THE BEST THING—and possibly the only good thing—about the day of the surgery was meeting my new Trinidadian neuropsychologist, Dr. Nicole Thomas-Ramparsad.
When she first arrived, a nurse was beginning her third attempt at starting my IV. “The problem,” the nurse was saying, “is that you’re so tense.” She tapped my arm some more with the pads of her fingers as if to say, See? Nothing. “You’ve shrunk your blood vessels.”
I peered at my arm like I might be able to help her find one. “You need to relax,” she told me.
“I agree,” I said, trying to slow my breathing down from hummingbird rate.
She added a second tourniquet. “When we get scared, our bodies pull all our blood into our core to protect the vital organs.”
Relax, I commanded myself. Relax.
“Look at these veins,” she called to another nurse, tapping around some more.
Nurse Two came over for a peek, giving a little headshake at the sight. “They’re like quilting threads.”
That did not sound like a compliment.
“She can’t get this over with until you relax,” Nurse Two said to me, a little scoldy.
“But I can’t relax until it’s over with,” I said, aware of the Catch-22. “Are you always a difficult stick?” Nurse One asked.
I wasn’t loving that terminology. It made me sound uncooperative at best. But there was only one answer to that question. “Yes.”
Nurses One and Two exchanged a look.
I tried to defend myself. “This is just how needle situations usually end for me—with tears. Or dry heaving. Or fainting.” At the words dry heaving, I could feel my veins shrinking a little smaller.
Relax, damn it. Relax!
But that’s when my future new favorite person walked in.
And let’s just say she brought a totally different energy to the room.
Dr. Nicole Thomas-Ramparsad didn’t just walk in, she strode—greeting me loudly as she did, her voice warm and rich. “Hello,” she practically sang. “You’re Sadie Montgomery, and I’m so delighted to be working with you today.” And with that, she put a firm, comforting, totally-in-charge-of- the-moment hand on my shoulder, and said, “Please just call me Dr. Nicole”—pronouncing her name like Ni-call.
Let’s just say her doctor voice sounded nothing like my dad’s. Which was a very good thing.
Because her voice—warm and motherly and confident—absolutely took over the room. She was such a big presence that she eclipsed everything else. It’s important to note that she, in her light blue scrubs and surgical hat, looked pretty much like everybody else who worked in that hospital. She shouldn’t have stood out like she had her own personal spotlight.
But she did.
Maybe it was her big fearless smile. Or the warm glow of her tawny skin. Or the laugh crinkles at her eyes. Or her tall posture, like she was the number one grown-up in the room. Or the fact that she seemed about the age my mom would be now, if she had lived.
Whatever it was, she appeared—and then positively hijacked my consciousness, leaning in close, squeezing my hand, and telling me more about herself in the first five minutes than most doctors revealed in years: She’d come to Houston from her hometown of Port of Spain, by way of McGill University in Canada—originally training to be a neurologist before getting fascinated with neuropsychology and switching tracks, much to her parents’ chagrin, since psychology was not a “real” science. Her favorite types of music were calypso, soca, and steelpan, because they reminded her of home and made her feel peaceful. Her favorite flower was the bird-of- paradise, which “grows like weeds” in Trinidad. And she made the best coconut bread in the world, if she did say so herself.
“I’ll bake you a loaf sometime,” she told me. “Thank you, Dr. Thomas-Ramparsad,” I said.
“Dr. Nicole,” she corrected, patting me on the arm.
And that’s when I looked down and noticed that Nurses One and Two were gone, and the IV was already taped happily in place like there had never been anything difficult about it.
Oh god, she was a genius. Bless her.
Anyway, I adored Dr. Nicole from that moment on—instantly, the way a teenage girl might love a pop star. I would’ve gladly hung a poster of her on my wall.
After the IV, everything got easier—especially since there wasn’t much for me to do. Also, since pretty soon I started feeling like my blood was made of maple syrup.
My dad scrubbed in for the surgery by the way—and it wasn’t lost on me that this was the first thing we’d done together in years. A little father- daughter time.
At last, something about my life he could get interested in.
Hospitals have an unfortunate need to explain in advance exactly what they’re going to do to you, and Dr. Estrera was no exception. When they had me good and sedated, he gave me way more information than I wanted or needed about how—and please prepare yourself for these coming words
—they would use a skull clamp to pin my head to prongs on the surgical bed, leaning me forward and to the side so they could access the right spot, and then erecting a plastic tent around me so the surgeons could see only the area of my skull they needed and nothing else.
Hell of a to-do list. But it made sense.
A disembodied patch of skull was probably far easier to drill a hole into than, ya know, a person.
Next, they’d wash my hair with Betadine solution to sterilize everything, and then they’d comb it with a sterile comb, and then they’d shave just the tiniest bit, and then they’d cut and peel a flap of my scalp back … and then they’d drill a four-inch hole in my head.
Like they were going ice fishing. No big deal at all.
 |
I STAYED IN the hospital for the full four days after surgery, which made me feel like I was getting my money’s worth.
I took a lot of naps. I slept partially sitting up on a bolster pillow to help with drainage. I ate a lot of Jell-O and wondered why I’d never appreciated it before.
The incisions in my scalp were sore for several days afterward. I had a few headaches and some shooting pains from time to time near the wound. My eyes got swollen enough that Dr. Nicole suggested I avoid the mirror for a while. All normal postsurgical stuff.
All in all, I felt back to my usual self surprisingly fast. The doctors were impressed with my resilience, and they chalked it up to my “youth and good health.” I took full credit for both. I even caught myself wondering if I was doing my dad proud.
By Sunday, my last day there, I was feeling so good, I felt silly for the way I’d resisted the surgery. In fact, I felt so good so fast, I had to remind myself I was an invalid.
I was just getting discharge instructions for the next day—things like no alcohol, no driving for three weeks, no ladder climbing for three months— when a stranger came to visit me.
I mean, I’d been surrounded by strangers that whole week—nurses in bubble-gum-pink scrubs coming and going, checking stitches, vitals, surgical tape. Those pink scrubs really gave the whole staff a very uniform vibe.
But this stranger wasn’t in scrubs, she was in street clothes. She came right in and pulled up a chair, and I remember wondering if she was maybe a social worker or even a reporter doing some kind of piece on cavernomas.
Maybe she’d ask me to star in a documentary. I wondered what people got paid for that.
But that’s when she started talking.
And as the words accumulated, I started wondering if she really was a stranger after all.
“I came the first day,” she said, “but you were so out of it. And then Witt’s grandma got sick, so we had to drive to San Antonio to check on her. But don’t worry, I boarded Peanut at that vet clinic around the corner from your place. Which is probably better, anyway, because Witt’s pretty allergic, and he was being a great sport about it, but his eyes were, like, watering and
itching the whole time. And that new clinic is awesome—though I know you like your old place. They’ve been sending me photos from the pup cam, and I think Peanut might have struck up a May-December romance with a Pomeranian.”
She paused for a laugh, but I just said, “What?”
I mean, why was this person talking about Peanut? Or Witt, for that matter?
The stranger leaned in a little. “What about what?” “What about all of it?”
We blinked at each other.
And that’s when something impossible occurred to me.
This total stranger … was talking like she was my best friend, Sue.
I cannot describe the intense cognitive dissonance of suddenly knowing those two opposite things at once. But there was no other explanation. I was clearly sitting across from a person I did not know … and she was clearly saying things that only Sue could say.
It’s fair to say that got my full attention.
Up until that point, all the other people who had moved through my room had been background noise. I’d taken them all for granted as I focused on postsurgical adventures like taking my meds, healing my incision, and shuffling back and forth to the bathroom.
I guess everything at the hospital had been just … as expected.
But then in came this person talking like Sue. And forced me to notice that she didn’t look like Sue. Which forced me to try to figure out what she did look like.
And that’s when I realized that I had no idea.
I mean, this lady in front of me had facial features. I could see them if I tried—one at a time. Eyes. A nose. Eyebrows. A mouth. They were all there.
I just couldn’t snap them together into a face. Any face at all. Least of all Sue’s.
“Sue?” I asked.
“What?”
“Is it you?”
“It’s me,” she said, like it might be a trick question. “What did you do to your face?”
I saw her lift her hand to it. After a second, she said, “New moisturizer?”
“No. I mean—”
“Do I look weird? I switched multivitamins.”
Did she look weird? I mean, the components of her face were like puzzle pieces spread out on a table. So yeah.
But I didn’t exactly know how to say that.
I was just staring at her pieces, trying to Jedi-mind-trick them into clicking into their proper spots, when one of those nurses in the pink scrubs walked in.
And I realized that I couldn’t see her face, either.
I mean, “couldn’t see her face” is not exactly right. I could tell there was a face there. In theory. It wasn’t just a blank slate. I could zoom in on eyebrows and laugh lines and lips.
It was just that the pieces didn’t fit together right. They didn’t make a face. It was a bit like looking at a Picasso painting.
I could see it, I guess. I just couldn’t understand it.
It reminded me of that game you play as kids where you lie upside down and watch someone talking where their lips are flipped, top to bottom. Everything suddenly looked so funny. And disjointed. And cartoonish.
I felt a rising comprehension. Had I been like this all week?
As crazy as this sounds, it’s true: It was only once I really started trying to look that I realized I couldn’t see.
“Sue?” I said again, blinking, like maybe I could clear things up that way.
“You look fantastic,” she said, leaning forward and clasping my hands in hers. “You’d never know they just popped a section of your skull out like the top of a jack-o’-lantern.”
Yep. That was Sue, all right.
“I expected you to be bald, to be honest,” she went on. “I was prepared to walk in here and say you looked better bald. I had a whole Sinéad O’Connor–themed speech prepared.”
I rubbed my eyes and tried to look at her again. But no change.
“How did they manage to keep your hair?” Sue asked.
I knew the answer to this question. Dr. Estrera had shown me in detail.
But it didn’t seem that important right now.
“I think I have a problem,” I said then. “I can’t see you.”
Sue waved her hand in front of my face, like, Hello? “You can’t see me?”
“I can see your hand,” I said. “I just can’t see your face.”
Sue leaned forward, like that might help, just as the nurse leaned in and said, “Are you having trouble with your eyes, sweetheart?”
“I don’t think it’s my eyes,” I said. “I think it’s my brain.”
|
WITHIN TWO HOURS, I’d done another MRI, and the entire faceless team of Estrera, Thomas-Ramparsad, Montgomery himself, and a whole posse of residents and onlookers had gathered in my room.
“The imaging shows some edema around the surgical site,” Dr. Estrera said, talking more to my dad than to me.
“What’s edema?” I asked.
“Swelling,” Dr. Nicole explained. “Very normal. Nothing to worry about.”
“It’s common to have some swelling after a procedure like this,” Dr.
Estrera confirmed.
Then he turned to me, and as he did, I looked down at the blanket on my bed.
Looking at faces—or the modern art pieces where faces used to be— was hard. It made my brain hurt a little. Fortunately, Dr. Estrera wasn’t offended. He went on. “As an artist, you know that the human face has a lot of variability.”
Not sure you needed to be an artist to know that, but okay.
“Penguins, for example,” he said, “don’t have that same amount of facial variability. Most penguin faces look pretty much the same.”
“I wonder if the penguins would disagree,” I said.
He went on, “The location of your cavernoma was very close to an area in the brain called the fusiform face gyrus…”
He waited to see if I’d heard of it. I hadn’t.
“It’s a deep temporal structure—a specialized area of the brain that allows people to recognize faces.”
I nodded and kept my eyes on my blanket.
He went on. “Humans have evolved highly specialized brain systems for recognizing faces, and most of us have near-photographic memories for them. The minute you see another human face, it triggers a flood of instant information about that person: name, profession, biographical data, memories you have together … and the fusiform face gyrus is crucial to that process.”
I nodded, like, Interesting. Like he was just telling me random brain facts.
Then he said, “Your cavernoma was located close to the FFG. Not in it and not touching it, but close.”
“Did you nick it or something? That’s why it’s not working?”
Dr. Estrera turned my MRI scan on the lightboard and circled on a gray area. “We believe the normal postsurgical swelling is pressing on the fusiform face area right next to it and causing some mayhem.”
“Causing some mayhem” seemed like a rather cutesy way to describe my situation, but I let it go. “What can we do about it?” I asked. “Ice it, maybe? Take some ibuprofen? Stop drinking water for a while and dehydrate myself?”
“There’s not much we can do about it,” Dr. Estrera said. “We just have to wait.”
“Wait?!” I didn’t have time to wait. “For how long?”
“People can vary quite a bit,” Dr. Estrera said pleasantly, like we were just chitchatting. “I’d say it’s likely to resolve in two to six weeks.”
Two to six weeks? I looked up. “I’m looking at you right now, and you’re like an upside-down Mr. Potato Head. Are you saying my brain could be doing that for six weeks?”
“I’m hoping it’ll resolve before that,” he said. “Assuming it does resolve.”
I felt a sting of adrenaline. “Assuming it does resolve?” I echoed. “Are you saying it might not resolve?”
“I think it’s very likely to resolve. Most postsurgical edema does. I can’t guarantee it, of course. But I’d be surprised if it didn’t.”
Okay, okay. “But assuming it resolves … what happens then?
Everything goes back to normal, right?”
“Then…” Dr. Estrera said, “we’ll see.”
Come on, man!
He must’ve thought he was striking a balance between being comforting and not making promises he couldn’t keep. But since the possibility that it might not resolve hadn’t even occurred to me, he was absolutely doing the freaking opposite.
“I just don’t understand,” I said then, my panic making me a little breathless, “how you could explain every minuscule head-clamp detail to me, and every aspect of the hair-sparing technique, but somehow fail to mention that the brain surgery I just electively signed up for might ruin my ability to see faces.”
“This is a very rare outcome,” Dr. Estrera said. “I thought you said it was totally normal!”
“Edema is normal,” he said. “But your cavernoma just happened to be very close to this particular very specialized area. The chances of this happening were infinitesimal.”
“Do you know what I do for a living?” I demanded. The whole room waited. They did not.
My voice was rising, but I didn’t notice. “I am a portrait artist. I paint portraits! Of faces! For a living! What am I supposed to do now? What happens to my livelihood? I need my fusiform face thingy to be working!”
In the silence that followed, Dr. Estrera nodded with an apologies-for- the-inconvenience vibe.
I sighed.
I looked over at Dr. Nicole’s puzzle-piece face for some help— emotional or otherwise.
“There’s no reason that it shouldn’t resolve,” she said, taking my hand. “We’ll just be patient. And I will work with you to teach you some coping skills in the meantime.”
I let out a long breath. “Can I still go home tomorrow?”
“Of course,” Dr. Estrera said. “Your site is healing beautifully. There’s no reason for you to remain here.”
My dad had been worryingly silent. I took a minute to note the unexpected high I’d been getting from being an accidental brain surgery
poster child—a sudden minor celebrity in his world.
But then, when he shook Dr. Estrera’s hand and left the room without a word to me, that high dropped to the ground.
Looked like it was time to be a disappointment again. Oh well.
|
THE MOMENT OF truth came later, after most of the doctors, including my dad, had left.
Dr. Nicole stayed to run me through some face recognition tests. Before we got started, I needed to pee. Which meant going to the bathroom. Which, of course, had a mirror above the sink. I avoided looking as I walked in, but as I headed out, I paused.
What would happen if I looked into that mirror? What would I see?
Don’t look, I told myself.
I didn’t want to know, but I also couldn’t stand not knowing … and so I wound up standing with my eyes averted, caught between curiosity and dread, for so long Dr. Nicole finally asked if I was all right.
The knock startled me, and then I coasted off that energy and glanced up into the mirror to check my reflection …
And what I saw made me gasp.
My face, my very own face, the one I’d had and known and lived with all my life … it was nothing but puzzle pieces, too.
|
WHEN I OPENED the bathroom door, moving in slo-mo with the shock, I kept my eyes pointed toward the floor, which felt like the safest place. I got as far as the threshold before slowing to a stop.
“Sadie?” Dr. Nicole asked.
“I can’t see my own face,” I said then, a little breathless. “I just checked in the mirror, and it’s not there. I’m faceless.”
But Dr. Nicole wasn’t giving in to my drama. “You’re not faceless,” she said, steering me gently by the shoulders back to bed, “you just have
edema.”
I wanted to be practical about it. Matter-of-fact. I wanted to fully understand that this was just a little brain glitch.
But there was nothing matter-of-fact about it.
I walked away from that mirror feeling … lonely.
No matter how alone you ever are in life, you always have yourself, right? You always have that goofy, imperfect face that forgets to take off its mascara before bed and wakes up with raccoon eyes. That one crooked lower tooth that the orthodontist never could manhandle into place. Those ears that stick out a little too far. Those lines on either side of your smile that always look like parentheses. That slight dimple at your chin that’s just like your mom’s.
Of course those aren’t the only things that make you you.
You are also your whole life story. And your sense of humor. And your homemade doughnut recipe. And your love for ghost stories. And the way you savor ocean breezes. And the appreciation you have for how the colors pink and orange go together.
You’re not just your face, is what I mean. But man, it sure is a big part of you.
Like your shadow. So faithfully and constantly with you, you don’t even notice it.
It’s just always there. But then one day it’s gone.
Except it’s not just the shadow that’s gone. It’s the person making the shadow.
You. You’re gone.
And the idea that anything could just disappear at any moment is something you suddenly understand in a whole new way. The way I did for a long while after my mother died.
“It’s like I’m not here,” I said to Dr. Nicole, my throat getting thick. “It’s like I disappeared.”
“You’re right here,” she said, taking my hands and squeezing them before holding them up to show me. “You know these hands, right?”
I nodded.
“Here you are,” she said. “You haven’t gone anywhere.” Then she gave me a hug and said, “But let’s not look in the mirror again for a while.”
She wanted to get down to business. She was organizing some tests for me to take on her laptop. While I waited, a random thought occurred to me: Peanut.
“This doesn’t apply to animals, right?” I asked. “What?” Dr. Nicole asked.
“I’m suddenly worried that when I get home, I won’t be able to see my dog.”
“You’ll definitely be able to see your dog.”
“His face, I mean,” I said. “I need that face. It’s my primary mood- lifter.”
“I understand,” Dr. Nicole said, attention still mostly on her work. “This face thingy’s only for human faces, right?”
At that, she paused. “Mostly,” she said, “yes.” “Mostly?” I asked. “What does mostly mean?”
“There’s not a lot of research on animal faces. There has been some research on cars, though.”
“Cars?”
“Some people with this condition have trouble recognizing their cars. They can also have trouble with direction. But it hasn’t been studied enough to understand why or how.”
“So…” Somehow this felt like the worst news of all. “You can’t guarantee that I’ll be able to see my dog’s face?”
But she wasn’t going to let me descend into self-pity. “Guarantees are overrated.”
I must have been spoiling for a fight. “Guarantees are underrated.” But she didn’t take the bait. “Let’s just take one question at a time.”
|
DR. NICOLE HAD queued up some facial recognition tests for me to take to see how bad it was. “This’ll give us a baseline,” she said.
The tests—the Glasgow Face Matching Test, the Cambridge Face Memory Test, along with a few others—were all online. She rotated the laptop toward me.
I folded my legs and geared up to begin. I was usually pretty good at tests. But I would not be acing these.
These tests were hard. Like if you made a kindergartner take the SAT.
Some of them asked you to look at two pictures and decide if they were the same person or a different person. Some of them asked you to study a set of faces and then find those people later in groups. Some of them showed you famous people with their hair removed. They specifically did not ask if you could name the person—because recalling names is a different brain system. They asked only if you could recognize them.
Could I recognize them? I could not.
It was all—and I mean this in the fullest sense of the word—nonsense.
From celebrities to presidents to pop icons to Oscar winners, all the faces in all the tests looked totally indistinguishable. I couldn’t tell the difference between Jennifer Aniston and Meryl Streep. I couldn’t tell Sandra Bullock from Jennifer Lopez. It was like looking at pickup-stick piles of facial features. I could tell that these people had faces. I could see the pieces of the faces. I just couldn’t tell what the faces looked like when you put the pieces together.
That feeling you get when you recognize somebody? That little pop of recognition? I looked at hundreds of faces that day, and I never felt it once.
By the end of the fifth test, I was in tears.
“That’s enough for today, choonks,” Dr. Nicole said, putting her arm around me for a side hug.
“Did you just call me chunks?” I asked. What on earth could that mean? “Choonks,” she corrected. “It means sweetheart in Trinidad.”
That felt really good for a second. I liked being a sweetheart. But then I started crying again.
She squeezed my shoulders tighter. “I know it’s a lot.”
“The thing is…” I said, really giving into the crying now. “The thing is … I just don’t know what’s going to happen to me.”
“We’re not going to worry about the future,” she said. “We’re going to focus on the here and now. You’re healing great. You’ve taken care of your cerebrovascular issue. You’ve done the hard part.”
She was patting my back now.
My thoughts were churning like a cement mixer. “What if,” I said, voicing my worst fear, “I get stuck like this?”
That’s when Dr. Nicole shifted her position to face me. I looked down at my blanket. “When I hear you say unproductive things,” she said then, “I’m going to call your attention to them and challenge them.”
“Did I say an unproductive thing?” I asked. She nodded.
“What did I say?”
“Here’s a hypothetical question,” she said next. “If there’s a five percent chance something bad will happen, and a ninety-five percent chance that things will be fine, which one is more likely?”
Was this a trick question? “That things will be fine?” She nodded. “I want you to work on that.”
“Work on what?”
“On which of your thoughts you’re going to choose to indulge in.” “Is this about my worrying I’ll get stuck like this?”
She nodded again. “Our thoughts create our emotions. So if you fixate on your worst-case scenario, you’ll make things harder for yourself.”
“You want me not to fixate on the worst-case scenario?”
“I want you to start practicing the art of self-encouragement.”
“So when I catch myself worrying, I should try to convince myself that things are going to be fine?”
“That’s one way to do it.”
“But what if I don’t believe it?” “Then keep arguing.”
I was supposed to argue myself into feeling optimistic? “I’ve never been great at optimism,” I said.
“That’s what the arguing is for.”
“I’m not very good at arguing, either.” “Maybe this is a chance to get better.”
But I’d learned long ago that arguing didn’t get you very far. “Can you give me a hint?”
“Try to step back and look at the big picture,” Dr. Nicole said. “That’s where you can see it more clearly.”
“See what?”
“That no matter what happens, you will find a way to be okay— whether your prosopagnosia is temporary or permanent.”
“My proso…” I asked, giving up on the word halfway through. “What’s that?”
“That’s the condition you have right now,” Dr. Nicole said, “based on these test scores.” Then she handed me a diagnosis: “Acquired apperceptive prosopagnosia.”
I waited for those syllables to make sense. But they didn’t.
So she said it again. “Acquired apperceptive prosopagnosia.” Then she added: “Also known as face blindness.”
