Remembering Smell (4 page)

In the film
Groundhog Day,
the character played by Bill Murray wakes up every day to find he's still living the previous one. Stuck in time, he is frozen in place. I was that character.
I can't smell and I don't know what that means.
The tape was my wake-up call, the shrill morning alarm that shattered the blessed relief of slumber and told the limbic system to rise and shine. Time to jolt the heart into overdrive and turn on the faucet marked
ACID
to begin the gastrointestinal slow burn. Sleep was now out of the question unless I was willing to drug myself with a megadose of those little yellow pills, the tranquilizer called Ativan, which I wasn't, because as bad as this was, giving in to fear would be worse.

Cam seemed to have bought my misleading portrayal of Dr. Cushing. The poor man was undoubtedly a quack. Cam ridiculed the notion that a nasal spray could destroy a person's sense of smell. That it was he who'd recommended I use Zicam cemented his conviction that the cause was not some innocuous gel but the cold itself—"if in fact you actually
have
lost your smell."

Dr. Cushing called with good news: the CT scan was clear. I did not have a brain tumor. I heard a click on the upstairs line. Cam joined the conversation. The doctor reiterated that my anosmia was almost certainly permanent. He repeated his theory that Zicam was the cause, adding that Cam shouldn't blame himself; millions of people were using the stuff, even though it had only a placebo effect at best, and loss of olfactory function was an exceedingly rare, albeit tragic, consequence. He also told Cam that "there is no test."

This was in response to my husband's suggestion that he "stick something up there and take a look." Feeling defensive on the doctor's behalf, especially in light of my unkind remarks the night before, I reminded him that Dr. Cushing already
had
taken a look.

There was a test that I could self-administer, the doctor said. The University of Pennsylvania Smell Inventory Test (
UPSIT
) rates the severity and specificity of smell loss. It measures a person's ability to identify up to forty different odors. Dr. Cushing said he'd found such tests unhelpful, however. "If patients tell me they can identify smells, I know they're probably lying."

While I tried to interpret this bizarre statement, Cam used it as the basis for his budding theory of a psychosomatic cause for my phantosmia. He suggested to Dr. Cushing that maybe I was just imagining all this. "She gets migraine headaches too," he told the doctor. "Emotional stress can have physical manifestations, isn't that so?"

Dr. Cushing said he left that sort of thing to the psychiatrists and maybe I should see one. All he had to go on was my own testimony that I was smelling foul odors, a classic sign of a damaged receptor sheet. Then he wished us both good luck and reminded me to come back in three weeks so he could check my "progress." He signed off on what he must have thought sounded like a positive note: "Remember what I said. You won't be smelling a thing by Christmas. The treatment usually takes about four days to start working."

Cam immediately suggested we see a psychiatrist. He said he'd come with me. If the psychiatrist believed, as Cam did, that the awful odors were psychological, then all I'd have to do was "let them go" and get on with the task of sorting out the real cause of my distress. The psychiatrist would help me. We'd have long talks. Eventually we'd talk my troubles away.

"You are obviously extremely anxious," the psychiatrist said.

Then he asked me how my mood was, apart from the anxiety, and had me count backward from one hundred by sevens. I got to ninety-three. What was going on? I used to be able to count backward by sevens.

Apparently satisfied, the psychiatrist scribbled the name of a new drug on a prescription pad, along with an Ativan refill. The drug was Lexapro, one of the SSRIs (selective serotonin reuptake inhibitors) that Dr. Cushing had told me about. The Ativan would keep my anxiety under control while the SSRI built up in my system. That could take a month or more. "Everyone reacts differently." The SSRI, if it worked, would deal with the chemical cause of my tendency to hit the panic button, as Cam often referred to that aspect of my personality. And it was not addictive. Nor would it put me into an altered state that could be habit-forming, as the yellow pills had been known to do. As for the tricyclics, he assured us that they were perfectly safe. While he hadn't heard of phantosmia, he had read some phantom-limb-syndrome case studies in medical school. Not long ago he'd treated a veteran with PLS. Awful stuff. Worse than losing the leg, the amputee had told him. "Almost as bad as the nightmares. The poor kid had done a tour in Iraq," the psychiatrist explained.

Driving home, Cam went on about "what a nice guy" and "how helpful" while my thinking brain totted up the clues and ran them by the limbic system. Then it dawned on me what had been going on in that office. The counting-backward exercise made perfect sense. The psychiatrist was testing me for early signs of Alzheimer's. Phantosmia was just the opening salvo. I was on my way to complete mental and physical disintegration.

Caroline had arranged to take a bus home from Madison for midwinter break. I tried to get some work done before picking her up at the Greyhound depot. The bills had been piling up. I noticed as I signed the first of the checks that the pen wobbled in my hand. I seemed to have acquired an elderly person's penmanship. I already had a slight tremor. It had started maybe three years ago, and it came and went like a cat. I'd decided to ignore it after my doctor guessed that I'd damaged a nerve in my neck hauling flagstones for a terrace I'd installed one spring.

But this morning the tremor was definitely more pronounced. What's more, I couldn't seem to focus my eyes. The fine print on the checks was blurry. Was my vision going now too? That ruled out Alzheimer's. I couldn't help myself. I went online and immediately hit pay dirt. Smell dysfunction and blurred vision are both early warning signs of multiple sclerosis. The disease has no known cause and often attacks women during and immediately after menopause.

Caroline wasn't hard to pick out among the students filing off the bus. Her heavy, almost waist-length brown hair had been shoved up into a bulging topknot that listed toward her left ear. She wore bright red Badger sweatpants and a black North Face parka with duct tape wrapped around the sleeve where she'd snagged it on something and opened a half-l nch gash in the fabric.

Before long I was dropping hints about eye trouble.

"Do you think you should be driving, Mom?" Caroline asked. Her sense of humor was intact.

"Do you think we'll get to see you without that parka on?" I shot back.

I suspected she slept in it. Maybe it was a substitute for the stuffed monkey she'd had since she was four and left at home when she went to college. The parka usually smelled of her favorite perfume, a new woodsy scent by Ralph Lauren, and body odor. This morning, the smell sent my nose into overdrive. Just as Cam's shaving cream had that first awful morning after I returned from Madison. Just as toothpaste did, and coffee, and perfume. It seemed that the stronger and more familiar the actual odor was, the worse the surrogate my brain conjured up to take its place. Perhaps a few of my odor receptors still had some life but distorted the smells they detected, or maybe my brain was just freaking out. I couldn't tell if the smells were distortions of actual odors or complete inventions. But the overwhelming result was a huge disconnect between my brain and the outside world.

"It's probably just the tricyclic," I said in reference to my blurred vision.

"Probably?"

I'd left the door open a crack with that word. I wanted to be ready in case—well, just in case. Caroline stared out the window, exasperation writ large in her body language. Then she turned on the radio and complained noisily when it refused to cough up a tolerable tune. After a while she turned the radio off.

"So how are you really, Mom?" she asked. "Is the drug working? Still smelling things?"

She did not take her eyes off the dashboard. Children aren't supposed to play parent. I let the question hang in the air. Then I said that people were being very kind; they tried hard to understand. How do you sympathize with a person with nose trouble? It's not like seeing a blind man crossing a street with only a white cane to guide him. Or having to shout at a deaf aunt to make yourself heard. Lots of my friends told me they couldn't imagine what I was going through. At least they were honest.

I still hadn't answered my daughter's question. How was I, really?

"Are you scared, Mom?" Caroline finally asked. "I'd be scared."

"I keep thinking the doctors know something I don't," I said. I mumbled the name of today's dread disease: MS.

"Well, I think it's syphilis. Who've you been hanging out with? Some retard gardener, probably. Have you told Dad?"

Sarcasm added a dark bass note to her husky voice. We didn't speak for a couple of minutes. "Who gets phantosmia?" I finally asked. "That shrink hadn't even heard of it. My internist told me I had burning mouth syndrome and that it was psychiatric. Now this other syndrome. Is this whole phantosmia thing a cover? Does everyone think I'm a nut case?"

"Mom,
stop!
" Caroline said.

I stopped. My vision returned to normal in just twenty-four hours. So it was the amitriptyline. But I was still smelling things—horrible things—that no one else could.

I
HEADED UPSTAIRS
to my office when I got home. I like to draw, and I decided to make a sketch of the olfactory system. Maybe then I would understand it. I would surgically implant this nose into my head with the help of the Micron #05 black ink pen that I used to decorate the pages of the
Garden Letter.
It struck me as highly unlikely that I'd ever use the pen again for that purpose. Whatever madness once possessed me to perform such creative heroics would vanish along with my sense of smell.

Don't go there.

I managed to choke out a derisive laugh as the pen began to shake ever so slightly in my hand. Caroline was right, of course. No way did I have MS. What I did have was a passion for coffee that even phantosmia could not extinguish. Coffee makes everybody's hands shake. And my coffee is strong. So, assuming that my pen would settle down on the paper and something resembling a nose would materialize and I could make enough sense of the diagram I'd found online to transpose it onto the white page with everything in its place and accounted for (this would require patience and some awfully tiny letters), maybe
then
I'd understand what was happening to me—if I could just make the inside of my nose as real as the bony ridge between my eyes that I could see in the mirror and feel with my fingers, the nostrils wide open to the world within...

I pulled out a sheet of paper and went to work. It took a few attempts—and as each balled-up failure missed the wastebasket I tried not to take it as a bad omen—before I'd produced an acceptable likeness of my own profile. There was the high bridge, and the bump for my glasses. I drew small dots representing odor molecules rising from my favorite coffee mug, and I drew the yellow mucus high up in the nasal lining. This isn't the green mucus associated with colds. Olfactory mucus slows the odor molecules down and begins a sorting process that continues after the smell penetrates the skull. The mucus helps the odorant find its own designated receptor neuron in the tangle of cilia dangling from the olfactory epithelium, or receptor sheet. The cilia snatch the molecules in their fibrous clutches (imagine fine wisps of baby hair tossed about on a strong sniff, like lingerie on a clothesline). I drew some squiggles in the upper nose and then the receptors' long axons.
Axons
are what important nerves in the brain are called. The smell system's axons deliver an odor's decoded message to the high brain by way of the olfactory bulbs, one for each nostril, and the adjacent limbic system.

I gave the axons a sturdier appearance. They reminded me a little of snakes rising, not from a snake charmer's basket, but from a forest of bowling pins. The axons appeared to be attached to the tops of the pins, which were supposed to represent the receptors (magnified a trillion times) on the olfactory epithelium; the receptors are proteins that decode the odorants and then send electrical signals up the axons for the brain to read and respond to appropriately. En route from the receptor sheet to the olfactory bulb, the axons are bundled into groups, each with its own message to be delivered to (synapsed at) the correct location on the olfactory bulb, the nerve tract leading into the brain. From there, the signals, now assembled into a pattern that represents a smell, are transmitted to two places. One is the limbic system, the brain's emotion and memory center. The other is the higher, thinking brain, where they meet up with signals sent from the other sensory systems, most of which have taken a far less circuitous route to get there.

I drew half a Q-tip. This was supposed to be an olfactory bulb. The fat end faced outward. (The bulb tapers as it heads into the brain.) It was not a delicate Q-tip. The axon bundles

hung off the bulb like a litter of piglets sucking on a sow's teats. So much for art class.

My dog, Mel, a small, white terrier mix, was sprawled across the beanbag chair, all four legs pointing straight up. I scratched his belly and looked at my watch. Something was running around in my stomach. Hunger. Mel's belly morphed into the face of Dr. Cushing telling me, "You're going to have to watch the appetite. You may have to force yourself to eat." If an animal lost its sense of smell, would it die, since it didn't have a thinking brain to tell it sugarcoated half-truths about how life is worth living even without it? Probably. I've seen dogs in chemotherapy. It's not just nausea that puts them off food. While humans are driven by hope, longing, and dread (that is, future consequences of present acts), dogs live in the present. They do not force themselves to eat.

My questions were like odor molecules flooding a functioning receptor sheet as that lucky person sniffed what promised to be a great meal. The more we sniff, the more we can't wait to dig in. I wondered why the smell of barbecued chicken was stronger than perfume, and why perfume fades so quickly, and why some smells are pleasant and others foul (and why some are delightful to me but not my husband, or revolting to us but transcendent to our dog—I'm thinking of deer scat), and why some smells are so hard to tell apart, and why people react so differently to them.