OxTravels

by Mark Ellingham

  Prior to the operation it seems some temporary brain damage had occurred as I made lewd advances (so I was later told) to a nurse in the hospital lift. Dimly I recall attempts at fumbling or lunging. Disinhibited sexual behaviour is a consequence of brain injury; as well as lewd, my movements had become uncoordinated and my pupils non-reactive as I drifted into unconsciousness.

  For two weeks I lay in the hospital’s neurosurgical unit with attendant memory loss and a degree of intellectual and physical impairment. My head hurt like hell and my right arm had gone blue where the Sisters of Mercy ministered their morphine jabs. Lying in the public ward, unable to do anything, I was nevertheless filled with relief at having pulled through. Each day I was visited for therapy by my surgeon, the quaintly named Professor Milza (Professor Spleen), and a group of trainee doctors. ‘And how is our Englishman today?’ Tests for hand-eye coordination involved a spatula pressed against the tongue and noting pupil dilation with a pencil-torch. Tests for mental alertness met with less success. With every incorrect answer I gave to my times tables in Italian (in fact there were no correct ones as maths is hard enough for me even in English), the doctors cast each other nervous glances and moved on to the days of the week instead. Here I encountered few difficulties as my spoken Italian had by now become unaccountably fluent. ‘Very impressive,’ Professor Milza raised an eyebrow. ‘It’s hardly the Berlitz method, but a blow to the head can certainly work wonders.’

  In the men’s ward with me were motorcycle crash survivors and victims of brain tumours and physical assault. As nuns and other paramedics were rarely to be found on duty at night, visitors were allowed to sleep in the wards. After midnight my flatmate was prevailed on to run all sorts of errands from procuring pain-killers to raising the alarm whenever an incontinent lost a catheter. ‘Signorina, signorina!’ the men beseeched her. Cries for help came in particular from the patient they called Luigi ‘Sure Thing’, a huge and porcine man whose habit was to break wind quite loudly after lights out. For such a visual phenomenon, Luigi had a small voice and quiet manner. Every day three women relatives of his would visit from Naples, all of them dressed in black and the oldest with a faint soupçon of a moustache. In a parody of the Adoration they would prostrate themselves before Professor Milza and even offer him foodstuffs. It was as though they divined a power in him of life over death. But Luigi was not long for this world. One awful day screens went up around his bed, and we never saw him again.

  From the solitude of my sickbed I took in the incredible sights and sounds around me. Food was usually a stew of fish and rice submerged in oleo-margarine, or else half-boiled lumps of pork gristle, soft and tallowy, which we patients resignedly referred to as grasso di rinoceronte (rhino-fat). On a good day we might find a few currants peeping from the pudding. One evening we were eating the pudding as usual in respectful silence as though a coffin were in the room, when a patient yelled out loud: ‘Oh what is it? I not taking fucking this stuff!’

  We all lowered our spoons. Mustah, a young Tunisian, was not right in the head after someone had assaulted him with a hammer. A great scar like a railway track ran jagged across his right temple. In his post-traumatic delirium he believed his mother and sister had been replicated by duplicates who looked exactly like his real relatives. ‘Ho paura di nessuno!’ (I’m not afraid of anyone!) he would yell at the nuns in broken Italian. Was Mustah suffering from Capgras delusion, a florid neurological syndrome caused by damage to parts of the brain which specialise in face and object recognition? Dr V.S. Ramachandran, in his influential book Phantoms in the Brain, suggests that Capgras is most commonly the result of traumatic brain injury.

  In response to brain injury, neurons may reorganise and re-map themselves in the most peculiar ways, altering the circuitry which was laid down in foetal life. Abnormal remapping in the wake of tumours, strokes, epilepsy, head injuries and other causes of brain trauma can give rise to absorbing neurological puzzles. Lord Nelson had experienced the most compelling phantom limb pain after the loss of his right arm in 1797 at Santa Cruz de Tenerife. The sensation that his fingers were digging into his non-existent palm led him to believe in the existence of the spirit after death. (If an arm can exist after it has been removed, why then should not an entire person survive annihilation of the body?) In terms of modern scientific revelation, the sea lord’s neural connections were trying to make sense of the pain of the injury, only the wiring had gone awry.

  As my brain began to adjust to the blow and the cells made new connections, I marvelled at my sickbed fluency in Italian. True, I had been trying to learn Italian prior to surgery, but that hardly explained my untutored brilliance in a language I previously spoke poorly if not at all. Though quirks of language are not uncommon following brain injury, speech restitution in neurological patients is still not fully understood. We still have no clear idea how the brain itself even works.

  A WEEK INTO my stay, and the men’s ward had become so stuffy after the air-conditioning broke down that a nurse suggested I sleep on the roof. A makeshift bed was set up for me on the terrace overlooking San Giovanni basilica and its stone statues of Christ and John the Baptist. A frozen late October light hung over the church with wisps of mist off the statues. Disquietingly, the terrace had been hemmed in with high mesh wire to prevent suicidal patients from jumping off, a not uncommon occurrence. One day I saw a group of patients in pyjamas running like mad towards the Egyptian obelisk in the middle of Piazza San Giovanni. Perhaps they were making a break for freedom; a handful hopped on board a public bus. Their hare-brained escapade cheered me.

  A few days later Professor Milza informed me that I was ‘clinically recovered’ and it was time for me to leave. Having regained much of my physical self-confidence I walked out of the hospital on the arm of my flatmate and hailed a taxi, bearded and no doubt unrecognisable. A week later, wonderfully, it was snowing in Rome – the first snowfall in ten years. Flakes were falling over St Peter’s like down from a pillow fight. I was convalescing steadily in my flat on Via Salaria when, wedged behind a cupboard, I found an X-ray of the previous occupant showing a fractured skull. The coincidence seemed extraordinary: had he too suffered a blow to the head? That night I dreamed that an intruder had hit me on the head just to watch the life run out of me. In a fright I took the next plane home to London. It was New Year 1985; a black January.

  A quarter of a century has now passed since the surgeons of San Giovanni contemplated the fall and rise of their Rome patient. Since then I have often dwelled on the circumstances of my injury and relived it too in dreams. For twenty-five years in fact I have wanted to thank Professor Milza belatedly for restoring me to life; but first I felt I needed to return to the scene of the accident.

  VIA SALARIA IS a wide airy street of nineteenth century tenement blocks near Termini railway station. At all hours the station mills with hustlers and migrants from the Philippines and Africa. Had my assailant come from here; or had I fainted and lethally banged my head? On the brass plate outside 195 Via Salaria, to my surprise, was the surname ‘Belluci’: twenty-five years earlier, Remo Belluci and his wife Raffaella had been the caretakers here. Were they still in business? I pushed the bell, and heard it ring inside far off. A wary-sounding voice answered: ‘Who is it?’ I explained my presence; yes, said the voice eventually, this is Raffaella. She remembered me all right; she remembered the night the ambulance came.

  I walked in past the porter’s lodge to a familiar-looking inner courtyard with washing hung out to dry and green-shuttered windows. Raffaella was waiting for me outside an apartment stairway. ‘Nothing’s changed much since you left,’ she said; she looked more careworn than I remembered, her hair dyed a smudged blonde. Solicitously she held the door wide, and I went in past her to a dim interior with an old-fashioned lift cage. A smell of frying hung on the stairs. We took the lift up to flat number 18, four flights up, where I used to live.

  I HAVE ONLY ‘islands of memory’ of what happened that autumn day in 1984, n
o consistency. At about 3 p.m. on the afternoon of 17 October Italo Calvino telephoned, and soon afterwards came the ‘thud’. And then what? A sensation of dizziness took hold as I tried to sit for a while on the marble steps on the landing outside the flat, my vision blurred and a taste of copper rising salty in the mouth. At a certain moment I must have tried to orientate myself back indoors, leaving the handprints of blood on the walls and floor as I did so. During semi-lucid intervals I remember the most excruciating headache.

  Gilly’s call for help had been relayed via the police emergency number 113. Owing to rush-hour traffic it took an age for the ambulance to arrive. When it arrived, the orderlies apparently had difficulty fitting me in the back as one of the doors had jammed. As they struggled with the door, Signor Belluci the caretaker made an appearance and, pointing to the casualty on the stretcher, exclaimed: ‘He’s overdosed! That’s why he’s gone all yellow.’ His face above me flashed a spectral white and blue from the ambulance beacon.

  My flatmate rode with me in the ambulance. At the Policlinico near Termini station they wheeled me in for neurological assessment, but the hospital lacked the technological know-how for conclusive diagnosis. Time was running out fast. At a subsequent hospital, the Nuova Clinica Latina, a prototype computer scanner with the user-friendly acronym of PET (positron emission tomography) took rapid cross-sectional images of my brain. These showed hyper-dense bleeding within the brain cavity, contusions at the brain-bone interface and a fracture in the lower left rear region of the skull. The fracture indicated the presence of a high-speed impact of some sort.

  Plainly I was a neurosurgical emergency yet precious hours had been lost in trying to locate a suitable hospital. The last my flatmate saw of me before surgery was as a group of white-coated orderlies rushed me down the corridor at San Giovanni to the operating theatre. ‘Stai ferma!’ they shouted at the terrified girl. ‘Stay right where you are!’ Eight hours were to elapse between the proximate time of the injury and the operation. The prognosis then was: ‘Coma oppure morte sicuro’. Coma if not certain death.

  RAFFAELLA UNLOCKED the door to my old flat, and I followed her in to a small pleasant hallway. The smells I knew so well from long ago – a compact of old carpet dust and camphor – hit me forcibly and it was as though I had never been away. The phone was still in its place up on the wall by the front door and the kitchen’s blue majolica tiles had not changed. The current occupant was away, yet the flat showed no sign of occupancy since I had left it. There was something mournful about the place – sad and lone. I thought of the unexplained mystery of the X-ray.

  Raffaella said, pointing at the front door: ‘I know what people say: a burglar came in and hit you.’

  ‘That’s what the police thought – I mean they didn’t rule out the possibility of third-party involvement. What about you?’

  ‘Who knows?’ Raffaella answered with a shrug. ‘There are too many things that could have happened.’

  I nodded but said nothing. In the hall by the phone I noticed a low, marble-topped table with sharp-looking edges. Had I fainted and banged my head against that? I do remember drinking a quantity of wine that lunchtime; fully half of traumatic brain injuries involve alcohol: perhaps the wine had done for me? Next door, at number 17, Signora Romaldini might have remembered something, said Raffaela, but she was in no fit state following recent diagnosis of a brain tumour. Disappointed, I walked off into the autumn night, not much the wiser, the sky above Via Salaria stained red from the harvest moon.

  PIER GUILIO MILZA was forty-seven when he operated on me in 1984, a little younger than I am today. Time had moved on fast yet I felt humbled to meet him again. Extending a hand, he said: ‘I remember you very well.’ Thrilled, I made him a gift of a bottle of Talisker malt whisky and (poignantly for me) a copy of my biography of the Italian writer and chemist Primo Levi. ‘I couldn’t have written this if you hadn’t saved my life,’ I said, meaning it.

  With his brown eyes attentive behind half-moon spectacles, Professor Milza struck me as a man of old-fashioned courtesies. He had retired from San Giovanni eight years ago, in 2002; we met at his private consultancy off the Via Appia Nuova. The walls were hung with diagrams of the optic nerve and of the brain in cross-section like a pink cauliflower. Noting my interest, Professor Milza said the brain accounts for just two per cent of our body weight, ‘yet its electro-chemistry works so hard that it burns up a fifth of the food we eat.’ As he spoke, morning sunlight filtered through slatted metal blinds.

  Such was the severity of my injury, the professor reminded me, that it ruptured the transverse sinus vein at the base of my skull. This vein receives blood from all zones of the brain, and its rupture can cause an insidiously slow build-up of venous blood in the brain cavity. In lucid intervals the subject may act and feel as if nothing potentially fatal had occurred. In 2009 the actress Natasha Richardson died of a seemingly mild head injury after a fall in Canada while skiing. At first she appeared unhurt, but then she developed a headache and was subsequently brain-dead on arrival at the hospital. ‘You were very lucky,’ Professor Milza said to me, adding: ‘It was a very close brush with mortality.’ Forty per cent of acute epidural haematoma cases are expected to die. At twenty-three, though, one is unprepared for so terminal a judgement. I had my life before me; death seemed an impossibility.

  For all the suffering it causes, some neural damage remains darkly hilarious. In 1931, in a famous case, a London plumber named Willy Anderson was seen to attend his adored mother’s funeral only to start giggling as the gravediggers lowered her coffin. Eventually he staggered off among the gravestones audibly guffawing. Later that evening he died of severe subarachnoid haemorrhage. At the time his behaviour was thought to be inexplicable (as well as highly inappropriate). Yet mind science has moved on immeasurably since then; brain damage that sets us giggling inappropriately is now known to be located in the hypothalamus area.

  Death by laughter might have resulted when I was interviewed for a job in London two years after my injury, in 1986. By then I had had a cranial plate fitted to protect my neural circuitry. (‘You are missing some bone and therefore less thick-skulled than before,’ Professor Milza had told me, charmingly.) Once more, surgery had left me without hair, exposing a scar. Melvyn Bragg was reading the previous candidate’s application when he looked up. ‘Good God! What have you done to your head?’ Needless to say I did not get the job.

  With the hindsight of twenty-five years, I still do not know for sure if I was hit on the head in Rome, but I believed it then. I remember a week later thinking that I could never be the same person again, as a head injury is an injury for life. After writing this article, and made anxious by Professor Milza’s talk of lingering brain impairment, I went for a check-up at the National Hospital for Neurology and Neurosurgery in Queen Square, London. My head was glued with electrodes as rolls of chart paper registered my firing brain cells. The frequency readings for the alpha rhythms were good; in medical terms at least I appeared to be ‘neurologically intact’ and I needed further surgery like a hole in the head.

  Cures for Serpents

  CHRIS STEWART (born Horsham, 1951) is the author of Driving Over Lemons, the story of how he bought El Valero, a peasant farm in a remote Andalucian valley. It has been a bestseller in both the UK and Spain, along with its sequels, A Parrot in the Pepper Tree, The Almond Blossom Appreciation Society, and a sea-going prequel, Three Ways to Capsize a Boat. In an earlier life, Chris was the original drummer in Genesis. He still lives at El Valero, with his wife Ana, and from time to time their student daughter, Chlöe. www.drivingoverlemons.co.uk

  Cures for Serpents

  CHRIS STEWART

  High in the Alpujarras, a four hour walk uphill from our farm, through the wildest of mountain scenery, lies a village which is blessed by the presence of a curandera. Which is to say something between a faith healer and a barefoot doctor.

  As a nation dons the cloak of modern urban existence, such people and their a
ncient gifts tend to vanish, but in the Spanish countryside today the tradition is very much alive. If anything there has been a resurgence in recent decades, now that they can practise without persecution. In Franco’s time, curanderos were frequently beaten and jailed by the Guardia Civil at the instigation of his henchman, the Church – who, typically, felt that the monopoly on miracles should be theirs alone.

  Now our local curandera was on my mind because I had just heard a story about a London journalist who had been on holiday in her village. The poor man suffered from eczema, and, hearing about the curandera and her particular gift for curing skin diseases, was intrigued enough to pay her a visit. Within three days she had cured his eczema, simply by stroking the affected part. Fascinated and impressed, and of course enormously relieved, he wrote the episode up in his column. This came to the notice of a man who was unfortunate enough to have shingles in, of all places, his eye. The doctors had told him that there was nothing they could do and he might as well get used to the idea of losing the eye. He made some enquiries and came to the Alpujarras, where, after three sessions with the curandera, the shingles simply disappeared.

  Of course, there are plenty of stories like this but they are not necessarily about healers in your own backyard – and it was the backyard aspect of the story that got me thinking. For I myself had been suffering from a skin complaint, albeit – unlike the journalist and his follower – neither shingles nor eczema. No. My complaint was of an altogether more delicate nature – and afflicted that part of my person of which we do not speak.