CHAPTER 25

TO MY SURPRISE, PAUL HAD THE URGE TO CREATE EVERY single day. The habit of using language to express himself, despite the Sisyphian difficulties, still persisted. The language mill in Paul’s brain may have been blasted by the stroke, but apparently not the pied-à-terre of the muses. Where might those fickle ladies reside?

By most accounts, the right side of the brain organizes creativity, but it’s a suspected whereabouts defined mainly by loss (people with right-hemisphere strokes typically lose their gift for poetry, music, or painting). Paul’s brain had always relished thinking in images, and he’d spent a lifetime being creative, in the process farming more of the neural landscape in his imaginative, intuitive right hemisphere. An ordinary feat. Every brain spirals and dovetails in unique ways, and propensity often leads to predilection—having a talent for something makes spending time at it pleasurable, which in turn shapes and fortifies the gray matter for it. Physical exercise develops muscles; mental exercise remodels the brain. Painters grow richer visual-association ranges; musicians auditory glens; writers language orchards.

Paul’s lifetime as a wordsmith would have built dense language country, with more back roads between the hamlets, even if the major highways had crumbled, and more neural networks, wired as java joints and hopping to serve. My hunch was that his brain still had tillable hills and valleys, where a crop of words might yet flourish. This would help explain why he was speaking at all, given his CAT scan’s grim cameo. Creative brains nimbly scout both hemispheres for raw material—it’s a whole-brain enterprise. One needs the left hemisphere to inspect the results emerging from the right, and decide if the work is apt, original, and effective. So a well-built bridge between the hemispheres (the corpus callosum) must also play an essential role in creativity, and Paul’s would be built for heavy traffic, because he’d been bracing (even frescoing) it for decades.

That seemed likely, especially since Paul had studied French, Latin, and Greek in school. Learning multiple tongues would have bolstered the language connections in his right hemisphere as well as in his left. We know from brain imaging done with bilingual speakers that most of us don’t take advantage of all the language room we inherit, which can be greatly enhanced. A person speaking one language shows activity in the classic left-hemisphere language areas. But as a bilingual speaker switches rapidly from one language to another, she increases the activity in both the right and left hemispheres, engaging more of what’s available for language, in time cultivating many more brain cells. Also, bilinguals, just like taxi drivers, jugglers, and symphony orchestra musicians, grow denser gray matter in areas related to their skills. The earlier the better, with the most changes in people who learn a second language before the age of five.

A neuroscientist friend had told me about a visit from a Norwegian colleague who was surprised by the frequency of post-stroke aphasia in the United States compared to Norway. His colleague theorized that Norwegians fare better because they learn several foreign languages as children, giving them a distinct advantage in later years. Quite often, like the Czech-speaking violist, aphasics who lose access to their primary language can still remember a foreign tongue. Paul began studying French at ten, Latin and Greek at seventeen—late by some measures, but tilling spare gray matter nonetheless, because the temporal lobes (replete with regions that process language and emotions) are still efflorescing until around sixteen, when another round of pruning begins to sculpt the topiaries of the brain. And even then, honing new skills, or even new ways of thinking, can fertilize a bed of neurons, increasing its size.

Ideally, post-stroke rehab should play to each patient’s strengths, the dense knots and networks of gray matter developed over a lifetime of use, one’s own private larder or offshore bank account. In college courses, a teacher often encounters the rubric of “all that must be learned,” but discovering how each student learns best is far more effective. It takes longer, and ideally the student and teacher will be a good “match.” The same is true with rebuilding after a stroke. Not just remodeling from scratch, but finding extra or out-of-the-way storehouses, and rewiring paths to them, bushwacking with unconventional tools if need be, uncovering lost or meandering trails, guiding by invisible and at times intuitive maps.

Since Paul was naturally creative, a wild and woolly thinker, it wasn’t really surprising that he balked at conventional speech therapy, with its linear, fill-in-the-blank, right-or-wrong answers. Before his stroke, his brain hadn’t worked that way; that’s not where his strengths lay. In any case, everyone learns better through play—though, after a severe stroke, finding a playground may not be easy. It depends on what amused a loved one beforehand, and blazing paths, at a snail’s pace if need be, to that hidden reservoir. In Paul’s case, progress could only be made by pointing out the slime left by the snail, the calcium “love darts” that snails use during courtship, and any grotesque scenery along the way, since he loved weird metaphors.

To build even such a slight metaphor, the brain hunts far and wide, across neural networks in both hemispheres, and connects seemingly unrelated tidbits that nonetheless have things in common. Different domains of knowledge are slammed together. It’s a pictorial kind of thinking, pre-rational and full of emotional intensity, a way of painting thoughts and feelings. When Lord Byron dubbed his wife-to-be “the Princess of Parallelograms,” he very effectively combined her rare gift for mathematics with her wealthy family, strict morals, elegant beauty, and cool demeanor.

What we airily label creativity typically blends so many features: risk-taking, perseverance, problem-solving, openness to experience, the need to share one’s inner universe, empathy, detailed mastery of a craft, resourcefulness, disciplined spontaneity, a mind of large general knowledge and strength that can momentarily be drawn to a particular, ample joy when surprised, intense focus, the useful application of obsession, the innocent wonder of a child available to a learned adult, passion, a tenuous (or at least flexible) grasp on reality, mysticism (though not necessarily theology), a reaction against the status quo (and preference for unique creations), and usually the support of at least one person—among many other ingredients.

In the throes of creativity, a lively brain tussles with a mass of memories and rich stores of knowledge, attacking them both sub rosa and with the mind wide open. Some it incubates offstage until a fully fledged insight wings into view. The rest it consciously rigs, rotates, kneads, and otherwise plays with until a novel solution emerges. Only by fumbling with countless bits of knowledge, and then ignoring most of it, does a creative mind craft something original. For that, far more than the language areas are involved. Hand-me-down ideas won’t do. So conventions must be flouted, risks taken, possibilities freely spigoted, ideas elaborated, problems redefined, daydreaming encouraged, curiosity followed down zigzagging alleyways. Any sort of unconsidered trifle may be fair game. It’s child’s play. Literally. Not a gift given to an elect few, but a widespread, natural, human way of knowing the world. With the best intentions, our schools and society bash most of it out of us. Fortunately, it’s so strong in some of us that it endures. As neuroscientist Floyd Bloom observes:

Schools place overwhelming emphasis on teaching children to solve problems correctly, not creatively. This skewed system dominates our first twenty years of life; tests, grades, college admission, degrees and job placements demand and reward targeted logical thinking, factual competence, and language and math skills—all purviews of the left brain. . . . [T]he brain is a creature of habit; using well-established neural pathways is more economical than elaborating new or unusual ones. Additionally, failure to train creative faculties allows those neural connections to wither.

Creativity is an intellectual adventure into those jungles where the jaguars of sweet laughter croon, with a willingness to double back, ignore fences, or switch directions at the drop of a coconut.

Why was Paul doing so well, all things considered? One small piece of the puzzle, strangely enough, may be that his earlier stroke—a small one, known as a TIA—probably worked in his favor. Swiss scientists Paciaroni, Arnold, van Melle, and Bogousslavsky reported, after studying over three thousand stroke patients, that “the occurrence of previous TIAs was significantly related to a better outcome.” They offered several explanations, among them that the slow blockage of an artery that leads to a TIA—like the narrowing of a hose—forced the brain to irrigate through other channels. After that, when the big stroke hit, there were backup routes for blood flow. Also, these patients were already on anticoagulants because of the TIA, a mixed blessing, preventing the use of tPA but still possibly protective.

Of course, that doesn’t factor in the role of other chemicals in the brain’s bag of tricks. Without a doubt, the antidepressant Zoloft was working, and the Ritalin helped Paul focus. But one of his heart medicines probably fostered creativity, too. In a University of Florida study neurologist Kenneth Heilman conducted with college students, some were given a stimulant (ephedrine) and some a calm-inducing beta-blocker that’s often prescribed for stage fright (Inderal). Surprisingly, the students on the beta-blocker performed better on tests requiring mental flexibility. For years, Paul had been forbidden coffee, tea, chocolate, and other stimulants by his cardiologist, but prescribed Inderal to lower his blood pressure and slow the speed of his quivering heart muscle. Made sleepier by the Inderal, he nonetheless stayed wickedly productive.

As much as I might relish a mug of oily, dark French roast coffee, revving up the brain doesn’t necessarily spur creative thinking. Vigilant calm works better. After all, the secret to good improvisation isn’t choosing the first thing that comes into your mind, but the best thing. That usually means generating different possibilities, rotating mental images, juggling, arranging, rearranging, testing how each lurks in the mind, before settling on a solution.

So, with one thing and another—the years of foreign language, his strong bridge between the hemispheres, his luck with medications, the previous TIA, etc.—Paul remained fiercely creative, even if he couldn’t process language well. Since he was motivated, it made sense to encourage his brain to recruit healthy laborers from the suburbs, and travel even farther afield to employ other gandy-dancers, however strange, who were still fit enough to hammer out a word or two.