How I Rescued My Brain (17 page)

‘Oh, did you? I haven't seen this yet.'

I had left the session feeling confused: it felt as if I'd done something wrong. He'd challenged Wayne's diagnosis of post-traumatic stress, hinted that I should not have taken my own initiative in regard to medication, and implied that the help I'd received from Wayne was — what, useless?

In our second session, two weeks later, not long before my stroke, we'd discussed the trauma link further — by then he'd read Wayne's report. I mentioned that some of my triggers were stories of health practitioners being harmed or even killed by their patients; in particular, there'd been a recent local incident of a mental-health worker being murdered by his patient, and this had triggered memories for me. After this discussion, Doctor Banister seemed more accepting of the significance of my trauma.

Today, as he turns away from me at the end of our session and leans over his desk, he says: ‘If you'd been taking antidepressants, you wouldn't have had the stroke.'

What? How does that work? I'm too flabbergasted to respond, and he doesn't elaborate.

As I return to my car afterwards, I'm angry.
So, I'm wrong again,
I think.
I caused my stroke by doing what I thought was right and following others' advice. Terrific.

THAT NIGHT AT
home, I pull the CD of the MRI images out from the radiography envelope. Once it is inserted into my computer, I watch the ghostly images of my brain as I click on different views. They're both beautiful and unsettling. Here is the wonder that makes me human, and here is the damnable thing that gives me nightmares, panic, and confusion. It's a love–hate relationship with my brain at the moment.

FRIDAY ARRIVES, AND
I find myself sitting in Doctor Small's waiting room. He comes in. ‘David, good to see you, although I guess not in these circumstances.' He extends his right arm and we shake hands; his handshake is firm. I follow him down the corridor to his office.

The practice is in an historic, impeccably renovated house. His room is spacious, and, while obviously medical, almost homely. On a shelf behind him, I see a large photograph of his son, whom I have met, playing football; there is a footy on the mantelpiece over the fireplace. Through the large bay window — the lower part obscured by white lace curtains — I see a hedge. While it's bright outside, it is pleasantly cool inside.

He shuffles through the MRI and MRA scans in an unhurried manner, every now and then placing one up on the light box beside his desk. I notice his broad shoulders and short, greying hair. He has a military-style moustache, which, I think, makes him look distinguished rather than unfashionable.

He squints, examining the scan, and points his finger to show me how my left cerebral artery, at the back of my head, caused the stroke with a blockage: ‘an infarct', he calls it. I have an area of damage extending from the left occipital lobe into the left hippocampus. This region borders on the left temporal lobe. The occipital lobe processes vision and images, the hippocampus processes everyday memory and factual memories, and the temporal lobe processes sound and speech, and long-term memory.

‘Your arteries are fine,' he says. ‘There are a few more investigations we can do, but my guess is that we won't find anything, and your condition will remain idiopathic: a fancy medical term for “we don't know”.' He explains that it could have been a random blood clot from anywhere that found its way into the cerebral artery. I don't have the usual risk factors for a stroke: no family history of vascular events, no hypertension, normal lipids, and I'm not diabetic. I don't smoke and I have a modest alcohol intake. At fifty-one years, I am a ‘young stroke'.

He will arrange for an echocardiogram of my heart, to exclude sources of embolism; a carotid Doppler study, to check my carotid arteries; blood tests to look for clotting, inflammatory markers, and homocysteine; and a full lipid screen.

When I mention Doctor Banister's assertion that I wouldn't have had the stroke if I'd been on antidepressants, Doctor Small responds with a look of bemusement.

Since I've been out of hospital and gone back to normal life, I've been buckling under daily demands that, before the stroke, were manageable. In Seaview, I only needed to look after myself: there were no chores to be done, and I could rest and go to quiet places whenever I needed to. Now I get incredibly tired, and often sleep during the day. I tell Doctor Small how fatigued I get with general walking and light gardening, and how it takes me the rest of the day to recover.

I explain that I've forgotten a lot of things, too, such as general facts and names (of actors, writers, musicians, song titles, movie titles). It's different, I say, from having a word on the tip of the tongue, one that you know will come in time: some words have completely gone. It's as if they've dropped off the back of a truck, scattering along the roadside, and I've kept on going. I've forgotten the names of acquaintances, although I remember the names of close friends and family — but even so, I now have to think about these, to recall them, in a way that I didn't need to before. Conversations are tiring. In the middle of speaking, I lose track of the point I'm trying to make.

I also have an almost constant low-grade headache, I tell him. When I drink a glass of wine, the hangover-like effect lasts for a day or two after. I like a glass of wine now and then, and the occasional beer, but the consequences are not worth the pleasure of a drink.

One good thing, I tell him, is that I can sing and play music as I did before. It's harder to remember the words of songs, but hitting the right notes is the same.

Doctor Small says that there's not a lot I can do. He doesn't think that I need to take blood-thinning medication because of the condition of my arteries, but recommends 100 milligrams of aspirin daily as a preventive measure. I am to take it easy and avoid stress as much as possible.

‘What about cognitively?' I ask.

‘Read, but nothing harder than the newspaper,' he says.

Good. I should be fine with
Eat, Pray, Love
then.

TWO WEEKS LATER,
Doctor Small has the latest test results. The bloods are all normal. I have no inflammation of the arteries, no heart condition, and no problem with the carotid arteries. It's good news that I don't have any of the nasties, but the cause remains uncertain — so there are no pointers to what might happen in the future.

The only physical sign that Doctor Small finds is low blood pressure: it's one hundred over sixty-five. He wonders if how easily I tire with minimal physical activity is because of damage to the cardiovascular centres in the upper brain stem. The MRI, he says, is not going to show everything. ‘It's unusual for a doctor to recommend this, but I'd encourage you to have more salt. And keep up your fluids.' He tells me to walk only on flat ground — no steep inclines — for the time being, and to avoid swimming. I'm doing a Pilates session once a week, and he thinks this is okay.

The risk of another stroke is low, he tells me. ‘Time is your best friend.'

‘What about stress?' I ask. I've told him of the financial pressure we've been under, and about my anxiety attacks. ‘Could this be a cause?'

‘I couldn't stand up in a courtroom and say that your stroke was caused by stress; no doctor is going to do that. The medical science behind that is unclear. Personally, I believe that stress can cause a stroke.' And he tells me of a close friend who he said had worried himself into a stroke.

There's one other thing I'm still puzzled by — the misdiagnosis. I know that Doctor Small ran a stroke unit in Melbourne before moving to our area, so he might have some idea of what the doctors were thinking. I lean forward. ‘Why did the CT scan at the hospital come up as negative?'

He says that it's normal practice to order a CT scan immediately if a stroke or a transient ischaemic attack (a ‘mini-stroke') is suspected. But a negative CT scan does not rule out stroke: the damaged area of the brain can appear normal soon after onset; the stroke region may be too small to be seen on a CT scan. An MRI is more accurate, but it takes longer and is harder to arrange. ‘Diagnosis is a matter of probabilities. Your only risk factors were being a fifty-one-year-old male and suffering from post-traumatic stress disorder. A stroke for someone like you is a far more likely outcome than a fugue state, which is rare. I often tell my medical students, “If you hear hoof beats in Texas, it's unlikely to be zebras.”'

He explains that a neurologist should have seen me within twenty-four hours, but the hospital doesn't have a neurologist, or an MRI machine. ‘In your case, I would've arranged for an MRI at the radiology centre up the hill, and given you a big dose of aspirin as a matter of course.'

I mention that I've read something about a medication that reverses a stroke. ‘You mean plasminogen activator?' he says. ‘It breaks up blood clots in the arteries of the brain. To work, it needs to be injected within six hours from the onset of symptoms. It was probably too late for you. In the end, I don't think the misdiagnosis has changed the outcome, medically speaking.'

This is reassuring. My stroke happened during the night, and Anna got me to hospital as fast as she could: faster, she reckoned, than if she'd called the ambulance. We did all we could.

THIS STROKE THING
is a process of discovery. The invisible hole in my head is a trickster; I don't know when or how it's going to trip me up next. Some days my brain decides to work, and on other days it's like a sullen teenager, refusing to cooperate for no clear reason.

My body's not behaving properly either. In Seaview, it took me several days to get up to a reasonable walking speed, but now, at home, I seem to have regressed. I walk daily into town, a distance of a kilometre, to pick up the post, do a bit of shopping, and stop for coffee at my favourite cafe. Marion is one of the regular waitresses I like to chat with; she is a singer in a reggae band.

One morning, I'm standing at the counter as she takes my order when she says, ‘Dave, you're scaring me. You're wobbling from side to side. Come and sit down.' She guides me over to a chair.

After the coffee and a rest, I head home, walking like a frail old man.

What is happening to me?

Over some weeks, I work out which activities bring on dizziness. They often involve physical exertion, such as swimming and long walks. Gardening — especially weeding — and packing and unpacking the dishwasher also bring it on; I think this is because of the up-and-down movement of my head. Pushing the lawnmower brings on extreme fatigue, and I need to lie down afterwards. Physical fatigue also drains my mental concentration, and then everything is harder.

I'm bumping into things on my right side, too. The grip in my right hand is not quite there, and more than once I drop cups onto the kitchen floor. My handwriting is clumsy, as if my right hand is drunk and stumbling across the page.

I can't multitask anymore — or perhaps it's more that I can't filter out distractions. I need to complete one thing before moving on to the next. If I'm derailed from my mental tracks — say, if someone speaks to me or if the phone rings — I have to work out, by a process of detection, what I was doing before the derailment. If this fails, I turn to the next thing that comes to mind, and I forget to return to the first task. When I read professional books, I can usually get the gist of the concept I'm reading about, but once I reach the next idea, a wall goes up, separating what I've just read from what I'm reading next. The ideas don't hang together — they're like a string of beads with the string taken out. I'm left with an attractive but useless pile of beads.

Each morning I write a to-do list, which I carry around with me. This is my best strategy for staying on track — so long as I can remember to take the list with me. But on the days when I wake up already worn out, I stare at the paper, waiting for items to surface in my mind. Nothing comes. Then I have no strategy.

I do most of the grocery shopping, but without a list it's disastrous. Once I'm at the supermarket, I have little memory of what we have at home. If I have made a list, I've often forgotten to take it: so many things divert my attention that it's like going through a mental minefield before I get out the door. So, listless, I cruise the shelves, dropping things into the trolley as if we have nothing at home. I'm always compelled to buy two cans of tinned tomatoes and a tin of kidney beans. Even the kids have noticed the growing profusion of these in the pantry.

Each time I return to the house, I have to place my car keys and wallet precisely in the left corner of the sideboard. But often I forget, and they end up wherever I happened to put them down. When I need them next, I panic, searching the house with absolutely no idea of what I've done with them. If the kids are around, I call out to help me look; they usually find them quickly. Sometimes the keys are on the sideboard, but to the right of the corner. I appreciate how much my brain was coordinating my everyday life — now, I'm like a car without a steering wheel.

When I need to make a decision on the spot, or under a time constraint, I become overwhelmed. I go into freeze mode, like a frightened animal. If someone else is there, I want to run away, my body telling me that this is the only way to escape this feeling of being under siege.