Even at moments of the most extreme duress, it is difficult for me to stop thinking like a scientist.
A few days after the birth of my son some twelve weeks ago, things were just starting to normalize for Richard and me. We were home from the hospital and, though the daze of sleepless nights had hit us pretty hard, we’d found time to get out of the house. I recall that walk in the park now as if it had been a dream, the baby snug in a sling against Richard’s chest, a little miracle with blue eyes and spun-gold hair: a warm autumnal afternoon, weak sunshine, leaves colored russet and flame and fluttering to the ground. We even picked a few late blackberries from the tangle of brambles by the pond. Richard ran up Stave Hill and I snapped his photo, silhouetted with our baby against the deep blue sky streaked with herringbone clouds.
The next morning, something began to be not quite right in my head. In the early hours during a feed, in the darkened bedroom, the streetlamp reflecting off the overhead lampshade looked uncomfortably like an evil eye that would not stop glaring at me. When I woke later to daylight, I started to register visual disturbances. Assuming it was the aura of a migraine, which I suffer from occasionally, I resigned myself to the inevitable headache. But the auras were all wrong: normally they scintillate in a crescent shape to one side of my vision, distracting but largely benign. This was something different: it wasn’t just a disturbance superimposed over reality: it was an alteration of reality itself. Fascinated more than alarmed at this point, I stood there trying to see a soap dish on the sink that I knew was there, but it seemed to slip away from view from whatever angle I attempted. It was both there and not there, in a blur of distortion similar to the way that ripples on a lake obscure the stones on the bottom. But in a few more minutes, I was almost blind.
I groped my way to find Richard: I have a distinct memory of trying to explain to him about the soap dish, and a memory that I was both very lucid and completely out of control: I could hear that my words did not make sense, and I even told Richard that I knew I was not making sense. That’s the last thing I remember clearly. There is a vague blur of being in an ambulance, the kindly paramedic asking me to touch my nose and then his finger: struggling to do this without concentrating very hard. I remember that the world was drenched in beautiful colors. I might remember being wheeled into the Kings College Hospital ED – or perhaps I only think I do. Much later, Richard was able to tell me that I’d suffered a grand mal seizure in the bedroom, that I’d nearly bitten his finger off, that after rousing from the coma-like finale, I’d babbled syllables that made absolutely no sense. After the ambulance ride, being unloaded from the wheelchair to a bed in the ED, I have a clear memory of saying, “Oh God, it’s happening again.”
Apparently, I then suffered a second seizure, but the next day is a total blank. After the seizures were controlled, Richard says I was sent for a head CT scan, cloistered in the HDU and given a drip of magnesium sulphate. My blood pressure was sky-high. My hands and arms sprouted cannulas; I was catheterized. Richard says I was aware during a lot of this, but amnesia has partially wiped my memory. I can’t quite recall when I came around. He says I would be speaking to him, and then I’d just dwindle away for minutes, forgetting that I was speaking. It was very difficult to find words, to formulate sentences. At one point I remembered that I had a newborn baby, and there he was, sleeping in the plastic bassinet next to my bed. A never-ending series of midwives, day and night, helped me change the baby and put him to my breast, or gave him formula when I was unable. I was so out of it that it didn’t even occur to me to ask anyone what was wrong with me, and nobody was telling me either, so that was fine. The worst times were when Richard went home, leaving me alone except for the night shift – who were kind, but very busy and seldom around. The neon cross on the Sir Giles Gilbert Scott-designed Salvation Army building, visible from my window, at first was comforting, but eventually seemed like an outpost in the middle of nowhere in South London and only reminded me of the incredible loneliness of those long nights.
The most memorable things about that transition from oblivion to reality were the visual disturbances. I was no longer blind, but the light show was spectacular. I was aware enough now to know that it was not real, but a few times I had to ask Richard if what I was seeing was an illusion. Parts of objects, outlines in particular, would occasionally flash like lightning. Every white space – the walls, the ceiling, the back of the hospital bed – would gradually fill up with evenly spaced red polka dots after each blink, like a Bridget Riley painting. Always dots, always red. But dark spaces, and the black universe behind my closed eyes, would become populated with the outline of interlocking green hexagons, very reminiscent of an epithelial tissue seen from a birds’ eye view, the sort of image I’d seen hundreds of time in my previous lab. Sometimes I’d see neon-like squiggles or lines. I was confused at that point, thinking it was a side-effect of the drugs. But it wasn’t: the drugs were struggling to cure me of the visions.
By the time I was taken down for the MRI, I was more or less fully coherent. As I lay in the cold, noisy tube, fighting against the panic of claustrophobia, I allowed the green hexagons to soothe me: at least they were familiar by now. The scan brought a diagnosis, and finally the doctors were telling me why I was there. I had suffered from eclampsia a few days after the birth, having had no warning signs beforehand – this is vanishingly rare (so rare that later, my GP would refuse to follow me up, declaring himself not qualified). At every antenatal appointment, my blood pressure had been normal with no sign of protein in my urine – the tell-tale signs of pre-eclampsia, a forerunner to this life-threatening complication of pregnancy. But my affliction had struck out of the blue. The resulting hypertension had caused not only the classic seizures, but had then stimulated my brain to swell – the posterior part, where the occipital lobe lies: the center of the brain that controls vision. Posterior Reversible Encephalopathy Syndrome: PRES for short, revealed by telltale patches of white on the brain scan.
Reversible. Thank God for that.
I wondered many things, and still do. Would I have died if Richard had not come home from shopping when he did that morning – would an hour later have spelled my end? Why did I develop eclampsia in the first place, without the pre- bit, and so many days after delivering? Why weren’t the doctors more concerned about my maternal age at the time, and why hadn’t they put that together with the fact that I’d reported the worst headache of my life, lingering 36 hours after the birth, coupled to a few really high blood pressure readings as I lay in recovery?
These are all important questions. But, scientist that I am, what I really want to know most of all is: why were my visual disturbances so uniform? Why the red dots, the green hexagons? Does everyone with PRES see these, or does each individual have his or her own special patterns for light and dark areas of vision? Did I see green hexagons because of some array of cells on my retina, somehow reverse-visualized – or was this pattern emblazoned onto some memory bank after years of looking at immunofluorescence images of epithelia in my previous lab? Do we know anything at all about these visions? And what does it say about the true reality of our environment, when something seemingly so subtle in the brain can alter it so completely?
I’m better now. I think I’ve made a full recovery. Sometimes I still search for words or the wrong one comes out of my mouth – but this could easily be nothing more sinister than new-mother sleep-deprivation taking its toll. I am left acutely grateful for my life, for my intellect, for my family, for my sense of reality being intact. Because there is a fine line between that and oblivion.
