A Stitch of Time

by Lauren Marks

  This was not a Quiet I had known before. It was a placid current, a presence more than an absence. Everything I saw or touched or heard pulsed with a marvelous sense of order. I had a nothing mind, a flotsam mind. I was incredibly focused on the present, with very little awareness or interest in my past or future. My entire environment felt interconnected, like cells in a large, breathing organism. To experience this Quiet was to be it.

  However, this sense of serenity was not shared by those around me.

  After the medics had taken me away in an ambulance, Laura and BJ had called my parents in the US. It was the middle of the night in Edinburgh, but early evening in Los Angeles, and no one was overly worried about my fall from the stage, since it appeared I was suffering a simple concussion. That all changed two hours after my hospital admission—when the results of my CT scan showed the actual crisis unfolding. An aneurysm had ruptured in my brain and the hemorrhage was spreading. A neuroradiologist explained to my parents how precarious my situation was—how often people died the instant an aneurysm ruptured, and even after treatment, only slightly more than half of these patients actually survive the next few days. With every second being critical, the doctor was preparing for an emergency operation. But my now-horrified parents were stranded in California. Their passports were in their safety deposit box, and the bank branch was closed for the night. My parents rattled on the windows of the bank the next morning, successfully convincing them to open early for them because there was no time to waste. My procedure was well under way when my parents boarded their flight the next morning, leaving my brother and grandmother behind at the house. The operation was already over when they got to Edinburgh. My parents and friends came together, relieved that I had survived the operation, but living with a keen awareness of how perilous my situation still was.

  It took a few days for me to wake up fully, under the influence of a combination of swollen brain tissue and heavy sedation. However, when I was more alert, the Quiet I found myself experiencing was much more interesting than my medical state. I had woken up to a new world, hushed, and full of curiosities.

  One of these moments of marvel took place during a move between the critical unit and the recovery ward. I was being transported in a mirrored elevator, and although there were no bandages on my face and my vision was clear, it was almost impossible for me to recognize my own reflection. Yet, somehow, this didn’t disturb me. In fact, it made remarkable sense because I was quickly realizing that my reflection was not the only thing that was different. Transformation felt abundant. Once-fixed concepts, like “wall” and “window,” weren’t as easy to identify anymore, and the differences between “he” and “she” and “I” and “it” were becoming indistinguishable. I knew my parents were my parents and my friends were my friends, but I felt less like myself and more like everything around me.

  •  •  •

  I was wheeled to a bed by a westerly-facing window, with three other women in the room. My suitemates were often in discussion with one another. Even through their brogues, I understood what they were saying, but I rarely took part in the conversations. I just enjoyed the way their voices plodded and pattered like footsteps.

  At this point I didn’t know much about my brain injury at all. I wasn’t in any pain, so my thoughts about my new condition were unfocused and fleeting. Instead of being occupied by questions about why I was in the hospital and what had happened to me, my mind was engrossed in an entirely different set of perceptions. The smallest of activities would enthrall me. Dressing myself, I was awed by the orbital distance between cloth and flesh. Brushing my teeth, I was enchanted by the stiffness of the bristles and the sponginess of my gums. I also spent an inordinate amount of time looking out the window. My view was mainly of the hospital’s rooftop, with its grey and untextured panels, though I developed a lot of interest in a nearby tree. I could only make out the tops of the branches, but I’d watch this section of needles and boughs intently, fascinated by how the slightest wind would change the shape entirely. It was always and never the same tree.

  Very few things disturbed me during this period of time. But even in this formless daydream I remember the moment that most closely resembled real distress. Or, at least, when I became aware of an actual loss.

  •  •  •

  It must have been midday because the sunlight was falling across my body, and that slat of light emphasized the white nightstand on my left. My parents had filled the shelves inside with clothing, and the nurses made sure there were plenty of liquids for me to drink in there, too. On this day, I noticed that there was a stack of magazines on the nightstand, as well as a book. I am not sure how long they had been there—for all I knew, they could have even predated my arrival—but this was the first time they piqued my interest.

  The high gloss of the magazine cover felt wet in my hands. And as I opened it up, I was instantly bombarded with photos of red carpet parades and illustrated makeup tips, a circus of color and distraction. I couldn’t linger anywhere. It felt as if the magazine were shouting at me. Closing it was a relief.

  I turned to the book. It was a novel by Agatha Christie, something I had probably read many years earlier. I opened to chapter one and flipped slowly and evenly through the first few pages, a motion that seemed to come naturally to me. But on the third page, I stopped. I returned to the first page and started again. Slower this time. Much slower. My eyes focused and refocused in the bright sunlight, but I continued to only see the black, blocked shapes where words used to be.

  Thinking about it now, I don’t know how I could be so certain that it was an Agatha Christie novel, especially since this was the very moment I became aware I couldn’t read anymore. With this simultaneously familiar and unfamiliar book in my hands, I first took in the actual loss of words. For my entire life, language had been at the forefront of every personal or professional achievement, and very few things had brought me as much joy and purpose. If I had ever been warned that I might be robbed of my ability to read, even for a limited amount of time, it would have been a devastation too cruel to bear. Or so I would have thought. But a day did come when I couldn’t read the book in front of me, when paragraphs appeared to be nothing more than senseless jumbles, and the way I actually processed this massive loss was surprisingly mild. The knowledge of the failure was jarring, without a doubt, but was there any misery or angst? No. My reaction was much less sharp. A vague sense of disappointment swept through me, but then . . . my inability to use words in this way just felt like transient information. Now that the ability was gone, I could no longer think of how or why it should have any influence on my life whatsoever.

  It’s shocking to reflect on that moment, and think about how the loss of something so crucial washed past me with such a vague wisp of emotion. But I was living so deeply in the present—and in the comfort of the Quiet—I couldn’t fully realize how my sense of identity had shifted. It would be several weeks before I detected how much of myself had gone missing, and how hard I’d have to fight to regain it. However, the unpleasant sensations that came with holding that book drifted away as soon as I closed it. And with no effort at all, my attention settled back on the impossible blue sky.

  2

  A few days after the surgery and a battery of tests, Dr. Rustam Al-Shahi Salman, the consultant neurologist overseeing my case, made my parents aware of the short- and long-term issues at hand. Dr. Salman was slim and soft-spoken, his gestures and words thoughtful, and he was never rushed, a demeanor that fit nicely in the Quiet I now inhabited. He was also probably the first person who used the word aphasia with my family. However, he explained it in much more detail with my parents than with me.

  He told my parents that aphasia did not attack a person’s cognitive abilities and most often left a person’s intelligence completely intact. But this condition could manifest quite differently in different people, and aphasia is generally divided into two categories: receptive and expressive. Expressive aph
asia (also called “non-fluent” or “Broca’s” aphasia) is characterized by word-finding difficulties, while receptive aphasia (also called “fluent” or “Wernicke’s” aphasia) affects language comprehension. The expressive issues were most pronounced in my case, but in the beginning, I struggled with receptive issues, too, unable to detect the missing or garbled parts of my own language.

  The speech and language therapist Dr. Salman appointed to me aimed to change that.

  •  •  •

  Anne Rowe was near my mother’s age, with faded red curls cut close to her head. For a while, it seemed to me that her only job was to hand me worksheets. Piles and piles of worksheets. One of the first worksheets she gave me had a panel of faces. Every day I was instructed to point at the bald man in the images to tell her how I was feeling.

  I feel fine, I said. Or thought I said. But Anne would insist on a more in-depth answer.

  Why don’t you just try to point to the picture that feels most appropriate for you? she would ask.

  It didn’t occur to me then that Anne was employing this image prompt not as an exercise but a necessity—because most of the time she couldn’t understand my responses to her questions. While my expressive aphasia prevented me from speaking clearly, my receptive aphasia prevented me from knowing when my language was not clear. According to my parents, in the first two weeks I could only say forty or fifty words.

  Anne’s records from our initial sessions mention that creating the sounds for speech was often challenging for me too: “Lauren is able to use fully intact phrases at times without hesitation, but has clear difficulties with word finding and motor planning for speech.” This meant I had trouble shaping my mouth to make the right sounds—a condition known as speech apraxia, which often accompanies an onset of aphasia. Children go through a similar process, stuttering into speech while parents ask them to repeat and refine what they are saying until they do it correctly. Anne’s worksheets had the same goal. Pointing at a drawing of a mouth, she’d say: The tip of the tongue goes here. . . .

  Then she would illustrate on her own face: T, T, T, Teh, is the tip of the tongue. Th, Th, Th is Thuh, the fat part of the tongue.

  I wasn’t disturbed when Anne asked me to take part in these articulation exercises. They didn’t indicate to me that there was something especially wrong. In fact, they strongly resembled the routine vocal warm-ups I had been doing—and enjoying—since theater school. Asking an actor to demonstrate the difference between a P sound and a B sound over and over was nothing out of the ordinary. When I was instructed to do so in the hospital, I assumed I was excelling at it, flexing my muscle memory, until Anne subtly indicated my failures and misfires with her feedback throughout our sessions.

  Very good, she’d say. Or: not exactly, try again.

  At some point, I realized that Anne was saying “not exactly” a lot. And if we hit too many “try agains”, Anne would suggest we move on to something else for a while. It was a major hint that something was amiss. I didn’t know exactly what was wrong, but I would try to fix it because I preferred positive feedback to negative.

  One week after the rupture, Anne administered the Western Aphasia Battery test on me. After the reading section, she made this note: “Testing was stopped as Lauren was becoming distressed. L. is very aware she could not do task.” Though I have a hard time remembering this distress, I trust in Anne’s reporting. My best guess is that my anxiety was only skin deep and short-lived. I also believe my awareness was more limited than Anne might have assumed. I probably wasn’t thinking about my inability to do this task and how that might affect my limitations on future tasks. At the time, I had very little concern for the past or future; but in the present, I simply didn’t like to disappoint. That, more than anything, was probably the source of my distress. Lucky for me, though, it didn’t last long. In the way I perceived the world, negative impressions could pass very quickly, as if I had never even had them.

  My trouble with spoken language was mirrored in my written language. I discovered as I progressed in my sessions with Anne that I had not completely forgotten the alphabet, but I had forgotten its order. If I isolated single letters at a time, I could still identify them on a page. It took a lot of guidance from Anne, but with her by my side, I could slowly sound out these letters, occasionally creating a very fragile word. Anne noted: “There are frequent errors reading aloud, especially words with irregular pronunciations, and Lauren finds it difficult to know if she is correct or not.” So, while I had not lost my ability to read entirely, “reading” in this new iteration of my life involved a razor-sharp focus, accommodating only a word at a time. I also wasn’t able to know my own accuracy without someone else’s support. I would slowly sound out a word, but it took so long that when I went on to tackle the next one, I often would forget what I had just read. Perhaps that was what had happened with the “Agatha Christie” book I had attempted to read by myself. I had been expecting the language on the page to behave the way it used to, and when it didn’t, the whole picture crumbled in front of me. Words could be approachable in small, isolated units. But a full sentence? That was beyond imagining.

  Aphasia can affect a patient’s hearing, too. Though Anne was quick to confirm that this was not an issue in my case, she mentioned in her notes that I needed a fair amount of repetition. My parents also noticed that I sometimes asked them to repeat themselves, but this was much more common between Anne and me. I was an American being instructed by a Scottish speech therapist on how to use the English language. Anne used a slightly different inflection on her words, and that sometimes made her speech radically strange to me. These occasionally ridiculous elements of our interactions were just par for the course. This was when my language was at its most vulnerable. She just didn’t identify the world in the ways my parents or friends did. Plenty of things got lost in translation. What she called a cushion, my mother would call a pillow; what she called a loo, my father would call a bathroom. And whenever the topic of lunch came up, we couldn’t always sort out the menu because the way she said herb or tomato hit all the wrong chords in me.

  But Anne was a consummate professional. I realize now that Anne was trying to address a systematic failure in me: my newly acquired aphasia. I just couldn’t think of it like that. I could flip-flop in our exchanges and not hear the mistakes. When I did, I would assume I was simply tired or that the disturbances were all minor and temporary. And as soon as our session would end, I would gently be redelivered to the happy stillness of the pervasive Quiet.

  Language was something I had never struggled with before, so it was hard to believe it could be a problem now. I don’t know if Anne could appreciate this blissful ignorance in me, but she was experienced and practical enough to know that any of my next steps could not be taken alone. All of her reports emphasized that I was still in the acute stages and that everyone close to me was going to be as involved in this process as I was.

  3

  When my parents had arrived from California, they joined Laura and BJ in Edinburgh, staying in a local family’s home. The Patersons were friends of friends, and they had allowed us to lodge with them during our Fringe tour, free of charge. When our trip took this much more serious turn, Alan and Alison Paterson welcomed my parents just as warmly as they had welcomed BJ, Laura, and me. My parents and friends had known one another for years, and since they were now all living under the same roof, they usually visited me in the hospital en masse.

  In these early weeks post rupture, I had a very shaky sense of personal recollection, lacking all sorts of details from my own life, but I wasn’t suffering from amnesia. I knew truth from fiction. And even though I had trouble saying or writing the names of the people around me, I certainly knew who they were and what sort of role they played in my life.

  Explicit memories, also called autobiographic memories, are the ones we can call up in the form of conscious recall, often things that have made a strong emotional impact on us. Implicit memo
ries are subtler than that, usually procedural in nature—things that may have shaped our abilities and talents long ago and continue to inform our current decisions at the unconscious level. We don’t know why some memories are forgotten and others persist like wounds that never close. But while my explicit memories floundered, my implicit memories, like how to bring a straw to my lips, were completely retained. Memories don’t exist in a single location, so encoding or retrieving them activates many parts of your brain. And actually, the company we keep can also affect the way in which we recall autobiographical memory. Though I was mentally rooted in the present, my friends and family often wanted to talk about the past. When coaxed by them, I could slowly recall people, places, or events, though when I did, these memories simply didn’t bring strong sensations with them. This frustrated the people around me. They wanted me to feel the way I always felt, enjoy the things I used to enjoy. But it wasn’t that simple for me.

  •  •  •

  One afternoon in early September, this large group arrived for visiting hours. After giving me a long, lingering hug, my parents stood together by the rocking chair while BJ perched on the wide windowsill. Laura planted herself on the corner of my inclined bed, took off her oversize brown windbreaker, and twisted her long hair up into a bun.