Bullet in the Brain

You wake on the morning you’re scheduled to give your MFA graduation residency lecture with severe double vision and dizziness. The room is spinning as you plant your feet on the floor. Not good. You’ve experienced bouts of imbalance and an inability to coalesce your eyesight before: the episodes started three months earlier, but were temporary, lasting just a few minutes at most. As you dress and prepare to head to campus for a day of lectures and workshops ahead of your own lecture, the disorientation continues unabated and your anxiety swells, not just from the expected nervousness in anticipation of public speaking, but from the distinct possibility you will be unable to read your script, see the PowerPoint images on your computer screen, or worse, keel over in mid-presentation.

The title of your lecture is “How to Own a Short Story: Tobias Wolff’s Bullet in the Brain.” In retrospect, the choice of subject story proved ironic.

You start by recollecting the ailments suffered during each semester of MFA study: Atrial flutter, detached retina, fractured elbow, and you joke not to worry if you pass out at the podium, your doctor is certain it wouldn’t be from a stroke or heart attack. Nervous laughter…you know you look like hell. But somehow you make it through, even the Q&A, and, gradually over the next week your balance and vision improves — and you graduate!

Still, you’re not 100%, and decide to visit your doctor once again. You constantly feel as if you’ve just stepped off a boat ride on a choppy sea, but it won’t let up. You tell him—once again—that your brother-in-law, the neurosurgeon, thinks you should have an MRI. Your doctor doesn’t have an answer, but says he doesn’t want to order a test without some idea of what he would be looking for; he sends you off to the ophthalmologist instead, maybe the symptoms relate to the year-old detached retina…

No, your retinas are fine.

You head off for four days of golf and fun with your golf buddies, a hard-earned break before focusing again on the novel-in-progress you nearly completed during MFA studies.

By the last day of golf a severe numbness starts in your left arm. It feels like the arm “fell asleep” while pressed too long in a funny position, but rather than correcting itself with stretching and motion, the discomfort persists. You meet your wife the next day and the numbness switches to your right arm. You try to ignore it and go to sleep.

When you awake you know something is seriously wrong: your right side is numb from face to toe. Your brother-in-law, the neurosurgeon, tells you to get to the hospital—NOW!

They admit you without even copying your health insurance card and after a brief exam, the emergency room doctor determines you are not having a stroke or heart attack and sends you to the MRI tube. Through earplugs it cranks and bangs and honks, one set of repeated staccato bursts reminds you of the opening to Helter Skelter: “When I get to the bottom I go back to the top of the slide, where I stop and I turn and I go for a ride…” You stay still in a trance for forty-five minutes as they scan your brain and neck. And then, back in the emergency room, you wait…

The doctor returns in half an hour; she is young, confident, but her expression searches for balance between compassion and the necessity of delivering bad news. You have lesions, three in the brain and one in the neck; they are small but located consistent with your symptoms. She thinks you have Multiple Sclerosis, rare for someone your age, but not unheard of. Your brother-in-law, the neurosurgeon, is actually relieved; he worried you had had a stroke or, god forbid, harbored a tumor. You’re hooked up to an IV of methylprednisolone (you will return each of the next two days for another infusion, pills for two weeks afterward), and the doctor suggests she acquire some of your spinal fluid for further analysis. She never uses the term “spinal tap,” but you figure it out; she promises that she will use a fine gauge needle and assures you she knows what she’s doing. Okay, but…

You lie on your side, fetal position, the IV dripping away, sterile environment: the doctor wears a mask, your wife banished from the room. You feel her hand exploring the indentations of your vertebrae, the Novocaine syringe at the ready. “This will pinch,” she says. It does, followed by pressure, and then she massages the area, working the anesthetic into position. You don’t look at the needle—whatever the gauge—that she readies. The area is fully numb, way beyond the loss of sensation from the lesions (three in the brain and one in the neck), and you feel only the pressure of her steady fingers, framing the vertebrae where she guides the needle. You only peek once to see the clear fluid flowing slowly into awaiting receptacles. It takes a while, your spinal fluid taking its own sweet time, but before too long it is all over, and soon the IV is done as well and you are discharged to a new reality.

The steroids will ease the worst symptoms, but you will have another flare-up one week later. It will settle after a couple days, but the instability, right torso numbness, and eyesight too often seeming like you’re peering through unfocused binoculars, will persist, along with fingertips unable to register a pinprick. You will go through another round of MRIs, this time “enhanced,” and more blood tests, your health insurance deductible blown away (the out-of-pocket bills still weeks from delivery), and you will fly to DC to consult an specialist MS neurologist (a friend of your brother-in-law, the neurosurgeon, whose advice—and sister!—you literally now can’t live without) who will confirm the diagnosis and recommend you begin monthly infusions of Tysabri, a highly effective medication at stopping disease progression, may even reduce or eliminate the lesions, three in the brain and one in the neck. But that will have to wait until your appointment with a hometown neurologist; the earliest available slot scheduled the week after Labor Day.

You know you need to get back to work on your novel, be disciplined—write something. You were warned before graduation how easy it is to experience a post-MFA letdown; you knew something was physically wrong, but this is ridiculous. Still, with magnifying glasses you can read your computer screen, books too; hopefully the worst is over, your brain will rewire, and it can’t hurt to get back to work…right?

You think that maybe you should write a few blog posts, establish a daily rhythm, tell of your MFA graduation, your adventure with disease, review summer reading — just try to forget what’s going on inside your brain…

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