Cassowary Crossing

IF MEMORY SERVES…
(c) David Astle

Memory is the pulse of conversation, the base of learning, the mother of wisdom. Yet more than these, memory is central to affirming the self. Unique as a fingerprint, memory is how we map our lives, learn our lessons, draw on the past. In every sense, memory makes us, us.

Our minds carry photo-albums of personal history, song fragments, residual sensations of first kisses, last glimpses, fears and feelings, faces and aromas, unwritten plans for scrambled eggs, tango, three-point turns.

Yet say we lost our memory? Carers of dementia patients know the anguish of seeing a memory erode over time, but what if you lost your memory in a millisecond? Snap – your lover is a stranger to you. In a blink you forget the art of talking, walking, sitting down. Your family comprises strangers; your past has disappeared –

The Girl in the Hall – Michelle Newland, St Albans, VIC

Ann Newland woke to see a shadow crumpled in the door frame. Her bedside clock read 4:15. Mum, said the shadow, take me to the hospital.
“I flew out of bed,” recalls Ann, “grabbed my tracky dacks, anything I could find.” Vic, her husband, grabbed the keys, ran outside, started the car. “By the time I left the room, Shell was on the floor, having a fit.”

Michelle, her daughter, – known by all as Shell – had just turned 19, a bright teaching student with a wide future. Yet here she was, flailing on the carpet, fighting for oxygen. The humming in Shell’s room was the nebuliser, a breathing aid to help control the girl’s intermittent asthma. The girl was turning blue.

Racing to Sunshine Hospital, the girl gasped in her mother’s lap. “I took a breath and gave it to Shell. And then I thought, Hang on, asthma is about getting air out – I didn’t want to put more in. She started frothing. To me, that was her last breath.”

Newland will never erase that night of 2002 – her limp daughter, the rushed red-light, the cop-car escort to Casualty. Michelle ‘died’ for ten minutes, revived by a trachea tube and electric paddles on her chest. A pulse returned. Doctors attached her to a ventilator, used drugs to keep her comatose for several days. CAT scans revealed massive swelling in the skull. As fears of death ebbed, the new dangers of coma and brain injury arose. For any brain to lose so much oxygen would only have long-term effects.

“Hypoxia,” explains neuropsychologist Sue Sloan, at her Melbourne clinic, “is severe lack of oxygen to the brain, and may lead to global effects on brain function, with memory disorder the most prominent feature.”

Typically, the trauma occurs to victims of drowning or asphyxia, where oxygen loss leads to a long-term toll on memory. The brain, a constant oxygen sponge, enfolds the hippocampus (the two seahorse-like clusters buried in the temporal lobes) that demands the most air.

Acting as conduit, the hippocampus is deemed the key to laying down new memories. Imagine you hear dontaku is Japanese for Sunday. Whether you choose to retain the fact is up to you, depending on need, priority, purpose etc. Yet neurally it is the hippocampus that dispatches the input as potential memory to allocated lobes (be they visual, aural, practical stimuli) within the brain. Asked to retrieve the word (now a memory), a net among your 100 billion neurons will ignite across the greyscape to find the fact, and haul it back through the hippocampus.

Such lightning-quick labour needs oxygen. Shell had lost her supply for at least ten minutes. By her bed, family and friends kept vigil, hoping against the doctors’ darker forecasts. Her sister Julie, a beautician, manicured the sleeping girl’s nails as a means of coping with the unknown. Would Shell wake? Would she recall her studies, her life, her name?

Behind the Lens – Tony Tait, Aberdeen via Clifton Hill, VIC

Rangy, handsome, with a Sean Connery brogue, Tony Tait was on the town. The 24-year-old animator from Aberdeen in Scotland had just finished a corporate gig in Hong Kong, inventing cartoon characters as mascots for Asian TV, when he opted to fly home via Melbourne, to catch up with an old school pal.

The year was 2003. The night turned into an ad-hoc pub crawl around Clifton Hill, the city’s inner east, when the world suddenly went black after a high-speed hit-and-run. Tony found himself airborne, landing flush on the skull’s left side. The fracture injured his frontal and temporal lobes, the segments which store and retrieve verbal memories, such as words, numbers and letters. (Sadly, it is specific impact to brain sectors which guide us in fathoming the organ’s complex layout and function.)

“I’ve seen stroke patients,” says Sue Sloan, “who due to damage to a specific brain area lose the ability to recognize their wife, visually, yet as soon as she speaks she’s recognized.”

Emerging from a prolonged coma Tony thought he was in Indonesia, not a rehab unit in leafy Ivanhoe. The error was due to memory’s erasure immediately before and beyond the accident. (Jakarta was the stopover prior to Australia.) Here was a young tourist with no sense of place, a lapsed ability to read or speak, to use a phone, to understand money. Only a stalwart sense of the self lingered, bolstered by the deeper, long-term memory the brain had protected.

Tony’s family arrived from Scotland within a week – his father, his younger sister – all except Mum who remains terrified of flying. The reunion was tough on everyone’s emotions, and Tony’s synapses. He couldn’t speak his name – though he knew it. After six months of rehab, slowly assembling his broken pieces, rebuilding some language, Tony left the centre to stay at Hugh’s place.

Nadine Starritt, the occupational therapist assigned to Tony, knew the “talking, joking, independent traveler” of the past would need to redefine himself.

“One of the first practical tasks we did,” she recalls, “was to make a meal together. Tony was no great cook before the accident, but he chose to make lasagna.” The challenge embodied the Scot’s tenacity, and disarray. He “somehow managed to get a library card”, despite his new illiteracy, and rely on cookbook pictures to stalk the local supermarket. “He came home with five different types of meat - mince, sausage, salami…” It wasn’t lasagna so much as progress.

A string of medical visas allowed Tony to stay in Australia until just recently, year by year the patient gradually surfacing from the murk. “I have a different life,” he says, in his retained accent. “I’m Tony but a different Tony.”

Chatting with the bloke, you may miss the chasms in his memory, even now, four years since the collision. Survival has taught him to resort to “camouflage phrases”, where “this, that and the other” “blah-blah” and “like I say” are signals of fugitive terms and topics. Market, the word, took four minutes to find. While his own portable recorder is there to remind him of the day’s task or an errand’s purpose.

Remarkably, despite his shaky hold of text and time, Tony has been to restore elements of memory by turning to his film-making skills. “I wanted to meet people like me,” he says. So plans for a DIY doco were hatched. Fiona, his UK girlfriend, 28, took time off teaching in Newcastle to help her fella with the project.

Together they lined up interviews with brain-injury patients. I sit at Tony’s desk, watching the rushes on his iMac screen. A dozen faces talk to me – drowners, drug ODs, assault victims, road survivors – each one trying to measure what memory they’ve lost since their injuries. The sense is of a group of people relying on depleted anagrams of their inner selves.

“Brain injury is the invisible disability,” says Nick Rushworth, president of the Brain Injury Association of NSW, speaking into Tony’s camera. “People are much more content to be confronted by damage to a leg, an arm, a spine, than people whose behaviour might be challenging, or someone who won’t remember from one hour to the next.”

In figures from the Australian Institute of Health and Welfare, from 1999, there are some 338,000 Australians with acquired brain injury (ABI), or one in 50 among us. Stroke, car accident, alcohol abuse: the causes are manifold. Just as the consequences can vary from physical to cognitive. Of these, memory loss remains the least visible (and possibly most distressing) of this “invisible disability”.

Memory loss is a blanket term. You may forget your password, a movie’s sequence, but that is wear and tear, an overload symptom where the neurons struggle to file facts with security. Likewise dementia in its prelude state is a benign mode of forgetfulness that active learning and treatment can alleviate. Brain injury is a separate affliction. Where you and I lose the Japanese word for Sunday, the ABI patient loses whole months of Sundays that come to mark who they are.

Rebuilding – Gary Hyland, Bronte, NSW

At the prime age of 50, Gary Hyland took his first and last honeymoon to Cairns two years ago. He and wife Pauline, then 36, flew north to sample the tropics. “I remember just sitting on the cabin’s veranda, early one evening, and I felt a bite on my inner groin.” A hardy builder, Gary ignored the irritation.

Until that wasn’t possible. A week later, back in Sydney, headaches worsened, joints ached, spring sunlight grew too painful for his eyes. “I don’t get sick as a rule,” said Gary. “It was very abnormal.”

Doctors agreed. Showing drastic lows in sodium, the builder was rushed to Prince of Wales in Randwick. Delusions bloomed. Gary told Pauline a garage sale was setting up in Intensive Care and that their two little kids – Dan and Asha – might not be safe under a friend’s care. Blood tests ruled out meningitis, Legionnaire’s…The drama resembled a House episode without no promise of a happy ending.

Gary’s body entered septic shock. Medical staff induced a coma, when finally the blood gave up its secrets. “Scrub typhus,” explains Pauline. “It’s other name is rickettsia. Gary had the first reported case in NSW. Probably from a flea bite.” Two weeks later, fighting seizure, delirium, Gary awoke thinking he lay in a New Zealand bed – again a travel phase from the mid-term past.

“On the surface I still remembered things. Close friends came, I knew who they were. But as the more peripheral contacts arrived, or work-related questions cropped up, I had no idea. It was literally – who? What?”

More gaps opened as Gary found he’d forgotten the basics of walking, road sense, kitchen skills – what neurologists term procedural memory. “I had to retrain myself to ride a bike, make tea, bake bread. Even now [nearly 18 months on], I won’t need a bread recipe ten days in a row – and on day 11 I can’t for the life of me remember how much oil I need.”

Gary’s diagnosis is a neurological brain dysfunction, a catchall term for “more misses than hits” when it comes to recall. “The main difference is what I took for granted,” says Gary, now training as an on-site safety officer. “Before, my life just happened. I was athletic, coordinated, bright, everything came easy to me.” Deplete memory, and such ease falters.

“If there’s no trigger, I might talk to a person, who obviously knows me, and then I walk away and say, Who was that?” Or the opposite happens, when Gary gets overfamiliar with a mild acquaintance, or a total stranger. “Can be awkward,” he laughs now. “You register their faces, and you need to back-pedal.”

Learning how to learn again proved the biggest ordeal. “I’ll retrieve the most useless Wikipedia stuff, but not things I really need.” Like the left-right discipline of walking which took three months. While driving required a year, no car-trip now omitting a map.

“The day I walked to my local pool, 200 metres away, and began to swim unassisted – that was huge.” Since then, joining the Coogee Surf Club, Gary has gained a bronze medallion in life-saving, and last November the honeymoon victim dared to swim the 2.4kms around Wedding Cake Island………

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A second cake, to mark her 21st birthday, awaited Michelle Newland on the day she returned home – after two years of ICU, live-in rehab, a nursing home. The feat was due to the girl’s determination, and the ceaseless love of Ann, Vic and their close circle – as carers are the unsung heroes in all brain-injury stories.

Unsung as anguish is never too far away. During one earlier home visit, Shell sat panicky in Vic’s car, refusing to enter the house. “I went outside,” recalls Ann. “I said, Hi darling, come on inside. And then my heart sunk. Call it mother’s intuition but I realized she didn’t know who we were.”
Five years since the attack, Shell has regained whole rooms in her memory. Of course, regular chats with family and mates help, as do childhood photos papering the home. From a passive lump in aged care (lack of initiative a common brain-injury symptom), the girl has grown into a mobile, engaging woman, albeit with a mountain still to climb. Anne relates the challenge to dancing: “You need to step back as much as you can and allow your partner to make a move.”

Swallowing is a lapsed memory. Shell must remember to clear her mouth until the subconscious takes control. Eating is via a stomach peg, yet sit with Michelle and she will delight you with her wit and whimsy, an impish sparkle that doctors never foresaw. Not long ago, stunning all, Shell wrote in spidery script a list of adjectives to celebrate her Mum: Adorable, Beautiful, Caring, Delightful, Elegant, Fearless…

Contrarily, a medical truism predicts brain-injury patients won’t improve beyond the second anniversary of their accident. “Absolute rubbish,” says Sue Sloan. “A lot of early outcome studies were based on specific impairments, such as memory loss. They neglected the bigger picture, seeing how a person went about their life, compensating that impairment.”

“Well,” says Ann, at a special BBQ to celebrate five years since Shell’s brief death, “for a vegetable, Shell’s a beautiful, amazing vegetable.” The yard erupts with laughter. “A pink vegetable,” adds Ann, looking at her daughter in ravishing taffeta. “What’s a pink vegetable, Shelly?” and the girl grimaces to think. She ums, she stalls, she searches her brain for that slippery noun. And then she remembers. “A radish,” she blurts. The love and laughter is too much for one small garden.

[Sunday Life, August, 2007]