The Ghost in My Brain (3 page)

The human brain is a magnificent device, and the complexity of the human mind it supports is staggering to ponder. It is not possible for us fully to understand the enormity of the changes that take place when someone suffers a traumatic brain injury (TBI)—a concussion
*
—without first having some idea of the phenomenal (astronomical!) computational powers of the device we are considering.

Some supercomputer researchers estimate they'll need
exaflop
computing speeds (1,000,000,000,000,000,000 floating-point operations a second) to model a single human brain. Put in layman's terms, that's 50
million
desktop computers all networked together—and a single such modern desktop is a pretty powerful device, far more sophisticated than the big boxes of the 1960s and '70s that might each support a company with thousands of employees. Another way to picture this is that 50 million desktop computers laid end-to-end would stretch halfway around the earth, with another three thousand miles to spare.

For those of us who are trying to mimic some of the brain's systems, these are not even the impressive numbers. Rather it is the
design
of the system—the organization of the software, so to speak, and the impregnated information—that is the truly extraordinary aspect of who we are.

Imagine for a second that you are back standing outside the front door of the place you lived when you were five years old. What color is the door? Does it have glass in it? Does it open outward or inward? Are there steps in front? A landing? Is there a doorknob or a latch? On which side are the hinges? Remember that door?

Estimates on the size of human memory vary widely. We are not even sure how to define it because, for example, retrieving information from memory also modifies it at the same time. But by almost all reckoning, it is very, very, large.

To get a handle on the numbers, let's imagine that we are writing everything we remember down on sheets of paper, in a 12-point font, on both sides of the paper (one byte per character). The more we have to remember, the more pieces of paper we put on our stack. The size of our memory is the height of the stack of paper. So how tall is the stack?

Harvard researchers have been able to store large amounts of information in DNA molecules, and if our brain were made of pure DNA, our memory-capacity stack of paper might stretch out into space for 2,485,795,454 miles—or circle the earth 100 million times. So we know that biological systems can store a great deal of information! Many estimates of actual human memory capacity have the pile of paper extending a much humbler distance—merely up to the moon and back.

But now we ask about the real magic—how did you get 238,000 miles up to the moon alongside that stack of paper, halfway back, another six hundred miles, twelve hundred feet, eight inches, fifty-eight pages, and two paragraphs along to find the exact location of the information about that front door you haven't seen in twenty years? How did you know to look there? How did you do that in less than a second? Because that is typically how long it takes us to retrieve that long-disused information . . .

What holds us in the greatest awe is not merely the hardware, but rather the design of the truly elegant system that runs on it, giving us the human mind.

And when we start talking about our
minds
—that which really makes us human—the numbers get even more staggering. At the University of Leicester, James Nelms, Declan Roberts, Suzanne Thomas, and David Starkey calculated that capturing everything that could contribute to a human's mental state would require 2.6 tredecillion bits (2.6 followed by 42 zeros).
*
In their fun paper, they note that to transmit that much information using a
Star Trek
–like teleporter, but at
high-speed Internet bit rates, it would take . . . several hundred thousand times the current age of the universe.

To simulate concussion damage to a human brain then, we'll need to gather together those 50 million desktop computers, the 500,000-mile-high stack of paper, and the almost inconceivable amount of information it takes to construct a human
mind
, then loose a hurricane on the system, ripping out network lines, laying waste to vast sections of memory, and sending landslides to smash hundreds of thousands of computers.

In this way we can imagine the size of the problem we are trying to address: with a single blow to the head—in that moment of impact from concussion—we've caused staggering losses in computational power to the unimaginably complex systems that go such a long way in making us human.

Fortunately, this magnificent device is also largely plastic and able to reconfigure itself over time, borrowing a little here, and a little there, and in this way able to restore much of its lost functioning—though, as we will see, not always without a little clever jump-starting of the stalled processes.

. . . My time was running out, but I was still stuck in the middle of Grant Park. And now, not only was my brain fatigued, but my mind was also growing dull from the onset of hypothermia. My body was giving up. I could not feel my toes or my fingers. I was fading away.

The question was,
How do I get moving before it is too late?

Then magic happened. I swayed in the wind and tipped forward. My left foot moved on its own to keep me from falling, then my right foot, then my left again.
Stump, stump, stump.
I stared intently at the now inconceivably distant horizon where I knew my car was.
There is where I am going.
My jaw dropped farther, and my tongue hung down in my mouth. I could not feel the soles of my frozen feet. My index fingers popped out again, to help with balance, and I walked with a
bent-kneed, shuffling gait—like a zombie. I willed myself toward my car a few inches at a time.

Within each unfolding moment, my world was made of fractured images: little scenes of blades of grass poking through the snow, of darkened tree branches, lights in the distance, and night shadows. Nothing was whole. The Dolly Zoom Effect was in full force, and though I knew, intuitively, that my car was just up ahead—thirty feet away—it still
looked
an impossible half mile distant. My feet were again coming . . .
to . . . a . . . stop. . . .
Out of desperation I changed tactics, and just
reached
for the car, let my feet walk toward the
feeling
of it, almost within my grasp. And then at last, from within the chaotic tunnel of my senses, my long journey—the first stage in the gauntlet—was finally over.

Now began the second stage. I still had to unlock the door, get in, and turn the car on. But I couldn't work it. I'd lost the concept of
center.
I had no internal representation, or visual understanding of
circle, target, middle, inside. . . .
Without these concepts I couldn't get my hand to move toward the lock, or put the key in the slot.

This situation may be a little difficult for nonconcussives— “normals”—to comprehend. There was nothing wrong with my eyes themselves, and I knew what I had to do:
put the key in the lock, open the door.
The problem was that I could not spatially or cognitively conceive of the
shape
of the problem. I stared at the door, the lock, my hand, the keys in my hand, wanting to get the door open but unable to form a physical plan to achieve my goal. I even knew the concept of
center
was still somewhere in my brain—I could feel it—but I just couldn't access it. I thought,
If I can't unlock the door, I'm going to have to walk back to my office and try again later.
I shuffled around to the
front of the car and slipped down onto the frozen slush in the street, with my back against the car's front bumper. I knew I couldn't make it back to my office. I had no plan at all. No voice spoke. No thought came to me for a long time.

Then, from within the kaleidoscope, the magic rose up one last time. I pulled my stiff and cramping body to my feet. With a final extreme effort, my eyes saucer-wide and three inches from the door lock, my right hand waving around in random circles as though with no direction at all, I finally found the lock, pushed my key in, and opened the door.

I had passed through the second stage of the gauntlet.

Now came the third: maneuvering my body through the doorway in the side of the car. But once again, I couldn't
see
it. I couldn't make sense of the opening through which I was to pass. I pleaded with myself:
Get in the car, you idiot. Don't think about it—just get in and sit down.
But I couldn't do it. Instead I stood there staring off into the void, as I felt myself falling into the tunnel that reached out before me. My eyes grew wide with the effort.

Yet over time I'd developed strategies to compensate for doorways. When I couldn't propel myself in the usual way, I'd learned to spin, and dance myself through them. But now, in addition to not being able to
see
the opening, I could no longer
turn right
either
.
The right side of my world just tapered off into oblivion. So instead, I turned left, away from the door and away from the seat—all the way around in a full circle. I turned once, then again, and then again after that, using a strange-looking, index-fingers-out, head-turned-sideways, half-swinging motion. At last I was able to weave and bob myself into the car.

Thankfully, getting the key in the ignition was easier, and
within five minutes I had the engine running. I glanced at the clock on the dashboard.
Twelve-thirty
. It had taken me an hour and a half to make the five-block trip from my office.

I rested with the car idling until 2:00
A.M
., staring at a tree in the park, completely still, completely exhausted, unaccountably hungry, but warm. A tricky moment came and went, as a suspicious cop came by, opened his window, and demanded to know why I was sitting there idling the engine. But in the end it was too cold to get out of his car, so after “rousting” me in this way, he drove away.

Soon after, sufficiently recovered, I headed for home. I never drove my car when I was under cognitive duress. But as long as my brain was sufficiently rested when I started out, then I would be okay to drive. In fact, if I was not too debilitated when I set out, the act of driving was itself restorative. Something about the staring straight ahead, and the regular motion along the sides of the road from the vanishing point past the periphery of my eyes, helped ease my impairment. Understanding directions could be tricky, as could making driving decisions, but on this night I was mindlessly following a well-worn path home, and I made the trip in about thirty minutes, without incident.

I had passed through the fourth stage of the gauntlet—but I was not done yet.

It took me another hour to get into my house from my car, though I was parked only forty feet from my front door. Finally, at 3:30
A.M
., I dropped my belongings on the floor, removed my shoes, climbed the stairs to my bedroom, and lay down on my bed. In this state, sleep was still not possible. I knew that the visual processing required for dreaming would
overload me when my brain was this tired. I would get sick. So, instead of sleeping, I lay in bed staring at the ice-covered branches outside my window for another hour. Then, with my brain sufficiently recovered, seven and a half hours after my class was over, I finally let myself drift off.

Another day in my life as a concussive had come to a close.

On September 27th, 1999, my world as I had known it for forty-three years ended.

I was sitting at a stoplight at the intersection of Oakton and Gross Point Road in Morton Grove, Illinois, on my way to give a lecture at one of DePaul University's suburban campuses, waiting behind two other cars. A steady drizzle was falling.

Without warning, a Jeep Cherokee skidded on the wet pavement and slammed into the back of my Mazda sedan. My head bounced off the headrest behind me, and then was flung forward. I saw stars, and blacked out for a second. I was groggy, but pulled my car out of the busy intersection, around the corner, and parked on the side of Gross Point Road. I felt shaken up, but only in the way anyone who had been in a relatively minor car crash might.

A Morton Grove police officer arrived to take the accident report, and I got out of my car to meet him.

“Get back in your car and sit there until the ambulance comes!” he said, after he got a look at me. “I'm calling them now.” This was puzzling to me. I couldn't understand why he was so concerned.

At one point, while we were waiting, I went to sit in the passenger seat of the other driver's Jeep. While chatting with her about a previous accident she had had that totaled her old car, I took my driver's license out of my wallet and showed it to her. But this did not make sense, because part of me understood that
I had already shown the woman my license
—in fact, just a few minutes before. After all, this is the ordinary thing: when you show a license to someone, then you know that you have done so. In this case, I
knew
that I had shown her my license, but another part of me—the part that had prompted me to show it to her in the first place—could not get the message that the task was already completed. Thus I didn't feel certain that I had performed the task, so I asked her again—would she like to see it? And then later, once more.

This would become a common occurrence: knowing something, but not knowing that I knew it in the part of my brain that needed that information to stop—or alter—the low-level generation of speech, cognitive thought processes, and physical actions. In this way I often knew exactly what was going on, could remember it later as I now clearly remember this event from fifteen years ago, and could even describe some strange, brain-damaged process while it was happening. But this still left me helpless to alter the processes that I was observing.

The ambulance came, and a pair of young paramedics, a
small man and a large one, had me sit inside it as they examined me.

“Do you know your name?” asked the bigger one.

I thought about it. It seemed like an easy enough question. But nothing immediately came to mind. I was reaching into the usual place in my mind, and retrieving nothing at all.
How odd,
I thought. After a minute I managed, “Sure. Clark Elliott.”

“Well, Mr. Elliott, I think you'd better come with us to get checked out at the hospital.”

“Whoa!” I said. “I can't do that. I have to get to class.”

“Listen, Mr. Elliott,” said the smaller paramedic, “pardon my expression, but you're pretty fucked up here. We really need to take you to the hospital.”

“Thank you for your concern,” I said, smiling at him, “but I'm fine. I really can't go with you because I have to teach tonight.”

I didn't hurt very much. I'd given a thousand lectures over twelve years without ever missing one. It would take a lot to make me miss class. My students were expecting me to show up shortly and teach for three hours. I felt strange, but
I could not recall what it was like to not feel strange.

I couldn't make sense of what they wanted me to do. I couldn't
see
it in the normal way. So, I refused to go to the hospital.

“Okay,” said the larger paramedic. “We can't stop you. You've got to sign these release forms, and then we'll let you go. But you are doing the wrong thing.” I climbed out of the ambulance and went back to my car.

The police officer knocked on my window, signaling to roll it down. “I need your insurance card,” he said. I knew the card was in my car. I sat there for a minute, then opened the
glove box and took out a small pile of papers. But that was as far as I got. I stared at the papers in front of me without knowing what to do with them.

The officer didn't understand that I really did know exactly where the insurance card was—it was in my hand. And I didn't know how to explain to him that for some reason I couldn't sort it out from the five other items I had in my hand and give it to him. He got tired of waiting, and instead confiscated my license—an act that would have significant repercussions later that evening when I went to retrieve it.

The officer gave me directions to get to the police station. They were quite simple—only two turns—but to my surprise, I couldn't make sense of them. Instead, with some effort, I wrote them down. I would return after class, post a cash bond, and get my license back.

The back of my Mazda was all smashed in, but the car was still running fine. My red tail lenses were cracked, but my brake lights still worked, so I drove to work, mindlessly following the path I had taken many times before. Fortunately, although I had eight miles to go through heavy traffic, I only had to make a single left turn to get to DePaul's O'Hare campus. Later that evening I thought it odd that I could not remember even a single thing about the rest of my drive to work.

The details of my evening-class lecture are spotty. I worked on autopilot, covering the very familiar material. I lectured sitting down. There were difficult moments when I just stopped in the middle of the lecture, and I had to rest several times by putting my head down on my desk. But DePaul's graduate students are a bright, multiethnic, salt-of-the-earth sort of crowd, and we joked about my loopiness being caused by the automobile accident. None of us took it seriously.

After my lecture I couldn't get up from my chair. Oddly, I had trouble getting through the door of the classroom. Then, when I reached the single flight of stairs that led to the ground floor, I froze up. I couldn't seem to
see
the stairs, even though my eyes were working fine. My feet simply wouldn't move. After ten minutes someone helped me down the stairs, while I clutched the banister. I had trouble understanding the geometry of the revolving door.

Once outside, I became disoriented. The well-lit parking lot was now only sparsely populated. It had a straightforward, traditional layout bordering two sides of the classroom building. But even so, I couldn't find my own car in it—something that had never happened to me before. I wandered around in the lot, but had no sense of its spatial nature, or of my car's placement within the space. I couldn't make sense of
car-ness
either, and when I encountered objects as I wandered around the lot, it took me some time even to figure out that they were cars.

At some point I must have found my car, because later I was driving home in it, but I don't remember how that came about.

My goal was to stop at an ATM, withdraw cash for a bond, drive to the police station, and retrieve my driver's license. It took me twenty minutes to withdraw the cash, concentrating intensely, looking at my hands, looking at my ATM card, imagining what the digits of my PIN meant, looking at the ATM display, trying to form a plan. The problem was that I could not
see
the sequence of steps in a linear fashion, and without seeing them I could not get my arms and hands to move. I was working so hard that it never even occurred to me that I should probably not be spending so long on such a trivial operation. I did not feel the least bit confused. I knew exactly
what I was doing, and in my own way was entirely coherent, methodically solving the steps of a difficult puzzle. In fact, I was hyperobservant of the raw building blocks of the reality we typically filter out, which state is the antithesis of being delusional. Yet at the same time I was in the grip of one of the dominant themes that would now become a peculiar part of my life:
I did not recognize that there was anything wrong.

Next I had to retrieve my license from the police station, which entailed a simple trip three blocks south from Dempster Street, the main thoroughfare, to get there. But now I discovered that something else had gone missing.

All my life I had had a nearly infallible sense of the North-South-East-West grid on the surface of the earth, and my orientation within it. If I lost my sense of north for even a moment I grew uncomfortable and made it a point to become immediately reoriented. But now, for the first time, I had no idea where north was, and had completely lost my sense of the NSEW grid. As it turned out, I wouldn't find more than the slightest part of it again for eight years.

So, without understanding why it was hard for me, I drove around in circles for an hour trying to find the station, trying to understand which streets were south of Dempster, which streets ran east and west, and so on.

At this point I experienced another weird phenomenon: I was
slowing down
. It was taking me longer and longer to decide whether to turn left or turn right. I had a strange sense of my mainspring just winding down. I was not sleepy, but just getting increasingly unable to function. Yet, oddly, at the same time the voice in my head—the ongoing dialogue about who I was and what I was doing—was for the most part operating in real time, at full speed, and observing everything.

Finally, I found the police station. I don't recall the exact sequence of events, but I do remember clearly my fear that the police were growing suspicious that I was intoxicated.
*
Using the last of my resources, I put on a game face and explained to them that I was exhausted because I had just come from a long day at work, and that I had been in an automobile accident earlier in the day. I had a sense that my believability hung in the balance, but in the end the desk officer decided to let it pass. I left the station in a hurry, then sat in my car outside for several minutes before I recovered enough from my having to “fake normalcy,” which was exhausting, to be able to negotiate my way around the corner, away from the station, park the car, and rest.

Although I was clearly having cognitive difficulties, it did not affect my native ability to drive the way, say, having had alcohol would. I most noticed impairment in the form of not knowing directions, not being sure where I wanted to go if there was a choice, and in my great fatigue. But my ability to drive, and my emergency responses, were working well enough, and my reaction time was the same as always. The best analogy to consider is that it is entirely possible to know when you are too sleepy to drive safely, and make the appropriate, safe choice not to do so.
*

I finally arrived home at one o'clock in the morning, after driving for three hours, which included two hours of simply wandering around in a fog not knowing quite where I was. It
was hard for me to get up out of the car. It was hard for me to walk from the car to the house. I had a strange and persistent difficulty unlocking my front door.

Despite my extreme fatigue, I felt too unsettled, too
wrong
to go to sleep. So I just took off my shoes and sat in my old Eames chair to rest for a while instead. I was living alone in the gutted house I was rebuilding, so there was no one to help.

My next memory was from ten o'clock the next morning. I was physically exhausted, and still sitting in the chair. I had stayed there all night without realizing that anything was wrong.

I tried to get up and start my day. But to my chagrin, I discovered that I couldn't move. I was giving the command to my body: “Get up!” but it was not listening. It was perplexing.
What does this mean?
I asked myself. I moved my head to the left and the right without much trouble. But, when I again told myself to get up, nothing happened. Nor could I move my arms. Intuitively I knew that I was not paralyzed, but my body was simply not responding to my commands.

Finally, after a very long three minutes, once I was able to manage the smallest
initiation
of motion I was able to stand up and move normally. Over the next hour I noticed several more instances of my being unable to initiate action. I brushed any concern aside, telling myself that my muscles had just been “shaken up” more than I realized the day before in the accident, and that because the muscles were sore and tired, it was hard for me to get them to respond.