CHAPTER 12

NEUROLOGIST OLIVER SACKS HAPPENED TO BE IN TOWN, lecturing on things cranial and sharing tales from the splendid curiosity cabinet of his mind. We dined together with mutual friends, and learning of Paul’s stroke, he asked if he might stop by the following afternoon, a time when Paul usually avoided most humans and only the Cyclops of the television felt safe and unjudging. An ephemeral splinter of day, when neither Paul nor the earth was brightly lit.

Oliver appeared at the screen door, a white-bearded man with a gentle smile, tucking a small single hand-lens into his pocket. I recognized the device because I’d thought of ordering one myself, a portable eye for peering more closely at things. He seemed a kind, quiet man, a little shy perhaps, with loam-dark eyes and a youthful face. It didn’t take him long to appraise Paul’s malady, and he gave us some encouragement we found valuable and comforting.

“Many people—including doctors—will tell you that there’s a window of opportunity during the first months right after a stroke, and after that the window closes and you won’t be able to improve. That whatever you haven’t regained by then you won’t, and you’re going to stay that way the rest of your life.

“Don’t listen to them!” he cautioned with soft-spoken fervor.

“You can continue to improve at any time, one year, five years from now. . . . I have a relative who kept making important improvements ten years after her stroke.”

Just as Oliver suspected, we’d both been warned by some doctors, nurses, books, and common wisdom that a “window of opportunity” would close about three months after Paul’s stroke, with further progress slowing to an imperceptible pace. A stressful, depressing, and potentially self-fulfilling message, which we were relieved to hear Oliver dismiss. What would Paul’s life be without hoping that he might one day recover some lost skills, however small?

As Oliver spoke, his face conveyed concern, respect, and good-will—all wordlessly. I was struck by just how legible a face could be, especially to someone like Paul, deprived of language. Bless those mirror neurons, I smiled, toiling away while we’re busy watching and listening. I wasn’t quite sure how it was possible, and I doubted Oliver was aware of it himself, but even while he spoke of serious matters, his eyes crinkled with an innuendo of lightness, hopefulness.

Out of the blue, gently tapping his hands once on his knees, Oliver invited Paul to sing “Happy Birthday” with him, even though it was neither one’s birthday. Then they celebrated their successful duet with a rousing verse of Blake’s Jerusalem, a staple from their English childhoods, which Paul sang heartily off-tune. It was a splendid scene, the two chaps rendering boyhood songs. To Paul’s own astonishment he could remember and sing most of the lyrics to both. And so he discovered, as Oliver had hoped, that it’s much easier to find familiar patterns than exact words, especially if they’re accompanied by music. This works famously well for children learning to sing their ABC’s and other lessons, but isn’t only true for humans. Among humpback whales, rhyme helps the males remember the lowing diphthongs of each year’s rhythmic, raga-like songs.

A few years later, Oliver would publish Musicophilia, a lyrical treasury of information, insight, and stories, in which he tells of doctors using “music therapy” to help aphasics communicate, especially those like Paul with large left-hemisphere lesions, because quite often “a person with aphasia may be able to sing or curse or recite a poem but not to utter a propositional phrase.” He urged Paul to try singing words out when speaking words failed him. And explained that in one promising field of treatment, melodic intonation therapy, aphasics learn to speak musically, in lilting phrases, which recaptures some of the childhood fun of singsong nursery rhymes, and calls on the musical haunts of the brain to lend a hand in the effort. After singing phrases, they slowly learn to say them. It can be a long demanding therapy, but after the torments of aphasia what price wouldn’t one pay for language?

There was an instant rapport between Paul and Oliver that came, I think, from Oliver’s genuine understanding of Paul’s lost and aphasic worlds, complete with Oxford days and the otherness felt by smart, quirky, creative boys growing up strange in a conventional society. He didn’t underplay the hard journey ahead for Paul, but he was encouraging, and his belief in Paul’s ability to improve lifted Paul’s spirits.

After Oliver left, Paul, drained from the effort of socializing, headed straight for the pool like a boy crawling into his mother’s blue arms. Climbing up and down the ladder, balancing in the water, skimming bugs and leaves, swimming the breaststroke and treading water all served as welcome physiotherapy for his body. As the visible waves oscillated happily around him and he rested his tired ears and mouth, sensing instead with the large silent organ of the skin, I took heart in watching him smile with inexpressible pleasure.

Before the stroke, the pool had offered him a lightness beyond or before words, a different kind of trance from the one in which he wrote in his star-crazed hours, most alive when alone in late night and early dawn. He used to quip that some days the pool was more lucid than he was. Or was it I who had said that? I no longer knew. A merry confabulation of ideas and phrases can arise in a twosome even if they don’t speak (or think) in the royal “we.” Since returning home, Paul had spent every afternoon swimming, just as he had in previous summers. But it took on a new poignancy.

“It’s only place where always happy,” he confessed.

Floating on pale blue surges and swells, while mesmerized by the pool’s lozenges of light, Paul found access to a mystical realm, an out-of-body weightlessness that, before the stroke, he always blended with the nonstop purl of music. Classical music, especially that of the Impressionists and Romantics, had not only filled his life with pleasure, it had stirred memories of his mother, a splendid pianist who had taught piano to every child in his boyhood village. After his stroke, though he could still sing simple songs like “Happy Birthday,” Paul abruptly lost his emotional response to music, and the pleasure of swimming no longer included the shimmery trances of Claude Debussy, the melodic quilts of Ralph Vaughan Williams, Fritz Delius’s lush pastorals.

The house was quiet now, where previously music had seeped from his study, and although I liked being able to hear birds throughout the day, the soundscape had pointedly changed and I sometimes found myself startled by the silence. Why no music? Different elements of music (pitch, rhythm, emotion, etc.) are widely distributed around the brain, and there are many anecdotal accounts of cases such as Paul’s, in which music suddenly loses its appeal after a stroke (this happened to me briefly after a concussion). Paul seemed actually irritated by music now; it may just have been sensory overload for his bruised brain.

The CAT scan of Paul’s brain hadn’t offered many clues. We knew he’d had a big clot in the left middle cerebral artery, with multiple areas of “subtle decreased attenuation,” within the frontal and parietal lobes—that is, a thinning or weakening, so that neurons now spoke to one another less often and with less intensity. And there were other tracts of tissue which had withered from lack of blood supply. That sited the damage in a few general areas, without revealing an MRI’s details, which could be read as one person’s fingerprints of loss. But it’s hard to judge exactly what happens where, because just as all people have feet, with the same basic parts, though no two are exactly alike, we all have a brain, but its folds and grooves may vary wildly. Because brains are wadded up tight like too many clothes jammed into a gym bag, everyone’s brain looks a little different in its shape and pattern of folding. All the basic landmarks may be the same, but a small eventful area might lodge halfway up a groove in one person and nearer the ridge in another. During imaging, one zone may show activity when the brain is doing something—but that only means it’s more focused on the task than its neighbors; other widely distributed neurons could be equally involved.

If it was hard to pinpoint where Paul’s brain had been injured, it was harder still to guess the full results, because a healthy brain stages elaborate checks and balances. In that strange tug-of-war, injury to one lobe can affect the dominance of another lobe simply by not putting up a struggle. For instance, some neuroscientists propose that artists have more activity in the rear of the right hemisphere to begin with, in areas that orchestrate our complex sensory response to the world. As a result, artists are born with sharper, more easily aroused senses, the theory goes. That tangle of smells, tastes, touches, sights, and sounds is usually strained and restrained by the dominant frontal lobes of the brain, but if the front is damaged during a stroke the balance of power shifts. With nothing to curb the sensory fantasia, the back of the brain may zoom with sounds and colors, and a torrent of creativity may ensue. That can be good or bad, depending on degree—bad if it overwhelms (maybe a bugbear of some schizophrenia); good if it offers heightened awareness (the mainstay of art). Would that happen to Paul? A stroke in Broca’s area meant frontal lobe damage. Without a doubt, Paul was finding the world noisier, brighter, and spikier to his senses.

When Impressionist composer Maurice Ravel wrote his famous Boléro, he had reportedly sustained just that sort of brain damage. Boléro captures the signature of Broca’s aphasia: seventeen minutes of compulsive, repetitive, simple staccato phrases. It contains just two bass lines and two melodic themes repeated obsessively over 340 bars, accompanied by mounting volume and thickening, layered-in instruments. Some say it captures the tempo of sexual intercourse, which is how it was employed in the male-erotic-fantasy movie 10. But it was written to accompany a ballet in which a female dancer leaps onto a bar in a Spanish inn and swirls with abandon, her petticoats foaming and flouncing over the dark wood, until they stir up a froth of longing in the carousers. Ravel described his piece in a 1931 newspaper interview as “consisting wholly of orchestral tissue without music—one very long, gradual crescendo. There are no contrasts, and practically no invention. . . .” Ravel felt proud enough of his work to have it performed, and yet recognized that its source might be partly “without music.”

As an adolescent, Paul had bought a recording of Boléro and played it endlessly, much to his mother’s distress. But Boléro hadn’t been Paul’s favorite Ravel to swim by before his stroke. As a lifelong champion of the moody and picturesque, Paul had much preferred the plush harmonies of Daphnis et Chloé, Ravel painting the rich watercolors of orchestration that gave his lyrical work such passion and poignancy. Combining technical virtuosity with a childlike sense of wonder, Ravel excelled at conveying a shimmering, dynamic sense of nature, including the many moods of water, leaves rustling, cats meowing, the moon rising like a cold white god. Creating perfect miniatures, he adopted “complex but not complicated” as his motto, which echoes violinist Albert Einstein’s dictum that physics “should be made as simple as possible, but no simpler.” Like a wood sprite, Paul had submerged in waves of Ravel, waves of water, and waves of light as he swam.

I relished how readily Paul had sung “Happy Birthday” and Jerusalem with Oliver—it was like stumbling on a hidden sliver of the old Paul, one who hadn’t lost quite all of his own musicophilia. Even if the nonstop classical score to his life was gone.