I shiver as I realize: I’m one of the lucky ones.
The precise cause of spontaneous spinal CSF leaks remains largely unknown. . . . A history of a more or less trivial traumatic event preceding the onset of symptoms can be elicited in about one third of patients, suggesting a role for mechanical factors as well.
—Wouter I. Schievink, “Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension,” JAMA, 2006
15
July 2015
When I was in graduate school, I lived in San Francisco near Ocean Beach, it was like permanently being in a 1940s movie. Dark, foggy, cold; everything practically in black and white. I’d shed my layers on my way downtown, starting off on the N-Judah dressed for winter, ending up aboveground at Civic Center in my summer clothes, my music bag stuffed with the sweater, jacket, long-sleeved shirt I’d discarded as I made my way to the sunlight. On the return trip home, I could literally see the fog rolling in, marveling how it was just like the way people always say it, the fog literally rolling in. In the distance it looked like something solid, something you could part with your hands or maybe carve your way through. Every time I’d keep waiting for that moment: waiting to get there, to the solid part. But that moment never came. Instead the fog just rolled in to meet me, so stealthily I didn’t realize it was all the way fully there until I found myself enveloped in it, stepping off the cable car and remembering: Of course, it isn’t solid, it isn’t carvable, it’s particulate, it’s not a wall, it’s not a door, it’s the air, it’s all around you. There isn’t a specific moment when you enter the fog or the fog enters you. It’s just there. You don’t even realize you’re in the middle of it until it’s too late.
That’s how it is right now. The fog is rolling in. And I’m at the edge of it now, the part where I can see it’s not a thing I can push against, where I can see it floating around me, swirling at my feet and obscuring everything far away, reducing the landscape to the few bright things that can penetrate the haze.
I’m back to wondering how many of my decisions are thoughtful, considered, smart thinking, and how much of it is this fog: That shiny thing there, I can see it, it must be a good idea. I’m wearing compression clothes, things that place pressure on my dura, sending the cerebrospinal fluid upward, helping my brain float a little, but still not as much as it needs to. I’m drinking caffeine, dilating my blood vessels, but not enough to provide the pressure I need inside my head. I have marshaled my resources to function, managing to be upright through relatives’ visits, through my youngest sister’s wedding, summoning my fading abilities to be present for the kids’ emergencies, the day Gil moved out of the house, his father telling me it was the worst day of his life, the same day the cat escaped, or so we thought, and we printed out and hung up missing-cat posters throughout the neighborhood before finding him doing what I should have been doing: lying down, hiding, sleeping in a dark place. The only time my head doesn’t hurt now is when I’m unconscious.
Awake, I’m permanently in this tipsy stage, the part where my drunk self congratulates every tangential idea it has. Great job! Yes! That sounds logical! You should do that! I can talk to people, usually, if I haven’t been upright too long, and I hear myself telling stories, making jokes, finding ways to be funny. It’s what my drunk brain does. It’s what my adolescent brain did, kicking into some gear to make me the funniest person in the room instead of the shyest or weirdest or quietest. I can gloss over things. I can make small talk. I sat down to play the piano the other day and to my surprise I found myself able to play through, almost all the way through, pieces I’d previously forgotten. I’d play through the parts I definitely still remembered and then get to the “Oops, that’s gone now” part and instead—just keep on playing. It was like some kind of special bullshit ability turned on in my brain and I could just bulldoze my way through. Not perfectly, but well enough to get through it, get through the parts that had fallen out of my head and back to the other parts I still had memorized. It’s all part of this brain fog/drunk brain thing, I think, this thing that takes over when my actual brain is shutting down a little bit from lack of fluid.
When it was really foggy, in the foggy part of San Francisco where I lived, if you walked far enough into the fog, it did get thicker—never an actual wall of fog you could slice through with your hands or fluff like a pillow, but thick enough so that on a dark night you couldn’t even see a streetlight until you were almost directly underneath it. If you walked far enough, if you kept walking past my house in that fog, in the seemingly interminable gray mist between streetlights, eventually you’d come to a place with no lights, with a bank you’d scramble up blindly, where the ground beneath your feet grew shiftable, changeable, and the fog itself began to have a sound. And if you walked far enough, if you followed that sound, you’d find yourself walking right into the sea.
I need to have this fixed before I get there. Before I get submerged again to the point where I can’t think or read or write or watch TV or have conversations. Before the things happen again where I can’t feel my arms when I close
