That Which Remains

“The fragrance always remains in the hand that gives the rose.”

Heda Bejar

The brilliant white light which illuminated everything is gone. Drifting into consciousness my eyes are a fixed on a handful of sparkling specks of brightness in the still night sky. Through the black silhouette of a sheltering oak tree I trace the pattern of dots as the big dipper emerges from my foggy mind like a series of pinholes punched into cool flat gray cardboard. The silence is consuming as there is no breeze to animate this solemn moment of passage. Against the dark tattered foliage is an intermittent yellow beacon of the first firefly of the summer. As it lazily drifts in and out of the arching boughs I slowly follow its assent from tree to tree in search of another firefly to complete the union. Where are the clouds of fireflies of my childhood which filled the meadows in a dancing choreography of abundance? Waves of shimmering sparks lost in the sultry heat of a summer dusk. No longer the ambassadors of nigh center stage beckoning us to take pause in the waning day, but now hiding in the dark shadows to few in number to reveal themselves in the ever expanding recesses.

I slowly realize that the pain is gone leaving a comforting sensation of warmth as I lie in a sanguine puddle of blood which trickles down my chest searching for earth from a small hole in my heart as I lie naked under the stars. The thick salty taste of blood in my mouth is familiar as it congeals on once hopeful lips. The chill of the evening floats over my skin but I do not shutter as numbness rebukes any sensation. For the moment all feelings and desires have been replaced with the ambivalence of simultaneous conflicted feelings toward life. I can not determine if I am grateful of survival or regretful of not perishing in the light. Appreciative the brutalizing chaos of toxic thunderstorms of rogue emotions have abated leaving an exhausted soul without the will to measure gain or loss. Lying motionless with no pain there is no need to discover the extent of disfiguring mental and physical wounds that invariability exist. Future disabilities have no relevance in this restful state of disconnection and isolation; there will be adequate time to hide the scars under a pall of normalcy and blinding routine. In the aftermath there is no one willing to help shoulder the suffering of loss so it will be hidden deep in a black hole where the demons play, where a past world of light and love are trapped by the inescapable gravity of darkness. Naked before the ebony curtain of closure, emotions have nowhere to cling, like a smooth granite surface the seeds of fragrant summer flowers can not germinate falling helpless to the ground. Seeds destine never to germinate in the fertile ground of aspiration. Seeds of dreams that once held the promise of a future of spiritual discovery while quenching flames of self denial, seeds of limitless possibilities will never support life.

Hanging on the pregnant dewy air is the charred scent of Pinyon long after the burning embers have given their warmth to the hungry land leaving only undetectable residual ash from once was a vibrant embodiment of life. Returning to dust its story of existence forgotten, its struggle for life unrewarded, the Pinyon will leave no mark other than meager trace elements it deposits on a cold mantle of soil which has no memory. Like the Pinyon my struggles, triumphs, loves, losses and memories will accompany me to the grave leaving the rest of the world knowing no different. In my foggy ravished mind the clarity of it all is so dreadfully apparent, nature does not care. Nature can not care favoring one action over another; it operates blindly to the equality all and the pretence of none. We all exist as a collection of our experiences, hopes and dreams wishing to find meaning in the random violence of indifference, but in the end even those fragile mental processions will be taken from us as the last struggling breath escapes our cold lips. The lesson we must learn is that tomorrow is not ours and can never be, so we must throw caution to the wind and capture every kiss, every embracing caress, and every opportunity to love regardless of the consequences of unknown probabilities. Endeavor to expose our soul to excesses of bliss and to debilitating suffering of pain, only then will fate assure us that maybe one of those fragile memories will fall to the ground to be cherished up a loved one before death erases them from the chronically apathetic record of existence.

Clutched in a drawn fist is a small charred image of yesterday which I can recognize without looking at. Its edges are worn and familiar where they are not burned. It is the only procession that remains from before the light. My fingers tremble as they caress the smiling figure of beauty incarnate as if the power in my touch could invigorate life into restoring an era of captivation. The wistful face in the photo did not make it to the other side with me, swept away by the storm unable to share in that which remains. An ocean of tears is beginning to ebb as I search my mind for chards of broken memories that I may have overlooked in the conflagration. Like fine sand these visions of the past will slowly seep from between my fingers as the erosion of time washes away what remains until it is uncertain if it ever existed at all. Nothing will prevent the once vibrant colors to fade until the indistinct stains evoke no meaning, seldom visited in the cluttered junkyard of abandon paths. The weight on my chest is heavy but is no longer crushing as I exhale deeply allowing my thoughts to wander aimlessly amidst scrapbook of the all too few fleeting encounters with happiness. Time permits perspective to evolve, but time can not be allowed to distance the feelings. Questions which were so abundant are unimportant as I attempt to heal in confines of desolation.

Fearful to move knowing that pain is still hidden below the placid surface of calm, there is little need to disturb this comforting void of solicitude. At the crossroads what lies before, the path remains highly uncertain as a forceful disregard for tomorrow is omnipresent. This mortal struggle to capture that which is impossible to capture, has exacted a horrific toll on the stamina required to move forward especially when a soft blanket of exhaustion is numbing the pain like a burning spoon of heroin raging through my veins. Lying so still that my own breathing keeps rhythm with a muted fragile heartbeat, I understand will need to stand erect and decide which path to choose. Aware that each new movement may reveal the prospect of searing pain hiding slightly below the façade of normalcy, it will be a long time of repeated motion before the agony will seek a new sanctuary to take root. Physical and emotional trauma can alter the foundation of perspective as new patterns reroute themselves around damaged pathways. Even in this relative state of inertia, the new patterns are emerging, some darkly foreboding while others are filled with possibility of restoration. Unfortunately those pathways continue to remain in the future and the future does not care. The future is as unattainable as the as restoration of the past, so I am investing little energy in the consequences of what is to be and instead be present in the moment with only that which remains.

“There is nothing like returning to a place that remains unchanged to find the ways in which you yourself have altered.”

Nelson Mandela (1918 - )

Wisp of Smoke

The fragile nature of our existence is ever more present in my thoughts. Having first hand witnessed the impact of a brain trauma, my understanding of the world has been deeply altered. Our collective life experience is nothing more than a wisp of smoke from a cigarette hanging in the still air; it only exists and is recognizable if undisturbed. Even the smallest of gestures can scatter and dissipate life’s delicate balance. A slight draft will mix and blend the smoke distorting all previous arrangements. The collective total of our memory can be lost or altered in a blink of an eye, like the breeze that consumes the fragile smoke. This appreciation of the fragility of self awareness leads me to focus on the moment, since it all we really know as truth.
I’ve watch how the mind struggles to reconnect to old pathways of memory. In my wife’s case it was as if her mind had quite literally experienced an earthquake leaving some items undisturbed, while others were either slightly displaced or completely destroyed. There was little pattern to what remained and what didn’t. She was extremely fortunate to only experience relatively slight trauma compared to most, but the impact in many respects was devastating. Isolated areas of memory and brain function were altered, like a file cabinet that had a few files fall from the drawer scattering the contents. In her case the entire dictionary of words starting with the letter S was reorganized. Instead of soup it was now stew and spaghetti was now spareribs. Tentative mental relationships tangled in a hopeless knot.

Another area of impact was names of relatives and associates. Names were randomly associated with new individuals like picking names from a hat. Surprisingly the new connection was not superficial, but deeply rooted. For a few weeks Marcy was Patti and Linda was Marcy. On the other hand, her livelihood is finance and there was no altering of mental acuity for mathematics, as she quoted from memory interest rates and amortization schedules to the attending physicians. I have yet to look deeper into brain function to determine if there is a correlation with these cognitive skills and the area of damage. I suppose that this particular area of the brain represents a crossroad for associative memory.

The dark side of the experience was truly frightening as I peered into a window of losing one’s mind. Watching her lost unable to find the past was profoundly painful. The loss of self identity and personal perspective created a chasm that I could not bridge regardless of how hard I tried, like watching someone lost through a crystal ball, your calls and pleas go unheard. My explanations and reassurances never provided solace as she struggled with the vastness of darkness of what was now her life. I constructed simple models to illustrate the complex processes that were in motion. Consider that you have worked in an office for the past forty years and all the manuals and references you require are within your fingertips. Each time you require an answer you instinctually reached up and open the right book where the information was located. Today you arrive at work only to find your office of forty years has been moved to a new location. As you sit in your new office you are now surrounded by cartons full of books and manuals, but you do not know which box to look in to immediately find an answer. The prospect of taking all the years of knowledge and organizing them back on the shelves can be intimidating and demoralizing.

The single greatest fear is that many cartons of books were lost never to be returned. How do you get someone to accept that not being who they were or that they will forever be a degraded version of themselves is still a blessing? How can you not grieve the loss and fear the future? The first couple of weeks were easier because so much of the brain was still sleeping. Slowly as the higher intellect of self awareness awoke distinct comparisons of who she was and who she is were now possible facilitating a mental struggle about who she will be.

One aspect of recovery that took a while to understand was absolute denial of the severity of the event. She refused to accept that anything extraordinary occurred, always more intently focused on repairing the damage and fixing the gaps. She would continuously question why people would consider her lucky or blessed, because she did not feel lucky. It took me a long time to understand why this was not a miracle in her mind. Ultimately the event needed to be viewed from within her experience. One normal Friday she had what they call a “thunderclap” headache and in the course of a few hours was rushed into surgery. A few weeks later her mind awoke with little memory of the preceding weeks, but physically she was normal without any pain or after effects. She did not experience the near death emotional trauma that all around her experienced. It was our near death ordeal not hers, deeply traumatizing everyone but herself.

Not only did she deny the miracle, but she refused to associate herself with any information about the procedure, recovery or probable long term disabilities. A number of good website clearly explained how to cope with the memory loss and therapies for a strengthening mental acuity, but she was offended that I had implored to read about her condition. Finally I had to accept the fact that it was not a life altering event for her, which lead me to wonder if this experience was intended to change the lives of those who surround her, because it most certainly did?

In my case, a new understanding of the fragility of existence is not confined by the line between life and death, but rather with an ability to maintain self awareness as grounded in your life experiences. Once we lose memory of ourselves we become divorced from reality and no longer exist as we were, only to wander lost in a new existence. In the blink of an eye everything we know of ourselves can be swept away leaving only a faint trace of the past. Conscientious is a delicate system of electrical charges and stored chemical patterns that shows an amazing ability to heal, but it pales in comparison to the frail temporal balance of existence. I now envision the mind as a wisp of smoke sheltered from the wind. Our existence depends on the smoke remaining connected and visible as it swirls. As each curl of smoke representing a memory or experience, its easy to see how memories change and reinvent the past as the smoke blends with new memories. It’s just as easy to see how memories are lost as they are replaced with new.

“Dream as if you'll live forever, live as if you'll die today.”

James Dean (1931-1955)

The Small Print

Everyone inherently knows that a brain aneurysm is deadly, but what does it really mean? With the shock of the emergency behind you, we begin to read the small print to find some truly disconcerting facts that are only disclosed on an as needed basis. It’s the medical profession’s way breaking the news to you slowly. Little by little a clear picture emerges of the devastation of this type of brain injury.

The first surprise it that the brain surgery is easy part of the procedure. Opening the skull and clipping the aneurysm is low risk compared to the recovery period. How can that be I wondered? Apparently surviving a ruptured aneurysm means that you suffered an subarachnoid hemorrhage or in layman terms blood pooled in the fluid between your skull and your brain. This is a very dangerous condition since red and white blood cells can not survive in the cranial fluid and over a period of three to four days the blood cells will die. As the blood cells die and decompose they can be viewed as small sacks of toxic poisons that are released into the cranial fluid. The most critical point of recovery is four to seven days after the surgery as the toxins from decomposing blood cells reach their maximum concentration.

As these toxins build in the cranial fluid they irritate the veins carrying blood to the brain. The natural tendency of the veins is to spasm and contract. If any vein becomes excessively irritated it will spasm and completely close resulting in a loss of blood to large portions of the brain or what is called a stroke. Where the aneurysm is located, degree of bleeding and distribution of the blood inside the skull dictate your chance of survival. During the operation the surgeon will attempt to remove as much blood any possible from the injured area. While some anchoritic hemorrhages are defused deep into the recesses of the brain tissue where vascular spasms are more probably, my wife was fortunate that most of the hemorrhage was contained in the frontal lobe.

The difficult part of the recovery is the waiting knowing that each day the risk of death is on the rise until the fifth to seventh day. Each day you sit unable to help, knowing that tomorrow might be the end. Quietly you are surrounded by elaborate machines and wires staring at the numbers displayed on a computer monitor afraid to look away. You learn to read the graphs and understand the beeps and alarms. This graph is oxygen level, that graph is heart rate, that number is blood pressure. That tone is a sensor alarm, this beep means a patch has fallen off. Each movement changes the graphs as your heart jumps into your throat wondering if the erratic graphic is just a temporary disturbance or a new serious condition.

The nurses in ICU tell us take we need to watch for changes in brain function. I ask what that means, what am I looking for? A change in brain function is a sign that the patient has had a vascular spasm or a stroke. Symptoms include slurred speech, disorientation, emotional eruptions, prolonged sleep, or weakness in extremities. Besides sitting watching the monitor you observe and scrutinize the smallest of activity. Is she blinking her eyes excessively? Should she remember what day it is? Has she been sleeping too long? Your mind is hypersensitive every moment as time creeps second by second.

Slowly the person you know so well periodically emerges from the fog, but it doesn’t come without effort and loss. At first there is no memory of our pets that she has daily cared for over the past five years. There is no memory of a private joke that been told thousands of times over the past twenty years. There are moments when she stares at you and doesn’t remember that you’re her husband. She asks her mother where her mother is. While she sleeps at night and you are alone in the ICU room you begin to ask yourself difficult questions. What if she doesn’t make it back all the way? What if she can’t work and requires home care? What if she dies? Sleep doesn’t come easy at night in ICU especially since to check brain function aneurysm patients are awoken every fifteen to sixty minutes throughout the night.

You stare in amazement at the list of twenty four drugs printed in large black oversized type that hanging over her bed indicating the drugs that are being pumped into her. You are hypnotized by slow methodical drips of the rack of IV bags, but most of all you just wait. Then out of the blue, the person you know is back to normal for a few minutes. There is so much small print that we never knew.

Probably the most surreal moment is reading the surgeon’s report of the operation. In clinical precision he describes how her brain surges from the skull to relieve the pressure from the hemorrhage. How a massive blood clot that shows signs of drying is evacuated from beneath first fold of the frontal lobe. How the aneurysm is masked by a second massive blood clot deeper in the brain tissue. How the aneurysm was clipped and lanced to remove another blood clot. How the patient “tolerated the procedure”.

Finally the attending surgeon explains the small print to you in terms that you can understand while your breath is stolen. “Of the past one hundred patients that were diagnosed with a cranial aneurysm and subarachnoid hemorrhage ninety died and eight are institutionalized with severe neurological dysfunction. Only you and one other girl have survived to resume their lives.”

“The most astonishing thing about miracles is that they happen.”

G. K. Chesterton (1874 - 1936)