And of course my brain agrees with this.
This is what my brain does now: It agrees with itself. And so I find myself thinking Of course. These medicines are not a plan. I will not take them all at once. I will throw them out at some point. Good idea! Good thinking!
I go back to bed. My friend has texted again.
“Didn’t mean to minimize,” it says.
“No problem!” I respond. “Going to sleep now.”
“You’ll probably feel better after a nap.”
I won’t. But I recognize that’s just his brain trying to be agreeable too. I push all the pillows aside to be as flat as possible, to make the pain as small as possible, put on a podcast, and float in the fog of Britain and the run-up to World War I. I hear the interviewer talking to a group of historians about the deaths of so many young people, and eventually I fall asleep.
PART FOUR
Insight
The prototypical manifestation of spontaneous intracranial hypotension is an orthostatic headache. Such a headache generally occurs or worsens within 15 minutes of assuming the upright position . . . but in some patients this lag period may be as long as several hours. Improvement of the headache after lying down is less variable and occurs within 15 to 30 minutes. The headache may be diffuse or localized to the frontal, temporal, or—most commonly—the occipital or suboccipital regions. The headache may be throbbing or nonthrobbing and is rarely unilateral. Some patients use descriptive terms for their headaches, such as the feeling of “an ice cube in an empty glass” or a “pulling sensation from my head down to my neck,” offering a clue to the diagnosis. Additional clues may be the patient’s recumbent position in the physician’s office or a pillow they carry along to allow them to lie down comfortably . . . . The severity of the headache varies widely; many mild cases probably remain undiagnosed, whereas other patients are incapacitated and unable to engage in any useful activity while upright.
—Wouter I. Schievink, “Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension,” JAMA, 2006
18
September 2015
I have exhausted the resources available to me at the hospital, with its one doctor familiar with CSF leaks and its many specialists who are not, and so I make an appointment to be seen at a different hospital, one with a headache center and neurologists who specialize in headaches of all kinds. I’m still toying with the idea of trying to reach out to the doctor of last resort, the specialist I’ve read about online, but my case seems too pedestrian, despite the way it’s taken over my life. It just doesn’t seem serious enough to merit a cross-country trip, my scans not dramatic enough, my symptoms not definitive enough. Although I don’t know what the threshold is, I’m sure I haven’t cleared it. And so this is the next step I feel I can take: to be seen by the headache center.
Before I can be evaluated by the headache center, I must go through a screening process. First I am required to take the Minnesota Multiphasic Personality Inventory test, which costs $300, will not be covered by insurance, and takes about an hour to ninety minutes to complete. Then I must meet with one of the headache center’s therapists, even though I already have a therapist. But I’ve run out of other options, so fine: I will take the expensive test, I will talk to the random therapist.
The center itself, which is less a center than a nondescript area on the second floor of the neurology building, presents as a fluorescent-lit waiting room with no place to lie down, which is how I evaluate everything at this point: Is it dark? Is there a place for me to be flat? It’s taken me more than a half-hour of being upright to get here, and so I am woozy with pain and brain fog, but I nod my head as the desk person informs me that insurance probably won’t reimburse me for the cost of the personality test and I sign a thing and take a sheaf of forms to a chair in the corner that seems like the least obnoxious place to lie on the floor if I have to.
The personality inventory test I have to take, the MMPI, is “the most widely used and widely researched objective measure of psychopathology in history,” according to what I read about it later, and was first developed in the 1930s. It was initially used to diagnose hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia (an outdated term for what is now considered obsessive-compulsive disorder), schizophrenia, and hypomania. Later, social introversion and masculinity-femininity (measuring how rigidly a person conforms to stereotypical gender roles) were added, creating ten basic diagnostic categories. Beginning in the 1980s, the test underwent a major overhaul, and by 2003, the MMPI-2 was introduced, with clinical scales intended to measure the perhaps more modern states of demoralization, somatic complaints, low positive emotions, cynicism, antisocial behavior, ideas of persecution, dysfunctional negative emotions, aberrant experiences, and hypomanic activation.
The test consists of 567 true/false questions. Some of them are innocuous and easy to answer, though in some cases oddly specific: “I wake up fresh and rested most mornings.” “I like mechanics magazines.” “I am very seldom troubled by constipation.”
Others are clearly red flags: “I am sure I get a raw deal from life.” “Evil spirits possess me at times.” “I see things or animals or people around me that others do not see.” “If people had not had it in for me I would have been much more successful.”
But others are harder to answer: “There seems to be a lump in my throat much of the time.” “No one seems to understand me.” “I have nightmares every few nights.” “I have had very peculiar and
