A Library After An Earthquake

The nurse spoke to me with kind eyes. I looked at his name tag, but I couldn't read it. It was just a jumble of symbols and colors. And that was when I understood that something had gone really bad.

"Do you know where you are?" he asked.

I thought about it carefully. It should have been a simple process, like solving a math problem; but this problem required knowledge I had never been given. It had never been taught to me; and I didn't know the equations for it.

My gaze shifted from the nurse to the clock on the wall, to the television. Nothing made sense to me. Fluorescent lighting scalded my eyes as I tried to focus. A plastic bracelet on my wrist bore more shapes I couldn't process.

"No." I finally mustered a response in a voice that surprised me. It was lower than I expected, as if the voice belonged to a stranger.

"Do you know your name?"

I searched my mind for an answer. But I couldn't think of it. I knew what a name was. I just didn't know my name.

Hours later, or maybe it was days – I didn't rightly know what the passage of time had been – a doctor with a clipboard was telling the man who claimed to be my husband what had happened. I remember watching his face while the doctor spoke, watching the way his expression tightened at the corners of his mouth. I didn't know his name either. I knew that, if he was truly my husband, that I loved him. But his face... a face I must have held in my hands and kissed more than a thousand times... was strange to me.

The story the doctor told was not complicated, though its consequences were. I had been anemic for at least five years. Likely longer, the doctor told him. Iron-deficiency anemia – a failure of the blood's capacity to carry oxygen, the iron molecule at the center of each hemoglobin protein unable to do the work it was designed to do. Tissues starved. Muscles weakened. The brain, which requires roughly twenty percent of the body's oxygen supply despite comprising only two percent of its mass, begins to fail.

I had told my doctor about the symptoms. A constant fatigue that sleep can't touch. The strange breathlessness I encountered doing simple chores like walking to the mailbox or going to the grocery store. How my thoughts sometimes slipped sideways even in the middle of a sentence. They would just... poof... vanish. What had I been talking about? There had been a pounding in my ears when I lay down at night — a condition called pulsatile tinnitus – caused by the heart working harder to compensate for the oxygen my tissues had been stimming my brain to provide. It pushed volume, but it could not push oxygen that didn't exist.

The doctor had not believed me. She said, "I think it's all just in your head." She said it evenly, trying to be reassuring that I'd be ok. The diagnosis was delivered in the same way you might speak to someone whose grip on reality had slipped away. But my blood work showed low ferritin and a hemoglobin of eight-point-four grams per deciliter, significantly below the normal floor of thirteen-point-five for adult men. She dismissed the data. Men don't get anemia, she explained. It must be a lab error. But she didn't reorder the labs; and I was sent home being made to believe I was crazy.

But my blood kept thinning, and my body continued to starve for oxygent. The source of the blood lose was never investigated. Later, I was told to "eat more broccoli."

And that's how I got here. It was a morning in July, somewhere near a staircase, the lights simply went out while watching fireworks. I remember looking up to watch a light blossom into a chrysanthemum... and that was the last thing I remembered before waking up in the ICU.

The medical term for what I experienced on the stairs is syncope – a sudden, complete loss of consciousness caused by insufficient blood flow to the brain. When the cerebral perfusion pressure drops below a critical threshold, the brain cuts out. One moment you are standing. The next, you're on the floor.

The fall did what the anemia alone couldn't do. I fell down the stairs, face first, incurring a physical trauma to my already compromised body. I struck my head, resulting in a concussion – a mild traumatic brain injury in clinical language, though mild is a word that should probably not be offered when it refers to this type of injury.

Inside my head, the electrochemical signaling in my prefrontal cortex and hippocampus – those regions responsible for short-term memory formation, linguistic processing, and the integration of past experience into coherent selfhood – had been disrupted. A hematoma – a pooling of blood between the skull and brain tissue – created additional pressure, compressing neural pathways, like a thumb pressed over a garden hose. Outside, twenty-five stitches closed the wound on my forehead. All told, the trauma had put me into a state of unconsciousness for eight hours. No wonder my husband was scared. I, on the other hand, was too clueless to be afraid.

When I woke, I came back to a world that had kept all its objects but lost all its labels. I knew a chair was a chair by its function, but the word was merely an arbitrary sound that I didn't understand. Words for many things were missing.

My name. Where I lived. Where I worked. What I did for a living, what I loved, what I feared, who I had been to the people standing at my bedside with their red eyes and cautious smiles. My daughter-in-law brought me some of the books I had written to help me remember. But that knowledge, too, was gone. It wasn't like forgetting a phone number and then being reminded of it only to say to yourself, "oh ya!" No. It was knowledge erased from the database, like words on a seashore being overwritten by blowing sand. I questioned if I had even written at all. How could I have?

The neurologist told me that memory works, not so much through storage of data, but from retrieval of data – data distributed like fragments, then reassembled from its component parts to impart remembering. What the hematoma and concussion disrupted was not the storage of those data, but rather the retrieval. My neural pathways along which those fragments could find each other and cohere, was broken.

"Think of it," she said, "as a library after an earthquake." The books are all still there, but the building is damaged, and you may not be able to use a card catalogue or take an elevator to the upper levels, but the information is all still there and needs to be resorted.

The analogy stuck. A library after an earthquake. It became, in time, the first metaphor I wrote down. And I remember crying, because that was the first time I had any hope of ever remembering anything.

Recovery from traumatic amnesia is not a linear process, and it is not passive. The brain is not a machine that repairs itself if left undisturbed. It is, as the rehabilitation specialists say, plastic — meaning it can rewire, reroute, build new roads around the damaged ones, recruit neighboring regions to take on work they were not originally designed to do. But plasticity is not automatic. It requires input. It requires new data. And, in the blunt language of neuroscience, it requires use.

My husband – whose name came back to me one night in a dream during the third week of hospitalization – sat with me every evening and ran me through exercises, using words and pictures, and naming objects. It was the cognitive equivalent of lifting soup cans when you are too weak for weights. My occupational therapist brought card games, pattern recognition tasks, simple narratives to read and retell. The goal was not memory itself but pathway reconstruction. I was learning how to reconnect the disrupted parts of my brain to make new connections, like an electrician splicing wires. We were laying down new ways to get from A to B on a network that had far too few roads.

But it was writing that saved me. And I don't mean that as metaphor.

It began with making lists. My therapist suggested I write down, each morning, everything I could name. Objects in the room. Colors. The sequence of the day before. Not because I was meant to study the lists later, but because the act of encoding language – of choosing a word, then allowing my brain to form letters on paper through my hand, and letting my eyes see those words on the paper – strengthened the neural circuits involved in ways that passive recall did not. By writing my thoughts down, I was giving them a body, and forcing my mind to commit.

The first lists were short. Window. Cup. Light. Husband. Tuesday. Then they grew. And as they grew, the words began pulling others behind them, like a crochet stitch. A single thread of yarn pulled from a knot, allowing the whole to take shape.

I remembered that I had written things before my fall. It wasn't that, I remembered what I had written — not yet — but the sensation of writing came back as a memory. That specific quality of making an observation and then compressing it into a descriptive sentence that worked... the strange mix of exhaustion and exhilaration at the end of a long day at the desk when the vision in my mind translates into a story. The body was beginning to remember, but my mind had not yet reassembled how the mechanics worked together.

So I wrote. Not memory. Not at first. I had very little to work with in those early days. But sensation, I knew. The texture of the hospital blanket. The way my husband's hand felt – heavier than I expected – when he held mine. The sound of fireworks, which remained the clearest thing, and which I wrote about over and over, as if returning to the scene of an accident to understand what I had survived.

I woke up in the hospital that morning in July, I wrote. The only thing I could remember was the sound of fireworks. I did not know, then, that I was creating literature. It felt more like journaling. But the distinction, I have come to believe, is smaller than it seems.

The recovery took years. It was never fast, nor was it ever steady. It came in fits and starts. There were mornings I woke and the day before was blurry. Did I go to that appointment? What did I eat for breakfast? These questions would later be answered through evidence, like a doctor's bill, or the dishes piling up in the sink.

There were conversations I had had without knowing it, books I read and reread with equal freshness because the first reading left no trace. There were moments of grief so specific and strange. I remember mourning the loss of myself once, and the life I used to have before the fall happened. I suppose it would be like continuing to mourn the World Trade Center even though there is a new one standing in its footprint.

And that was where I was then... I remembered enough to know who I had been; but when I looked into the mirror, the reflection looking back at me now was someone I didn't know... but I did know I would have to learn to love that reflection, the way I had loved the one that had been there before July came.

My neural pathways were eventually rebuilt. Words came back in clusters. I remembered the city I grew up in. My first apartment. Then my work. The books my daughter-in-law had brought to the hospital suddenly felt familiar. And later, I would eventually be able to once again recognize my own voice in the writing. And that was when I felt like the darkest chapters of this story were finally put back on the shelves in that earthquake-damaged library.

Our brains are not static. It is an organ that can be damaged. It can heal. And it can be developed, and rebuilt. Language, too, is not merely a tool for communication but a technology for assisting memory. Now I write every day. I see it as a physical therapy that allows me to remain healthy.

And every morning now, I remember my name, and how my husband saved me when he called 9-1-1 after finding me at the bottom of the stairs. Then I look in the mirror, I see myself, and the scar on my forehead that reminds me this had all been real.