One Year On and All is More Than Well!

I know I said I wouldn't mention it again, but today it is exactly one year on from the night I had my sub-arachnoid brain haemorrhage and I find myself unable not to reflect on what has been a very strange year.
From the moment of the explosion of the pain, light and noise in my head at pretty much the stroke of midnight (pun possibly intended, but it lightens the mood a little, don't you think?), my life has been different. Even now that I am, as far as I can tell, almost completely recovered, the way I view things is necessarily different. Those kinds of afflictions kill people. In fact, most people who experience it die. That rather puts it in perspective for me. After such a realisation that more people than not die from a SAH, it is impossible not to feel somehow as if you had a significant and lucky escape.
Life therefore has an entirely different complexion as a result. This is a Good Thing.

From the exquisite agony of the happening itself, the months of painful recovery, the confusion, tiredness and frustration, I have arrived here. It feels a good place to be. Paradoxically, it feels a better place to be than had I been a year on without it having happened. Perhaps this sounds a little trite, and I am sure that those close to me who had more awareness of what was going on than my addled self, might disagree. But it was a profound experience.

What strikes one, having viewed the world with a brain which had various regions malfunctioning, is how mechanistic the process of cognition, of sentience itself is. Parts of the brain have specific functions relating to how information is gathered and processed. When they are not working, cognition works differently.
I am going to be blunt here, and some of you might this difficult to accept, but when one experiences existence with a damaged brain and perceives just how different the experience is, it is not difficult to extrapolate this to what it might be like to have more impairment of the circuits. And ultimately, if the experience of consciousness is so altered by physical damage to the brain, then the complete removal of neural activity by death, must surely produce the ultimate change in consciousness: Oblivion.

My recollection of general anaesthetics tend to bear this out. And it does not bode well for notions of a soul or consciousness after death. I think now, if I ever doubted (and that would have been a very long time ago now) that definitely "This Is It: This life is all there is". Notions of afterlife seem fanciful hopefulness, and I have had all the confirmation I personally need to make it completely evident that consciousness is solely produced by the action of the neurons in the brain. When that stops, we stop.
And I am ok with that.

I am ok with that because it means that this new flavour life has, as a result of my reminder of mortality, acquired a new deliciousness. To be alive, to be mobile, to have a mind, and inside that a vibrant, colourful Life of The Mind, is, if we take the time to examine it, a dazzling experience. It is one I shall henceforth never take for granted.

My mind came back in stages. There were times I thought it was all back. I was wrong then. But then the problem was with my organ of cognition. It is excusable that this organ, self-regarding but damaged, might be unable to examine itself correctly. I think as a result, I pushed too hard, came back to work too soon and set myself goals that were too high for the various stages of recovery. I hope this learning will not be required again. But it does perhaps make a case for a little compassion towards ourselves and others.

But now, I really do think I am all there. I thought so before and have said so here. But this time, I think I am right. There have been times this past week for instance, when I felt my mind was on fire with agility and a euphoric sense of its own possibility. I have so missed that.
Small physical symptoms persist which hint at the possibility that subtle cognitive effects may linger, though I personally am not aware of any mental impairments. If I bend my head forward on my neck, the pains in my limbs return: Stabbing pains, almost as if in my femurs and radius and ulna bones. It would seem reasonable to assume that these residual effects might be mirrored mentally and I am vigilant, in a curious rather than anxious way, to see if they manifest themselves. At this stage though, I can discern no phenomena of this nature.

So, here we are. A year. And an enormous amount of strange experiences. I have made the acquaintance of my own brain and how it operates, seen it not operate properly, relearned to use it, discovered new ways to use it in order to circumvent it's dysfunctions, and discovered a new taste for life. My memory is better than before, my ability to evaluate information is better, I have taken up tango, started reading fiction again and feel, if I may say, 110% at least of what I was before.

In all this, somewhat self-regarding, piece of prose, I hope there might be messages of hope for what can be achieved in the face of setbacks.

I have been asked by several people to document all I can recollect about the whole experience in the hope it may help other sufferers of brain injury to make some sense of the experience. I was initially against it. Until yesterday actually when it suddenly, for some inexplicable reason, seemed a good idea. So, I shall do that.

Well, if you have read thus far, well done. I admire your patience. But what I want to say to you is this:
The brain is an incredible machine (and sorry, but machine it is, but don't let this detract from its wonder). It is unbelievably configurable. And there is no manual! So, given as how lost function can be regained with practise and discipline, what else might it be configured to do???
I exhort you! Play with it! Feed it! Teach it and challenge it! Learn a language, take up dancing, write a blog, or just plain start talking to people in the street. And I promise you, you will be rewarded with unexpected and delightful results. It will reconfigure itself by what you do. You just have to do it.

Overdoing it

I don't want to dwell on matters neurological but my journey back to health continues on its lurching rollercoaster path and it was suggested to me that writing it down at each stage might be helpful. I confess that the linear act of committing complex happenings into a narrative is very therapeutic for me and helps me make sense of what is going on in my still below par brain. So, I shall continue to document it and should you find it tedious, other content will soon appear which might be more interesting. Or not. Either way, I will point to that in the final paragraph, so if you are still reading and even mildly interested, but the find the rest of the rambling tedious, you could always skip to there.

So, after such a lovely two weeks' holiday with all the attendant joys of music and revelry and absolutely no intellectual activity at all, it came as rather a shock to go back to work. Opening my inbox to find 1496 unread messages as initially unsurprising, but once I had knocked off the easy corporate-spam, the  remaining 972 suddenly seemed quite overwhelming.
The nature of email is such that multiple threads of conversation can arise from a single initial question, copied to many people who then respond with their contributions to various different distribution lists. The result is a tangled mess of communication of varying relevance and currency. In fact I wonder how I ever managed it, or anyone does in fact!

Anyway, my brain crashed. Like a PC with too many windows open and too little memory for the new operating environment, the hourglass popped up and the whole thing ground to a halt. I sat there looking like I had been hit with a mallet.
Then the phone rang and I was "invited" to attend a meeting in Dusseldorf for which I would have had to have left at 4 a.m. tomorrow morning. My requests to change the date were rejected and my confidence and mental coherence crumbled into abject distress. In a state of agitation, I was forced to call Occupational Health and gibbered incoherently down the phone for half an hour until the nice lady calmed me down a little.
What followed was several days where The headache returned and I had to resort to painkillers to get some relief and eventually sleep.

And it becomes clear to me: The neurologist had said to me "You will make a full recovery, but it will take six to twelve months before you are back to normal. In the meantime, executive function will remain impaired. You can go back to work, but you will be disappointed."
He explained about cellular debris and what the pre-frontal cortex does and some of the effects I would continue to experience.

I did go back to work and I am disappointed.

Physical injury is no stranger to me. Over the course of my life, I have partaken in various daft activities and occasionally a hare-brained scheme would leave me with some injury or other. In each case, the doctor would say "Six weeks..." and I would think "Four weeks then.." and usually, I was right. The medical profession is by necessity somewhat pessimistic.

So when the learned fellow said "six to twelve months" I heard "Four months".
But I was grossly mistaken. Brains don't work that way. Ok, you see here a coherent thread issuing forth from a "working" brain. But what I hadn't anticipated was the subtle but profound problems associated with the remaining impairment. Categorising and comprehending information, and then adding it to an existing context is still incredibly difficult and this is pathological - something was damaged and needs to be repaired. It's quite fascinating in its way.

Each email I read contains information which swims before me like a myriad of tiny fishes, slipping out of my grasp and taunting me by darting away before I can even see what shape they are. It frustrates me beyond belief and must be a nightmare for those around me who merely want a straight answer to what seems a simple question. I just can't get it together (yet).

But it will get better. The necessary neural pathways just need to be built and reinforced. It will take patience and practise.

So, what can one do? Well, I was advised to attempt cryptic crosswords. I tried. It felt like writers cramp in the forefront of my brain. And anyway, there are too many conventions in each newspaper for me to know what is expected.
Then there is the Roald Dahl approach of puzzles and suchlike to challenge the brain. This was a helpful suggestion I received here (thank you Kay) which I am still researching and which shows promise.

But a friend suggested, as I lamented the dearth of plums this year, that I write down my wine recipes and methods. I do, though I say so myself, make excellent home made wine. My ginger had caused trained wine tasters to exult loudly and call for rich fruit cake as a worthy accompaniment and my damson has caused long minutes of silence with its richness and velvety gorgeousness. (The secret with the ginger wine is to put a couple of bananas in the must. But more of that elsewhere)

Last year's pink plum wine. Cheers!

The thinking is, and it seems sound to me, that by putting the recipes and techniques into writing, I can take complex information and organise it, thereby getting the hang of the whole logical sequential approach thing originating from an amorphous cloud of knowledge and information. I think it might help.
I had been meaning to write a book on this for some time and had started my sister blog in preparation for this very purpose. But it rather fell into disrepair. Well, perhaps now it is time to put it all together. So that's what I shall do!
But if anyone has any idea how to get better at cryptic crosswords, I would be very grateful!

Attention!

I was in a cafe today in Bath. It is Cafe Retro which is one of my favourite places to get a coffee or lunch when I am about town. I find it cheerful and unpretentious and the coffee is excellent. Coffee has been a great help to me these recent months. It helps me focus and clears away the confusion for a bit.
However, what struck me today was the hum of conversation in the place. Now, I have had some trouble with my brain of late, as you probably know. Some bits subsequently weren't working very well, causing me to feel a bit thick on occasion and to have trouble concentrating when there was a lot going on. A crowded place, with a lot of conversation has been a challenge to me, causing me to sometimes have to go and sit outside somewhere quiet whilst my brain cools down.

As an aside, I have had the last two weeks off as annual holiday.

Van in the mountains

We piled up the van with all manner of stuff and headed to a friend's farm in North Wales, where every year for the past, oh, maybe seven, he has cleaned out the barn and used it to host a private mini-festival. Everyone present is selected from friends and aquaintances and amongst those are a number of members of most excellent bands.  During the days, living was communal and if I picked up my guitar or banjo to play, often someone with a guitar would wander across to join in and ere long, a small session would be taking place.

Tents and vans appear in a freshly mowed field and we stayed from Thursday to Monday, helping where we could with preparations, clearing up and most importantly, haymaking. After all, it is a farm.

Children of the Revolution

So, the festivities and outdoor living carried on over the weekend and there was much singing, dancing and consuming of beer. 

Soundcheck in the now-clean barn.

Dogs roamed around with stolen sausages, children chased them laughing and not a care in the world was entertained for the whole time. It was a bohemian dream for a few days where pleasure, music and company dominated everyones' consciousness. I am chilled in a way I find hard to describe.

Party in the barn: Somewhere in this night, I got my brain back

And somewhere in that weekend, a switch seems to have been flicked in my brain. Something came back which I have previously lamented the  loss of. I feel complete again. More than complete in fact, if I articulate a feeling that is hard to explain. The experiences of the ghastly happening and subsequent recovery have left a mark which will stay with me forever. From the rudimentary consciousness of those first few weeks through the headaches and regaining of physical coordination and mental faculties, I have learned a tremendous amount which provides an almost endless supply of inspiration for curiosity. And gratitude. I met recently, before my malaise occurred, a survivor of a much more serious SAH and he was significantly different from his former self. I realise how much I have to be grateful for and shall never ever take my life, or my brain, for granted. It could do easily have been otherwise.

And so, as I was sitting in the cafe today, i remarked to myself how the hubbub of voices would have caused me a major "moment" a few weeks ago as my brain tried to make sense of it all at the same time.
But now, I find I can "float" on top of it all and "tune in" to individual conversations or voices. This is an improvement I welcome. But also, it gives me cause for thought.

Normally, where we direct our attention is not consciously under our control. Ok, we may sit writing an email in the office, or watching television, thinking we are concentrating, but if a man cam in wielding a knife or even wearing a silly hat, our attention would be drawn to him and away from the task in hand. This makes sense and is to be expected. However, it becomes clear that some process in our unconscious constantly monitors our surroundings and takes note of what to ascribe significance to and the relative weightings of pieces of information in our environment. And this is not visible to us, or even a process we are aware of.
Well, this has not been working in my brain for some months. All information is equally significant and my brain has been trying to process the whole lot simultaneously. This is obviously impossible and the attempts have caused me some distress. However, today, I sat in the cafe and realised that not only can I focus now and allow this repaired process to do its job, but that I am actually aware of its exixtence and of its operation. Where it was "below the waterline" before, now its workings are apparent to me.
And it is utterly fascinating!

Sitting listening to the hum of discussion, I note some voices demand attention more than others. Speech which is emphatic is more difficult to ignore. Emotional emphasis is flagged as more highly significant and more worthy of attention.
Some male voices are quite compelling. I cannot work out why, but a certain resonance or tone causes the attention to be drawn to it. Also, some bossy women seem more evident in the surroundings than before. I note that with the compelling or emotional voices, I am drawn to examine the content of the speech: With nagging voices, I am afraid the initial response is somewhat more visceral and less civilised.

To observe this process in action is utterly captivating. From a maelstrom of noise that would paralyse my consciousness for a period of time, now information is emerging and the process of extracting it and ascribing significance to it is becoming less of an effort and more unconscious. Unconscious and yet now transparent.

So, now there is another set of questions to occupy the curiosity: What are the criteria upon which our minds base their decisions of where to direct the spotlight of attention to?

These are questions I probably won't find answers to but out of a near-catastrophe, I have had the opportunity to examine some of the intricate functions of the human brain at first hand, as an observer. As a self-regarding mechanism, the brain does give us some wonderfully interesting insights into our own humanity.

So, next time you are in a pub, a restaurant, anywhere with a lot of enthusiastically interacting people, I urge you to just pause a moment to listen in to the whole, and then individual components of the verbal melee. And become aware of the incredible amount of work your brain is doing without you having to worry about it. It really is very impressive.

I am back! :-)

As a postscript, I would like to say thank you to those who have encouraged me to see the positive in all of my recent experiences. Your insistence that I be patient and that I was still compos mentis has been appreciated greatly. Thank you all.

Radio Silence

There's not much doing in my head these days. A cursory listen to the space between my temples shows something akin to a pub with no beer. Everyone has buggered off.
Whereas once it was a bustling, noisy place where a throng of voices clamoured for attention, now it seems to be deserted. I don't know where everyone went.
It used to be that an idea would spark a torrent of words, each one falling over itself in its rush to be expressed. One word led to another which led to another until ere long there was a number of paragraphs which somehow explained what had occurred to me and gave some release.
It's not that the words have gone. I can wield them as deflty as ever from the mace-blow of a blunt statement to the stilletto precision of a careful inference.
But the ideas seem to have departed. Things just don't pop into my head any more. Even writing this is like passing a kidney stone.

It could be that my brain is rewired after my haemorage. Indeed, given the area of my brain in question, this is quite likely. The pre-frontal cortex performs a lot of high level  executive functions and it may just be that the spontaneity of observation and reaction I relied upon, which  "just happened" just isn't working now.
I know some neurons, I don't know how many, will have died and with them some of the functions they performed. A loss of blood flow in the brain can do that, even a small interruption.
I know also that planning and attribution of significance to information is impaired. I confess, I don't feel as clever as I did before. Thinking is hard and makes me immediately fatigued. Perhaps all of this is implicated in the departure of the Muse from my life.

But I miss it painfully. I feel stupid, mentally clumsy, profoundly empty and somewhat lonely as a result of the loss of this drive to communicate. The long rambling email conversations I used to have with friends just dried up. The meandering discussions of abstract concepts, arcane but relevent to the experience of the human condition we all share just no longer happen. And I miss it all. Abjectly. I just find suddenly, I have very little to say. And I feel lesser.

Perhaps it will come back. I know the latest research on neurons seems to indicate that they do not regenerate. We do not make more of them as adults: Dead neurons are not replaced. However, there are an awful lot of them and those functions which were once performed by now defunct circuitry can be remodelled by the remaining adjacent neural machinery. This is "neural plasticity". To retrain the brain to do what it once did but is now reluctant to do takes application and persistence. I must do those things I want it to get better at. I must do them a lot. and the circuitry will gradually be built by that doing.
Whether this can return an ability that defined a character, I cannot say. Only time and experience will tell. But I am going to give it a bloody good try. And if it doesn't, then it doesn't and I will live with what I have available to me now. At least I still have my words.

Back on the road again...

Perhaps it is the final step on the road to normality. I am sitting in the Westin Grand Hotel in Bogenhausen, Munich, eight floors up suddenly aware that what I thought were clouds on the distant horizon are actually the Alps. How suddenly they jut out of the otherwise flat land! They are some distance away so their stature is evident in the fact they are visible. Somehow their presence suddenly lends a different complexion to my stay. From being a business trip, I have a sudden tinge of "Holiday" feeling intrude momentarily as this exotic location in the distance becomes part of my landscape.
I have a headache. It's the same headache at the back of the head that I was so familiar with during my stay in hospital in March and in the following month or two. It's a strange back-of-the-head headache which was what grew to a pulsing crescendo on the dance floor that fateful night. I am not happy that it reappears, but when I asked the neurosurgeon about it, he waved away my concerns telling me it is "just a migraine". That may well be so, but it's presence still unnerves me.

But I probably deserve this headache. I did after all consume three half-litres of beer last night. About three pints: Not an amount I would normally associate with a hangover. But these are not normal times. Beer allows the confusion. I expect to be mildly confused after beer. It's a pleasant, familiar confusion that males all other recent experiences of confusion seem comfortable and unthreatening. But I wish it didn't give me that particular headache.

I was concerned about how I would cope on this trip. I am still somewhat vague where information is concerned and I get tired between my temples when two conversations are present in my field of hearing. Usually this requires me to go and have a lie down but I have been sufficing with escaping to somewhere quieter and breathing deeply. It works up to a point.

So, I managed the driving, the chaos of Heathrow and Munich airports. Getting to the hotel was easy and my presentation went quite well to a roomful of attentive people. I heard my own faltering voice explaining things and realised that I am not quite "there" yet, but given how I felt even two months ago, i am astonished to be back in circulation.

It's hard to work out what it all means. Oh, I m not one for undue symbolism, but I feel different. I saunter through the airport terminals feeling that I have had an experience that renders the petty tribulations of everyday travel somehow far less significant. It feels like a freedom to accept (or reject) expectations on my own terms. I feel I can just walk up to people with a smile and say "Hello! I am Pete. Who are you? What's that you are doing? Will you be my friend" because a whole new frontier of existence has been reached and in it, I am innocent and ignorant of convention: Many older conventions seem redundant now.
I said it was hard to explain.

But here I am, back in Germany, doing what I always did and this seems both familiar but new. I don't really know what to make of it all. I am sure it will all fall into place at some point.
But for now, my grumbling tum bids me head down for breakfast.

Looking for Realisations

At the risk of seeming self-indulgent (and is blogging generally not a self-indulgent passtime anyway?), I am adding an update with regards to my cognitive state subsequent to events of twelve-weeks-ago-tomorrow.
Recovery, physically, is complete. I can cycle, dance, run, do anything I could before from a physical perspective. (But not drive yet as the medical panel of the Driver and Vehicle Licensing Authority needs to get together and talk about me to be sure I am safe before they allow me to drive again).

Given that many sub-arachnoid haemorrage sufferers are permanently affected (i.e. estimates vary but about 50% die immediately, 20% more in the next couple of days and a significant proportion never fully recover their original cognitive function) I am blessed to come out of it generally unscathed. I suppose on the spectrum of SAHs, mine was at the very-less-severe end, for which I am immensely grateful.

It is in fact, in its way, quite fascinating to observe the modularity of the brain's function. A small impairment in the functioning of the left pre-frontal cortex correlates with an inability to direct one's attention. It also seems to cause problems making decisions. Similarly, it affects motivation and I find myself sitting for long periods just thinking, unable to rouse msyelf to any form of action, even for activities I enjoy.
But most of all, and this causes immense fatigue, any noise or distraction, especially conversation in the immediate vacinity, prevents concentration and brings about a feeling of confusion and distress which subsequently makes me sleep for a couple of hours.
I am told that this will persist for six to twelve months after the initial occurrence. Impatience grows....

Whilst it is annoying not to have full function of my brain, I find the tendency to distraction actually quite liberating. I can daydream and blame it on my "condition". And I do seem to have become significantly more prone to daydreaming, an activity which in recent years  I lamented the absence of.

But what I really wanted to "throw out there" was an attitude I find myself holding that I feel quite guilty for.
Often, when people ask how I am, I try to explain as succinctly and accurately as I can what progress has been made and to outline the residual effects as described above. Now, I have to stress that without exception, everyone has been absolutely lovely these past 12 weeks or so.
But so often, people will say, in an obviously well-meant attempt to imply a sense of normality: "Oh, well, I feel like that all the time!" or "Now you know how the rest of us feel!" (a comment which has an implied compliment in it which makes me cringe with embarrassment)
And guiltily, I suddenly feel incredibly irritated by these responses. Is that wrong? Am I being ungracious?
Oh, the implications and intentions are good. But I am frustrated by the fact my brain cannot do what it used to (albeit temporarily). To be told, jokingly, that this is normal operation for some people, which undoubtedly is not really the case, does not help. Or is that just me being curmudgeonly?

So, twelve eventful weeks have passed. The unbelievable pain, the headaches, the immobility and permanent confusion at the World, have all passed into indistinct memory now. What remains is feeling that something should be learned from events. I just don't know what. To my chagrin, no unavoidable and profound "carpe diem!" revelations leap out to change my world view or provide resolve to "ignore the irrelevent niggles". To derive significance from the experience, I would have to go looking for it and possibly conjure something up from clichés and accepted wisdom.
My attitude remains, it seems, disappointingly unchanged by my experience.

But if anything does stand out, it is this: People have been lovely. As I resume the activities of normal life, shopping, going to the gym, going to work a few hours a week, I am struck by the immense compassion of people. There have been so many who I either bump into or who actively seek me out who tell me, with genuine concern, how shocked they were to hear about what happened and how pleased they are to see me back in circulation. So many people, people I didn't even know were aware of my existence, have come to find me at my desk and expressed the loveliest thoughts and wishes and I am genuinely humbled by their kindness. Some even brought cake!
So, perhaps I take that from it: That I have more friends than I thought and that more people care about me, and hold me in high regard, than I had realised. I guess, up to now, I must have done something right.

So, and I hope this does not sound too trite, maybe, in return, I will show a little more consideration for others, as I and my family have been shown these last few months.

Life on hold but hopeful

I have been sitting in my van, listening to the rain. There has been a lot of rain and I am told there will continue to be so. It was, after all, inevitable after the pronouncements of drought by the weathermen. But the rain falls on the metal roof of the van and I sit wistfully, regarding my reclaimed cedar cladding and watching the rain run in rivulets down the windows.

 The tendency to introspection engendered by the atmospheric and moody (Literally!) charm of rain is much portrayed in popular culture of all types, but sitting in here, the picture of Me Old Dad looking down at me with amusement, the longing for adventure is poignantly underlined by the tip-tapping of huge rain drops outside, like a thousand unsynchronised tap-dancing weasels on my roof. I look longingly at the steering wheel, reminded that the DVLA (the government dept responsible for all matters automotive) still have not given me the go-ahead to drive.
I have no idea if driving would be a challenge for me yet. I suspect not. Mostly it is brain stem stuff and automatic, but perhaps my still-addled attention machinery might pose some level of risk. Hard to say until I try and until I get the letter from their medical panel, I suppose I can't try.

So, I sit in my van and I potter. I make a new cupboard with the remainder of the ancient planks and admire the beauty of the woodgrain. And the rain falls. And I Imagine it is sea-rain, driven off the Atlantic after a long day's paddling about in my kayak.

My Sit-on-Top Kayak. My favourite toy, by the sea at Putsborough

 When I got my van, it was a ex-railway crew-van, with all manner of industrial gadgetry inside. It all had to come out. And gradually, I have built it into a comfortable mobile beach cabin and lodgings without spending any significant cash on doing so (except for the £450 I got from the sale of the van's Predecessor which the kids affectionately named "Venus" after an astronomical event a few years ago - it is a Transit, you see).

But given my recent gift of New Perspective, I am eager to rejoin life. There are things I am impatient to do, like get traveling and "doing stuff!". There are beautiful woodlands to explore.

Lower Woods, Inglestone Common, Gloucestershire.

 There are distant, historical towns to visit, where we can walk at twilight and perhaps eat dinner in some rustic restaurant where they only seem to serve dishes containing duck or goose.

There are moody sunsets to be watched as they fade to dark, when we can retreat inside the van, draw the curtains, make some cocoa and read the papers before going to sleep, with the rain pit-pattering reassuringly on the roof, as we drift off cocooned snugly in warmth and comfort.

And in the morning, after a hearty breakfast, the rain will have stopped

there will be a walk along the beach and the space will get into my head and all will be mellow and happy.
But first I have to get back to full health and to be allowed to drive.
It won't be long. And then, there is Stuff to Do and I am going to jolly well do it! You just watch me!

Not quite Phineas Gage but...

For my birthday last week, I went to see a neurosurgeon. Well, it wasn't for my birthday, but it was a worthy day to sped visiting such an august fellow. I do so admire experts, especially those who you would be happy to sit next to at a dinner party, should I ever get invited to one.

He was an interesting fellow and answered all my questions, which have been burning in the area of my brain which deals with curiosity for sometime.

So, to quickly explain, merely by way of illustration of a point I want to come to later, about my lingering interesting symptoms and their explanation: The gentleman in question listened patiently for me to articulate precisely my frustrations and to ask for some understanding of the nature of their origin.
Then he got out his brain. Well, not his brain, obviously, but a life-sized model of a brain in, I suppose, carefully modeled plastic. I was shown the places through which the arteries and viens are routed and the point at which my own creaky blood vessels had succumbed to the pressure and let out some of their contents into spaces where there shouln't be blood.

"But!" cried I in indignate incomprehension "If my own haemorrage was down at the less scary end of the scale, why all the fuss and headaches?"
Apparently, at the other end of the spectrum, huge bleeds fill the ventricles of the brain and kill its owner immediately. I did not have such a serious form of this affliction, fortunately. But nevertheless, the brain does not like blood in the wrong place and finds it extremely irritating and disruptive to function, even with a relatively small bleed. It's still, apparently, extremely serious and not to be taken lightly. I started to calm down a little.

So, the esteemed gentleman continued, the part of my brain afflicted was the pre-frontal cortex. It seems there is still a lot of "cellular debris" and the wreckage of clots hanging around in various membranes, disrupting the blood flow and causing various problems with normal brain activity, and this will continue for some months if not a year.
"Just what kind of activity?", I wondered aloud.

Well, quoth he, "executive functions". And this is where it gets interesting. It is now understood from extremely credible evidence, that the pre-frontal cortex deals with interesting higher functions of mental processing such as motivation, decision making, attention and personality. It is, he said (and after all, he should know!), "that part of the brain which makes us us"
"Ahh!" I exclaimed mischievously "That's where the soul lives!"
I surmised from his expression that he had long since discounted the notion, given his understanding of the machinery of cognition and concsciousness.

However, motivation here is a fascinating concept. It is not, as it might initially seem, that which causes us to want to go to a football match or consume another pint of beer, or even strive towards a goal at work. Though, it is implicated in all of those. No, in this case motivation means "that which causes us to want to choose one course of action over another on an unconscious level".
You can probably see then how it has and effect upon attention and decision making. Given a panoply of data from the eyes, ears, nose and perhaps a rumbly tum, the brain has to categorise that information and choose what significance to apportion to it.
This was helpful when there were leopards, for instance, because a leopard shape glimpsed fleetingly through the trees was a more powerful piece of information than "Gods! I could murder a yam!" or "Ogg has a splendid new loin cloth. I wonder where he got it", at least where survival was concerned. Those who put their attention in the wrong place perhaps ended their introspective days under the hooves of an angry bison and did not get to pass on those genes, leaving their more switched-on contemporaries to survive to produce us (though sometimes looking around me in a shopping centre, I do wonder at the results of this particular selection process...)

Hence attention seems not to be under our control. It is directed by an unconscious decision making process based upon inputs from our senses, apportioning relevence and accordingly causing us to look in that direction regardless of our previous interesting thoughts. And this is the case for the defence when I find my eye drawn by a pert female bottom on a sunny day at the beach. But I digress in a shameful manner.

When I am in a roomful of people and there are mutliple conversations going on, I currently find it distressing. That process which directs my attention and decides where I should focus it is not functioning correctly. Because of the detrimental effects of this aspect of my brain of bits of blood clot and inflamatory agents from my immune system, I am unable to follow a conversation in the presence of other information. At this point, my mind stalls and I have a small kind of panic attack. Usually someone notices and takes me to one side and gives me a biscuit or something, for which I am grateful. But it is a wonderful illustration of how the brain works (or in my case, currently doesn't work).

So, on further investigation, I discover there are other bits: The amygdala which recognises emotional stimuli and flags them to the aforementioned frontal lobe for processing, the facial fusiform gyrus which deals with facial recognition and interpretation of expression, the anterior cingulate cortex which (I think) deals with error detection in expected perceptions (for an understanding of how this bit is exercised, try saying out loud the colours of the following words - Blue Purple Red. Thats called the "Stroop Test" and you have probably seen it before).
Its all really rather exquisitely put together and connected.

But what comes across to me again and again is just how contingent upon the integrity of the brain our cognition and consciousness is. Having had mine not working properly, I am fascinated by the way the function of the system (i.e. me and my personality and all the things I do, say and experience) is dependent upon the correct functioning of all of its parts together.

And though I may look at this process - the process as the man says which makes me me - with awe and fascination, I cannot help but begin to reaslise it is nothing but (and this in no way diminishes its spectacular wonder) a very powerful and complex difference engine - an analogue computer, if you will, which balances up a number of inputs to provide an output.

Ok the resultant phenomenon of consciousness which I enjoy every day (except for some periods during sleep) is pretty amazing. But it appears to be an emergent property of this incredible and complex machine (which currently is providing me with an altered view of consciousness on account of not working in the same way as usual). There are evident and glaring conclusions from the recent improved discoveries of neuroscience. I shall not go into those here because sometimes I find my views upset or offend people.

But for now, I shall continue to work with this astonishing machine that evolution has provided me with and since it has no manual, I shall carry on seeing what it can do by playing with it and being generally in a state of childlike delight at what I subsequently discover. Even when it's playing up a bit.

Getting Back into the Swing of Things

Well, it is now just over three weeks since a blood vessel in my head went pop and laid me low. Progress has been non-linear but in the right direction. Concensus is that I am still the Same Old Pete, just a bit more subdued and tired. Indeed, sleeping is something I do a lot of lately. I eat breakfast, I go back to bed exhausted for an hour. I entertain a visitor for forty minutes, I sleep an hour. I walk to the shops, I sleep for two hours. It becomes evident that I need to pace myself very carefully if I am to maintain recovery without setting myself back with each exertion.
And tramadol is a very welcome companion several times a day for the headaches.

When I think back to the High Dependency Neurology Unit in Frenchay Hospital, my first memories are of a week of shades of consciousness and a long tunnel of pain and confusion alleviated by regular, merciful morphine. Wonderful stuff, morphine.

But also, I am reminded of some of the other chaps in the ward and very grateful that my own decisive but oblique graze with fate was not as serious as some of theirs. Many of the other patients had horrendous conditions to live with. There were people afflicted with serious, debilitating depression, alzheimers and epilepsy. Some of the crosses these guys had to bear seem beyond human endurance to suffer. It is very apparent just how easily this organ can malfunction.

Also, the amount of compassion I witnessed is humbling. The nurses, bless 'em, were a little variable in their levels of empathy and I suppose this is understandable when one considers they deal with ill people and their unpredictable humours on a daily basis.
But there were some patients who had attendants 24 hours a day for various reasons that were never quite apparent. To see a hulk of a man, all cauliflower ears and broken nose, speaking softly and kindly to his charge as the poor confused fellow attempts to get out of bed every ten minutes due to confusion and frustration is quite humbling. There are some lovely, caring people in this world and they don't always look like you would expect them to.

My memories of that week are somewhat incomplete and jumbled. It was not a time of coherent thought for me. I remember not being able to speak, only to squeeze a hand; once for yes, two for no. I remember not being able to move my head, or even my eyes, due to the agonies of whatever was in my cranium being far too big for the skull that was trying to contain it. I remember drinking from a baby beaker for several days and my first glorious cup of tea after my several days of nil-by-mouth.

And I remember that there was a place full of incredible people with astonishing knowledge, equipment that was the pinnacle of human medical and scientific endeavour and poor souls with various chances of recovery.

And I am very grateful to be both still alive and on my way back to my old self, with whatever improvements I can make with lessons extracted from the whole experience.
It is a grand thing to live in the 21st century and to benefit from several centuries of cumulative medical knowledge and progress.