I often joined the floating fellowship. When we talked with Paul in the pool, we paid attention to his mood. Did he seem like he wanted to space out and just meditate? Did he seem open to questions? We’d ask a few. Babble on a bit. Give his brain some quiet time to rest. Babble some more. Ask another question or two. Give him lots of time to answer. Do little charades to help him with words. Coach as needed. (Something like: “Hmm. City . . . in New York. Do you mean . . . ? Upstate? Rochester? Albany? Buffalo? Saratoga?”) This created less pressure than a formal speech therapy session, where he’d have to focus and perform without the luxury of frequent long rest periods. More time to answer, less pressure, less frustration, a more relaxed mood, conversation that was tailored to his life and interests, and lots of varied clues—with all of that, he found himself most fluent when half submerged.
That he didn’t swim at all the first season after the stroke—however happy he might be lolling in the pool—really concerned me. Along with his inability to button a shirt, work household gadgets, or remember instructions, it suggested serious damage to his procedural memory, the unconscious memory for how something happened, or how to do things. Not that something happened, which involves a different brain system. Drawing on many areas of the brain (cerebellum, basal ganglia, various sensory and motor pathways, among other regions), subtle skills like bathing, dressing, walking, and swimming evade language, but help the body remember itself in the world. It’s why one rarely forgets how to ride a bicycle, despite the intricacies of balance it requires. One needs to think about how to float only while learning; after that the body remembers how to angle arms and torso just so, without consultation. For most people, such skills lie beyond words.
Paul remembered what swimming was, and where it took place, and even the sweet spell of gliding through the water. The missing piece of the equation was how to thrash his arms, kick his legs, and glide—all in unison. With practice, he had relearned how to use a spoon, a chair, a comb, the toilet, but some household tasks still eluded him. He regarded a can opener as a contraption from hell. Pens escaped his fingers. Shaving required lots of energy and focus, and he was completely baffled by cleaning his electric razor, which meant taking bits apart and then reassembling them in the right order. It made me wish he’d spent more time in occupational therapy at the hospital.
The two fingers on his right hand remained clenched from the stroke, and needed to be pried open and stretched each day. Before the stroke, Paul had had dry cracked hooves instead of heels, but a routine of regular foot massage restored the circulation and kept the hooves soft. Liz did the stretching and massaging on weekdays, I continued on weekends and whenever Liz was away. No amount of stretching would ever straighten his fingers again because their problem wasn’t entirely muscular. Yet stretching and massage did ease them for a short spell, long enough to grip a pen and practice writing, or hold a fork or spoon for dinner, and it felt soothing, and helped keep the contracture from getting worse.
The daily routine never varied: hand massage preceded swimming, and swimming always ended promptly at 4:50, so that Paul could get ready to watch Judge Judy, a new addiction and instant mainstay of his verbal rehabilitation. After an hour of courtroom drama and dialogue—money owed on used cars, unpaid loans, scam artists, angry “keying” of a rival’s or a cheating lover’s car, nasty disputes over minor objects between ex-spouses, evil girlfriends, unleashed pitbulls, inheritance disputes, freeloading boyfriends, and bad debts—he watched the dire BBC news, then the national news, and after that ate dinner and tried to talk with me until movie time.
We developed a habit of watching a TV or rental movie almost every night; Paul couldn’t always follow the plot, but I gave him updates at regular intervals and answered questions. He found old movies we’d already seen easiest to grasp, though anything with many characters or intersecting plotlines rattled and confused him. In his sundowning state, he could still manage language in this more passive way, with the help of Hollywood’s enticing images and musical scores, provided they didn’t make too many demands.
Ironically, he understood better than I the canny, ornate, electrifying Shakespeare plays filmed and acted in by Kenneth Branagh, because he had studied the plays as a boy, at a time when some of the colloquial English spoken in the British Midlands wasn’t all that far from Shakespearean. And he’d often heard the local miners addressing one another as “sirrah,” the Elizabethan word for sir.
I also adored Shakespeare, but half the time I couldn’t translate the Elizabethan spoken at such a natural, conversational clip, and, unlike Paul, I didn’t know the plays nearly by heart. But in Henry V, Hamlet, Much Ado About Nothing, and Love’s Labour’s Lost, Branagh, Emma Thompson, Paul Scofield, Laurence Olivier, and the rest of their brilliant troupe acted so expressively that my mirror neurons helped me fathom what they meant, despite my stumbling over some of the vocabulary. Watching the plays put me, however faintly, in Paul’s aphasic shoes, struggling to understand words I once knew, spoken too fast, and having to rely on the primitive cues supplied by masterful acting: facial expressions, tone of voice, and body language.
We may owe all of our cherished parlance to those aptly named brain cells, our mirror neurons, with which we mirror one another’s yawns or smiles of contentment. They’re plentiful in Broca’s area, which processes language in humans, signing in monkeys, and communication in other animals, too. Before humans shared words, our ancestors would have used hand gestures and facial expressions to communicate, until what they needed to say grew far too subtle and complex for mere pantomime, and prodded by necessity, they made the ingenious leap to strings of words. At times, Paul now reminded me of those crafty folk—when he cobbled together words the way two-year-olds, Tarzan, and speakers of “pidgin” languages do, re-creating a sort of protolanguage. Like the time he asked for “nice ice,” and meant lemon sorbet. In those moments, was his brain paging back through evolution and tapping the vestigal traces of how language first evolved?
Just keep his language mill churning, I thought, that’s key. I pictured a sunlit gorge and cascading waterfalls in the Adirondacks, where we once visited an old fashioned, water-powered grist mill on our way to Cooperstown for a weekend of opera. A lumbering and indelicate image of the brain, to be sure, but practical, mercantile. His grist mill cried out for new fittings and sluice gates, help restoring the grinding stones and fixing the sieves. And it might need to outsource. But it couldn’t function at all without tons of grain. So, one way or another, from waking until bedtime I tried to keep Paul drenched in words. This much seemed elemental, and it proved critically important. It exhausted him mentally, of course, so he had to take several naps during the day. But it forced his brain to harvest words and mill language nonstop, whether it wanted to or not, planting seeds for growth, I hoped, among the desolate neurons.
CHAPTER 22
SOMETHING I FOUND ESPECIALLY ODD, BUT ALSO merciful, was that Paul’s temperament had sweetened since the stroke. No longer dealing with the frustrations of teaching or publishing, he wasn’t waking up in a high blood pressure rage, or barely containing a volatile anger. When we met, he’d been a charming alcoholic with a violent temper, a James Joyce sort of artist with a sparkling gift for words. I’d grown used to never knowing when Paul would explode. But he wasn’t always combustible; most times he was quintessentially loving, a real sweetheart. The lurking land mine was part of a pattern: his unpredictable explosions, my fright and crying, our coming apart, his regret and promises, my forgiveness, our reunion. For years of our marriage, I’d walked on eggshells around him, because it took so little to trigger what he described as his “Irish temper.”
Not now. Surprisingly, his temper vanished a few weeks after the stroke, when he became mellower, more patient, deeply appreciative, and I felt grateful for his new twist of mind. His struggles and goals weren’t competitive, he was swaddled in overt love and encouragement, and he
was taking an antidepressant for the first time in his life (50 milligrams Zoloft). The combo—plus whatever had happened in his brain during the stroke—produced a sweeter, less stormy Paul, which I found wonderfully welcome.
Such a spirited change is not unusual. Personality can about-face after a stroke, sometimes for the better, sometimes for the worse. A placid soul can become impulsive, angry, irritable, anxious, or emotionally flattened. President Woodrow Wilson, who suffered a stroke during the Versailles Peace Conference, is one dramatic public example.
Even though the stroke didn’t paralyze him, the people who knew him saw an immediate negative change in his personality. He was irritable, inflexible, and spiteful, whereas before he was forward thinking and able to compromise. He also became less sociable. Several weeks after the first stroke, he had another one that paralyzed his left side. Despite his obvious infirmity, he denied having any problems (denial is very common). . . . Those around him became very distressed. He fired his secretary of state for trying to discuss his medical situation with the cabinet. His stroke may have involved setting the stage for World War II. After his stroke, he could no longer argue effectively for the League of Nations.
—Daniel Amen, Healing the Hardware of the Soul
Did Paul’s personality change owe more to the stroke or to the circumstances following it? Hard to say. What we call “personality” doesn’t exist in isolation; it defines itself by how it interacts with others. It’s not an impervious phantom, but interpersonal; and, since the stroke, his relationships had all changed. A bit paranoid before, he now found people acting more caring, forgiving, and encouraging. In this one way, Paul’s changing psyche felt better for me, even despite the heart-wrenching loss of my intellectual companion, because he was able to love me more completely. So perhaps I persisted, not just to keep Paul alive, or even to keep myself from experiencing loss, but because in some ways he finally was more alive for me.
But as my energy continued to flag, I realized I couldn’t meet my work deadlines. I would need an extra year to finish The Zookeeper’s Wife. And I would need to cancel spring and summer talks and readings. Although I’d promised to write a regular column for Discover magazine, I emailed the then-editor, Steve Petranek, explaining about Paul’s stroke, and that I hadn’t the time or energy for work. Steve replied with an encouraging account of his father, a conductor and accomplished viola and violin player who had had a stroke at about the same age as Paul. Steve’s father had also lost his ability to speak. Actually, what he lost was his English vocabulary—he could still speak the Czech he had learned as a boy growing up in a Czech community in Cedar Rapids. He never regained his mastery of the viola, his favored instrument, but after relentless physical therapy he became remarkably better than he had ever been at the violin (even though the two instruments are quite similar). Meanwhile, he began tackling children’s crossword puzzles. By the time he died, he was back to enjoying his daily New York Times crossword puzzle. A testament to the power of plasticity and practice.
From Petranek, I learned that a person has to hear a word repeated about two thousand times before it’s deeply embedded in long-term memory. On an index card, I jotted down a list of everyday words Paul was having special trouble with—such as Paul, Diane, drink, checkbook, hummingbird, wallet—ones seemingly erased from his universe, and I began including them in sentences as much as possible.
“Do you think hummingbirds have checkbooks?” I asked Paul one day. He laughed, nodded yes, and drew the tiniest oblong checkbook in the air. Ten times in a row I had him repeat checkbook. Half an hour later, he had already forgotten the word, as if his brain had written it in invisible ink.
“Look! At the feeder, there’s a bird—what is it?”
Fumbling for the right word, but failing in his quest, he produced something which he didn’t understand: “Zinc quadrant.”
“No, it’s named after the carefree sound it makes,” I hinted. “Hhhh . . . hummmm . .. innng .. .”
“Hummingbird!” he chirped triumphantly.
“Right! Hummingbird. I wonder what hummingbirds keep in their wallets. Pin-ups?”
“Sugar?” he offered.
“Where’s my . . . fool’s cap?” he then asked unexpectedly.
Fool’s cap? I thought. Does he really mean a court jester’s hat? I pictured the gaily colored cap with many peaks, each tipped by a jingling bell. Or—and I feared this was more likely—did he mean a dunce cap, the paper cone slow students were once sometimes forced to wear?
He made a writing gesture. Of course! Heavyweight paper. The original manufacturer of it had used a watermark of a three-pointed fool’s cap with little bells. It was years since I’d glimpsed that watermark. But surely he remembered where the paper was—I’d seen him taking some sheets from the shelf in my study only an hour before.
“Do you possibly mean checkbook?” I tried.
“Yes!” he said with relief, and I led him to the special drawer where he kept his checkbooks.
Sometimes these non sequiturs were funny, but at others simply awful, jamming his brain when he most wanted to comunicate.
“The second stage of yawning presses down on my feet,” he complained one morning after much hesitation and false starts, in which words caromed like bumper cars. After hard digging and what he called “blockades,” and many yes/no answers to questions designed to help him sort the words into general categories, I finally understood what he was trying to say, something homely and mundane—that the soft green blanket I’d added to his side of the bed the night before had felt too heavy on his feet. Simple words like “blanket” and “bed” were still eluding him. I added them to my growing list of words to repeat often during the day.
Around this time, for some reason, I began addressing him as “wombat.” Though not entirely strange, since we always did have lots of totemic names for each other, “wombat” was a sparkling fresh new endearment. I showed him a photograph of adorable baby wombats, wombats digging holes with their long claws, and two fluffy wombat mates sleeping together in the sun. An Australian friend sent us a fleecy stuffed toy wombat, whom we named Woodrow, and who assumed a regal position on the purple swooning couch.
Snuggling in bed one morning, I said to him, “Good morning Mr. Wombat.” And he echoed: “Good morning, Mrs. Wombat.” He was often wonderfully more fluent then, half awake, with no pressure on him.
Sleepily, I posed the question: “Hey, I wonder what Mr. and Mrs. Wombat’s first names are. Let’s see. His name is . . . Hydroelectric . . . Hydroelectric Wombat. And hers?”
He thought for a moment. “Clopidogerel,” he said.
“Clopidogerel?!” Where did that come from? It slowly dawned on me: it was a drug name he must have heard in a television commercial. “Right—Hydroelectric and Clopidogerel Wombat. Do you suppose they have kids?”
“Six,” he said. “Half, half.”
“Three boys, three girls?”
“Yes.”
“Well, what are their names?”
At this he began giggling, and finally said “German . . .” He couldn’t find the next word, so he made a diving motion with one hand.
“Airplane?”
“No.” His hand plunged shallowly this time.
“U-boat? Battleship?”
“Yes!” Eyes lighting up. “But sick.”
“They named their kids after sunken German battleships?”
With a wicked smile, he said: “Bismarck, Graf Spee, Tirpitz . . .”
We began laughing uncontrollably, me from the sheer relief of hearing him play with words again so imaginatively, as we pictured Hydroelectric and Clopidogerel Wombat introducing their six children named after sunken German battleships. When we finally emerged from the bedroom at last, Liz, who’d arrived for the morning to help with Paul, asked with a grin: “What on earth was going on i
n there?” Still giggling, we had a splendid time explaining.
After a stroke, play is the last thing on a couple’s mind, but it drew us thankfully together in innocence, it felt so good to laugh and romp with words together again.
After lunch, Jeannie and Steve joined us for a short visit, and conversation turned to TV’s Catholic nuns. Steve’s elderly mother was devout and watched Sister Angelica all day long, which meant that whenever Steve visited her, as he did almost weekly, he was subjected to a Sister Angelica marathon, too. Paul unexpectedly described Steve’s mother as a “holy constabulary,” dissolving us all into peals of laughter. A banner day. Laughter really is a wonderful elixir, and it can be hard to find in the shadow of misfortune.
After they left, and Paul began sundowning, the house felt familiar and silent. We sat purposely listening to the silence, broken now and then by the liquid marbling of birdsong. The sun had begun dusting the treetops with crimson.
“Do you dwell on things a lot, brood?” I asked Paul.
“No,” he replied. “Watch trees. First time I’ve noticed how gorgeous. So tall. Lots of different.”
“So many voluptuous shades of green,” I said, and he nodded yes, approving of the word “voluptuous.”
“The plants are fluorescing,” he observed appreciatively.
I imagined leaves with the beauty of fluorescent minerals, glowing like brilliantly colored neon flowers. Or maybe he was picturing the fluorescent fungi in the woods, whose visible part, the “mushroom,” looks innocent enough, but whose tentacles invade rotting wood and glow an eerie green, making logs shimmer like they’re burning inside. It always amused me that mushrooms, lightning bugs, and trick-or-treating children with “light sticks” are all lit by the same cold green fire.