Brain On Fire: My Month Of Madness Part 6

"Yes," my mom said.

"They have a hospital bed ready this moment. I don't know how long it will be open, so I would advise you to go to NYU immediately."

"Great," she said, gathering her purse and folding her paper. "We'll go right away."

We entered through revolving doors into the busy, recently remodeled lobby of New York University Langone Medical Center. Nurses sprinted by in green scrubs, followed by nurses' a.s.sistants in purple scrubs; doctors in white lab coats chatted at the crossroads of the corridors; the patients, some with bandages, some on crutches, some in wheelchairs, some on gurneys, journeyed past, dead-eyed and unspeaking. There was no way I belonged here. here.

We found our way to Admitting, which was a group of chairs surrounding a small desk, where a woman dispatched patients to different floors across the gigantic hospital.

"I want coffee," I said.

My mother looked annoyed. "Really? Now? Fine. But be back right away." A part of my mom believed the old, responsible me was still in there somewhere, and she simply trusted that I wouldn't escape. Luckily, this time she was right.

A small stand nearby sold coffee and baked goods. I calmly chose a cappuccino and a yogurt.

"What do you have on your mouth?" my mother asked when I returned. "And why are you smiling like that?"

The strange taste of foam, a mixture of saliva and steamed milk, on my upper lip.

White lab coats.

The hospital's cold floor.

"She's having a seizure!" My mom's voice echoed across the vast hallway as three doctors descended on my shaking body.

From here on, I remember only very few bits and pieces, mostly hallucinatory, from the time in the hospital. Unlike before, there are now no glimmers of the reliable "I," the Susannah I had been for the previous twenty-four years. Though I had been gradually losing more and more of myself over the past few weeks, the break between my consciousness and my physical body was now finally fully complete. In essence, I was gone. I wish I could understand my behaviors and motivations during this time, but there was no rational consciousness operating, nothing I could access anymore, then or now. This was the beginning of my lost month of madness.

PART TWO

THE CLOCK

What is today's date?

Who is the President?

How great a danger do you pose, on a scale of one to ten?

What does "people who live in gla.s.s houses" mean?

Every symphony is a suicide postponed, true or false?

Should each individual snowflake be held accountable for the avalanche?

Name five rivers.

What do you see yourself doing in ten minutes?

How about some lovely soft Thorazine music?

If you could have half an hour with your father, what would you say to him?

What should you do if I fall asleep?

Are you still following in his mastodon footsteps?

What is the moral of "Mary Had a Little Lamb"?

What about his Everest shadow?

Would you compare your education to a disease so rare no one else has ever had it, or the deliberate extermination of indigenous populations?

Which is more puzzling, the existence of suffering or its frequent absence?

Should an odd number be sacrificed to the G.o.ds of the sky, and an even to those of the underworld, or vice versa?

Would you visit a country where n.o.body talks?

What would you have done differently?

Why are you here?

FRANZ WRIGHT, "Intake Interview," Wheeling Motel "Intake Interview," Wheeling Motel

CHAPTER 15

THE CAPGRAS DELUSION

I was admitted in midafternoon on March 23, ten days after that first blackout while watching the PBS show with Gwyneth Paltrow. The NYU Langone Medical Center has one of the largest epilepsy units in the world, but the only bed available on the eighteen-patient floor was in the advanced monitoring unit (AMU), a four-person room dedicated to "grid patients," people with severe epilepsy who need electrodes implanted in their brains so that the center can record the electrical activity required before some types of epilepsy surgery. Occasionally other patients, like me, ended up here due to lack of s.p.a.ce. The room has its own nurses' station, where a staff member monitors the patients twenty-four hours a day. Two cameras hang above each bed, constantly surveying every patient on the floor so that the hospital can have physical as well as electrical evidence of seizures (when a patient is discharged, most of the footage is discarded; the hospital keeps only the seizure events and abnormal circ.u.mstances). All of this surveillance would prove essential to me later, when I began to try to reconstruct what happened to me during these lost weeks. was admitted in midafternoon on March 23, ten days after that first blackout while watching the PBS show with Gwyneth Paltrow. The NYU Langone Medical Center has one of the largest epilepsy units in the world, but the only bed available on the eighteen-patient floor was in the advanced monitoring unit (AMU), a four-person room dedicated to "grid patients," people with severe epilepsy who need electrodes implanted in their brains so that the center can record the electrical activity required before some types of epilepsy surgery. Occasionally other patients, like me, ended up here due to lack of s.p.a.ce. The room has its own nurses' station, where a staff member monitors the patients twenty-four hours a day. Two cameras hang above each bed, constantly surveying every patient on the floor so that the hospital can have physical as well as electrical evidence of seizures (when a patient is discharged, most of the footage is discarded; the hospital keeps only the seizure events and abnormal circ.u.mstances). All of this surveillance would prove essential to me later, when I began to try to reconstruct what happened to me during these lost weeks.

After my seizure in the lobby's admitting area, my mother and stepfather trailed behind the gurney as the medic team wheeled me onto the epilepsy floor. Two different nurses then brought me into the AMU. Diverted by their new roommate, the room's three other patients quieted when I arrived. The nurse pract.i.tioner took down my health history, noting that I was cooperative with just a hint of delay, which she figured was related to the aftermath of the seizure. When I was unable to answer questions, my mother, clutching her folder full of doc.u.ments, answered in my stead.

The nurses settled me onto a bed that had two precautionary side guardrails; the bed itself was lowered as close as possible to the ground. Nurses began to arrive approximately once an hour to get my vitals: blood pressure, pulse, and the results of a basic neurological exam. My weight was on the low side of normal, my blood pressure high-normal, and my pulse slightly accelerated but not alarmingly so, given the circ.u.mstances. The a.s.sessments, which covered everything from bowel movements to level of consciousness, were all normal.

An EEG technician interrupted the screening, pulling a cart behind him. He began unloading handfuls of the multicolored electrodes-reds, pinks, blues, and yellows-like the ones from my EEG at Dr. Bailey's office. The wires fed into a small, gray EEG box, similar in shape and size to a wireless Internet router, which connected to a computer that would record my brain waves. These electrodes measure the electrical activity along the scalp, tracking the chatter of electrically charged neurons and translating their actions as waves of activity.

As the technician began to apply the adhesive, I stopped cooperating. It took him half an hour to place the twenty-one electrodes as I squirmed. "Please, stop!" I insisted, thras.h.i.+ng my arms as my mother caressed my hands, trying ineffectually to calm me. I was acting even more mercurial than in recent days. Things seemed to be going downhill fast.

Eventually my tantrum receded, but I continued to cry as the smell of fresh glue permeated the air. The tech finished applying the wires and, before he left, handed me a small pink backpack that looked as if it belonged to a preschooler. It held my little "Internet router," which would allow me to walk around but remain connected to the EEG system.

It was already clear that I would not be an easy patient, given the way I screamed at visitors and lashed out at nurses during those first few hours on the floor. When Allen arrived, I pointed and yelled at him, insisting that the nurses "get this man out of my room." Similarly, I loudly accused my dad of being a kidnapper when he arrived, and I demanded that they bar him as well. Because I was still in the midst of what seemed to be psychosis, many tests were impossible to conduct.

Later that evening, an on-call neurologist came to conduct a second basic health history. Immediately she noticed that I was "labile," meaning p.r.o.ne to mood swings, and "tangential," meaning that I skipped from topic to topic without clear transitions. Nonetheless, I did manage to describe my history of melanoma before I began to grow so illogical that the interview had to be postponed.

"So what year was it that you were diagnosed?" the neurologist asked.

"He's playing a trick on me."

"Who's playing a trick on you?"

"My dad."

"What do you mean?"

"He's changing into people. He's turning into different people to play tricks on me."

The neurologist wrote "unclear if hallucinating" on her consultation form and prescribed a low-dose of the antipsychotic drug Geodon, often used to treat the symptoms of schizophrenia. She put in a request for a member of the psychiatric team to perform a closer examination.

Not only did I believe that my family members were turning into other people, which is an aspect of paranoid hallucinations, but I also insisted that my father was an imposter. That delusion has a more specific name, Capgras syndrome, which a French psychiatrist, Joseph Capgras, first described in 1923 when he encountered a woman who believed that her husband had become a "double."12 For years, psychiatrists believed this syndrome was an outgrowth of schizophrenia or other types of mental illnesses, but more recently, doctors have also ascribed it to neurobiological causes, including brain lesions. For years, psychiatrists believed this syndrome was an outgrowth of schizophrenia or other types of mental illnesses, but more recently, doctors have also ascribed it to neurobiological causes, including brain lesions.13 One study revealed that Capgras delusions might emerge from structural and circuitry complications in the brain, such as when the parts of the brain responsible for our interpretations of what we see ("hey, that man with dark hair about 5'10", 190 pounds looks like my dad") don't match up with our emotional understanding ("that's my dad, he raised me"). It's a little like deja vu, when we feel a strong sense of intimacy and familiarity but it's not connected to anything we actually have experienced before. When these mismatches occur, the brain tries to make sense of the emotional incongruity by creating an elaborate, paranoid fantasy ("that looks like my dad, but I don't One study revealed that Capgras delusions might emerge from structural and circuitry complications in the brain, such as when the parts of the brain responsible for our interpretations of what we see ("hey, that man with dark hair about 5'10", 190 pounds looks like my dad") don't match up with our emotional understanding ("that's my dad, he raised me"). It's a little like deja vu, when we feel a strong sense of intimacy and familiarity but it's not connected to anything we actually have experienced before. When these mismatches occur, the brain tries to make sense of the emotional incongruity by creating an elaborate, paranoid fantasy ("that looks like my dad, but I don't feel feel like he's my dad, so he must be an imposter") that seems to come straight out of like he's my dad, so he must be an imposter") that seems to come straight out of The Invasion of the Body s.n.a.t.c.hers. The Invasion of the Body s.n.a.t.c.hers.

EEG video, March 24, 1:00 a.m., 6 minutesI am sleeping in bed, wearing a green and brown striped T-s.h.i.+rt and a white cotton hat. The ivory bedsheets are pulled up to my throat, and the cus.h.i.+oned guardrails are at their highest level, making the bed look, from above, like an adult-sized ba.s.sinet. I sleep in a fetal position, clutching my pillow. In a moment or two, I awake; fiddle with my cap, looking upset; and pull at the patient ID band on my right hand, folding my arms over my chest. I grab for my cell phone.End of tape.

I need to pee. I s.n.a.t.c.h up my pink backpack and unplug the cord and head to the shared bathroom. As I lower my black leggings and my underwear to my knees, I can't shake the feeling that I'm being watched. I look to my right, and a big brown eye peers in at me from a slit in the door.

"Get the f.u.c.k away from me!"

I cover my private parts, lift my pants, and sprint back to bed, pulling the covers to my eyes. I call my mom.

"They're trying to hurt me. They're making fun of me. They're putting shots in my arm," I whisper, trying to keep my voice low enough so that the other three patients and the nurse manning the in-room station can't hear me.

"Susannah, please try to stay calm. I promise you no one is trying to hurt you," my mom says.

"They're spying on me. They watch me when I go to the bathroom."

She pauses before speaking again. "Is this true?"

"How can you ask me that? Do you think I'd make it up?"

"I'm going to talk to them about this," she says, her voice growing frenzied.

"Do you think they'll tell you, 'Yeah, we're abusing your daughter'? Do you think they'll admit that?"

"Are you sure this is happening, Susannah?"

"Yes."

I hang up on her as I hear the shuffling of feet. A nurse walks near my bed. "Please don't use the phone with the EEG equipment. It interferes. And it's late. Everyone is sleeping."

Then she whispers, softly, tauntingly, without moving her lips, "I see you on the news."

"What did you say?"

"Why you no let your father in? He's a good man," the nurse says, her voice wafting around me like a vapor until she disappears behind the curtain.

Everyone is out to get me. I'm not safe here. I look up at the video cameras. They are watching me. If I don't leave now, I will never get out alive. I grab a handful of electrodes and pull. A patch of hair comes out with it, but no pain registers. Absently, I stare at the virgin roots of my dyed blond hair and then reach for more.

That night, I dashed out of the hospital room and into the hallway, where a group of nurses caught up to me and returned me to the AMU room as I battled ferociously, kicking and screaming. It was my first, but not my last, attempt at escape.

CHAPTER 16

POSTICTAL FURY

Deborah Russo, an attending neurologist on the epilepsy floor, visited me on the second day to conduct yet another examination. She came during the morning s.h.i.+ft, accompanied by doctors, nurses, and a few med students. They were "the team." Knowing about my escape attempt the night before, Dr. Russo sized up the room and confirmed that all seizure precautions were being maintained before moving on to the basic neurological exam: "touch your nose, stick out your tongue," etc. I interrupted her midreview.

"You need to let me out of here. I don't belong here," I confided, looking nervous. "They're all saying bad things about me."

"Who's talking to you?"

"The people on the TV."

Dr. Russo allowed me to ramble on for a few minutes before redirecting me. "Can you tell me a little about how you felt before you came to the hospital?"