Despite the fact that I am clearly struggling with so many simple tasks, I continue to be very driven, especially with regard to getting back to the sports I love. I have a powerful desire not to interrupt my training routine and daily life. Altering my habits means I have to accept that I am not okay. Conversely, willing myself through a draining workout proves that I can overcome any obstacle and beat any foe—even brain cancer.
But my feelings of power and strength are an illusion, born in large part of the high doses of steroids I am taking combined with my natural determination to survive.
And while I’m feeling better, my frontal cortex is not functioning normally. Just days earlier, it was being squeezed and pressed against the inside of my skull because of the inflammation and swelling in my brain. If I hadn’t been treated with high doses of steroids in the ER, I might have suffered permanent damage to my frontal lobe. I could have lost forever critical cognitive functions, such as judgment, as well as my social skills, empathy, and personality. In fact, if the inflammation and swelling had not been caught in time—had my brain stem been choked off and sent me into cardiopulmonary arrest—I could have died.
Since my frontal-lobe function is still compromised, my brain cannot respond appropriately when faced with complicated or demanding tasks. That morning before we went to the park, when I was still at home in a quiet, familiar environment, I behaved normally. For that reason, there was a strong emotional incentive for all of us to believe I really was fine, especially when I insisted I would have no problem walking in the woods.
But after walking for seven and a half miles, I became exceptionally tired and hungry, and at the end of the two and a half hours, my brain was in no shape to handle much of anything. Depleted and exhausted, it had entered survival mode. When called upon to do anything that was even slightly complicated—such as finding Mirek’s phone number, calling him, processing his request to locate him, retrieving from my memory a visualization of the road, understanding it was a loop, or recalling which way the one-way traffic went—my traumatized brain fell apart. With that kind of information overload, the neural connections within and between my frontal lobe and other brain areas became clogged, like a traffic jam in my head. Finally, my advanced thinking came to a near-complete standstill. Sensing itself endangered—too much going on, too many demands!—my brain ignored everything but primal necessities. Rest, rest, rest! it told me. Rest and eat! Do not engage in anything else! Your survival is in jeopardy!
Try asking a hungry toddler, or even a hungry eight-year-old, to solve a puzzle after you explain that dinner will be ready soon. She will throw a tantrum, kick and scream, call you names. Since her undeveloped frontal lobes will not mature until her mid- or late twenties, she is controlled in large part by her instincts and basic emotions related to survival. She has no impulse control, is not rational, has a short attention span, and cannot understand the concept of waiting for a reward—food—that will come later. Her brain is telling her one thing: she must eat now.
Try the same experiment with a marathon runner who is just reaching the finish line. He would rather slap you in the face than try to solve a simple algebra problem. With its energy stores almost completely depleted, his brain is hoarding whatever’s left for the region essential to survival: the primitive limbic brain, which operates autonomous functions, like keeping his heart and lungs operating, and regulates basic emotions like fear. His brain has switched off the luxurious, sophisticated frontal lobe, which enables problem-solving and other higher cognitive functions that make us human, including the ability to evaluate options in order to make judgment calls. For the exhausted marathon runner, these more refined skills simply aren’t as essential as the basic brain functions that will keep him alive, so they go into a kind of hibernation until there is enough energy for them to spring back.
I experienced this phenomenon myself when I ran marathons. In the final several miles, I could never calculate my pace because my brain could not do the necessary arithmetic. As I approached the end and focused only on getting across the finish line, I was in a zombielike mental space. If anyone interrupted my singular focus, I reacted with anger. When my husband tried to tell me encouragingly that the finish line was close, I would snap: “Bullshit! It isn’t close enough!”
Or take my elderly mother. Otherwise brilliant and fully functional, she cannot engage in more than one task at a time these days because her frontal cortex—which deteriorates as a person ages—gets overloaded easily. When too much is happening around her, she becomes disoriented, panicky, and angry.
Similarly, patients with schizophrenia don’t perform well under conditions of increased cognitive pressure. Brain-imaging scans show that when people with schizophrenia are presented with overly demanding tasks, such as solving complex tests, their prefrontal cortices are not activated at the same level as neurotypical people’s. When too much is asked of them or there is too much stimulation in the environment, their already compromised brains fall apart further. They might behave angrily and inappropriately, like I did during the park misadventure.
Before we went to the park, I was largely fine. But with too many demands on my brain that day, the most advanced part of it—the most human part—simply shut down. My meltdown was clear evidence that I was not out of the woods yet. And I would need even more aggressive treatment to stay alive.
9
What Happened, Miss Simone?
One afternoon at the beginning of July, I’m walking with Witek on a quiet, empty street, holding tight to him as if I’m afraid I’ll lose him. We’re headed from home to a nearby pharmacy to pick up my prescription
