The Memory Book (23 page)

“She wields a strange power over people.”

Rose thanked me again, then introduced me to her young man.

“Old family friend,” I muttered at him as I made room for the next people in the reception line. As I moved away, Rose was whispering my secrets into the pink ear of her beloved.

I circled the refreshments table again and found a few canapés I’d missed on my first trip around.

It was easy to spot Steve Mapesbury and his family. His golden curls gave him away. Dympna looked six going on twenty. The baby was suckling her mother’s breast, which she managed without upstaging any of the scheduled events. Somehow I knew, from our brief telephone acquaintance, that this might be in character for Laura Mapesbury. Steve had had his missing tooth restored and his face showed few signs of the painful ordeal he had suffered at the hands of his one-time friend and benefactor. I introduced myself to him on his way back from the drinks table. He had glasses of champagne for himself, Perrier for his wife and bubbly of another sort for the little girl.

“I don’t think that he would have killed me,” he said, after I had introduced myself. But I could see there was a particle of doubt in his mind. Samson, Heather, and a college dropout who had guarded Steve had all been charged. Steve was to appear as a Crown witness, having made a detailed confession in exchange for a suspended sentence. Mapesbury’s description of being held captive in that Holstein house sounded less dramatic than the
accounts Anna read to me from the papers. But there was a reserve of doubt in his voice as he told it to me.

“Gauche was my friend and mentor,” he said. “He got me my job and found a way for me to get out of debt.”

“He killed a teacher.”

“I know. I know. Sometimes you get so close to people you can’t see the harm.”

“He might have killed you. It was the only permanent solution.”

“We’ll never know, will we? Come and meet my family.”

On the way across the lawn, I thought of what it would be like to meet the people whose lives had passed so close to mine. It would be interesting to close the circle on these last few months. There might be some chord struck that would somehow resolve all the discordant echoes running around in my head. Still, I hesitated. But, at Steve’s urging, I did go over and chat with them. In books, people always remember whom they are speaking to, but at weddings you simply chat. Nobody asked my name. Moreover, I was able to find a piece of wedding cake for Dympna. It had rosebuds on it. Weddings are all about our best hopes for the future; my anonymous appearance could hardly stir up unpleasant echoes of the past.

As I joined in a toast to the bride and groom, along with the rest of the wedding guests, I had a sudden glimpse of little Dympna staring at me from across the lawn. She moved back into the crowd, where I lost her.
Nor was I about to pursue Stella further. Besides, I could see Anna making her beautiful way through the crowd toward me.

ACKNOWLEDGMENTS

In the mid-1960s there was a film called
Cat Ballou
starring a young Jane Fonda. In it the veteran star Lee Marvin plays the part of a dissolute former gunfighter named Kid Shaleen, a washed-up, drunken wreck, scarcely able to stand. Looking him in the face, an oldtimer says to him, “Your eyes look
terrible!”
Kid Shaleen replies, “You should see them from
this
side.”

In writing this book, after my illness of a couple of years ago, I’ve tried to show what the changes in perceptions and cognition are like as seen from “this side.”

In order to bring it off, I’ve had a lot of help from many people. It’s only fair for me to mention the names that come to mind while I still have a toehold on my memory. Those who helped to bring me and this text to this point are Beverley Slopen, Madeline Grant, Mary Adachi, Michelle Cohen, Cynthia Good, Nancy Vichert, Griff Cunningham, Don Summerhayes, Jennifer Glossop and my children, William, Charlotte, and Jacob.

AFTERWORD

by Oliver Sacks, MD

In January of 2002, I found myself thinking about the problem of alexia, an inability to read resulting from damage to a particular area in the occipital cortex, the visual part of the brain. I had been seeing a patient, an eminent pianist, who had become unable to read music, and then to read words. She saw them as clearly as ever, but now they had become “unintelligible … meaningless … just marks on paper.” All this, my patient had explained to me in a letter, for she was perfectly able to write, though, of course, unable to read what she had written.

Shortly after this, by coincidence (such coincidences seem to happen oddly frequently in my life), I received a letter from the Canadian novelist Howard Engel, and soon afterward I met him.

One morning, some months before, he told me, he had got up feeling fine, with no sense that anything was amiss. He dressed, made breakfast, and then went out to get his newspaper. But
The Globe and Mail,
while it had the same format as always, seemed to have undergone an uncanny transformation, and had apparently been printed in “Serbo-Croatian” this morning. (“Whatever I’m looking
at,” he wrote to me in January of 2002, “turns into unfamiliar blocks of type that could at first glance be taken for Serbo-Croatian.”) There came to his mind, in this moment, the memory of an odd case history he had read a few years earlier, my own “Case of the Colorblind Painter.” He remembered in particular how my patient, Mr. I., following a traffic accident, had found himself unable to read the police accident report—how he saw print of different sizes and types, but could make nothing of it, and said it looked like “Greek” or “Hebrew” to him. Engel wondered if he, like the painter, had developed alexia, and perhaps had had, without realizing it, a stroke.

He went to the local emergency room, accompanied by his son, and the journey there seemed somewhat strange to him—roads, landmarks, the geography of Toronto, which he had known intimately for years, did not seem as immediately familiar and recognizable as usual. He was admitted to hospital, where it was ascertained with various tests that he had indeed had a small stroke, affecting only a limited area of the visual parts of the brain, the occipital cortex, on the left side. It became apparent, with further testing, that there were also some visual problems besides the alexia: a quarter of the visual field was missing, high up on the opposite side (neurologists call this a quadrantonopia), and there were some difficulties in recognition of shapes and colours, though these were mild compared to the impossibility of recognizing words or individual letters or numbers by sight.

Alexia,
or “word-blindness,” as it was originally called, has been recognized by neurologists since the late nineteenth century, and has always been a source of fascination, for one thinks of reading and writing as going together, and it seems bizarre, counterintuitive, that someone should be able to write but be quite unable to read what they have just written. This
alexia sine agraphia
is a classic example of what neurologists call a dissociation, or a disconnection syndrome. It has often been observed that this is a purely visual problem; people with alexia have no difficulty, for instance, recognizing letters or words if they are traced on the hand. The intactness of such tactile reading, as well as of speech recognition, showed that Engel did not have
aphasia
—a disturbance of language in general—but a pure word blindness, the result of certain areas of the visual cortex being cut off, by the stroke, from the language areas on the same side of the brain.

Thus, though he could see letters perfectly well, he could not interpret them. We normally think of reading as seamless, occurring in a single indivisible act, and one has to encounter a disconnection, such as Engel now had, to realize that, in fact, reading involves at least two, and perhaps several, separate processes and stages.

It was a huge relief for Engel to realize that, though he could not read, his ability to
write
was unimpaired—even though he might not be able to read what he had written. As an omnivorous reader, accustomed to reading newspapers each morning and a dozen or more books a week,
and a prolific writer, he started to wonder what alexia would mean for him—how (if it failed to improve with time) it would affect his life in general, and, in particular, his life and work as a writer. For while his other symptoms—the field defects, the problems with colours and shapes—seemed to be gradually diminishing, the alexia remained unchanged. Hopefully, with time, this too would disappear.

Being able to write, without the ability to read what he had written, might be all right for a short letter or memorandum, a poem, an essay, a page or two—but how could he hope to go back to his previous work, to write a whole book, an elaborate story of crime and detection, to do all the corrections and revisions and redrafting a writer must do, without being able to read? He would have to get others to read for him, or perhaps get one of the ingenious new software programs that would allow him to scan what he had written and hear it read back to him by a computer. But either of these would still involve a radical shift, from the visuality of reading, the sight of words on a page, to an essentially auditory mode of perception and thought. Would this be possible?

These were not thoughts that came to him during his two weeks in hospital, for he was quite ill at the time and retained little memory of this period. It was when he moved to a rehabilitation hospital, where he was to spend the next six weeks, that he studied himself, what he could and could not do, and, with his therapists, explored new—sometimes radically new—ways of trying to read
and to spell (which he also discovered, at this point, was very difficult for him). For the alexia affected his visual imagery as well. He could not “see” words as words in his mind’s eye any more than he could perceive them as words when they were printed before him. Lacking this internal imagery, he had to employ other strategies for spelling. The simplest of these, he found (since his writing remained unimpaired), was to write a word in the air with his finger.

Sometimes, if he looked at a word, a couple of letters would suddenly jump out at him and be recognized—for example, the
bi
in the middle of his editor’s name, though the letters before and after this remained unintelligible. (Thus guessing, inference, became supremely important.) He wondered whether such “chunking” was the way he had originally learned to read as a child, the way, perhaps, we all learn to read, even though later we may take in words as a whole. Normally the perception of letter clusters, syllables, or words, as well as inferences and hypotheses based on such perceptions, are instantaneous and automatic, so that we read fluently and swiftly, able to attend to the meaning (and perhaps the beauty) of written language, unconscious of the innumerable cues and inferences that make this possible. But it was very different for Engel at this point, for it was only occasionally that a recognizable fragment of a word might jump out, and such a fragment would be surrounded by an entire page of “Serbo-Croatian.”

With help from his therapists, Engel learned to slowly and laboriously puzzle out the names of street signs or grocery aisles, or headlines in a newspaper. This, even in the absence of normal reading, made day-to-day life possible.

Engel’s weeks in the rehabilitation hospital thus proved to be a neurological revelation as to how the mind works and how seemingly automatic processes can fall apart and have to be reconstructed in other ways. It was a very rich human experience as well, and Engel, indefatigably curious, and with his novelist’s eye and ear fully intact, got to know his nurses and his fellow patients, their feelings about illness, their idiosyncrasies, and the intricacies of their lives. Being a patient, experiencing and observing the whole atmosphere of hospital life, stimulated Engel’s imagination, and it was at this point that the idea of a new book came to him, one in which his alter ego, Benny Cooperman, would be a patient in a hospital ward with alexia (as well as a few other neurological problems), and in which he would solve a mystery—the mystery of how he had ended up, brain-damaged in a hospital ward—without ever leaving the ward.

Once he was home, Engel moved into high gear with his writing, and the manuscript of
Memory Book
rapidly took shape. Within a few weeks, he completed the first draft, and he wrote to me at this point:

I have finished my book.… As an author, you’ll know how meaningless that word finish is. What I
mean to say is that I have reached the ending for the first time. How many more times will I have to finish it before it leaves the house for the last time? From now on it will be a matter of rewriting and reworking the material.… My publisher has lent me an editor, who has marked certain parts of the manuscript for my attention.… I am able to deal with the simple problems of spelling, syntax, and repetition by taking them one at a time, orienting myself on the page by making use of paragraph breaks to show me where I am.… It remains hard to get a fix on the flow of a book working this way. I can replace divots and monkey about to my heart’s content, but I wonder whether I will be able to see serious plot or design flaws in time.

I found this letter astonishing. How was Engel able to deal with the “simple” problems of spelling, syntax, and repetition when (as he wrote in his letter) “the old casual recognition of familiar words remains occluded”? The answer, or a partial answer, he wrote, lay in concentration, deciphering words letter by letter, decoding English print as if it was hieroglyphic, doing consciously and laboriously what had been, before his stroke, unconscious, automatic, and easy. “I can make myself see that certain letter groupings are indeed familiar words, but that comes only after I have stared at the page.”

He also started to bring in other senses to complement the visual. Thus he often moves his tongue, almost unconsciously,
as he reads, tracing the shapes of letters on the roof of his mouth. This enables him to read a good deal faster. He is about a third of the way through
Great Expectations
now, he tells me (though it now takes him a month or more to read a book he might previously have read in an evening). The neurologist Kurt Goldstein, many years ago, described something analogous to this in a patient with alexia who showed a marked improvement in the ability to read as he used his eyes to “palpate” the shapes of letters: in effect, a visual Braille.