by Lauren Marks
It would’ve been hard to fault Jonah for being unable to remove sexuality from our dynamic, especially since it had been at the forefront of our past relationship. I had been flirtatious before the rupture, but I wasn’t like that now. Jonah was torn between the demands and predilections of two entirely different women. Initially, he must have tried to please the woman he had known before her accident, and now he was learning to address her unfamiliar twin. The first woman wanted much more from him, and strangely, the second one wanted much less.
As I considered the sharp turn in this conversation, my own thoughts began to wander. I wondered specifically: How did Helen Keller deal with physical attraction? How did she perceive herself while she was being perceived?
The worldview Keller espoused in her book did not evoke the delicate body of the twenty-two-year-old who imagined its extensive philosophy. Keller was lithe and her unseeing eyes were bright and active. She was beautiful by even the most traditional standards. Propelled by her curiosity and formidable appetite for knowledge, she had attended Radcliffe University, and with Harvard a stone’s throw away, she would have been constantly milling through the pulsing throngs of graduates and undergraduates, college students newly liberated from their parents’ watchful gaze, their libidos significantly loosened. Was it possible that Keller had embarked on all of her passionate exertions without a single pheromone? Where was the space for the love of learning, the love of friends, and the love between lovers? How did they separate? When did they commingle? And how does one indulge in a single passion, without it being at the expense of all others? I just wanted Helen to advise me.
I had spent so much time physically separated from most of my social circle, and mainly disconnected from all things Internet. Yes, my reading was slow, but literature never rushed me. So my attachments to the people I read about in books were intensely personal. We were in a constant discussion, one in which I could never accidentally offend them. The way I read, and the way I used my journal, was taking up most of the space that used to be allotted for conversation with others. There was just less energy for dialogue with living, breathing beings who could be in the same room with me. This didn’t mean that my need for that companionship totally went away, but it was safer for me to interact with characters in books than the people around me.
21
In mid-February, my final days of speech therapy and ASL classes at GLAD were both approaching. Although Justine and I had discussed the possibility of continuing our sessions, the financial difficulties couldn’t be ignored.
If you really wanted to stay, Justine said, I could try to seek out more creative solutions. But, from my professional perspective, our classes have sort of developed into informal conversations instead of structured lessons.
And I actually agreed with her.
But I don’t think I am done with my rehabilitation, I told her. Not even close. I certainly don’t think I can go back to school or memorize lines for a play. So I don’t know where to go from here.
Unfortunately, I can’t tell you that either, she said. The goal of speech and language therapy after a stroke is to give patients the tools to be self-sufficient. And safe. You’ve been an unusual case from the very beginning.
What are the next steps for other people, usually? I asked her.
Most people who have had strokes aren’t able to return to the exact life they had before, but I see you are motivated to do more work to hone your language skills. I certainly think you should proceed on your unique path, she said. But this is not the sort of thing I can help much with.
I’m just glad we were able to do it at all, I said. And I am relieved we finished a final draft of my essay before my angiogram.
It was my pleasure. But I am curious—what does that essay have to do with your upcoming procedure?
I thought this was self-explanatory.
Well, I said. Anything can change in a brain, right? So I want to have something written down. Finished. In case I wake up . . . different.
And “different” was a serious understatement. I wasn’t stricken by fear exactly. It just felt like I was at the edge of something big, like a first-time skydiver, completely unsure what was on the other side of that jump. And brains changed. They just did. I felt I needed to put something out into the world before this brain changed on me again.
You know, I’ve thought about that essay a lot, Justine began. And I don’t think your friends should have responded to it the way they did.
Oh no? I asked. I’m sort of glad they said what they said.
Having a support group is important, Justine said. And everyone is entitled to their personal opinions. Clearly they are very intelligent people and their love for you is abundant, which means a lot. I just wish they had been a little more understanding. . . .
I had felt the same way soon after I had spoken to Jonah and Grace. But my thoughts on the matter had evolved since then.
I think I need to be around people who really challenge me, I said. It’s like medicine.
Sure, she said. Too much judgment can suffocate our growth or expression. But lack of judgment doesn’t nourish us either.
Exactly, I said. Without them, it would’ve been impossible to put myself in context. I would have just continued to believe that everyone read my writing the same way I did. Which is a pretty limited idea. What would you call that? Neeve?
I looked for Justine’s approval.
Naive, she said. And naive is the perfect word, Lauren. But there are worse things in the world than being naive.
22
I arrived at the USC hospital at the end of February for my six-month post-rupture angiogram. I was shown to a room, where I swiftly changed out of my yoga pants and into my hospital gown. A little restless, I waited for the doctor to arrive so we could get the whole thing over and done with. Instead, a woman dressed in a suit jacket and pants walked toward my room. Her gait was determined, almost strident. She looked at me cursorily, then at my parents, who were standing nearby. I had no idea who she was, or what she might want. She brandished a clipboard like a badge, and then asked, Who is financially responsible for this patient?
Money. It took a second to sink in. My sense of anxiety quickly transformed into irritation—these were moments of quiet reflection and preparation, to be spent with my family, mentally preparing myself for something entirely unknown. It felt completely inappropriate to discuss money right before this procedure began, and according to Laura and BJ, it had been radically different in Scotland. My friends had dutifully collected my passport and insurance cards when I was taken to the hospital and tried to deliver them to the appropriate entities, but no one was interested in such trivia. Some administrator told them that the doctors were busy trying to save their friend’s life, and they would deal with these scraps of paper at a later date.
After my parents and the administrator worked out a payment plan, I was given a wristband and some forms to fill out. I tried to decode the abbreviations on the paperwork. Most of it was simple enough:
NME—Name
DOB—Date of Birth
ADD—Address
But the next one gave me pause: RLG.
RLG . . . I asked the woman. Is that asking about my religion?
Yes, she said. But if you don’t identify with any traditional options, you can put “Other” if you’d like.
After a few moments of tense consideration, I left that line blank. I hadn’t put that much thought into this trip to the hospital.
I was transferred from the bed to a gurney to a table in an operating room. Still alert and awake, my head was put into soft clamps. It felt like trying on a child’s bike helmet. A heavy lead apron was draped on my torso, covering my feet and legs, and part of my hospital gown was peeled away at my upper right thigh. I could feel them shaving a small section around my upper groin, where the catheter would be inserted.
As powerful light bulbs were shifted to spotlight my body, the anesthesiologist appeared
at my side. She was muscular and dark-skinned. Her voice was pleasant, as was her soothing touch against my arm. She looked for a place to insert the needle with as little pain for me as possible. I wouldn’t feel anything, but I might be awake for the procedure.
This drug supports a twilight sleep, she said. You probably won’t remember anything from this point on. Most people doze off before their angiograms begin.
The anesthesia kicked in quickly. Though I couldn’t feel the nick near my groin, I did feel the jet of hot contrast dye that was inserted into the catheter and created a liquid stampede from my leg to my head. From that point on, I was too drugged for pain, only sensation. When the dye arrived at its intended target, the four blank screens to my left started to light up.
There was no way I could fall asleep now. The veins of my head began to sprout in front of me, like trees on an alien planet. It was surreal. I was both thinking and observing, realizing I was seeing the exact site of those thoughts and observations. I hadn’t prepared to see all of this, though it didn’t bother me. Everything around me was a psychotropic miracle. After a small bit of navigational chatter, I heard Dr. Teitelbaum speaking to his surgical team.
See that? he asked. Right over there?
And yes. They saw. Right there.
Well, looks like we can’t do anything more today, he said conclusively.
His congress of colleagues easily agreed, but I didn’t.
Why? I slurred. Why can’t we do anything today?
Dr. Teitelbaum’s eyes widened in shock, and his face mask billowed. He hadn’t realized I was awake the whole time, clearly focused on the task at hand.
Are you quite comfortable down there, Lauren?
Better than comfortable, I said. S’brilliant. Greatest show on earth.
Would you like some more anesthetic? he asked. Because I am sure the anesthesiologist would be happy to give you a stronger dose.
No! I said. Don’t change a thing. But whatssa problem, Doc?
The aneurysm at the middle cerebral artery has substantially recanalized, he said.
Oh. Mmm. I tried to mull this over, but my stupor didn’t allow much high-level cognition. Recanny, I murmured. Recamping something. Say again?
He gave up trying to silence me. Think of a bag of potato chips, he said. From the outside, it looks like it’s full, but when you open it up, the chips have all settled at the bottom.
I was far too high for metaphors. I was asking about my brain and Dr. Teitelbaum was discussing snack foods.
Can’t you just put more coils into the aneurysm? I asked.
No. We can’t, actually. The aneurysm is refilling with blood and its neck is too wide to keep coils in there. The shape just won’t allow it. It looks like you’re going to have to consider a craniotomy because that’s the only way to treat this.
Oh, I said. Okay, then. Good. Well . . . I’ve considered it, I said. Go right ahead.
We can’t do it now. Dr. Teitelbaum shook his head. The angiogram is a neuroradiological procedure that goes up a tube, but a craniotomy goes through the skull. That’s not something I do. We have a surgeon in our practice who specializes in that, though. Dr. Giannotta.
All right, I said, trying to be as proactive as much as anyone on mind-altering drugs can be. You just get Dr. Digiorno and I’ll wait right here.
Giannotta. And that’s not possible today, Dr. Teitelbaum said, probably praying my jabbering would finally stop.
What about the other aneurysm? Can you do that one now? As long as you’re up there?
It’s in the other hemisphere. And it is too small to worry about at the moment, he answered. As far as the craniotomy is concerned, I’ll try to arrange for Dr. Giannotta to see you right away. He could probably fit you in tomorrow.
• • •
The twenty-four hours between the angiogram and the craniotomy consult were strange, to say the least. When I was much more sober, I took in the actual dimensions of the thing. My head was going to be cracked open. It was an experience that people would spend their entire lives avoiding, but I would have to submit to it willingly and even have to pay for it! It was an uncomfortable idea to adjust to, and the absurdity of it brought me to the verge of tears and laughter simultaneously. But Dr. Teitelbaum said this was the only way to treat the aneurysm, so there didn’t seem to be any other choice. I had to accept it quickly. However, with the little agency I had at my disposal, I started to think of the kind of language I could use in this surgical consult. Should I make a joke to relieve the tension a bit? Maybe I would tell the surgeon, “I’ll give you a piece of my mind!”
More than anything, I felt I had to be practical, informed, and—even though I would struggle with this—completely stoic. I didn’t want my prospective surgeon to see my weakness, because this whole operation was going to leave me exposed. I wanted to preserve my sense of dignity in some way. I wanted to exude hard-boiled grit. And I felt there might be someone who could actually help me get it.
The only thing I could think to do in way of preparation was to call my friend Shafer. A poet by day and bartender by night, he had been my drinking buddy for years. He indulged his life with a headlong gusto, and accordingly, he could be a reliable steward of just about any kind of conversation. He would discuss esoteric poetic forms like the “sestina” without a shred of snobbery, and then go on to extol the virtues of the Big Buck Hunter arcade game, without a hint of irony. Joy, suffering, and Pickapeppa Sauce on cream cheese could all be considered in one boozy breath. How many times had I leaned on his barrel chest, scratched first by his bushy red beard, then sandwiched between the arm with the Texas flag and the other with the life-size possum? It was such a relief to surrender to one of his legendary hugs. Without any chance of that physical relief, I hoped his distinct brand of comfort could extend to the phone as well. Though we had not spoken a lot after the rupture, he’d shown his unflagging support from afar, sending me dozens of chapbooks from a variety of poets throughout my recovery. I had never met anyone capable of being so gruff and so kind at the same time. I sensed that his lack of sentimentality might be the only thing that would really counteract the shock of upcoming brain surgery.
Shafer listened to me explain what was going on, with a bartender’s patience. He instinctively knew I was seeking his advice, and his grizzled tones were dulcet to me.
Well doll, he said. This can’t be easy. But if there’s gonna be a showdown between you and some starch-ass surgeon, I’d put all my bets on you. In a mental arm-wrestling contest, you’ve always been Champeen.
By the end of the conversation, I actually did feel more confident. Shafer had given me the perfect pep talk. I even borrowed some of his irascible language when I faced Dr. Giannotta the next day.
My mother joined me in the exam room. The surgeon’s name had sounded Italian to me, but he looked more Irish in person. Freckled, with almost transparent skin, a few years younger than my dad. He shook my hand as he introduced himself, and I started in on my rehearsed cowboy-like resolve, dispensing with all pleasantries.
So? I asked. When do we crack some skulls?
Wh . . . He stumbled. I beg your pardon?
The brain surgery, I said, feeling linguistically leveraged into a position of power. You have to break into my skull, right?
Well, yes, he said, appearing to be reeling slightly from my unexpected introduction. But those aren’t the terms we use in the operating room.
Okay, I said, giving him my practiced smile and unflinching gaze. Craniotomy, if you prefer.
I was pure cowboy.
Miss Marks, I’m here on the recommendation of my colleague George Teitelbaum, who tells me the coiling you had done six months ago has recanalized.
He told me that too. I am a little confused by that, though. Dr. Teitelbaum saw the scans from Scotland and they appeared to be 100 percent treated.
Dr. Giannotta scoffed. Well, you must’ve misunderstood. George would never have said that because it’s not
even possible. With a wide-neck aneurysm like this, there is always a chance of recanalization. The structure is filling with blood again, and the coils that were inserted are now only covering . . . I’d say . . . 75 percent of the aneurysm.
My mother shot me a worried look. Dr. Teitelbaum had already told me that the aneurysm was refilling, but the percentage startled me, too. My brain was only getting a C grade. But I couldn’t give in to the fear, and I certainly wasn’t going to let this stranger see it.
Fine, I said. If we’ve got to do this, let’s just do it. I was pleased how I was able to utter this statement matter-of-factly, almost nonchalantly.
We haven’t even discussed the procedure yet, he protested.
Oh, all right, I allowed. But I have done this sort of thing before.
No, you haven’t. Dr. Giannotta’s warning was stern. A craniotomy is nothing like a neuroradiological procedure. Not at all.
I’m just saying this isn’t my first neurointervention, I hedged, slightly less in control.
You had a primary procedure in Scotland, he interrupted. You need to appreciate that this is a repair job, and an operation over an operation is much more complicated. I’ll have to clip over your existing coils and that isn’t going to be simple.
He was calling my bluff. He used his freckled, orange fingers to illustrate. The right fist stood for the aneurysm, with two fingers of his left hand against the fist to represent the clamp. He explained that a clip would dam off the aneurysm from the blood flow outside, with the coils remaining inside.
Okay, I said, getting a little queasy from the gory logistics. At least this operation can’t be as risky as the one before it.
Why on earth would you think that?
I was momentarily stunned. And then started to feel smaller and smaller with every word I uttered.
Well, uh . . . because . . . well because Scotland was an emergency, I sputtered. Right? And now we have time to plan.
Yes, but Lauren, a procedure like this is pretty rare, he explained. In fact, I’m one of the only surgeons in America who does stuff like this. And I do this every two or three years, at the most. If anything, I’d say this operation is much more risky.
