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New Fiction: The Autobiography of a Brain

Introduction

To continue to celebrate Spellbound’s launch and book tour (hello from Dallas, btw), I’m publishing another organ-based magic realism story. As with The Heartbreaking Work of a Staggering Liver, this is an experimental bit of fiction that helped me to explore the close relationship I experience existing between literature and medicine. So, without further ado, here’s is a short inspired by a brain I dissected during a second year autopsy elective.

Here’s a short bit told by a liver I dissected during a second year autopsy elective. The bald medical student is me. The “Man in the Pan” class is the same as in the previous story.  

The names and details of the story are fabricated. No identifying patient information exists in this story. Though the pathological conditions described are real and the narrative was inspired by multiple real-life events, the narrated course of events is purely a work of fiction.

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License.

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THE AUTOBIOGRAPHY OF A BRAIN

A bath when you are born,

a bath when you die,

how stupid.

That was a haiku Teresa Malinski once read. I like it. It is simple. It is also serious and silly. It comes from silence and falls into silence. I like that about haiku. Perhaps I am biased. It is possible. Consider my situation: I am a brain in a bucket.

 

The bucket is filled with water and formaldehyde. Yesterday, the pathologists used an electric saw to open Teresa Malinski’s skull. Out I came. I’m small for a 69 year old brain. Parts of me have shrunk away into nothing.

It is quiet, here, in this bucket.

Outside Teresa’s other organs lay in steel pans. They are constantly talking. Also outside of the bucket are three medical students. Also talking. This class is called Man in a Pan. Teresa was a woman. I am glad I am in the bucket.

Perhaps you supposed brains would be chatty organs.

We’re not.

 

But the way, that haiku was written two hundred years ago. A Japanese man named Kobayashi Issa wrote it. An American named Robert Hass translated it. Issa means “cup of tea.” That is nice. I don’t know what Hass means.

But I associate it with avocados.

Hass avocadoes?

In any case, Robert Hass edited a book of translated poems named The Essential Haiku: Versions of Basho, Buson, & Issa. Teresa liked it. She read it in 2005. I remember the book perfectly. It was the last book Teresa ever read.

In late 2000, when Teresa turned 60, she retired from a directorship of a local charity. She and her partner went to Bhutan. She returned with a curiosity about things South and East Asian. She took a Chinese calligraphy class at her YMCA. She read about Taoism and Buddhism. She practiced yoga.

She tried to cultivate the quiet mind.

I was her brain.

Her mind was never very quiet.

That was fine.

When she practiced yoga, her mind was quieter. Then the pains that shot down her leg got too bad. Doctors called it sciatica. One of them thought she should have spine surgery. Another thought she should wait and try physical therapy. She wanted to wait at least until she was 65 and on Medicare.

Teresa tried tai chi and water aerobics, both hurt too much. She gained ten pounds.

 

She moved in with her partner, a retired engineer named James Wilcox. She called him Jimmie. But they started to argue, mostly about small things.  She moved back into her house. They saw each other more when they lived apart.

 

Teresa was born just outside St. Louis, Missouri.

When she was born, I was less than one third the size of the brain I would become. However, I was already complex. My neurons performed their slow dance of connection.

Infant brains need to develop their rear portions. That is where movement and balance are regulated. Babies are not capable of dexterity because that region needs to grow. Fast growth means a higher risk of cancer. Most childhood brain tumors arise lower down in the brain.

I was surprised to learn that.

 

When Teresa was two years old, I had reached four fifths of my mature weight. No tumors. No malformations of my stem or of the blood vessels. Nothing wrong yet. I was proud.

Teresa was proud she could use the toilet.

 

There are many types of cells in a brain. Likely you’re familiar with neurons. Perhaps you think brains consist entirely of neurons.

We don’t.

Perhaps you believe the thing you call you is an electrochemical storm flying around in neurons.

You’re not.

 

Brains are made mostly of glia. They are the cells that hold neurons in place, provide nutrients for them, isolate them from each other, and remove toxins. Glia can alter how the electrochemical signals fly about in neurons. The thing you call you is as much glia as neuron. I think so. You are as much stomach as brain, as much lungs as brain, as much liver as brain. And so on.

The soul isn’t a singer.

It is a chorus.

I figured all this out when Teresa attended college at Washington University in Saint Louis. I had reached my full size, in perfect health. So did Teresa. At five foot seven she wasn’t tall. She wasn’t short. She had short brown hair. Her pale face was usually serious.

Teresa learned to enjoy smoking.

 

After graduation, Teresa got engaged to a young man in her class. She thought she would stay in St. Louis for the rest of her life. But he broke off the engagement. The next year he married a girl who had been in her sorority.

It was 1963.

Of all the American cities Teresa had ever heard about, San Francisco sounded like the most different from St. Louis. She applied for jobs and received an offer as a paralegal.

 

In 1968, Teresa married a tax lawyer, another California immigrant, named Bob Malinski. He was from New York. They lived in the Berkeley Hills and raised two sons. It was a typical, pleasant suburban life. Once their younger son was in college, Teresa and Bob separated. They completed the divorce in 1994. She was 54.

 

Two years later, she met Jimmie Wilcox at a charity dinner. Jimmie asked her to a museum in San Francisco. It was a pleasant date.

But the next morning she was upset. She never thought she’d be dating at 56.

 

Teresa called her oldest son, by then a lawyer in Chicago. She asked if it was okay that she was seeing someone who wasn’t his father. The son said that it was so long as she didn’t ask him for dating advice.

 

Jimmie would sometimes nag her about her smoking. She wondered if dating him would help her quit.

It didn’t. But she smoked less than a pack a week.

 

After the sciatica made Teresa’s life more sedentary, she read more. She started gardening. Her hips began hurting. She wondered if it was the weight she had gained.

 

In 2002, her ex-husband called her. He’d had a heart attack, two weeks ago. The doctors put a stent in his heart. It scared him. He apologized for some things he had said during their divorce.

Teresa listened carefully. She tried to be gentle with him.

But he was still an asshole.

 

From the time Teresa left Saint Louis to when she returned from Bhutan, I changed only subtly. Neurons rewired, fired differently. I had lost weight. All brains shrink with age.

Then I began to change very rapidly. No one else knew it.

 

In 2005, Teresa flew to Chicago. She stayed with her eldest son’s family for Thanksgiving. Mostly she played with her granddaughter.

On the flight home, Teresa felt at first too hot and then too cold. She coughed.

 

The next morning Teresa felt hot and weak. Jimmie came over toward noon. He noticed that she wasn’t using her left hand. She didn’t believe him.

Toward dinner on the following day, Teresa’s fever broke and the weakness in her left hand was gone.

I could have told her why.

 

Teresa was now on MediCare and considering spine surgery to remove the shooting pains. But the surgeons were equivocal. Some thought it would help. All agreed it could make things much worse.

She decided to wait.

 

Five days later, Jimmie gave Teresa a copy of The Essential Haiku. She was feeling better. But it was raining. She felt lazy. She read the whole book between 10 in the morning and 1 in the afternoon, pausing for lunch.

She read it again after dinner.

 

Teresa had never enjoyed poetry. She felt like she didn’t ‘get’ poetry. There seemed to be secrets to enjoying verse known to professors and particular kinds of people. It seemed to her that most of those particular kinds of people owned black turtle necks.

Teresa didn’t own a black turtleneck.

 

The haiku in Hass’s book were different kinds of poems. Teresa had never encountered anything like them. These were poems open to her. On her second reading, she read Hass’s introduction and discovered there were rules to classical haiku. Rules that were often broken.

A classical haiku should use simple language. It should be understandable. It had to contain an image of the ordinary world. It should reference the season either in the first or third line. This reference might be done by describing snow for winter. Cherry blossoms symbolized spring. And so on.

Most surprisingly the haiku—or at least Hass’s translations—did not follow to the five then seven then five syllable rule she had thought mandatory.

Her row veering off,

The peasant woman plants

Toward her crying child.

That poem was also written by Kobayashi Issa. It notes the season in describing planting. Issa’s mother died when he was three years old. Issa must have been thinking of his dead mother and his infant self when he wrote this.

That connection made Teresa feel sad. She thought of her sons.

 

Of the three masters in the haiku book, Teresa liked Issa the best. His poems were often about small animals or simple things. Many were silly. Some were angry. All were a little pathetic.

She had a weakness for the pathetic.

The book included a self portrait of Issa. He had drawn himself as a dumpy little monk. He has a bald head and a big nose.

 

These are the poems that moved Teresa most.

Children imitating cormorants

Are even more wonderful

Than cormorants

 

What a strange thing!

to be alive

beneath cherry blossoms.

 

Asked how old he was,

the boy in the new kimono

stretched out all five fingers.

 

I’m going out,

flies, so relax,

make love.

 

Nursing her child

the mother

counts its fleabites.

 

Pissing in the snow

outside my door—

it makes a very straight hole.

 

It once happened

that a child was spared punishment

through earnest solicitation.

 

The toad! It looks like

it could belch

a cloud.

 

Napped half the day;

no one

punished me!

 

In the spring rain

a pretty girl

yawning.

 

This stupid world—

skinny mosquitoes, skinny fleas,

skinny children.

 

The day after Jimmie lent her The Essential Haiku, Teresa read it for the last time. She had a realization. Before she picked up Hass, she had never encountered haiku. She had read only parodies of haiku. Authors who obey the 5-7-5 syllable rule but ignore the other values. It produces nonsense:

Haiku are easy.

But sometimes they don’t make sense.

Refrigerator.

Teresa thought these parodies were a shame.

Was there’re anything about haiku more or less absurd than a sonnet?

It got her thinking. The only other form of poetry she had encountered as parody was called Deaf Poetry, or Slam Poetry. She knew that that form was associated with black people.

Teresa learned that Robert Hass was a native to Northern California. He had been the national Poet Laureate from 1995 to 1997. She wondered if she could see him read.

 

oh god the bucket lid is opening. gloved hands are lifting me out.

put me back. put me back.

they’re staring at me. the three medical students. and spread out on the table are all the organs. yammering. the repetitive heart, the moody liver, the needy bowels, and groaning bones.

it is too loud.

they’re talking about what might have killed teresa. they wonder if it was the surgery.

put me back. put me back.

the gloved hands are turning me over. they all point to the places where i’m sunken in. they’re looking at my lesions, correlating them to teresa’s disabilities.

oh god help me. put me back. please, put me back.

one of them, the bald one, is staring most especially at the lesion that kept teresa from ever reading another book.

They put me back.

 

It strikes me now how ridiculous this whole affair is: A bath when you’re born, a bath when you die.

 

Five days after she read The Essential Haiku, something happened to Teresa. While watching television, she had trouble focusing on the screen. She changed her glasses and realized that she couldn’t see out of her left eye. She went to the mirror. She watched herself wave her right hand in front of her left eye. She saw nothing.

She called Jimmie. He didn’t pick up. She left a message and thought about calling one of her sons. She didn’t want to be a bother.

Then vision began coming back to her left eye.

But the time Jimmie called back an hour later, she felt normal.

She wanted a cigarette.

 

The next week she woke up and wondered if she were hung over. She and Jimmie had watched a movie and shared some wine. After he had left, she had another glass.

Now her head hurt. Sunlight was pouring into her window. She wanted to go to the bathroom. But when she tried to stand, her right arm felt like it was anchored to her bed. She looked down at it. It did not seem real. It felt a rope that was stretching down from her to some sea of white cotton sheets.

She wanted to call Jimmie. But when she looked at her phone, she couldn’t remember his number.

She looked from her arm to the phone on her bedside. From the phone to her arm.

Time did not seem to pass. Time seemed to have gone away.

Abruptly, she remembered her cell phone. Jimmie was the first number programmed into the phone. With her left hand she opened it.

All of the names seemed to have been written in Russian. She stared for a long time. She was frightened.

Then she remembered that Jimmie was first on her contacts list. She selected the entry at the top and pressed call.

His sleepy voice answered. She tried to say, “Jimmie, I think I’m having a stroke.”

She only said. “Ji… Ji…” She tried again. “Ji…Ji…Ji…”

 

In the emergency department, the physicians examined her and then sent her to a large tubular machine they called a non-con CT. The noise it made around her head bothered me. However, I was preoccupied. Part of me had died the night before. Trying to cope with the dead tissue, I was swelling.

 

The physicians admitted Teresa to the hospital. The left middle portion of her brain had died. That was the portion of me that handled most of Teresa’s ability to speak, write, and read.

Reacting to the injury, I continued to swell. Teresa lost consciousness.

 

Teresa was not aware of her visitors. Later she would hear their stories. Jimmie, her ex-husband, her sons, two old coworkers.

Teresa didn’t like the stories. She couldn’t eat on her own. She lost bowel control.

An MRI of her brain indicated that she had sustained several smaller strokes before the latest and largest. The fever she had had after Thanksgiving had taxed me and so “unmasked” a small stroke in her right hemisphere. That’s what caused her right handed weakness. The narrowing of the blood vessels in her head had caused the stroke. It had also caused her brief episode of one sided eye-blindness.

 

During her second week in the hospital, one of the nurses heard an abnormal heart sound coming from Teresa’s chest. The doctors ordered an echocardiograph, and discovered that her aortic valve, which normally had three leaflets, had only two. They did not know what role, if any, this had played in her strokes.

 

When Teresa went home, Jimmie moved in with her. She had to learn everything all over again. Eating, using the bathroom, speaking.

Every morning, before she grew tired, Jimmie would patiently talk her through the day. Defining most every word for her.

It took a long time.

 

I often thought about the haiku Teresa had read.

 

After two months, Jimmie hired a nurse to help take care of her. The nurse suggested they buy an English-as-a-second language program for her computer.

It didn’t work. The letters on the screen made no sense to Teresa. No matter how long she stared at the letters, she could not make sense of them.

 

On a follow up doctor visit, a neurologist explained that she might have a condition called ‘alexia,’ or ‘word blindness.’ Another phrase for it was ‘acquired dyslexia.’ The part of her mind that had recognized the sight of letters and words had died. He suggested that she try tracing the letters with her hands.

 

This worked, to a degree. That part of me that understood what letters looked like was dead. But other parts of me remembered how words were written. When Teresa traced the letters with her hands, I could deduce what letter she was trying to write.

We could read, very slowly.

 

The year went on. Teresa remembered how to walk. Her speech became fluid again. She could move about her house. She was upset to see how messy Jimmie had made it. But she didn’t say anything. She could leave the house on her own. She bought small things at the convenience store. The temptation was to buy cigarettes. But the neurologists had said that smoking increased the risk of a second stroke.

Eventually she broke down. She never let Jimmie see the cigarettes.

 

She didn’t want to try driving. Jimmie insisted.  She never drove far. She couldn’t read any of the signs.

 

Eight months after her stroke, Teresa had recovered enough to begin arguing with Jimmie about housekeeping.

Jimmie moved back into his house. It made her a little sad to see that he was relieved to go back. She took him out to a fancy dinner in San Francisco.

 

Things were almost back to normal.

 

But Teresa never regained the ability to read quickly or for pleasure. She listened to NPR. She watched more television.

 

She never read another book. The Essential Haiku was the last one.

It was a good one to end on.

 

And that nearly ends my autobiography. Eventually, I removed the cells that had died. In those places, I became smooth.

 

Teresa’s life was everyday life despite her disability. It made her sad that she could not read the emails her granddaughter sent her. Mundane tasks were harder. It took her hours to sort the junk from the bills in her daily mail. She struggled to deal with anything that pushed her to online interactions.

But her disabilities were only disabilities. She was grateful for the extra time.

 

Jimmie was diagnosed with pancreatic cancer. It didn’t seem fair. He had never smoked a cigarette in his life.

It was Teresa’s turn to take care of him, as much as she could.

He died seven months later.

 

In 2008, Teresa was visiting her youngest son’s family in the North Bay. Teresa felt light headed when she walked up the stairs. Once her chest hurt.

She was afraid it was her abnormal valve in her heart. The doctors had warned her this might happen.

 

A month later she received an echocardiograph. The two-leafed aortic valve was calcifying and growing smaller. Her heart couldn’t push enough blood out of the stiff valve when she was exercising. They scheduled a “bicuspid aortic valve repair.”

 

The procedure went well. Her younger son visited her the day after. She seemed fine.

That night she ran a slight fever, and the next morning the nurse noted that Teresa was having trouble speaking. Worried that she had another stroke, they took another CT scan of her head. She hadn’t.

 

They drew blood to culture for a possible infection and started her on intravenous antibiotics. She began sweating profusely. Her heart rate accelerated and her blood pressure dropped.  They transferred her to the critical care unit.

 

That evening she died.

 

I heard the pathologists say that the blood cultures grew out bacteria. The theory is that Teresa died of septic shock. They performed the autopsy to confirm this. They also want to make sure that nothing went wrong with the surgery.

The pathologists have the answer already. It was sepsis. Now the medical students are trying to figure out the same. I just hope they don’t pull me out of this bucket again.

 

It’s peaceful in here.

 

A bath when you are born, a bath when you die—it’s a little stupid.

But, then, there was everything that happened in between.

Comments

9 Responses to “New Fiction: The Autobiography of a Brain”

  • “It is quiet, here, in this bucket.”

    I can’t quite put my finger on why, but that line is really, really beautiful. It feels odd for me to be calling it that, but I think it is true all the same.

    That whole thing was fantastic. Thank you Mister Charlton, sir. Thank you very much.

  • E! You are very very welcome. I had fun writing this, trying to let Issa’s voice color the narrators voice 😉

  • Just now finally got around to reading this. How do you manage to make organs in containers so dang touching?!

    • viv, bless your heart (hopefully not in a container); i saw this comment at the end of a frantic monday and it made everything a little better. 🙂

  • “That’s what caused her right handed weakness.” Wasn’t it her left hand that was weak?

    I enjoyed this a lot. Didn’t have the humor of the last one, but I liked it even more because, as Vivienne said, it was very touching. I especially love the voice and mood throughout this piece. And that last line is excellent!

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