I. On Holes in the Brain, and Other Woundings
Among the 15,000 items housed in the Warren Anatomical Museum in Boston is the skull of Phineas Gage, a railroad worker who survived after a large iron rod punctured his left frontal lobe. The bleached bone shows a jagged U above the empty hollow of the left eye’s socket, bone that never again seamlessly met other bone. The rod, which was described by The Boston Post as “an inch and a fourth in circumference” and is also on display, was driven through his skull with such force that upon exiting, it landed yards away. While Gage was still able to speak and physically function, the accident left him radically changed. He had trouble holding a job; he was “fitful,” restless—never fully recovered from his wounding.
Gage’s case would remain of interest for years to come. Scientists saw Gage’s case as an opportunity to learn about the aftermath of physical trauma, how the brain can teach itself to circumnavigate a wound, to pass it by, even if it could not escape it. I am interested in Gage’s case, as well, though for very different reasons. It has led me to wonder whether we are all defined by our gaps, the places within where nothing breathes or where something leaps but is not caught. Whether we are only the products of our woundings, defined by the scope of our losses.
It has been more than a year since I first learned of Gage in an article in Scientific American Mind, yet I think of the railroad worker again on the return leg of my first train trip, as the train from D.C. to Chicago moves out from yet another small station, jerking in fits before it catches its rhythm. It is 4:00 a.m. Unable to sleep, I have been sitting in the observation car of the Amtrak all night, listening to the low murmuring of other awake passengers and watching the small towns dip in and out of the hills, desolate way stations of chipped graffiti or lonely houses whose painted roofs proclaim that Jesus Saves.
Through the train windows, I can see the next city’s lights reflecting in the water. My own face also reflects back, illumed only by the interior lighting: a slash of cheek, a V of skin above a shirt collar. A second reflection from the window behind me slightly overlaps and superimposes the first; the second is lighter, more ghostly, a fog of me coming out of the skin like mist. A self-haunting, if you will, by the me I might have been if my brother had lived. The slant of my nose, his nose—these things become confused in this reflection, cannot be separated into distinct bodies occupying separate orbits, separate spaces.
No other ghost wants this much from me, not even the child who died before gendered, whose blotchy gray and white picture lies hidden at the back of my closet. Though not physically a rod piercing through my lobe, carving cavities near the midbrain, my brother’s death has nevertheless been a kind of puncturing. And perhaps it is this thought that leaves me awake in the dark, that leaves me nearly breathless with the weight of it crouched on my shoulders and pressed into my chest—the thought that, like Gage, I will never recover. Inside, there will always be a hole, a gaping, disordered mess.
II. On Hemispheres of Thought
In the left hemisphere of my forebrain, I’m told, there’s a signal abnormality, too small to be a worry, though the neurologist never explains exactly what this means. Instead, I’m left to imagine my brain as a sort of vast power grid with a downed line in some sparsely populated rural quadrant; the chain is broken, the path washed away by spring flooding, the circuitry faulty. My untrained eye, looking at the 157 slides the doctor took during an MRI of my brain, can never find it: that small spot where the current skips, where the wires get crossed—my bad part. Is this where the soul is? Does it reside somewhere in the slippage between synapses, just a jumble of electrical impulses choosing their own destinations? Perhaps this is why no one can map the soul, and why when it leaves, it is always beyond our reach. Sepia-toned, the slides arrived on a disc, mailed to me in a white window envelope, innocuous looking, like computer software.
The spot, less than a centimeter in size, tells all of those who look at my slides that I am likely a migraine sufferer, though the cause of the headaches, like the definition of a signal abnormality, has never been fully explained to me by doctors. Like the soul, a migraine is visible only through its signs—the way your vision shrinks to a pinprick and pain blooms like razor wires being strung throughout your skull, looped spools of vines winding their way through the cortical folds. Like a migraine, the soul, too, can be dark. Like the brain, the soul, too, can be wounded.
I went to see the neurologist after visiting my primary care physician, as well as an ear, nose, and throat specialist, who CT-ed my sinuses, and an ophthalmologist, who slid my face into a plastic holding device, tinted my eyes with some yellowy substance, and shone tiny lights into the centers of them, leaving me looking jaundiced for several hours afterward. My white counts had been low for nearly three months, and after five different prescriptions from three different doctors, my face and skull still hurt. Each day after work, for three months, I slid into bed with ice packs cradling my scalp; breathed steam in and out from hot showers, with puffs of mist coating the mirror; and took high doses of ibuprofen, all in an effort to numb my head’s pain. After looking at those 157 slides, the neurologist hooked an IV full of steroids to my arm, then sent me home with two new drugs and a bagful of peppermints to suck away the coppery taste in my mouth. After the first new drug failed to help, I stopped taking it, and half my face swelled. For three days, only one half of my face gave any of my emotions away. Only one half of my face responded to the brain’s instructions.
I never filled the final prescription. I took it to the store, but while wandering the aisles near the pharmacy counter, I remembered the neurologist’s face as she gave it to me, hearing her words about following up in a few months. It was clear she thought my pain was not physical so much as psychological. In the family history she took during the course of my treatment are the written words, Parents living. One sibling. Deceased. Age 24. And suddenly, there was a part of me that wondered whether, like Gage, I’m meant not to be fixed.
Or rather, if it is our wounds that define us, who do I become without them?
III. The Memory Train
Inside the skull, two seahorse-shaped neuronal clusters frame your midbrain, like halves of an oyster cupping a pearl. And indeed, what’s inside the hippocampus, the seat of memory, is precious. It’s why I can still hear my younger brother’s voice though he’s been dead for six years and why I can remember that the last thing we did together was smoke a cigarette on our mother’s deck.
Named from the Greek for “horse” and “sea monster,” the word hippocampus evokes the mythical creatures tied to Poseidon’s chariot, swiftly bucking through sea currents and pulling the god of the sea to any desired location, forging paths through the untamed deep, like the pathways formed in the brain. A cognitive map made of memories—appropriate, since the hippocampus also plays an important role in spatial navigation.
Like the ocean, memory is fluid. As it happens, the first memory I have is of water: I’m three years old, wearing a red dress I am inordinately proud of. We are at the zoo, and my grandmother is holding me up so I can peer into the dolphin tank. When they splash me and the pretty red dress, I cry.
Besides this, I have far fewer memories of my childhood than my mother imagines I should. I have no recollection of whole years—most of elementary school and junior high, parts of high school, too. Why does the brain choose to remember some things and abandon others? Is memory little more than a series of endless file cabinets with sometimes poorly labeled folders? Nothing but jagged synapses jumping off like lemmings from cliff edges? Or perhaps memory is but the mother of grief. In the afterbirth, loss gathers flesh, recounts itself again and again. My memory is a box of unlabeled pictures found while moving, in which my brother’s face is always half turned away.
Overstimulation of the hippocampus can provoke what people term a “near-death experience,” in which a blindingly white light blocks out normal vision. This light precedes the brain’s random selection and rerunning of memories from your life. This phenomenon is not quite the mystical, holy experience many people originally thought it to be, but rather simply a series of chemical responses in the brain, which can be replicated in laboratory settings through the stimulation of neurons or possibly through the use of drugs. But what comes after a near-death experience—how a person may choose (or not) to reshape her life—can be holy.
Of all the memories I still possess from my childhood, those of my brother are the most prominent. I was only a year older, and when we were small, we were nearly inseparable despite our many differences. I was overly cautious, the one who came up with ideas I was never willing to try out myself. I designed the parachutes for toys he launched out of windows; gauged how big a pile of leaves would need to be if he were to jump off the deck stairs into it without breaking anything; rigged the tarp with rope in the woods where he’d hide to scare our parents; suggested that our father’s orange plastic snow shovel would work perfectly well as a sled, the handle a sort of rudder he could use for direction. This last idea led to a quarter-sized gash on his skull and very nearly to stitches. We were a well-organized team. Our parents eventually learned to punish us together or not at all.
I am afraid of losing these memories altogether someday. For more than six years now, my brother has been silent, and even his voice in my head has grown distant, a tongue stoppered by stars, just an impression, like the glimpse of sky left by a lightning burst or like when droplets hit a windowpane, fat and heavy, then slide trembling down. His voice, to me, is like that: just a streak through the otherwise dark.
The November 22, 2008 issue of Science News reported on scientists working on therapies that could “erase traumatic memories for people suffering from post-traumatic stress disorder,” and further explained how, through the use of an altered protein, the scientists were able to wipe out an entire memory from the brain of a mouse. He no longer feared entering a chamber where he had previously been shocked. Either the altered proteins had completely erased the offending memory, or they had rerouted the pathways inside the mouse’s brain so that the painful memory was no longer accessible.
Though the applicability of this experiment to humans is far from being proven, I find myself less than interested in this new form of self-erasure. Time does enough of that all on its own, and I am unwilling to give up even my pain. But after reading the article, I find that I am interested in whether or not this can work in reverse. Will it be possible someday to stimulate the hippocampus region into overdrive by altering other proteins, so that memories, like those I have of my brother, might not be lost?
Until the day that the science of the brain catches up to my longing, I am left to write, document, record—to leave these words, my fictions and poetries, as a tether to tie him here. Or, perhaps, my words are but the slim metal tracks of trains, gleaming by moonlight where they are laid out in the darkness, a crosshatching of iron and wood across countryside—paths marking the way for me to follow someday.
* Illustration by Anna Hall