Now, Patient
Neuropsychology, the persistence of symbols, and being inspired by Andy Warhol in Part Five of a series by Amy Leigh Wicks.
H introduces herself at the door to the waiting room. Her voice is clear, unaccented. Set to a vibrational frequency low enough that my body relaxes when she speaks. I stand and walk slowly toward the room where my brain will be tested for damage over the next few days, and H offers to make me coffee before we begin. At home, coffee is a medicinal ritual. I grind beans tested for mold toxins each morning then blend the brew with butter and medium chain triglyceride oil derived from coconuts. I drink my coffee outside with bare feet to dirt to let the morning light reset pain signals in my brain.¹ Here I nod at the offer and watch H lift the red plastic lid from a tin labeled ‘French Vanilla Latte.’ Mom used to have a tin like that hidden in the back of our kitchen cupboard. Hers was an orange, white, and red striped tin labelled ‘Café Vienna’ and she drank it only on special occasions. This is a special occasion. A full neuropsychological assessment. H puts two heaping spoons of sugary sand into the Styrofoam cup and steps away. Maybe you want more or less, I’ll let you fix it, she says and indicates the room behind her where she will wait for me. I nod again and quickly add two more scoops to the cup, stirring to dissolve the mound in the hot water, shy about the sweetness of my own taste.
I enter the room and notice a large beige machine in the corner with a chin rest and viewing platform that reminds me of the red View-Master binocs we had as kids, the ones that came with white paper rings filled with tiny negatives. You insert the paper reel into the View-Master and flip through images of Jack and the Beanstalk, The Little Mermaid, and The Jungle Book, with your thumb on a tiny lever. It’s magic, truly. But this machine does not have a lever; instead, a desk level panel displays four rounded black glossy buttons that might be the bottoms of magic eight balls. A small wooden table separates H and me, holding a radio with cassette player, her clipboard, a stack of paper, and two pencils. The large window behind my chair lets the morning sun warm the potted plant on the floor, and the lights above us are off.
Here I am a patient, a client, a thirty-three-year-old female suffering from post-concussion symptoms fifteen months after a mild traumatic brain injury. Chronic pain has made me a minimalist of personhood. What does it matter which poem is most lucid, which job brought promotion, which country is lost, right now? I will not be assessed on my ability to argue a dissertation or prepare Coq au Vin. This is a performance test of cognitive functions: reasoning, language, judgement, memory, spatial awareness, attention, processing speed, problem solving. Results are measured against global normative standards.
There will be a series of exercises. You will be timed for each exercise, but you do not need to rush. If you need to take a break, just say. I hope I get to interpret ink blots. Or draw my childhood house with my family standing to the right of the house with no regard to scale. Instead, I write my name with pencil on paper in cursive as she asks. Then in print. This is easy for me. This I can do. The pencil, my name, the scratch of lead on paper, all of it feels personal and familiar. I write a simple addition problem and solve the problem. I answer out loud the day’s date, the state I am in, my home address. If the whole test is like this, I will be fine. I write a subtraction problem on the paper and my hand begins to shake. What is the answer? I stare at the numbers on the paper, but they don’t look like numbers anymore. What do they look like? I shake my head. I don’t know. Water rises in my eyes and spills over, splashing when it hits the problem. H presses a button on her stopwatch. Why don’t we take a break? Here are some tissues. The restroom is just downstairs, the key is hanging on a nail beside the receptionist’s window.
The cold water feels good, the rough brown paper towels are from middle school. No more math. God, no more math. I return and sit and H asks if I am ready to continue. I want to blurt out random details about myself — how I’m not usually this emotional, how beautifully I’ve handled failure in the past, how I once took a software specialist job in Vienna for a summer without understanding German or software and spent my off days drinking coffee and eating Buchteln at Café Hawelka² where Andy Warhol and Henry Miller hung out — but I imagine the blank, or kind, or distressed look I will receive in response, perhaps a nod, perhaps a nod and a note on the clipboard, and I’m afraid I will burst into tears again, so I bite my tongue.
Now I look through a spiral bound flashcard book at photographs of faces smiling, sad, neutral. The book must be from the seventies, the thick pages slightly yellowed. I relax noticeably at the sound of cards flipping. Phhp, phhp. Phhp. We come to a blank page. The next series will be a larger selection of faces, and this time I must touch only the faces I’ve seen before. I find myself wanting to do well on this exercise, and I want doing well to mean something. Maybe I cannot fry an egg or read a book, but I can touch someone’s face and have it mean something.
Now let’s move to the beige machine. Look through the viewfinder. Four images will appear in front of you. Three of them will have something in common. Touch the button of the image that does not fit the pattern. The connections will become less obvious as you progress. If the answer is incorrect, a buzzer will sound. You may try again. If you answer correctly, a bell will ding and the image will change. Three triangles have a piece missing from the bottom line, the fourth does not. Ding. A circle with a dot in the upper quadrant, a square with a small square in the lower quadrant. A triangle with a dot in the upper quadrant, and a circle with a small square in the lower quadrant. What if I don’t know? I don’t know. I touch a button and the buzzer makes me jump. Try again. Buzz! The test continues. Do not try the same answer twice. If your answer is incorrect, you should look for a different pattern.
I am presented with a large flip book. On page one is a squiggle. This squiggle, I’m told, is a tree. This upside-down V is a house. Two linked circles mean friends. Three dots mean next. The arc is a cowboy, the two lines are called Jack. A circle is ’s. Two crosses mean the previous word is plural. Now read these sentences made entirely of symbols. More symbols. Andy. Green. Tomorrow. They. Horse. Red. This is my favorite exercise. Perhaps I am a polyglot. The symbols are language. Language unwraps itself inside me, even with a hurting brain. After I read pages of symbols, easily, I feel, flashcards of faces return. Which faces have I seen already, which faces are new? My energy levels are rising. My head is starting to ache, but I love what I am doing. Am I making a humming sound? I feel like I must be humming or purring at the joy of something making sense to me. The cassette player now, and H hands me a pencil. Marm. Circle the sound you hear. Marm, Murm, Morn, or Marn. I hesitate for a second and circle the correct answer. Yearn. Yarn, Yurn, Yern, Yorn, Yerm. There are hundreds of sounds crackling through the speaker and I yawn, and circle and circle and circle, less and less sure of what I am hearing and seeing. Back to a page of symbols. Read the sentence out loud. Tomorrow, Jack and Andy will ride horses. Jack’s horse is red. Andy’s horse is black. We will stop there for the day. Do you have someone to drive you home? Good. It might be helpful to rest, have a hot meal, and I’ll see you tomorrow.
M is in the waiting room when I come out. I lean on him walking down the stairs and rest my head on the passenger window as he starts up the truck. We stop at Chu’s and he comes back to the truck with a large brown paper bag, receipt trailing down from the stapled fold. It’s not New York take-away, but the scent is familiar enough. I feel too tired to eat until M opens the bag and sets a quart of hot and sour soup on the table, then dumplings, moo shu pork pancakes, plum sauce. He opens and closes the cupboards softly, and carries a tray to where I am sprawled on the couch. I shouldn’t look at screens. My symptoms are flaring, my brain needs rest. But maybe more than a rest protocol, my brain needs comfort. Maybe more than ketones, my body wants dumplings. I flick the screen on and settle for a rom-com where a burnt-out detective eats her microwave dinner watching her movie while I eat my dinner watching mine.
I wake and it is morning and I am in my bed. M drops me off back at the neuropsychologist’s office, and H offers coffee and this time I open the red lid myself and shovel an extra spoonful of sand into the cup and meet her at the table and we begin again. Is it going well? I make it through the day and back to my couch and this time the tray has a plate filled with falafel, tzatziki, hummus, and the movie is Now, Voyager. In the morning, I need to be coaxed out of bed, into the truck, out of the truck, up the stairs.
I am blindfolded and there are wooden blocks (by the sound) placed before me and a board with shapes cut out set on the table. I need to feel the blocks and put them into the corresponding shapes cut out of the board with only my left hand, and then with only my right hand, and then I may do the exercise using both hands. Has anyone ever moved so slow? Or am I breaking records for how fast I’m going? I can’t tell and when the blindfold is removed H shows no sign of being either disappointed or impressed. My brain is being assessed for permanent damage, but at the moment I am more concerned with the approval of H, the neuropsychometrist. Me in kindergarten, sixth grade, college, and now, functioning at a fraction of my capacity and still wondering how to gain a nod or gold star from the person in charge.
I fall asleep on the ride home. I dream of Bette Davis saying, “Oh, Jerry, don’t let’s ask for the moon. We have the stars.” And when I wake it’s dark, and everything hurts and M is coming in the front door with dinner and he sets the bag down and hands me a plastic cup of Thai iced tea, so cold and sweet. We are eating green papaya salad with fresh chili and mint and I’m chewing on a blackened bit of chicken satay when M asks how it’s all going. I set the skewer down and shrug and take another sweet sip from what feels like a baby bottle. I tell him about the wooden blocks and how frustrating it is to not know what the tests mean or how I’m doing or if I’ll get to be myself again. I cannot strategize or explain or argue whatever the results end up being. He doesn’t say anything, and I take the silence as an invitation and tell him how frustrating it is when I can’t do things that seems so basic. So simple. Or I can do some things, but only for a short time and then I feel yanked back to nothingness, like I’m on a short leash that pain holds. I feel like I’m missing my own life and the more I want it back, the further away it gets. God, and I feel embarrassed at wanting someone to tell me I’m a human, and exceptional, even if it’s just for knowing a squiggle is a tree. I hate not being able to control the impression I make on the world around me with what I know, or how I interact, and I hate how much I care. Maybe admitting how badly I want approval will help me to care a little less. Or maybe it will rob me of the sliver of dignity I feel like I’m clinging to and expose me as being needy. Caring takes energy, and pretending not to care takes energy, and there isn’t anything I can do to be anything other than this list of symptoms I’ve become. I’m getting worked up and it hurts. M doesn’t say anything and finally I start to cry. He sits with me and I cry some more and it feels like the first real cry in a long time where fear mixes with anger and sadness and causes a chemical reaction in my body. These tears are hot, and I’m gasping for breath. I shudder and scrunch my fists and punch the couch then give up with a sigh, too exhausted to hold on even to my own feelings, and drain down my Thai tea. I’m drifting off when M finally stands and takes the empty cup from my hand. I feel a blanket float down to cover my body. I hear the shhh of water filling the kitchen sink.
¹ Earthing: Health Implications of Reconnecting the Human Body to the Earth’s Surface Electrons | National Institutes of Health
² Café Leopold Hawelka
Amy Leigh Wicks is the author of The Dangerous Country of Love and Marriage (Auckland University Press) and Orange Juice and Rooftops (Eloquent Books). She holds a PhD from Victoria University of Wellington, New Zealand, and an MFA from The New School. She loves to swim, ride motorcycles, and finger paint.
