One Hundred Names for Love: A Memoir (10 page)

Liz, a senior-year nursing student interning at the hospital, first appeared as magically as everyone else did. I knew Liz was a student because she was wearing the telltale nursing-student
whites
. (Cricket players and nursing students had that in common.) And I’d seen shoals of students in the hallway with their instructors.
I’m sure she has her orders
, I thought warily, sizing up yet another new nurse,
but won’t have had much experience, so I’d better monitor her.

A tall woman of maybe thirty with short blond-streaked hair, Liz was shaped like an upside-down triangle—with muscular shoulders over slender hips and legs. We would come to know Liz very well, and in time I would learn that she’d muscled up from her part-time job, heaving bales of hay and mucking out stalls on a thoroughbred farm. Wearing no makeup, she looked cute in a healthy, outdoorsy way, and entered the room briskly, shadowed by another nurse, a slightly older woman with a stockier frame.

“I walked in hurried and rushed, as I almost always felt as a student,” she would tell me later, “nursing preceptor behind me, watching to make sure I didn’t flub up. Administering medication comes with piles of rules, for good reason. We were trained to start with the five R’s: Right Time, Right Place—oral? subcutaneous?—IV? Right Dose, Right Drug, Right Person. Right Person means proper patient identification, which means you methodically ask the person for their name and birth date, and double-check their answer against your medication chart and their wristband.

“Which is why I recall meeting Paul so vividly. A moment of utter flummoxness when I confidently walked in with a little cup full of medications, and routinely asked Paul for his name and birth date. And he pleasantly responded with a faintly beatific smile and a bit bemused look that seemed to say something like
I’d love to help you but I really don’t have any idea.
I had never met an aphasic. I stammered something to the preceptor like ‘What-do-I-do-now?’ I remember acutely, she answered: ‘Just give him the medication. We all know he’s Paul West.’ ”

From then on, Liz mainly appeared alone, and something about her manner with Paul touched me. For one thing, his plight didn’t seem to disquiet or bewilder her. Had she worked with a handicapped person before? Maybe a grandparent with a stroke? She wasn’t at all awkward spoon-feeding him—Did she have children? She didn’t raise her voice as if he were deaf, and she spoke with him at all times like a grown-up, often smiling or joking. Her tone with Paul was strict, yet kind. When she told him it was a good idea to get out of bed and sit in the armchair for a while, just to change position, and he sulkily refused, she lifted his back up, spun his legs off the bed, shouldered his weight, and helped him into the chair—while chattering good-naturedly nonstop—before he could mobilize any sort of resistance. I laughed. He laughed. She laughed.

“Predatory nursing,” she explained with an impish smile and a wink.

Then I noticed her socks. Dressed all in the mandatory white, she was sporting a pair of socks with loud orange spots.
A woman who likes cute socks,
I thought,
someone after my own heart
. It couldn’t be easy to imprint one’s personality on a boring uniform.

Liz told me later that when she overheard the floor nurses grumbling about Paul’s flights, instead of disapproval she had felt a guilty twinge of amused respect. Paul was obviously a feisty contrarian, one wily enough to slide out of his gown when the nurses weren’t looking and hightail it toward the door. She had to admit she admired that, even if, from a nursing standpoint, she also had total empathy with the lament of “He’s
noncompliant
!”

I would come to learn that Liz’s mom had had a stroke when Liz was young, and Liz had watched her stagger down hallways, struggle with simple tasks, and slowly relearn how to use her body, while nonetheless raising three small children. In time, her mother recovered fully, and returned to teaching kindergarten in the challenging schools of urban Washington, D.C. I think Liz had gradually absorbed her tone of determined goodwill, caring and amusing, but brooking no dispute. The “
SIT down,
we’re
all
going to be reading
NOW
” tone of a teacher who finds pleasure in teaching and chasing after a posse of five-year-olds every day. Her father was a minister in a small Lake Wobegonish Midwestern town. Noticing me getting more and more bedraggled, she cautioned me about needing to “take care of the caregiver,” and suggested that I go home for a hot bath and a nap.

She was right, of course, caregiving takes a colossal toll, and I was feeling its legendary strain.

CHAPTER 8

T
O THE AMAZEMENT OF ALL, PAUL BEGAN TO SAY MORE
words, and even string some together, but his mood was bleak.

“Finished,” he muttered in a despairing tone, his face expressionless as pounded copper.

“You’re
feeling
finished. Are you depressed?” I asked, feeling eroded and hollow myself, yet concerned.

Paul nodded yes, then groped for a long while. His mind seemed to bulge as a word threatened to surface. Finally, his face withered into an image of outright scorn for the thing he had to say, but getting on with it nonetheless he added: “beaten.”

After thirty-five years of our living together, I could taste the acrid depths of his despair. “You’re feeling finished and beaten?”

Paul’s eyes welled with tears. I wrapped an arm around him and held him close. His freshly laundered gown gave off a trace of bleach. The hospital scents were starting to make his body smell unfamiliar to me.

“I understand,” I said, desperately trying to reassure both of us. “It’s been horrible. You’ve gotten a few words back. There will be others.”

“Dead,” he pronounced in a leaden tone.

“You’re
feeling
dead?”

He stared at me hard. I sat down on the bed beside him and cradled his limp hand.

“You wish you were dead?”

He nodded yes, this time with a look so desolate raw it chilled me. I knew from my research for
An Alchemy of Mind
that gusts of sadness or bouts of anger were a familiar story with left brain injury. And I was afraid Paul was just mobile and lucid enough to find a way to kill himself. His black mood continued all day, and I hovered anxiously, not letting him out of my sight.

Sitting beside the bed while Paul slept, I agonized as I reviewed what I knew about the two sides of his brain and their contrasting outlooks on life, how they specialize in different facets of mind. The left is the chatterbox, the storyteller, the fictioneer, the con man, the liar. It’s superb at list-making and alibis. It values a grid of rules (and in their absence will gladly invent some). It lines up pieces of information in logical ways, nice and tidy, before drawing conclusions. The left relishes reality, adjusts to the world it finds, and whistles a happy tune. The right, on the other hand, is Munch’s terror painting
The Scream
, a cauldron of negative emotions. A wizard of insight, the right intuits an answer first, and limns the big picture, before it moves on to the details. It excels at reading facial nuances, fathoming music’s spell, feeling words. It’s not enough to catch the information ferried by a sentence. We also need to glean the speaker’s intentions, beliefs, and emotions. The right hemisphere adds hints, leading us beyond the corridors of literal meaning into a labyrinth suffused with irony, strong emotion, metaphor, and innuendo. Pinpointing a noise in space, the right decides whether we need to respond, and if so, how intensely. Juggler, puzzle-solver, and artist, the right feels quite at home with fantasy’s mirage.

Of course they’re not as rigid as all that. Both halves of the brain cooperate, on math, language, music, emotion, and other curious enterprises. Most people blend left and right brain use so fluently they’re not aware of the divide, or that one side toils silently while the other is questioning nonstop. Some people use both sides equally, in others one side dominates, but what we call mind isn’t so much a duel as a collaboration, in which the brain relies on vital checks and balances. I worried that Paul’s severely injured left hemisphere might be eclipsed by his right, with little to offset the glacial sadness he felt. Not just because of his new circumstances, which would be depressing enough, but simply because his brain had a crippled cheerleader.

As evening fell, sunlight flickered across the window like a rumba of snakes. For a long while, Paul and I stared at the illuminated frame.

Then, turning toward me, he pleaded, “Home.”

“You can’t leave yet,” I insisted again. “Not until you’re a little more stable. I’m sorry. . . .”

Extending both arms toward me, he drove them down sharply, as if planting something.

“H-h-here!” he said, again begging me to stay.

Pale with fatigue, I explained once more that I was bushed and had to leave for a few hours, if only to sleep a little.

“Look . . . at . . . me!” he whispered with a derisive laugh.

His isolation, boredom, and fear were an avalanche for him. And it was also bone-crushing, mind-crushing, soul-crushing for me.

That poor brain of yours,
I thought.
Now with small graveyards of cells.
As Paul grimaced, repositioning his pillow with one hand, I wondered if he had any idea what I was thinking.

I wasn’t sure what mood I’d find him in the next day, but as he yawned and finally grew heavy with sleep, I knew he’d pass the night safely.

“I’ll come first thing tomorrow morning,” I reassured him, too bleary to try to explain further.

Before I left I asked the nurse on duty to keep a close eye on him, and wrote a pleading note to the head of the Rehab Unit, reporting that Paul was terribly depressed and talking repeatedly about killing himself. I knew that, in Paul’s eyes, in losing his words he had already died, all that remained was killing the empty
husk. Even though his brain hadn’t settled down yet, and we didn’t know the full extent of its injury, I asked if the doctor would consider starting him on Ritalin and Zoloft immediately, two drugs sometimes prescribed after a stroke; I’d read of promising results with both.

Ritalin has been shown to stimulate the prefrontal cortex, the brain’s executive suite, which plans and analyzes, and in clinical studies, patients who took Ritalin thirty minutes before language therapy sessions made faster gains. Zoloft helps with mood, but that isn’t all. Typically prescribed for depression, one of Zoloft’s seldom-mentioned benefits is that it spurs the growth of new brain cell connections in the hippocampus, a rich site for processing memories, including the memory of words learned. A colossal number of brain cells (hundreds to thousands) are born each day, but most die within weeks, unless the brain is forced to learn something new. Then more neurons revive and sprout connections to their brethren. The harder the task, the more survivors.

According to studies done by Tracey Shors, a neuroscientist at Rutgers University, “learning rescues these new cells from death.” During a long-term depression, cell birth slows dramatically, and the hippocampus may even shrink in size. Keepsake memories vanish. Antidepressants in the class of SSRIs, such as Prozac or Zoloft, trigger the birth of new brain cells, which wire and fire with others, boosting memory while ringing the changes in mood. But, unfortunately, this wellspring usually takes four to six weeks to materialize. Now more than ever, Paul needed the ability to remember likely words, bring them into focus, and spotlight just one.

It didn’t seem surprising that Ritalin, an amphetamine-like drug, was being bootlegged and sold on the streets, or that it had become hugely popular with high school and college students. Would Paul or I have taken it when we were in school? Maybe so. Or maybe the craze for it is endemic to our high-speed culture, where the merely fast fall behind, mail by post is for amateurs, and “one thing at a time” is so last century. Ritalin improves a brain’s ability to focus in a sea of warring sensations, which is why it stars in the treatment of attention deficit disorder—and also in cramming for exams.

Learning something new always costs the brain a colossal amount of energy. The mind devotes countless neurons to the project, and over time recruits a web of more and more, until the effort is reinforced and the brain develops a skill. But this means paying close attention, tuning out the rowdy world while you focus on the relevant details. In Paul’s brain, it was as if some filter had gone awry and too much sensory noise kept seeping in. Shutting out the background static, focusing on anything for long minutes, exhausted him. I’d read a paper by Jean-Marie Annoni, in
Neurological Sciences
, about the syndrome of “post-stroke fatigue,” striking half of all stroke victims, which can last for a year or more. It’s not normal tiredness, but a confused doldrums, which demands lots of sleep but isn’t remedied by rest. Thoughts become hard to organize, and memory develops plugs and blockades. Yet it’s not truly a memory disorder, but a rift in the brain’s system for paying attention. As chaos reigns, the brain can’t decipher figure from ground. Any forest becomes a smear of trees, and the exhausted brain can’t focus on just one. Ritalin sharpens that focus by boosting neurotransmitters in underactive parts of the brain.

Paul spent most of each day sleeping or in therapy, but usually got a second wind after dinner, when there was little to occupy his spare hours.

In the pre-stroke years, we’d often passed the time by playing a jazzy game like the one we called Dingbats, which wasn’t so much a contest as a sort of mental solitaire for two with a common object used in uncommon ways. For the last one, as I recalled, we had chosen pencils. What can you do with a pencil—other than write?

I’d begun. “Play the drums. Conduct an orchestra. Cast spells. Ball yarn. Use as a compass hand. Play pick-up sticks. Rest one eyebrow on it. Fasten a shawl. Secure hair atop the head. Use as the mast for a Lilliputian’s sailboat. Play darts. Make a sundial. Spin
vertically on flint to spark a fire. Combine with a thong to create a slingshot. Ignite and use as a taper. Test the depth of oil. Clean a pipe. Stir paint. Work a Ouija board. Gouge an aqueduct in the sand. Roll out dough for a pie crust. Herd balls of loose mercury. Use as the fulcrum for a spinning top. Squeegee a window. Provide a perch for your parrot . . . Passing the pencil-baton to you . . .”

“Use as a spar in a model airplane,” Paul had continued. “Measure distances. Puncture a balloon. Use as a flagpole. Roll a necktie around. Tamp the gunpowder into a pint-size musket. Test bonbons for contents.”

“Good one!”

“No heckling! . . . Use as a spear against hecklers. Crumble, and use the lead as a poison. Wind a kite string around. Dangle to test the direction of the wind. Pull juicy ants from a log with if you’re a wild chimpanzee. Create a fan-shaped design on wet painted walls. Write your name in fresh cement . . . Let’s see . . . A musketeer mouse could fence with it, or a knight could joust with it. Test for quicksand. Hold a tarantula at bay. Put up your nose. Douse for water.”

And so we’d volleyed back and forth, until after a while our mental springs tired and unwound, or we just grew bored.

To pass the time now, Paul watched television, though I wasn’t sure he knew what was really happening onscreen, and he had trouble working the simplified remote. The nurse’s call button still confused him. Over and over I showed him how to use the two devices, but the coaching just wouldn’t stick to his brain. Although he didn’t want to be escorted to the toilet, which he clearly found demoralizing, I helped him nonetheless because he refused (or couldn’t figure out how) to summon the nurse and he walked unsteadily. Sponge baths he enjoyed, and once a kind nurse even vigorously massaged his legs, after which I scratched his bed-numb back, which made him sigh with pleasure. He often tried to engage me in conversation, which in the end just frustrated and infuriated him because I so rarely understood.

“Ff-ff-fox going return?” he posed anxiously.

Latching onto the word return, I said: “Yes, if I go away, I’ll return.”

“
Noo
,” he waved an erasing hand. “Mem, mem, mem, drive skutch!”

“Skutch . . . uh, Florida grass,” I thought out loud. “I’m sorry, I don’t understand.”

He threw up his hands in irritation, and spat out: “Bog off!”

I laughed before I could stifle it. In London’s Heathrow train station a dozen years earlier, as we’d hurried to a train that would carry us to Eckington and his waiting mother, Paul had collided with a Pakistani man making equal haste in the opposite direction. Both men had shifted to the left and right at the same time, back and forth, growing more irate.

“Bog off!” Paul had snarled.

“Stinkeroo!” the other man had shot back.

Then, slipping past each other, they’d pushed forward and the farce had ended. Afterward, we’d often recalled that incident with a laugh, as an example, Paul insisted, of the bygone British Empire in all its dysfunctional glory.