in his mind. Given the chance, Danny would never miss a landing again.

“It was an accident,” I tell him. “Everyone always thinks they could have done something to prevent a bad thing from happening. But that’s why it’s called an accident.”

“Yeah,” he says, and I almost see the phantom shrug of his still motionless shoulders. “I guess.”

THE VERTIGO GRADUALLY
eases, and eventually Simon is deemed no longer at high risk for choking and is cleared to eat the solid foods in the general cafeteria. In the area of bowel and bladder care, however, there is a frustrating lack of improvement.

“You must hate this,” Simon says one morning, his tone surprisingly harsh. Accusing. I am helping him with his bowel routine, trying to get through it without nursing support. “You must hate having to do this.”

“I hate that you have to go through it,” I say. “But I wouldn’t be anywhere else.”

“I’m so sorry,” Simon says, his voice softening. He says this often, randomly apologizing, and it always shocks me when he does. “Stan, I’m so sorry to do this to you.”

“Don’t apologize, Beau.” It’s too much: having to live through what he is living through
and
his need to apologize all the time. “Please don’t be sorry. You have nothing to be sorry for.”

JOHN, DOWN THE
hall, brings Simon graphic novels. He often parks his electric wheelchair at our table in the cafeteria, joining us for lunch and a conversation that covers a wide range of topics, everything from the intimate to the philosophical. Discussions often include the trials and tribulations of rehab, the intricacies of interpersonal relationships, and the state of arts funding in Canada. Simon and John usually wind up by discussing their favorite sci-fi stories. Ursula K. LeGuin, they agree, is a genius. Isaac Asimov too. John is a veterinary surgeon from the Yukon, a man who, confined in the rehab center, confined in his injured body, is articulate and passionate in his longing to return to the wide open spaces of the North. A motorcycle accident on a late-night highway sent him here, to Vancouver, with a high-level incomplete injury and a hard knock to the head. The months he spent in the hospital before coming to
GF
Strong are lost to him, his brain a sieve through which days passed, leaving no silt trail behind.