Three Messages and a Warning (11 page)

“I see boats and old cars, planes and aerial battles. But I prefer seeing rare fish, seahorses, and exotic birds,” he tells me. Immediately my attention is drawn to the verb “to see” (which he conjugates in the first person, “I see”), since my patient is in fact blind, as blind as Jorge Luis Borges in his later years. “Before becoming ill, I painted every now and then. In my adolescence I took painting lessons; but above all I visited as many museums as I could: including those in Amsterdam, Belgium, Paris, Madrid, Mexico City, Washington, D.C., and New York City. When I wasn’t reading biology books, I studied the history of art. Some twenty years ago, I had the pleasure of visiting the Vatican. Even now I can see that seignorial city, vividly, the Holy See, and revel in its architecture. I turn my attention to an altarpiece carved in wood, but then I feel a motion in my spirit: a tremendous temptation to make the altarpiece even more intricate, to make its form even more complex; and I work, carefully, at achieving this. With enormous effort I manage to gradually change the details of the altarpiece. I can re-create the entire structure of the Vatican with tiny imaginary sticks. Usually I can erect such three-dimensional structures in a matter of minutes, but sometimes I may need three or even four days to get it right.”

January 13, 1999. This afternoon Alejandro speaks to me about his frustrations via the indirect language of parables, which is to say that I discern an unusual continuity between the tale he recounts and his daily experience.

“I like to interpret my dreams. I’ve dreamed, for example, that I am with my friends and we embark on an excursion in the woods. I get lost and arrive at a lake. I climb a tree to leap over the extensive body of water, but I find myself in an uncertain position. I’ve climbed so high as to be unable to climb down, but I can’t continue climbing higher either because the branches aren’t strong enough at that height. Then I direct my sight to the lake itself and peer into its depths: I see very large fish, primitive sharks, and manta rays. My own interpretation of the dream is that it represents my resentment against God for burdening me with an illness from which there is no exit. I can never be the man I was before, and only death would release me from this state, yet I do not wish to die. Sometimes, in the dream, I try to leap over the water, but I fall. I manage to surface, but the fish come rushing towards me and devours me. Other times, I wake up, and yet I can still I see the creatures of my dream—the fish, the sharks, and the manta ray—floating in the air beside me, while I walk to the bathroom or the kitchen. This vision persists for more than an hour of wakefulness, beyond my control.”

“Do you mean to say that once you are awake, the images of the dream continue to be present? How do you know that you are really awake then?” I ask him. “Pardon my ignorance, but when is it, precisely, that a blind man realizes he is no longer dreaming but awake? I mean, in my own case it’s easy, since all I have to do is open my eyes and the early morning light tells me I’m awake.”

“Give it some more thought, Doctor, and you’ll see that you’re speaking a little too lightly. Haven’t you ever woken up at night, when the darkness is such that you might as well be blind? How, then, do you know you’re awake rather than dreaming?”

“Well, in that case, I can tell by the contrast between the light within the dream itself and the abrupt shift to the darkness of my room in the middle of the night. There is always an abrupt shift of some kind. The shift might be from the quietness of the dream to the noisiness of the morning’s activities, or the opposite—a nightmare may end when I open my eyes and ears to the stillness of the night.”

“I agree, Doctor. There is always a shift of light or sound that comes with a change in consciousness. In my case, it’s mostly a change of sound, but also one of visual images. In my dreams the entire space is full of lively, independent details. I would go as far as to say that in my dreams I find myself in a state of nature: though seen from the perspective of wakefulness, it is only the imaginary nature of the soul. In contrast to my dreams, when I wake up there is a sort of white, opaque background upon which I can design my own creations. The other difference is one of perception, wouldn’t you say? Of course, you’re the doctor . . . but speaking from experience, I believe that the greatest shift that occurs from sleep to wakefulness is one of perception. For example, I was telling you all about how certain images from my dreams, such as the sharks and manta rays, tend to follow me around after I wake up. Yet once I am awake I always know they are imaginary. Can you imagine what it’s like to walk around your house, the kitchen, let’s say, surrounded by floating fish? For a while it’s amusing, sure, but if it lasts too long or if it interferes with my ability to concentrate on other tasks, it can become unbearable.”

Alejandro seems dispirited. His hunched figure stiffens for a few moments such that I imagine he might break into sobs. I place my hand on his shoulder, gently, to let him know that I am there for him. His tears are stifled.

“I have so much to say, but no one wants to listen. Once I created a chess table with all its pieces, and I began to play. Very soon I lost control over the game because my memory proved insufficient to keep track of the myriad positions and successions of movements. Even if I could have managed to keep it all in my head, the game would have been frustrated, naturally, by the fact that I must play against myself. Who else could possibly join in such a game?”

January 14, 1999. Today I received an urgent call from the neuroscience unit. At midday, Alejandro was tranquil; then, suddenly, he began screaming for help. A nurse went to his aid. She found that his pulse was elevated, he was drenched with perspiration and was panting. He did not complain of any pain, yet he remained in a state of agitation, pleading for help. He was then transferred to the electrophysiology unit, where a record of his cerebral activity was effectuated so as to discard an epileptic crisis. The profile of his electrical activity turned out to be normal. By the time I met with him I found him more settled. He tried to laugh the matter off.

“I’m okay,” he told me, “I just got a little scared by one of my visions.”

“But you usually have control over them, isn’t that right?”

“Almost always, with the exception of the most grotesque ones: worms, flies . . . they are beyond my control. I see the barrel of a gun. I take aim at them. But to no avail.”

“Do your hallucinations appear suddenly or gradually?”

“It depends. When they’re unwelcome, like flies and such, I see them in a sort of ‘fast-forward’ mode. But when I welcome their arrival, for example, when I’m constructing an edifice of some sort, I can keep the vision stationary for several hours.”

“Is there any particular time of day when the more grotesque images appear?”

“Not really. It can be at any time. But the process is always the same. I feel nervous, desperate, an urge to shout or to flee, as if there were no air in the room and I were at the point of losing consciousness . . . at such times, I lose control over my visions. I see my grandmother on her deathbed, blood on her lips, just the way I remember her at the time of her death. I could still see perfectly in those days. Seeing my grandmother in such a fragile situation, so vulnerable, hurt me very much. I’ve never forgotten it. When those moments of terror come, the vision of my agonized grandmother appears with great vividness. I see that I am at her bedside in a large chamber within a hospital. I feel the urge to leave that place immediately. But I see that all around me there are hundreds of hospital beds, and in every bed I see my dying grandmother. Whenever my visions become uncontrollable, I take refuge in one of two options: the first is to force myself to sleep; the second involves casing or framing the nightmarish images as if putting them on stage or setting them on a theatrical dais, and next I invent some enormous curtains, and I gradually bring the scene to a close by drawing in the curtains, little by little. If I draw them in too quickly, the trick never works. But if I do it gradually and I try to relax, the nightmare of the hospital and the beds vanishes, slowly, behind the curtain. Occasionally this trick is of no use and no matter how slowly I draw in the curtains, my anguished grandmother remains there, suspended, incompletely vanished, and the whole scene begins to pulsate . . .”

“Perhaps the pulsating you describe corresponds to the beating of your heart?” I told him. In this fashion my patient and I develop a tentative theory to rationalize the nightmare. I take his pulse and teach him how to do it himself.

January 18, 1999.
Alejandro is interned in the neurosurgery unit. He will never see daylight again. The optical nerves that transduce solar energy into the language of the brain have been destroyed. Clearly, Alejandro needs his inner light, the subjective illuminations that astonish and renew his consciousness every day in the form of hallucinations: flexible, moldable, often marvelous, sometimes terrifying.

I speak with my superior at the hospital about Alejandro’s case. Impatiently, he refers me to journal articles on the usefulness of certain antipsychotics in suppressing hallucinations: “The Efficaciouness of Risperidone in the Control of Hallucinations,” “The Efficaciousness of Haloperidole in the Control of Hallucinations,” the exact titles do not matter: they all have the same disillusioning effect on me. I raise the matter with Alejandro, but he considers the use of antipsychotics to suppress the images he creates daily to be an act of barbarism. I cannot help but agree, in this instance.

“I like religious and mythical images,” he insists. “I’m an aficionado of Greek mythology; but I also create my own myths. I invent minor gods, having the ability to intervene in the affairs of men in real time. It’s usually around twilight when I work on such projects. My palette consists mostly of greens and blues, and sometimes a flash of red. My inspiration comes from the turbulent incommensurable waters of the Aegean Sea, where I imagine two shipwrecked individuals on a raft. They are on the verge of perishing, condemned to solitude, isolation, hunger, dehydration: adrift on the depressingly vast body of salty water. Above them is the curved immensity of the celestial sphere from which my minor gods descend to save these souls with whom Poseidon couldn’t be bothered.”

I strain to summon the right words with which to confess to my superior that, in this case, I am compelled to disobey him, for I have not attempted to suppress Alejandro’s hallucinations. His blindness has transformed him into both a wanderer through, and a guide to, the mysteries of creation. His hallucinations are the source of his prodigious creativity; but they can also be a curse. Fortunately, we have devised a treatment for his anxiety attacks. We conclude that if he can learn to maintain a modicum of control over the subjacent emotions in his visions, then he might he also gain control over their origins and, by extension, their very nature.

“Yesterday afternoon they came back, those terrible images of my dying grandmother. I remembered what we discussed, about the potential correlation between my hallucinations and the beating of my heart. So I took my pulse and I observed its rapidity. I became aware, as never before, of the palpitations of my heart, and its pulsations occupied the entire field of my consciousness: I saw an organ, yellow and red, bloody, pulsating so strongly it might explode at any moment. I feared that death was not far off. Just when I believed I had no alternative but to call for help or risk death, I saw my heart suspended in the middle of an empty, white sky. I took some deep breaths. Then the sky’s hue took on a lighter shade of blue: and as my pulse began to slow and my respiration grew steady, I saw the light blue sky illuminated in the distance by the sunny resplendence of my heart. There were clouds in the sky, large puffy ones, which came toward me when I inhaled and moved away when I exhaled. Eventually only the clouds remained in the sky, swelling and contracting with the beating of my heart. The images of my agonized grandmother and my bloody heart completely vanished from the scene.”

As I walk toward my superior’s office, I think of that Russian story according to which a blind man returns to his home at night and in his hand he carries a lantern. “How stupid,” someone tells him. “Why would you bother to cast light on your path if you cannot see?” The blind man responds that the lantern is not meant for him, rather for the people with functioning eyes to keep them from knocking into him or running him down. A part of me wishes that Alejandro might extend his stay with us, so that I might have the pleasure of learning more about his wondrous powers of creativity. I am blind to his creations, for only he can see them. My eyesight ends where the opaque backdrop of my blind patient’s imagination begins.