A Blow to the Brain

She woke up with a throbbing pain. Within a few minutes, her orderly world began to unravel.

ON THE MORNING OF DECEMBER 10, 1996, I awoke with a pulsing pain behind my left eye. I got up to begin my morning routine and jumped onto my cardio-glider. The exercise, I thought, would get my blood flowing and banish the throbbing inside my head. While I exercised, however, the pain became more intense. Within a few moments I started to feel very peculiar--confused, yet clearheaded and alert.

When I got off the machine, I noticed that I was slightly off balance and feeling strangely detached from my body. I climbed into the shower, my movements slowed and deliberate, almost jerky. When I held my hands up in front of my face and wiggled my fingers, I felt as though my consciousness was suspended somewhere between normal reality and some esoteric space. I felt light, almost ethereal. The running water of the shower felt like little bullets spattering into my flesh, and my chest started to tingle.

At this point, I knew something was very wrong with my brain. I dimmed the lights, because they made the throbbing behind my left eye worse. Time seemed to stand still. The background sounds of the world outside faded away into silence, and that silence grew louder and louder. I was disturbingly aware that the intricate networks that operate the different functions of my mind were shutting down.

I tried to visualize myself driving to work, and in the next instant my right arm went totally dead. I couldn't feel it or move it. In that moment I knew I was having a stroke. I was 37 years old and, testifying to the impact of my scientific training, my next thought was "Wow, this is so cool!" I am a trained neuroanatomist, and this was an opportunity for me to study my brain--from the inside out.

I witnessed the breakdown of my higher cognitive skills, the skills that make orderly sequential connections--A is followed by B, B is followed by C. I could no longer integrate and associate my thoughts with the incoming sensory information. I lost all comprehension of mathematics--even the concept of dialing 911. Numbers simply didn't exist for me anymore. I knew I was in grave danger, but I felt tired and confused, and I longed to lie down in my warm, cradling waterbed. Although I felt no sense of urgency, I understood that the prognosis of stroke is often determined by how quickly a patient gets to the hospital. To save my life, I had to make a plan and then consciously hold it in my memory long enough to execute it. But I kept forgetting what it was I was trying to do.

After minutes of effort, I dialed the phone number of the Harvard Brain Bank at McLean Hospital, where I worked. I tried to ask for help, but although I could hear my voice speaking clearly within my mind, my throat wouldn't form the words. The sounds I made began with a gasp ... then a grunt ... then a longer grunt. It was sort of like priming a pump. Eventually I blurted something out, but it was unintelligible. I heard my colleague speaking, and I knew that I knew what was being said, but I just couldn't grasp the meaning. Fortunately, he sensed the danger of my condition and with soothing tones he assured me that he would get me help.

While I waited, I felt desperate to contact my doctor. Even in this debilitated state, I was terrified that my HMO would not cover the costs if I was brought to the "wrong" emergency center. But the task was daunting. Imagine holding a three-inch stack of business cards and seeing in your mind's eye your doctor's card, with its red Harvard crest at the top. Imagine realizing that you have absolutely no idea if this is your doctor's card, because your brain is no longer capable of distinguishing colors, letters, or numbers from the card's background. It took more than 45 minutes of intermittent waves of clarity for me to identify the right card.

When my colleague arrived, I handed him my doctor's card. I felt my inner self shifting from an anxious alertness to a peaceful acceptance as my mental deterioration continued. Eventually, I welcomed the silence. I felt serene.

At the hospital, I was placed in a CT scanner. The resulting images revealed that I was indeed having a stroke, with severe bleeding in my left temporal lobe. I vaguely remember hearing the word stroke, and it brought me some sort of satisfaction that I had been correct in my diagnosis. But I was past the point of caring. My brain had shut down to a level of semiconsciousness, and I surrendered to the care of others. Later I learned that 10 percent of people who experience this kind of stroke die immediately. Another 50 percent remain in a vegetative state.

Most strokes are caused when a blood clot lodges in an artery that is supplying life-giving oxygen-rich blood to the brain. The artery that is blocked determines which cells will be starved and die. For some people there is extensive neurological destruction, while for others there is minimal effect. My stroke, however, was not caused by a clot but by an arteriovenous malformation (AVM). Normally, capillary networks--fine-mesh structures of tiny blood vessels--function as a buffer zone between sturdy arteries, in which blood flows forcefully, and thin-walled veins, which return blood to the heart and lungs. With an AVM, there is a shortcut between arteries and veins, and a low-pressure vein is directly hooked up to a high-pressure artery. Some people have the condition and never have symptoms. But in others the direct connection between the artery and the vein becomes so weak that the connection bursts.