An Anthropologist on Mars (1995) (23 page)

On October 31, the cataract in Virgil’s left eye was removed, revealing a retina, an acuity, similar to the right. This was a great disappointment, for there had been hope that it might be a far better eye—enough to make a crucial difference to his vision. His vision did improve slightly: he fixated better, and the searching eye movements were fewer, and he had a larger visual field.

With both eyes working, Virgil now went back to work, but found, increasingly, that there was another side to seeing, that much of it was confusing, and some downright shocking. He had worked happily at the Y for thirty years, he said, and thought he knew all the bodies of his clients. Now he found himself startled by seeing bodies, and skins, that he had previously known only by touch; he was amazed at the range of skin colors he saw and slightly disgusted by blemishes and “stains” in skins that to his hands had seemed perfectly smooth.
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81. Gregory observes of S.B., “He also found some things he loved ugly (including his wife and himself!), and he was frequently upset by the blemishes and imperfections of the visible world.”

Virgil found it a relief, when giving massages, to shut his eyes.

He continued to improve, visually, over the ensuing weeks, especially when he was free to set his own pace. He did his utmost to live the life of a sighted man, but he also became more conflicted at this time. He expressed fears, occasionally, that he would have to throw away his cane and walk outside, cross the streets, by vision alone; and, on one occasion, a fear that he might be “expected” to drive and take up an entirely new “sighted” job. This, then, was a time of great striving and real success—but success achieved, one felt, at a psychological cost, at a cost of deepening strain and splitting in himself.

There was one outing, a week before Christmas, when he and Amy went to the ballet. Virgil enjoyed The Nutcracker: he had always loved the music, and now, for the first time, he saw something as well. “I could see people jumping around the stage. Couldn’t see what they were wearing, though”, he said. He thought he would enjoy seeing a live baseball game and looked forward to the start of the season in the spring.

Christmas was a particularly festive and important time—the first Christmas after his wedding, his first Christmas as a sighted man—and he returned, with Amy, to the family farm in Kentucky. He saw his mother for the first time in more than forty years—he had scarcely been able to see her, to see anything much, at the time of the wedding—and thought she looked “real pretty.” He saw again the old farmhouse, the fences, the creek in the pasture, which he had also not seen since he was a child,—he had never ceased to cherish them in his mind. Some of his seeing had been a great disappointment, but seeing home and family was not—it was a pure joy.

No less important was the change in the family’s attitude toward him. “He seemed more alert”, his sister said. “He would walk, move around the house, without touching the walls—he would just get up and go.” She felt that there had been “a big difference” since he was first operated on, and his mother and the rest of the family felt the same.

I phoned them the day before Christmas and spoke to his mother, his sister, and others. They asked me to join them, and I wish I could have done so, for it seemed to be a joyful and affirmative time for them all. The family’s initial opposition to Virgil’s seeing (and perhaps to Amy, too, for having pushed it) and their disbelief that he could actually see had been something that he internalized, something that could literally annihilate his seeing. Now that the family was “converted”, a major psychological block, one hoped, might dissolve. Christmas was the climax, but also the resolution, of an extraordinary year.

What would happen, I wondered, in the coming year? What might he hope for, at best? How much of a visual world, a visual life, might still await him? We were, frankly, quite unsure at this point. Grim and frightening though the histories of so many patients were, some, at least, overcame the worst of their difficulties and emerged into a relatively unconflicted new sight.

Valvo, normally cautious in expression, lets himself go a little in describing some of his patients’ happier outcomes:

Once our patients acquire visual patterns, and can work with them autonomously, they seem to experience great joy in visual learning—a renaissance of personality—They start thinking about wholly new areas of experience.

“A renaissance of personality”—this was just what Amy wanted for Virgil. It was difficult for us to imagine such a renaissance in him, for he seemed so phlegmatic, so set in his ways. And yet, despite a range of problems—retinal, cortical, psychological, possibly medical—he had done remarkably well in a way, had shown a steady increase in his power to apprehend a visual world. With his predominantly positive motivation, and the obvious enjoyment and advantage he could get from seeing, there seemed no reason why he should not progress further. He could never hope to have perfect vision, but he might certainly hope for a life radically enlarged by seeing.

The catastrophe, when it came, was very sudden. On February 8, I had a phone call from Amy: Virgil had collapsed, had been taken, grey and stuporous, to the hospital. He had a lobar pneumonia, a massive consolidation of one lung, and was in the intensive-care unit, on oxygen and intravenous antibiotics.

The first antibiotics used did not work: he grew worse; he grew critical; and for some days he hovered between life and death. Then, after three weeks, the infection was finally mastered, and the lung started to re-expand. But Virgil himself remained gravely ill, for, though the pneumonia itself was clearing, it had tipped him into respiratory failure—a near-paralysis of the respiratory center in the brain, which made it unable to respond properly to levels of oxygen and carbon dioxide in the blood. The oxygen levels in his blood started to fall—fell to less than half of normal. And the level of carbon dioxide started to rise—rose to nearly three times normal. He needed oxygen constantly, but only a little could be given, lest his failing respiratory center be further depressed. With his brain deprived of oxygen and poisoned by carbon dioxide, Virgil’s consciousness fluctuated and faded, and on bad days (when the oxygen in his blood was lowest and the carbon dioxide highest) he could see nothing: he was totally blind.

Much contributed to this continuing respiratory crisis: Virgil’s lungs themselves were thickened and fibrotic; there was advanced bronchitis and emphysema; there was no movement of the diaphragm on one side, a consequence of his childhood polio; and, on top of all this, he was enormously obese—obese enough to cause a Pickwick syndrome (named after the somnolent fat boy, Joe, in The Pickwick Papers). In Pickwick syndrome, there is a grave depression of breathing, and failure to oxygenate the blood fully, associated with a depression of the respiratory center in the brain.

Virgil had probably been getting ill for some years; he had gradually been increasing in weight since 1985. But between his wedding and Christmas he had put on a further forty pounds—had shot up, in a few weeks, to two hundred and eighty pounds—partly from fluid retention caused by heart failure, and partly from nonstop eating, a habit of his under stress.

He now had to spend three weeks in the hospital, his blood oxygen still plummeting to dangerously low levels, despite his being given oxygen—and each time the level grew really low he became lethargic and totally blind. Amy would know the moment she opened his door what sort of day he was having—where the blood oxygen was—depending on whether he used his eyes, looked around, or fumbled and touched, “acted blind.” (We wondered, in retrospect, whether the strange fluctuations his vision had shown from almost the day of surgery might also have been caused, at least in part, by fluctuations in his blood oxygen, with consequent retinal or cerebral anoxia. Virgil had probably had a mild Pickwick syndrome for years, and could have been close to respiratory failure and anoxia even before his acute illness.)

There was another, intermediate state, which Amy found very puzzling; at such times, he would say that he saw nothing whatever, but would reach for objects, avoid obstacles, and behave as if seeing. Amy could make nothing of this singular state, in which he manifestly responded to objects, could locate them, was seeing, and yet denied any consciousness of seeing. This condition—called implicit sight, unconscious sight, or blindsight—occurs if the visual parts of the cerebral cortex are knocked out (as they may be by a lack of oxygen, for instance), but the visual centers in the subcortex remain intact. Visual signals are perceived and are responded to appropriately, but nothing of this perception reaches consciousness at all.

At last, Virgil was able to leave the hospital and return home, but to return a respiratory cripple. He was tethered to an oxygen cylinder and could not even stir from his chair without it. It seemed unlikely at this stage that he would ever recover sufficiently to go out and work again, and the Y now felt that it had to terminate his job. A few months later, he was forced to leave the house where he had lived as an employee of the Y for more than twenty years. This was the situation that summer: Virgil had lost not only his health but his job and his house as well.

By October, however, he was feeling better and was able to go without oxygen for an hour or two at a time. It had not been wholly clear to me, from speaking to Virgil and Amy, what had finally happened to his vision after all these months. Amy said that it had “almost gone” but that now she felt it was coming back as he got better. When I phoned the visual-rehabilitation center where Virgil had been evaluated, I was given a different story. Virgil, I was told, seemed to have lost all the sight restored the previous year, with only a few bits remaining. Kathy, his therapist, thought he saw colors but little else—and sometimes colors without objects: thus he might see a haze or halo of pink around a Pepto-Bismol bottle without clearly seeing the bottle itself.
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82. Semir Zeki has observed in some cases of cerebral anoxia that the color-constructing areas of the visual cortex may be relatively spared, so that the patient may see color and nothing else—no form, no boundaries, no sense of objects whatsoever.

This color perception, she said was the only seeing that was constant; for the rest he appeared almost blind, missed objects, groped, seemed visually lost. He was showing his old, blind random movements of the eyes. And yet sometimes, spontaneously, out of the blue, he would get sudden, startling moments of vision, in which he would see objects, quite small ones. But these percepts would then vanish as suddenly as they came, and he was usually unable to retrieve them. For all practical purposes, she said, Virgil was now blind.

I was shocked and puzzled when Kathy told me this. These were phenomena radically different from anything he had shown before: What was happening now with his eyes and his brain? From a distance, I could not sort out what was happening, especially since Amy, for her part, maintained that Virgil’s vision was now improving. Indeed, she got furious when she heard anyone say that Virgil was blind, and she maintained that the visual-rehab center was actually “teaching him to be blind.” So in February of 1993, a year after the onset of his devastating illness, we brought Virgil and Amy to New York to see us again and to get some specialized physiological tests of retinal and brain function.

As soon as I met Virgil at the arrival gate at LaGuardia Airport, I could see for myself that everything had gone quite terribly wrong. He was now almost fifty pounds heavier than when I had met him in Oklahoma. He was carrying a cylinder of oxygen strung over one shoulder. He groped; his eyes wandered; he looked totally blind. Amy guided him, her hand under his elbow, everywhere they went. And yet sometimes as we drove over the Fifty-ninth Street Bridge into the city, he would pick up something—a light on the bridge—not guessing but seeing it quite accurately. But he could never hold it or retrieve it, and so remained visually lost.

When we came to test him in my office—first using large colored targets, then large movements and flashlights—he missed everything. He seemed totally blind—blinder than he had been before his operations, because then, at least, even through his cataracts he could consistently detect light, its direction, and the shadow of a hand moving before him. Now he could detect nothing whatever, no longer seemed to have any light-sensitive receptors: it was as if his retinas had gone. Yet not totally gone—that was the odd thing. For once in a while he would see something accurately: once, he saw, described, grasped, a banana; on two occasions, he was able to follow a randomly moving light bar with his hands on a computer screen; and sometimes he would reach for objects, or “guess” them correctly, even though he said he saw “nothing” at such times—the blindsight that had first been observed in the hospital.

We were dismayed at his near-uniform failure, and he was sinking into a demoralized, defeated state—it was time to stop testing and take a break for lunch. As we passed him a bowl of fruit, and he felt the fruit with swift, sensitive, skillful fingers, his face lighted up, and he regained his animation. He gave us, as he handled the fruit, remarkable tactile descriptions, speaking of the waxy, slick quality of the plum skin, the soft fuzz of peaches and smoothness of nectarines (“like a baby’s cheeks”), and the rough, dimpled skin of oranges. He weighed the fruits in his hand, spoke of their weight and consistency, their pips and stones; and then, lifting them to his nose, their different smells. His tactile (and olfactory) appreciation seemed far finer than our own. We included an exceedingly clever wax pear among the real fruit; with its realistic shape and coloring, it had deceived sighted people completely. Virgil was not taken in for a moment: he burst out laughing as soon as he touched it. “It’s a candle”, he said immediately, somewhat puzzled. “Shaped like a bell or a pear.” While he may indeed have been, in von Senden’s words, “an exile from spatial reality”, he was deeply at home in the world of touch, in time.