Prognosis

by Vallance, Sarah

  Two types of amnesia affect people with traumatic brain injuries. Retrograde amnesia affects memories of events that occurred before the accident, while anterograde amnesia affects memories of events that happened after the injury. My head injury left me with difficulties remembering things that happened before and after the accident. But my greatest problem with memory has been locating an event at a particular point in time.

  It isn’t uncommon for people who have suffered traumatic brain injuries to experience clouded autobiographical memory, in which certain events can be recalled quite clearly while others are seemingly lost forever. The more poetic term “islands of memory”11 has been used to describe detailed memories that can be located in time and space (when and where). These are memories that appear “in an ocean of forgetting.” Autobiographical memory combines recollections of events, episodes, objects, and people at a particular time and place, along with a general knowledge of the world and its events. For much of the two years between my father’s death and my accident, and for the year or so that followed, it seemed to me that random events had been documented on small strips of paper and thrown inside a hat for a lucky draw.

  Emotion is one of the most important factors that allows autobiographical memories to be encoded and retrieved. Events that are emotionally charged, like getting married or losing a parent, are much easier to remember than the mundane comings and goings of daily life. That explains why my memory of the months leading up to and including my father’s death is so clear to me, and also why I can remember my accident, my visit to the hospital the day after my accident, my session with the psychologist at the Brain Injury Unit, and the conversation with the neurologist when he told me I would not be returning to work. Those were the most powerful events I had ever experienced, and they changed my life irrevocably. My memory of the time I spent teaching myself to write and read and interpret information is also quite clear, perhaps because it caused me such distress.

  While writing this book, I spent months with pen and paper trying to piece together events in the order in which they occurred, but it has been like trying to create a wall-sized fresco with a single box of tiles. Placing that trip to Southeast Asia within the broader story of my life became impossible, until I found the passport.

  I do remember a birthday card my mother had sent me in the mail, which I must have received when I returned from that trip. “Happy birthday, Sarah, from Hilary,” the card read. Enclosed was a check for $200. I went straight to the bank and cashed the check. The best wine shop in Sydney was only a few doors away from my house, and I planned to spoil myself. When I started my doctorate, I had received a generous scholarship for my research, which covered the costs of my travel, but my disability pension was swallowed up each month by groceries, bills, and the fresh mince George liked to eat.

  I returned home with the wine, and called my mother to thank her for the money.

  “How are you?” she asked.

  “I’m fine,” I said. “How are you?”

  “Fine. Good, well bye,” she said, and the line went dead.

  I do not remember how much time passed after I returned home from that trip, before I decided to find a job. I needed to resume some approximation of a normal life, and I was running out of money. I do remember my job-hunting experience, even though I cannot place it in time.

  One Saturday morning, I walked across the road from my house to the newsstand and bought the Sydney Morning Herald. I flicked past the news section and found my way to the jobs section. The first posting that looked even remotely suitable was for a policy director with a nonprofit organization in aged care. I tore out the ad and studied it closely. It seemed like a job I could handle, but I hadn’t gone through an application process in years. I needed a CV and a cover letter, and it took me most of the day to prepare them. I found an unused envelope, wrote the address on it, and checked my application three times. The brain-damaged me spent a lot of time checking and rechecking things. A good thing too, as I often found I had forgotten something or made an error that had eluded detection not once but seven or eight times. Once I was satisfied, I walked to the post office and mailed my application.

  On Tuesday morning I received a phone call inviting me to interview for the position that Thursday. The efficiency of the nonprofit sector surprised me. In government, seasons would pass before anyone got called for an interview. The quick response sent me into a panic. I studied the ad again, phrase by phrase, and started making notes. I imagined questions I might be asked based on each sentence in the job ad and scribbled them down inside a notebook. I wracked my brain for short, sharp answers to each of the questions. Hours after I had written down as much as I could, I went into the bathroom, taking the chair from my study, and sat down opposite the mirror. I practiced my answer to each question, looking intently at my reflection for any possible signs of brain damage. My habit of dribbling had stopped, and as long as I remembered to keep my mouth shut, I hoped I could pass as normal. I spent the evening in front of my bathroom mirror practicing, and eventually I seemed able to create a reasonable likeness of a person with a healthy brain. I tried to affect two expressions that might fool someone into thinking I was intelligent: The first involved a long (but not too long) serious look, a look of focus and concentration. The second was a look of mild curiosity, a look of interest but not eagerness.

  The next day I sat on the sofa and pretended George and Bess were my interviewers. I spent the day going over every question and every answer. It had been so long since I had talked to anyone that I had lost the art of conversation. Now I needed to get it back. Fast. I repeated the answers again and again until the words came out in the right order. My plan was to go into the interview with my notes scribbled inside my diary in case I got stuck. I smiled at my dogs in turn and took my time to answer.

  I decided the best approach was for me to say as little as possible. To think about my response and answer each question succinctly. A long, rambling response would almost certainly give things away. Offer the least amount of words you can, without being too miserly, a voice inside my head told me. No one is ever thought to be a fool by keeping quiet. What am I doing? I wondered. Am I ready for this?

  Absolutely not.

  Four people sat around a large conference table. The convener was an attractive woman who looked to be only a couple of years older than me; she wore frameless glasses and her hair in a bob. Her name was Rita, and she was the boss. An older man began asking questions, quizzing me about my career, my approach to developing policy, and the concepts behind aged care. I knew very little of aged care, I confessed, but it was an area I considered critically important. They seemed to swallow it. I went one step further—too far, perhaps—and told them that nursing homes have a lot in common with prisons.

  Four confused faces peered back at me. I had blown it. I had likened old people to criminals.

  “Not in terms of their patrons, of course, but in terms of their management,” I added, after an awkward silence.

  “Ah, yes, I suppose so,” a man who represented the Alzheimer’s Association said, and the others nodded along. “I’d never thought about it like that,” he added.

  So, I had almost blown it but not quite. I had managed to think on my feet. That in itself was an astonishing achievement.

  The interview lasted a very long time. I remembered to clamp my mouth shut when I wasn’t talking and to offer a half smile, to remind my interviewers I was human. I did my best to look intelligent, alert—but not too alert, for fear of looking crazed—and to ponder each question before I responded. It was a lot to remember, and I feared I might not be able to avoid looking like a moron. This was a serious job, and realistically I didn’t stand a chance—my only offer of work since the accident had involved cutting up fabric for stuffed toys. Yet there I was being interviewed for a job in an office. I tried to banish that thought from my mind and focus on Rita, who was telling me about her goals for the year ahead.

  The
interview finally drew to a close, and Rita asked me about my salary expectations. I was dumbfounded. I had no expectations of anything much, including salary. I did not tell those kind, good-natured people that I was the recipient of a disability pension from the Australian government thanks to my badly damaged brain, and that anything they offered was likely to be a significant improvement.

  Instead, I told them what I’d earned in my last job, an amount that struck me as stratospheric. Rita looked at me apologetically and said that they could only go to $80,000. That was their limit. That was fine, I answered. I wasn’t motivated by money. I was motivated by an intrinsic desire to improve the lives of the elderly.

  I was also motivated by a mission to repair my brain and get my old life back, although I left that last part out.

  Surprisingly, no one asked for references. That was a relief. After Rosie the social worker told my last boss I was brain damaged, I never heard from him again.

  The following afternoon I received a phone call from Rita.

  “Hi, Sarah, I wanted to tell you how impressed we all were by you yesterday, and to offer you the role.” I covered the mouthpiece to hide my squeal.

  “Oh, that’s wonderful news. Thank you!” I said, trying to compose myself.

  “Can you start work next week? We have so much work to do.”

  “Next week is fine!”

  “I’ve got your address. Do you mind if I drop off your contract and some materials for you to read? I live nearby.”

  “Of course! Thank you.”

  I hung up the phone in shock. I had found a job. The only job I had applied for. It was unthinkable. I had survived a one-hour interview and no one had noticed my damaged brain. I was ecstatic. I was also terrified. The woman in the park had been right.

  Before my accident my career had thrived. At university I had won prizes, and I had held a series of senior jobs; I looked good on paper.

  By the time I was thirty, I was earning nearly the same money my father had earned when he retired from the University of Sydney. My father had argued vigorously against my decision to study government at university. He told me once, when I was a teenager, that he hoped I would become a scientist. He was passionate about science and nature. He was also slightly delusional. The fact that I played the violin and went to the Conservatorium High School—which didn’t even teach science—and that I struggled with basic math meant science was not a viable option. When I pointed that out to him, he sighed, “You might be right.” It saddened him to think that I was missing out on something extraordinary, something that had given his life meaning and a sense of purpose.

  I had already learned the hard way that letting my parents make decisions about my future was a mistake. My mother, for some inexplicable reason, wanted me to be a violinist. Although I loved listening to the violin, I hated playing it, and, it turned out, the violin did not like me much either. That wasn’t enough to deter me from applying for a place in the Conservatorium High School. Terror—coupled with my mother’s prodding—had been my primary motivations for applying. There was a bully at my primary school who had threatened to kill me if we ended up at the same high school. We lived in the same catchment area, so there was no way to attend public school and avoid her. I had never even spoken to the girl when she chased me home for the first time. One day she waited for me outside the school gates wielding a bicycle chain. I lived in constant fear, and when my violin teacher told my mother that the Conservatorium was holding auditions, we all agreed I should apply.

  The Conservatorium offered a limited academic curriculum, and for the last two years of high school we had to choose between studying French, German, and art. I had topped my class in art the year before and, after English, it was my favorite subject. My father thought art was a waste of time. He wanted me to study French. I was terrible at French, but my father was insistent. In the final exams I managed somehow to scrape through with a passing grade. If I had kept studying art, my results would have been much better. Not to mention I would have spent two years studying something that interested me. By the time I was seventeen, I decided that I would make all future decisions about my life. It turned out that I sought my father’s advice on almost every one of those decisions. Occasionally, I chose to ignore it.

  And while I felt confident eschewing his chosen path of natural sciences, he wasn’t alone in thinking the study of government would guarantee any graduate’s unemployment for many years to come. For a while I worried he might have been right. But I was lucky, and a good job came along before I had even graduated.

  “You have made some truly baffling decisions,” he said to me once, with both eyebrows raised, “but you have managed to land on your feet. You have forged your own way and done everything on your own terms. Few people can boast that. I am very proud of you, Pod.”

  My father grew up in a prefab house in a working-class suburb in the south of Sydney. His father was a milliner, a worker in someone else’s hat shop. When my grandmother died at twenty-six, my grandfather was left alone to raise two young boys.

  Every Saturday when I was a child, my father used to drive me across town to visit my grandfather. The house had not been refurbished in the sixty years since it was built. The floors were covered with the original brown linoleum that curled up at the walls in protest or rose to a peak, tsunami-like, in the middle of the floor. My grandfather seemed to know every crack and peak in his floor, and I never once saw him trip. He kept the house dark to save electricity. I remember when sewage pipes were finally laid in the street and a toilet replaced the large steel tin in the outhouse, which was emptied every morning by someone known as the nightsoilman.

  My father had survived a nasty bout of polio and a year in leg irons when he was six. He did well at school and was the first member of the family to go to university. He won the university medal and then a Fulbright. After a year at Berkeley, he returned to a teaching job on the faculty at the University of Sydney and finished his PhD.

  There was never any question in my mind that I would do a doctorate. My father had one, my brother had one, and not to be left out, I would get one too. Not doing a PhD would only confirm my mother’s vocal doubts about my intelligence, or so I felt. My father and brother had enjoyed the luxury of full-time study when they did their doctorates, but I worried that a full-time PhD would stall my career. I also had a mortgage to pay down. Part-time study seemed the only practical option.

  My thesis topic was “The Influence of Culture Upon Administrative Practice in Singapore, Thailand, and the Philippines.” It was an odd choice given that Bangkok was the only city in Asia I had ever visited, and I had stayed there less than twenty-four hours. But during that brief visit, something inside me had been awakened. I had never experienced anything like the clamor and smell and chaos. Bangkok was home to some of the most delicious food I had ever tasted. I was eager to learn and experience more; I wanted to go back, and not just to Thailand.

  When I read about a scholarship for doctoral students that covered the costs of field research in Southeast Asia, my ill-advised topic seemed more like a brilliant destiny. The timing was perfect. I submitted an application and months later received a letter in the mail and a generous check.

  Not long after I returned from my first field trip to Southeast Asia, after hearing about my father’s cancer, I made the mistake of asking him to read the first two chapters of my thesis. He delivered them back to me covered in red scribbles, his glasses resting on the tip of his nose.

  “How on earth are you ever going to manage this?” he asked.

  “What’s wrong with it?” I asked indignantly.

  “I don’t know where to start,” he said.

  And that was well before my accident, when I was still in possession of a healthy brain.

  Before he died, my father told me I was the only person who had ever stood up to him. The only person who had dared. He was proud of me for making my own decisions and sticking to them.

  �
�You have guts,” he said. “You really do.”

  “I am fearless,” I said, and I meant it at the time.

  “You are,” he said, and smiled.

  A better word might have been reckless.

  I cannot determine exactly when I started my new job in aged care. I don’t have any helpful records to assist me, nor was I in contact at the time with any friends or family who may have been able to recall on my behalf. My best estimation is that my first day occurred around ten to twelve months after my accident—making it either toward the end of 1995 or the beginning of 1996.

  What I do recall is that my new workplace was nothing like my old one. I had traded prized office space in a building overlooking the Royal Botanic Gardens for what appeared—from the outside at least—like a dental surgery, the kind where a person might feel the need to remind the hygienist to use clean gloves. The office was situated above a sandwich shop, and the atmosphere was relaxed, the people friendly. There were no men in suits. No men at all, actually. I was shown to a room, which was more of a cubby than an office, with three plasterboard walls, a glassed wall at the front, and a glass door. Inside the room was a desk that faced the glass wall, a chair that swiveled, and a stack of metal filing cabinets. It was perfect. I had landed a job that didn’t require me to cut up fabric for stuffed toys or sweep leaves in a park.