April 24, 2012

Putting a "Face" on Brain Damage

Back in December my turn finally came for a long awaited Neuro-Psychological test to assess if I had lost any brain functioning over the course of my treatments. I was on a waiting list for 10 months, with the dim knowledge that, when my turn finally came, I would be subjected to two days of cognitive tests. A walk in the park!

As you can imagine, as my turn approached, I began to wonder exactly what kinds of tests I would have to perform (for two full days), and was also quite curious as to what they would have to say about me. I simultaneously felt quite smug in my personal knowledge that I felt that I had not lost anything, (save for a few cubic centimeters of brain matter), but also a little nervous that they would rock my boat and tell me something I didn't want to hear.

I imagined that there would be a fair amount of spacial and memory testing. With dread, I remembered how much I hated these types of tests back in Gr.5. Flipping and rotating 3D images in my head or recognizing and extrapolating complex patterns and then filling in my final choice on a bubble sheet are not my idea of fun. My short term memory has always been lacking, but even I have noticed an increased deficiency since my tumor treatments.

I also didn't know how much of these two days might involve sitting on a psychiatrist's couch and being prompted to spill my guts so that they could probe into my psyche.

Well, my predictions were not to far from what actually happened (which surprised me; I often make mental predictions to myself, but expect to be surprised). The first "day", which only turned out to be a few hours, was spent first talking to the psychiatrist, then filling out bubble sheets. The psychiatrist asked me deep probing questions about my adjustments, my mental processes, my relationships to others, my views on life, etc. (no couches!  Boo!). Then I was turned over to the bubble sheet questionnaire to answer more questions of the same variety worded in different ways. Did I feel understood by those around me? Did I ever have overwhelming urges that I couldn't contain?  And so on. I tried not to blow through the questions, reminding myself that I would only benefit from examining myself and being honest.

The second day, I spent many hours in a room with the psychiatrist's assistant, who performed numerous other tests on me. Every test started off very simple, then got harder until you could no longer perform the task that was required. Lists of words to remember (read only once). Word associations to remember (seeing them only once). Patterns to solve. Mental math problems. Social/common knowledge questions. Reading ability. Building patterns with colored blocks. Categorization abilities. You name it! A timer counted all my response times.

At the beginning of each one, I had to remind myself that they used these tests to establish ALL levels of mental ability. Even a child would have found some of them to be very simple. But as they progressed in difficulty, I got slower in my answers until eventually I had to say that I didn't know the answer. The assistant reassured me that this is how it was supposed to happen. Here are some of the more memorable tests (no pun intended):

1) I was given 30 seconds to study a nonsensical line drawing, then asked to reproduce it from memory. Several tests later, I was asked to reproduce the same drawing (much harder given the shift in concentration!).

2) After being read a list of twenty or so objects, I was asked to repeat them back and to categorize them. I was given several tries at this one as I have always been very bad at remembering lists.

3) Given a letter of the alphabet, I was told to rattle off as many words beginning with that letter as I could before the timer stopped. At first I thought this would be a breeze... until I got going. I quickly realized that my pitfall was that I would get stuck on themes. For example, the letter S got me stuck on two themes. Out came "scientific, sarcoplasm, sarcomere, salicylic acid..." Realizing how dumb the words were that came out of me, I couldn't help but start laughing! And with the laughter came a new theme, this one far more creepy! "Sad, sadistic, Satan..." (more laughter and thinking to myself "why can't I think of more simple words than this, like... silly?") This train of thought brought out "silly and stupid". The end result was that I spent a lot of the time laughing at myself, and didn't get a lot of words out. The human anatomy theme continued to dog the rest of the letters they gave me. "Anatomy, anabolic, anaplastic, anemia..." The researcher's inevitable question was to ask what my undergraduate degree was in.

4) Given number and letter combinations, I was asked to repeat them back and/or reorder them. The researcher read them to me once. When it started with 4E this wasn't too hard. But getting up to something like 5j9pu7, it was a little harder. List the letters in ascending order first, then the letters in alphabetical order: 5j9pu7 became 579jpu. You can imagine that hearing it only once, this was quite difficult. I managed to get up to combinations of 8 before I had to say that I couldn't go any further.

5) Given similar number combinations I was told to remember that combination while verbally subtracting three from a number they would give. For example, I was told to remember A9T6, then starting with 76 talk out loud subtracting three. ...76, 73, 70, 67, 64, 61, 58, 55... then STOP! and tell the researcher the number that I was supposed to remember. The number I had to remember increased by one digit when I showed that I could continue. I think I got up to 7 digits before I had to stop.

6) Questions of general knowledge or educational level. Who is the President of the United States? What year did Canada become a country? What is the distance from the earth to the moon? What is the circumference of the earth? Who wrote Alice in Wonderland? Etc. I was pleased with myself for only missing two of these questions. But seriously now, is the circumference of the earth really considered general knowledge? I was, however, quite bummed out at forgetting that Sir Arthur Conan Doyle wrote Sherlock Holmes.

I walked away feeling very good about myself... which made the results a little shocking to me! While the analysis determined that I am functioning at a high level of cognitive ability (relatively), and that I am well-adjusted considering the life changes I've had, it also revealed some other things. Apparently, it is because of my pre-existing higher level of cognition that I have been able to cover up certain deficiencies that have come about from receiving brain damage.

Brain damaged. Of course they didn't say it like that, but that's essentially what it means. It felt like a fist in my stomach to read that in the Neuro-psychiatrist's report. Even though the vast majority of the report reinforced my smarts, my superior emotional adjustment and my positive attitude, it shook my confidence to read that I have used my intelligence to cover up my areas of weakness. As though I were some kind of con artist, fooling everyone around me. But even more shocking was when I found myself thinking, "How did they know?". It is true that I have been using my brains to figure out ways to cover my weaknesses, not in a deceptive way, but more as a kind of coping mechanism and technique to "save face."

There is a trace of irony in me trying to "save face", however, as recognizing faces in particular is one of the ways that my mental abilities have changed.  To some degree, I have lost is the ability to recognize new faces!  It now takes a few interactions and significant associations before I can remember a person's face. Until I recognize their face, I will only recognize someone by what they are wearing, or by the conversation I had with them. But if they change their clothes (something people tend to do) or don't give me any indication of prior interactions (as in, "Hi, I'm the guy who talked with you yesterday about rubber plantations in pre-Independence Malaya"), I have no idea who they are.  (This shouldn't be read as a request to always wear a colour-coded jumpsuit and begin all conversations with a long preamble.)

This makes it interesting to work at a coffee shop where people are constantly streaming past me. There are people who come in every day and order the same thing, but as far as I am concerned they are a new person every day. I need to have meaningful interactions with someone (sometimes several) before I will remember their face (unless it is outstanding in some way: monstrously ugly people get remembered). This doesn't apply to people I already know.  If there is something exceptionally striking about a person, I will remember their face.  I am often able to remember people if I pick out facial features on them that look like someone else that I already know.

A few weeks ago, I read a BBC article which talks about the area of the brain that helps to recall faces. Lo and behold, above and behind the right ear (right where my hole now lies) is where the brain stores memory of faces. Here is the link to the article: http://www.bbc.com/future/story/20120209-why-names-and-faces-are-so-vexing

It was very enlightening to see that for all of my feelings of stupidity, there is a justifiable reason for it.  So I have figured out other ways to either determine if I know people or, if all else fails, to hide my ignorance.  By far the most embarrassing situation is if I have had a meaningful interaction with someone (especially if I've had multiple meaningful interactions), but still forget their face and greet them as a total stranger (or, worse than that, not greet them at all).  Imagine yourself saying "Hi, welcome to Starbucks, Stranger," when you just saw that person an hour ago.  During my interactions now, I find myself watching and listening carefully for an indicator of who the person is.  Often it is something very subtle that clues me in (good old body language to the rescue), and if I am successful, that person has no idea of what has been going on in my head.

Its never boring being me!