How I Rescued My Brain (34 page)

‘Yes, it's not denial,' I say, ‘it's staying with the emotion and knowing this. I still get a bodily reaction. I'm watching it, but I have a choice.'

‘How long has it taken you to get to this stage, using mindfulness and meditation?' she asks.

‘About two years,' I reply, ‘but I don't have complete control.'

‘That's short,' she says. ‘Getting to this stage requires a lot of training, and it's not easy.'

She points out that the insula is the interoceptive cortex and acts as a relay station, bringing bodily sensations to the cortex, which interprets emotions based upon these sensations. Its activity is enhanced through mindfulness and meditation practices, and this may be one of the pathways that help to change the psychological response to traumatic memories. ‘Training the heart' through loving-kindness practice is training the attachment system — the caregiving system that we respond to as babies and children. Mindfulness stabilises the mind so that we can more readily access our mental and sensory experiences, giving us the capacity to focus the mind in a way that alters brain function.

Tania has confirmed, so neatly, what I've been working out for myself: mindfulness and meditation have changed my brain for the better.

AFTER THE DAY
is over, my mind tumbles with insights. I think of Choeying. She told me that she moved through empathy to compassion and that such compassion is necessary to be with others in distress. Does her version of compassion correlate with the activation of the compassion network that Tania has described?

Tania's preliminary findings suggest that those who employ a compassionate view of human distress are not dragged down by it. What I observed in Choeying was not detachment from those she was helping, but a desire to help, followed up by action. Choeying said that she felt uplifted in the face of others' suffering: not trying to fix their pain, but helping them to see a way through it, and, in the process, gaining insight.

Why was the Dalai Lama's teaching in Sydney such a positive experience for me? Was I responding, through the ‘resonance circuits' that Daniel Siegel describes, to the presence of those around me — soaking up their calmness and their caring outlook? Was there something about the intense compassion I witnessed in the Dalai Lama that my body and my brain responded to?

As I look back over the five years since 2006, what stands out for me is the compassion of those who have helped me. My ocean-swimming friends, who were there each week to talk; Lily, who, through singing, showed me a way of transforming my heaviness; Wayne, my bedrock and counsel, helping me skilfully as a psychotherapist; Doctor Franklin, with his commonsense advice and advocacy for me with my insurer and others; Doctor Small, with his reassurance that I was doing the right things for my recovery, and encouraging me to write; my mates Ian, Doug, and David; James, with his encouragement of my neuroscience enquiries; Nick and my muso friends; my GP; and my former professional colleagues. I'm surprised to realise that many of these have been men — steadfast, caring, wise males who have been instrumental in my recovery. My faith in men has been restored.

And there is my family, who endured the intensity of my personal hell and the awful confluence of life events that beset us.

And me. When I walked into Wayne's office for the first time in October 2006, I was carrying failure, shame, and self-criticism, and an admission that I could not do this thing on my own. Now I have a feeling of renewal. Is this self-compassion?

I wonder: has compassion changed my brain? Tania's research suggests that it has.

My auditory processing has improved dramatically since the stroke — my comprehension of speech and my working memory in particular. I can think again, hold conversations, and make sense of what I hear and read. Mindfulness is no longer a mystical concept; it is a real, constant way of apprehending my inner world.

My emotional life has been rebalanced; is this due to the assiduous activity of my prefrontal cortex? Writing and therapy have definitely helped. Exercise, nutrition, music, and forming nurturing relationships have amplified the neuroplastic changes.

I'm still not back to where I was, but I'm steadily improving. And in other ways, I'm far ahead of where I was. I've rescued my brain. Have I also found my psychological insurance policy?

IN THE YEAR'S
final session with Wayne, I ask, ‘What are the long-term effects of post-traumatic stress disorder? Will I have a permanent disability?'

‘You won't be the person you would have been if you had never been exposed to those experiences,' he says. ‘Ask:
Am I still controlled by the trauma memories when they come unbidden?
'

He thinks I'm now in control, in many ways. When certain situations arise, like they did at the writers' festival, the original injury is like a scar. The old, disturbing memories are reawakened, and highly emotional when I access them. What's important is how well I manage them when this happens — how much it affects me in a day-to-day way.

‘You will be particularly sensitive to children's stories,' he says. ‘It's a healthy coping response to practise avoidance and denial at times. But if you live like some Vietnam veterans I've worked with, who exist by themselves in isolation, that is pathogenic; their experience is so limited they can never change the way they think about things.

‘In your case, you are mixing with people and taking up new challenges, and your perspective on the way you think and react is changing. You've done your frontline duty and experienced the burnout that almost inevitably comes with this kind of work. You will not be the same person you would have been if you had never experienced these things, but you are wiser for it.'

I'm starting to like the new person.

EPILOGUE

RECENTLY, I WENT
back to Lismore Hospital. I found the ward where I had stayed and walked the path I must have taken to the canteen. The hospital and rooms were smaller and duller than I remembered. The staff in the canteen that I had thought were ‘at a party' looked like a regular bunch of workers on their break, this time. I didn't stop for a coffee.

A while ago, I gained my hospital records from my admission. These confirm that a CT scan was done. The CT report says:
No evidence of intracranial haemorrhage, infarction, or a space-occupying lesion.
I remember what Doctor Small had said about lesions sometimes not showing up on CT scans. I was seen by the serious doctor, a physician, in the afternoon of the day of my admission. He wrote in the notes:
Most likely TGA [transient global amnesia], with differential diagnoses of CVA [cerebrovascular accident] and encephalitis less likely
. I find it puzzling that throughout the notes amnesia is remarked upon, as well as confusion, but in some instances the notes say I was oriented to time and place. The notes reveal that the medical personnel were aware I had vomited on the way to hospital (reported by Anna) and that I had a headache. My C-reactive protein count, ascertained from the blood tests, was slightly elevated. These are all signs, I've since learnt, that are consistent with a stroke.

There is the serious doctor's written request for a psychiatric review, but no evidence of a psychiatrist or Doctor Banister coming in to see me before I was discharged.

Almost three years post-stroke, in March 2012, I undertook a full clinical review, with new brain MRI, an ultrasound, and blood tests, all ordered by the neuropsychiatrist I first came across at Seaview. Doctor Franklin had referred me to him for advice on the cause of my stroke and whether there was medication I could take to help with my neurological condition. The neuropsychiatrist found no medical reason for me to have had the stroke. Although he agreed that there is a link between depression and stroke, he said that the underlying mechanism for this has not been delineated. My arteries were clear, and there was no evidence of further bleeding in the brain.

He also confirmed that mental fatigue is common following brain injury, but could not explain why; he suggested a sleep study to ascertain if sleep apnoea was a cause of my mental fatigue, but this revealed no sleep disorder. Yet I was relieved that he confirmed I was doing all I could for my rehabilitation, with no further medication appropriate other than the 100 milligrams of aspirin directed by Doctor Small and the fish-oil tablets. He thought that Doctor Small had done all the right things.

The neuropsychiatrist referred me to a neurologist. He looked at all three sets of MRI scans done over the three years and gave me a more detailed description of the likely areas of damage to my brain. His observations confirmed that areas in my left temporal lobe were probably more affected than suggested in the radiologist's initial MRI report (which is what had led to the stroke diagnosis), and the ‘tail' of my left hippocampus had been damaged. This makes sense to me because of the constellation of auditory, memory, geographical, and learning deficits I experienced — these were more extensive than would be expected solely from an occipital infarction. The neurologist said that there would have been more brain swelling evident on the day of the stroke, and soon afterwards, than appears on the first MRI, which was done three weeks post-stroke.

Just over four years post-stroke, in September 2013, my ophthalmologist, Doctor Mercer, conducted a visual-field test. During this, I was able to see pinpoints of light in the previously dark upper-right quadrant, although they were fainter than the points of light in the other parts of my visual field. Doctor Mercer declared that my visual capacity had returned to normal, nevertheless.

Recently, I started cognitive training using the latest Posit Science exercises for auditory processing, now called BrainHQ. I was pleased to see that I moved through the basic levels of these new exercises very quickly, and I am now on to the harder levels.

All my treatment practitioners have asserted that I should not return to clinical psychological work; it remains too risky. In a medical sense, I have not completely recovered, neurologically or psychologically. However, I feel recovered, in a very important way: I very much like the person I am now. I have strengths that I didn't have prior to the stroke, and I accept that some of the old strengths, such as the analytical mind and the sharp memory, are gone.

My intention is to continue with writing, public speaking, and advocacy for mental-health and disability issues. Oh, and with drinking coffee, playing music, being a father, swimming — and investigating my brain.

Wayne has since retired from clinical practice and is engaged in other pursuits. Choeying has withdrawn from formal teaching and no longer lives in Hervey Bay.

FURTHER READING

THERE HAVE BEEN
several books, people, and organisations that have helped me in my recovery from trauma and stroke between 2006 and 2011. The following is a list of the principal resources I read or accessed during this time. I have included them, along with some other references, for those who would like to read more about these topics. They may be helpful to those going through similar experiences to mine.

Stroke and brain injury

Carter, Rita,
The Human Brain Book: an illustrated guide to its structure, function, and disorders
, Dorling Kindersley, London, 2009.

The MRI scans of a real brain, and the graphics showing brain function, in this wonderful illustrated guide enabled me to visualise my brain and get a better sense of how it worked (or didn't). It is a terrific starting point for understanding brain anatomy and function, and would be particularly useful for those who have trouble with reading, as the images are plentiful.

National Stroke Foundation, www.strokefoundation.com.au, and Brain Injury Australia, www.bia.net.au

These websites, which I referred to frequently after my stroke, provide easy-to-understand information about the effects of brain injury. They have links to other useful services and organisations.

Osborn, Claudia L.,
Over My Head: a doctor's own story of head injury from the inside looking out
, Andrews McMeel Publishing, Kansas City, 2000.

This memoir describes the author's experience of life after a head injury, and how she approached her cognitive recovery. It confirmed for me that the cognitive difficulties I was experiencing were real, and gave me more encouragement to address them.

Taylor, Jill Bolte,
My Stroke of Insight: a brain scientist's personal journey
, First Plume Printing, New York, 2009, and ‘My Stroke of Insight',
TED
, 28 February 2008,
www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight

Taylor's book was the first account I read of another's stroke. I did not understand the full import of her message until I watched her TED talk: it was her description of a ‘nirvana-like' experience following her stroke that confirmed for me that my feeling of transcendence during my stroke had a neurological basis. I recommend watching the talk if you have had a stroke or know someone who has. It's thought-provoking stuff.

Trauma

Saakvitne, Karen and Pearlman, Laurie,
Transforming the Pain: a workbook on vicarious traumatization
, W.W. Norton & Company, New York, 1996, and Skovholt, Thomas and Trotter-Mathison, Michelle,
The Resilient Practitioner: burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals
, Allyn & Bacon, Boston, 2001.