A Stitch of Time

by Lauren Marks

  She took out a piece of paper that had a sort of collage of dozens of thumb-size images.

  Let’s start in the lower left hand corner of this page, Laura said. Because this image is probably the hardest one to recognize. That’s the gag gift you gave BJ a few years ago: Billy the Big Mouthed Bass. Do you see how the fish is singing? The way you liked to sing . . .

  I looked at this photo of a plastic fish—a little nonplussed. Apparently I liked to sing.

  What about this? Laura was pointing at one of her thumb-size pictures again. Kale, she said. Remember how you like to prepare kale with sesame seeds?

  I looked at the rendering of the bumpy, dark vegetable. Okay, I liked kale. That seemed possible, though it didn’t seem especially relevant at the moment.

  Laura continued, undeterred. There was a picture of a football stadium, and Laura pointed at that, too. It’s the Rose Bowl, she said. It’s in Pasadena, California. Your family lives in Pasadena.

  Altadena, actually, my dad corrected her. That’s where the house is, but our office is in Pasadena. It’s the Pasadena in Pasadena Advertising. And Lauren knows that one, don’t you, kiddo? Because that’s the company your mom and I set up when you kids were little.

  Now, my mother took her turn speaking to me. Mike has been missing you terribly, and he really wanted to be here, she said. I am sure you’ve been wondering why we left your little brother behind. . . .

  In fact, I hadn’t been wondering that at all. Not until my mother mentioned it, at least. My brother and I were the only children in this family. Almost seven years apart, I had been one of his main caregivers as a child, and we had remained close as adults. Now a sophomore in college in Northern California, he would call me with some regularity in New York. We’d catch up or talk about a movie we’d both seen, or he’d need advice about something he didn’t want to ask our folks about. But if my mother hadn’t mentioned him, I might even have forgotten I had a brother.

  That kind of extreme forgetfulness seems so incongruous to me now, so impossible, but this was just the kind of disruption I was experiencing within my autobiographic memories. Previously, like most neurotypical people, at a moment’s notice a certain word, sound, or smell could transport me out of my current time and place; thousands of invisible strands would be plucked simultaneously, cross-referencing a lifetime of experiences, weaving together a rapid emotional tapestry, and producing a complex feeling. But my thoughts in the hospital rarely made this mental time travel. Instead, I could only focus on what was directly in front of me. Right here. Right now.

  I often wonder how much my aphasic language played a role in this disjointed memory retrieval process. Words had always been powerful triggers for me, capable of bringing forth evocative memories, but they didn’t have that same potency anymore. Everyone who came to these visiting-hours sessions has told me that I gestured and nodded and seemed to understand what people were saying, but I didn’t contribute to the conversations much. My sentences were short, and my grammar was shot. From my decimated vocabulary, I could only put together two or three words in a row. My father says he did (somewhat) enjoy the sort of words I unwittingly coined back then (like emborrosing—when I combined the words boring and embarrassing), and he also says I cursed and slurred like a drunken sailor. My mother tells me I said the word time a lot. Time this and time that, time when it didn’t make any sense in the context at all. And, of course, I didn’t hear any of these problems myself.

  Laura returned to her images for a final push. She pointed at a new picture, this one taken near my current apartment.

  Greenpoint, Lauren. You live in Greenpoint, Brooklyn.

  Her finger pushed to an image of a school crest.

  You’re in grad school, pursuing a PhD in theater.

  She directed me to a photo of men in ties, standing in line.

  You just received a teaching fellowship from Baruch College.

  With little response from me, BJ unraveled his tangle of limbs from the windowsill and stretched his long legs to the floor. What about the play, Lauren? Can you remember the show we brought from New York to the Fringe? And the whole stress-tival?

  He turned to Laura. Maybe we should remind her of some of the productions we saw during the Fringe? But then again, maybe we’re doing her a disservice. Most of those plays were so miserable they weren’t worthy of anyone’s attention, let alone a commemoration.

  My father guffawed at BJ’s snark. My parents, former actors themselves, found his low-level gossipmongering a guilty pleasure, and soon their voices became a chattering knot. I liked that my family and friends enjoyed one another, but when there were too many sounds in a room, it all started to blur together. They were discussing recent events, but since I didn’t feel connected to those events anymore, I started to tune out the conversation entirely.

  Laura noticed and leaned over the bed, hoping to recapture my attention.

  Do you remember the bar, Lauren? You and I singing in Priscilla’s Bar?

  Was I meant to say something? Do something? My confusion was now teetering on all-out frustration. What did Laura need from me? Want from me? At least soft-spoken Anne was slower on her worksheets and gave me time to think.

  I realize now that my friends and family were simply trying to be proactive on my behalf. They had been told that a feeling might incite a bit of language, or some language might incite a feeling. But this just wasn’t happening that afternoon. The only reason I took part in these exercises wasn’t because the material mattered to me, but because it seemed to matter to everyone else.

  •  •  •

  My life had always been populated with big personalities, and I had created different approaches as a way to interact with each of them—as a daughter, as an older sister, as an actress, as a roommate, as a girlfriend. Before the stroke, my ability to appreciate the needs and desires of these complex characters around me came pretty easily. But after the stroke, my emotional sensitivity had dulled tremendously. It was hard to know what other people might be thinking, and I wasn’t that interested in finding out. My general disinterest in interpersonal interactions was probably rooted in both emotional and anatomical aspects.

  The rupture had originated on the middle cerebral artery in the left hemisphere of my brain, bleeding into the Sylvian fissures and my left basal ganglia. This cerebral artery supplies the blood for the two language centers of the brain—Broca’s Area and Wernicke’s Area. The basal ganglia are usually associated with motor control, but they also affect habits, cognition, and emotion. Some basal injuries can blunt emotional awareness and slow “goal-directed” activity. With such a wide range of influences, the alterations to the basal ganglia were probably affecting me in many ways at the time, but after the rupture, it was my faltering language that was my most visible symptom.

  My aphasia had invisible effects, too, in ways that many people wouldn’t even think about. It was not just my external language that was ailing. My inner monologue, my self-directed speech, had also gone almost completely mute. In its place was the radiant Quiet. The nourishing Quiet. The illuminating Quiet.

  •  •  •

  The Quiet was not something I spoke to anyone about. While my parents were on alert for signs of a secondary stroke (vasospasms are common after a rupture), I was happy enough floating in this meditative state. It felt deeply unique to me, but I later learned of other people (who also sustained damage to the left hemisphere of the brain) who have reported similar phenomena. Clinical psychologist Scott Moss describes waking up in the hospital with his own aphasia. His account is included in Injured Brains of Medical Minds. He writes:

  “I did comprehend somewhat vaguely what was said to me. . . . I didn’t have any difficulty focusing: it was simply that the words, individually or in combination, didn’t have meaning, and even more amazing, I was only a trifle bothered by that. . . . I had also lost the ability even to engage in self-talk. . . . I simply existed. . . . It was as if without words
I could not be concerned about tomorrow.”

  And Jill Bolte Taylor, a Harvard-trained neuroanatomist, who is well-known for being the author of the bestseller My Stroke of Insight, lost this inner monologue as well. She describes it as “brain chatter” that was “replaced by a pervasive and enticing inner peace.” In addition, she writes that she “didn’t think in the same way,” partially because of the “dramatic silence that had taken residency” in her. Bolte Taylor specifically identifies her perceptual changes as related to a shift of attention between the two hemispheres of her brain.

  In The Master and His Emissary: The Divided Brain and the Making of the Western World, psychiatrist and writer Iain McGilchrist goes much further into detail about the differences between these hemispheres. The brain looks like a walnut split down the middle, and its two lobes are called hemispheres. Each is a fully functional processing unit, like a PC and Mac side by side in the skull. Though they usually work together to create a seemingly uniform worldview, a human being can live with only one functional hemisphere, or one hemisphere can do the heavy lifting while the other is under repair (as is often the case for a person who has suffered a stroke). McGilchrist takes issue with the pseudoscience of people calling themselves “left-brained” or “right-brained,” but that being said, the hemispheres do have different strengths, or as McGilchrist describes it, their differences deal with “competing needs” and “the types of attention they are required to bring to bear on the world.” This bifurcated arrangement doesn’t just exist in humans, but in most vertebrates, too. In a single moment, a bird, using its left hemisphere, must identify if an item is food or sand and using its right hemisphere, simultaneously be on guard for predators. McGilchrist mentions that these are “two quite different kinds of exercise, requiring not just that attention should be divided, but that it should be two distinct types (of attention) at once.”

  These hemispheric differences are not so divergent in humans, only more sophisticated. Our left hemisphere is much more detail-focused, and since both language centers exist on this side of the brain, it is much more verbal. But the right hemisphere has a keen awareness, too, and it is more vigilant than the left, more receptive to new information. McGilchrist writes:

  “The left hemisphere’s ‘stickiness,’ its tendency to recur to what it is familiar with, tends to reinforce whatever it is already doing. There is a reflexivity to the process, as if trapped in a hall of mirrors: it only discovers more of what it already knows, and it only does more of what it already is doing. The right hemisphere by contrast (is) seeing more of the picture, and taking a broader perspective.”

  This description resonates intensely with me. Without language, I was paying attention to the world in a new way. Without the talents and abilities I had once relied on—and used to identify myself—I was interacting with more ineffable senses. I had escaped from my old hall of mirrors, and with my language-dominant left hemisphere somewhat disabled, I was probably taking in a whole host of perceptions from the right hemisphere that were suddenly prioritized.

  I was experiencing a near-constant sensation of interconnectedness, but my observations often lacked specific categories and dimensions, and a sense of my own personal preference. My “self” didn’t seem at all pertinent in this kind of processing. It was all happening to me and through me, but not necessarily because of me.

  I believe this temporary shift—changing the dominance from one hemisphere to the other and losing my inner voice for a while—was a huge part of what made the Quiet so quiet. The constant stream of language, which I had always assumed was thought, had stopped. It’s hard to describe this voice exactly, and even harder to describe its lack. It is the internal monologue that turns on in the morning, when we instruct ourselves to “Get up” and “Make breakfast.” It’s a voice we use to monitor ourselves, to criticize or to doubt—and it can be pernicious this way. However, it can be an effective tool as well. We can motivate ourselves with it, understand our environment better, and sometimes modify our situations as well. My inner speech returned very slowly, not on a certain day, but in bits and bobs. In the hospital, though, I didn’t realize that I no longer had access to it, only that something in me felt substantially . . . different.

  However, I certainly was able to think after the aneurysm’s rupture. In many ways, my thinking had never been clearer. I retained the capacity for complex thought, but it was not represented by words or phrases, and my ideas didn’t cluster or activate one another the same way. It wasn’t ignorance, but there was an element of innocence.

  And on the whole, this silence served me very well. With my internal monologue on mute, I was mainly spared from understanding my condition early on. Unable to ask myself: What is wrong with me? I could not, and did not, list the many things that were.

  I was no longer the narrator of my own life.

  •  •  •

  When you don’t have words to probe and investigate the world, mystery can exist everywhere. My own body was a landscape of enigmas. For instance, I could still use my right arm, my dominant arm, and feel pressure there during my neurological exams. But it felt light, almost hollow.

  And there was my head, too. Doctors and family members had told me that I was a brain patient, yet I had walked my fingers around my head and I hadn’t found a scar or even a bump there. So how could I have undergone brain surgery? The only part of my body that was sore was my upper leg, and that hardly seemed related to my brain.

  Later, I learned that a stroke to the left hemisphere of the brain affects the motor skills on the right side of the body. That was why I had that hollow, doll-like feeling in my hand.

  As for my head? My doctors hadn’t gone through the skull at all during my operation. It was a neuroradiological procedure. An incision had been made near my groin, where the doctors accessed the femoral artery. A neuroradiologist had pushed a thin wire and a camera up a surgical catheter through the length of my body. When it arrived in my brain, the camera oversaw the work as the wire was compacted into tight coils, blocking the aneurysm from the rest of the blood flow. That explained the discomfort in my groin.

  When people ask me these days, I describe the procedure a bit like putting a cork in a bottle of wine. But closer to the time of the actual experience, any descriptions at all would have felt irrelevant. My arm was just my arm. My head was just my head. Both were the same, and not at all the same, as they had always been.

  And such were the little mysteries I could live inside of.

  4

  My parents and I have very different memories of the day I drew them a map in the hospital. They remember this being one of my most difficult periods of time, after the rupture itself. And I remember it as the day I drank the World’s Best Diet Pepsi. But all of us agree this was a turning point, a moment in which I became more active in my own recovery.

  The morning started out in the best possible way. One of my suite-mates had told me she wanted to go down to the vending machines on the ground floor of the hospital and invited me to join her. It was a thrilling proposition, since I had never ventured past the recovery ward. My bare feet welcomed the coolness of the stone steps and linoleum underfoot. I had no money on me, didn’t even think of it before we arrived at our destination, but my suitemate was more than happy to buy me a soda. The volcanic sweetness fizzed across my lips, and a kind of raucous joy sparkled across my tongue. Though I had certainly drunk sodas in the past, the entire sensation felt explosively new.

  We returned upstairs, and my parents arrived as I was finishing the final drops of my soda. I tried to tell them about this incredible sensation still lingering in my mouth, but the more I tried to express my cheer, the more concerned they seemed to become. To them, I was speaking almost exclusively in nonsense, and worse yet, I was completely oblivious to it.

  They called Dr. Salman and went to talk to him in the hallway privately, to express their building concern out of my earshot. They told him my language seemed much w
orse than the day before. He explained that backslides did happen in cases like mine, and the regression might only be temporary. When my parents returned to the room, they came back talking about how I might need more support than they had originally thought. They might need some help. And this was when I said one of my first intelligible words of the day. It was a name, actually: Betsy.

  Betsy who? my mom asked. Betsy from high school? Both of my parents were confused. Betsy and I hadn’t spoken for years.

  I couldn’t understand why my mother couldn’t understand me. So, I started to draw her a map. I sketched a house in the hills to represent my parents’ home in Altadena. Betsy, I said. I traced an intersection at Lake Avenue and Altadena Drive. Betsy, I said again as I pointed. I marked a building at the end of the long line. Betsy. I tapped the destination. Betsy, Betsy!

  The map itself had only a small relationship to my old friend. I wasn’t trying to contact her, but instead was drawing a route to her alma mater, California Institute of Technology. I had no idea if that university treated issues like mine, or even what my issue was exactly. But clearly there was a problem, and some part of me remembered that Caltech was a place where problems were solved.

  My parents eventually understood somehow, and when my mother tried contacting Betsy, something incredible—and peculiar—happened. It turned out that her father was the head of the Department of Communication Disorders at a neighboring university, a fact I was completely oblivious to. And, with a position like that, there were very few people in California who knew more about aphasia than he did. He became an invaluable resource for my parents, familiarizing them with the disorder, informing them about what could happen in acute stages, and giving them treatment advice. This was something they desperately needed and his expertise made their next steps navigable.

  Afterward, everyone was impressed I had orchestrated this complicated course of action, brought all of these disparate parties together, and even with my limited language skills, sought out the perfect expert for this exact situation. The truth was a little more complicated. In point of fact, I had initially tried to lead my parents in an entirely different direction, but the outcome couldn’t have gone any better. It was my first lesson in how there can be a very thin line dividing the mistaken and the miraculous. There can be direction, even in the misstep.