Memento Meninges

1.

Despite my protests, neither my mother nor my father will concede the point. I was not, according to them, in my right mind when I called from a hospital bed at Ajou University Hospital. They detected something. An aberrance. Like an incoherence of speech, or a delirious register of voice. It’s only natural they would conclude that my memory of the episode is suspect. I was admitted to the hospital at Ajou University, a few blocks from my apartment in Suwon, with a preliminary diagnosis of viral meningitis. I spoke to my parents several times from my hospital bed, sounding—distressed; unglued? I was in a lot of pain. But I’m certain I was lucid. The pain no doubt hindered my capacity to speak in plain, clear sentences. The memories nonetheless are as clear as day—as clear as the taxi ride from Incheon International Airport; or the wide expanse of the Han River; or the heavy, stinging prick of the anesthetic needle in the Operating Room of Soon Chun Hyang University Hospital a few months prior.

In his book Stumbling on Happiness, the psychologist Daniel Gilbert expounds on the shortcomings of memory. The brain doesn’t preserve every bit of palpable information that comes to it through the senses. Memory isn’t stored in its entirety as neuro-electrical equivalents of the sights and tastes and so on of our past experiences. So why does it seem like it’s all there? Gilbert explains that memory has a way of filling in the gaps of experience. This is less a glitch than a practical adaptation, one that allows human beings to remember the past with remarkable coherence, if not complete accuracy. Without this basic mechanism, memory would be too patchy and muddled to be useful. The artifice makes the act of remembering relatively smooth and efficient, an important function in the spontaneous, sometimes dangerous contexts of human life. For the same reason, however, the details of memory are often flawed. This is especially true of remembered feelings—details related to emotions and subjective experiences. It is the basic predicament of memory that its coherence goes hand in hand with its unreliability.

Much later, when I recall this scene in writing, I will want to sympathize with her. I will want to write—the nursing profession seems taxing and thankless and I genuinely admire the dedication of anyone who undertakes it. But here, in the crowded space behind the ER, my sympathy finds no channel to pass through.

The predicament of memory makes the writing of memoir especially hazardous. If your life is a story you tell yourself about yourself, then it is not a reliable one. There are plenty of things that can be recalled with accuracy: names; dates; even some dialogue. But experience is another matter. What does it mean to remember something that was felt vividly at the time, in a condition of sound mind, if not sound body? To recall it as if it were happening once more? Memoir isn’t reportage. The writer doesn’t take notes or speak into a voice recorder for playback later. It is remembered. And the past can never be made whole again. As Gilbert notes, to remember an experience with absolute accuracy would mean having to replay it in your head in real time, which would effectively paralyze us. We’d be stuck endlessly replaying memories and never attending to the present. Instead, we remember the gist, the essence, the bullet points, the threads that help us survive better. Memoir, wherein the past is distilled in language, is as much a process of deformation as revelation. It can only ever recall a past that is out of focus and extinct, and meditate in the present (that other perilous zone) where time slows down and hardens into some willful meaning. Therefore, it must be conceded in advance and without evasion that, as memory goes, the course of memoir will be more than a little—dishonest.

2.

I’m certain of at least one thing—all of the events will unfold and come close to being resolved within the span of seven days. It was Friday when I first noticed a dull pain in the node of my left armpit. Saturday, the fever picked up steam and dehydration set in. Sunday, I began to notice a deep ache in my right abdomen. Monday night, I was admitted to Ajou University Hospital. It will be Friday again when the headache finally subsides.

It’s late Monday night. It’s early Tuesday morning. It feels like Monday night. There are no vacant beds upstairs. I will remain in the ER ward tonight, or rather this morning. It’s just past midnight. I drift into a fitful half-sleep. When I wake, I’m lying crumpled on my left side. It can’t have been more than an hour. A nurse must have started an IV drip. And I changed into hospital clothes at some point. When I look down at the IV, I can see red running through the line. The blood is backing up. I don’t know for how long. When I roll onto my back, a red stain is revealed to cover most of the left side of my shirt. The sight of the large red smear startles me. I lift the gown to check my torso—no apparent rips or slits in the flesh—then carefully wheel the IV pole to the nurses’ station. I wave to one of them and direct her attention to the dark red seeping into the fabric of the shirt. She draws a small, quick breath. I point to the IV in my arm. She seems to register what has happened. In fact, she seems a little irritated, as if to suggest that the ruined shirt was the result of my carelessness. Her impatience irks me, and I in turn become irritated. I shake my head and hold up both hands, indicating something like—how’s this my fault? We talk over each other in our respective languages. I unbutton my top, and she hands me a new one. Much later, when I recall this scene in writing, I will want to sympathize with her. I will want to write—the nursing profession seems taxing and thankless and I genuinely admire the dedication of anyone who undertakes it. But here, in the crowded space behind the ER, my sympathy finds no channel to pass through. I don’t see the nurse standing in front of me holding a bloody shirt. I only see an obstacle frustrating my expectations—I’m the patient; this isn’t my fault; it’s your job to help me and so on. I can’t know what she sees standing in front of her—a frightened patient; an inconsiderate lout; one more in an endless series of interruptions; or someone in distress. I don’t know enough Korean to ask her what she’s feeling. I can only guess. And she wouldn’t be able to answer me in English. And anyways there’s no time and a million other things to do. It really is an admirable profession. I shuffle back to my bed buttoning the smear-less shirt as I go.

3.

It’s Tuesday morning. The headache, which will continue unbroken for the next three days, wakes me up. A man is leaning over my bed—a specialist from Infectious Diseases. He informs me that the most recent blood work indicates a serious illness. My head pounds up and down like a parabola. I ask him for something to ease the pain. I mistakenly assume that, lying inert on a hospital bed behind the ER, the drugs will come straightaway. They do not. In the days to follow I will make numerous requests for pain medication. My requests will be rebuffed with halting English and untranslated Korean. By degrees I will become paranoid and desperate. I’ll convince myself that the nurses and doctors are spitefully withholding the drugs that could otherwise mute this damn racket in my head like a damned TV that lands on static with the volume maxed out. Their repeated instructions to take Extra Strength Tylenol will be met with exasperation and impatience and more than a few sniveling protests meant to indicate something like—are you goddamn kidding me? What I will repeatedly fail to consider is the possibility that no medication can assuage the headache caused by meningitis.

Meningitis is an infection of the membranes, called meninges, that surround the brain and spinal cord. There are different types of meningitis, each defined by its underlying cause. Bacterial meningitis is extremely serious. Even with treatment, the mortality rate in adults is 19-37%. Viral meningitis, on the other hand, rarely causes death and typically resolves on its own. It will be weeks before I read about this on Wikipedia. For now, I’m mostly in the dark. My doctor seems confident that I have viral meningitis. I trust him. The aggressive, infectious agents in which he specializes do not bespeak his manner, which is one of unaffected regard. But he won’t be able to make a definitive diagnosis until my spinal fluid is examined. In two days, a young resident will extract the fluid with a spinal needle, a procedure known as a lumbar puncture or, more commonly, a spinal tap. The specialist says the lumbar puncture will involve “some amount of pain.” Something to look forward to, eh? No one responds to my mocking, rhetorical question because I’m speaking only to myself inside my pounding head.

A single-occupancy room is open on the eighth floor. No other rooms will be available for two days. A single room is not covered by insurance, but there’s no room in my head to worry about that now. Despite my very private and very expensive room, I won’t be able to sleep because of the headache. They say severe to describe the pain; they say the pain associated with the headache as if it were a business partnership. These descriptors are stupidly inert. They impart a technical designation. The classic 1-10 pain scale, another impotent gauge, is replaced with oblique words like mild, moderate, and severe. In the face of a real, honest-to-god pain that you never would have imagined (because no person in their right mind would), the numbers and words lose whatever substance they might have had in ordinary life. Perhaps someday far removed from this moment I’ll feel grateful. The ordeal will prove to be a test of character, and I’ll come out the other side stronger—or something like that. In the midst of its unfolding, however, I am not grateful. I’m ill-tempered, defensive, misanthropic. I recoil from words of consolation. And who gives a damn about personal growth anyway? Or the condition of my liver and kidneys, which could be damaged by the overuse of certain medications that nonetheless reduce the fever and diminish, by just a hair, the headache, and I’ll take a hair. I’ll take anything. My liver and kidneys can shrivel and rot as far as I’m concerned. I’ll get new kidneys. And my liver will grow back. But I swear to god this throbbing is going to blow my cranium wide open, and goddammit if the gooey insides won’t make a perfect mess of my very expensive room. When a doctor or nurse drops in and asks me to indicate my level of pain, I have no recourse to any meaningful response. Just grab hold of the sheets and make a fist as tight as you can and ride it out. They look puzzled standing over me unable to quantify what they’ve observed. For a second, I take comfort in the thought of them standing at the foot of my bed, covered from head to waist in the clumps and shards of brain matter and skull.

4.

I am sitting upright in bed. The door has been left open a crack. The opening forms a cleft through which the hallway light cuts down my face in a vertical dash. The light falls over one or the other of my eyes. I could close the door, but that would mean getting up. Getting up is a problem. The headache falls loud and heavy like a factory machine; its pounding coincides with the blood propelled by the pounding of my heart. If my heart stopped beating then my head would stop beating. The beating feels like what a heart attack might feel like—too much blood trying to squeeze through too small a vessel. I press my fingers to my temples. Trying to open something up in there. Nothing opens. But it’s better to keep pressing because the movement of my fingers is a diversion, a way of forgetting, if only for a second or two. I keep pressing and the pressing is a rhythm and I sigh after every seventh or eighth beat and the sighing is a rhythm and soon there’s a whole chorus of noiseless effects. These details—the door and the rhythms and the light—will one day seem like a sterile cloud, devoid of that potent agony of the present moment.

I will continue to not eat, save for some homemade yogurt one of the teachers from my school brings me. They will eventually have to start a nutrition IV and weigh me every few hours. And that’s how it will go for the next few days. Everyone will continue urging me to eat. But they don’t get it. And I don’t get how they don’t get it. And none of us will get it.

Movement, at the moment, presents a dilemma. It amplifies the pounding. But it is necessary—to avoid getting sore; to go to the bathroom; to change the cold wet rag against my forehead. The pounding arouses a keen awareness of movement. Not movement in a hypothetical sense, but the singularity of each and every movement. The pounding thus encourages a kind of kinesthetic efficiency. Even a few inches registers like forty dump trucks driving off a four-mile cliff, hitting the ground and getting reduced to a fine metallic dust. The relationship between pounding and movement is exponential—if movement were graphed horizontally and pounding graphed vertically, then a point less than one horizontal value would shoot straight up. Walking to the bathroom involves the longest and most dramatic movement. It’s so big and sustained that the pounding registers beyond any threshold of pain. For a second, it actually ebbs. And, so, going to the bathroom offers a tiny respite, a relief more acute than that of emptying the bladder. The insane pounding nullifies itself on the way to the bathroom. But because movement halts at the toilet, the pounding slows just enough to register below that neutralizing point as a sustained, concrete pain. Urinate with eyes closed. Walk back to bed. The pounding is neutered again. Get into bed. The worst of it comes when getting into bed. Unspeakable really. The pounding will slow in the morning. It’s morning now because it’s past midnight. It will slow when the sun comes up in seven hours. An hour of sleep, at most, will offer the only real break. Then it will be time to wake up and get looked over by all the people who mean to take care of me.

5.

It’s Wednesday morning. Presently a young doctor will enter my room. She will sit in the chair next to my bed and ask me questions—about my pain; my symptoms; my condition in general. Finally, she will ask about the quality of my sleep:

– Did you sleep well?

– I didn’t sleep.

– How long did you sleep?

– Not at all.

– Really?

– Maybe one hour.

– Are you sure?

– Not more than an hour and a half.

– I think you slept more than that.

– No.

– How can you be sure?

– I didn’t sleep.

It will go on like this for a few minutes until I fall silent. I won’t have an answer that satisfies her. I’ll even start to second guess myself. Wouldn’t the inflamed tissue surrounding my brain and spine affect my ability to accurately report the previous night’s sleep after all? Maybe the young doctor checked up on me during the night. Maybe she really does know better than I do.

Later, a hospital administrator will come to my room to inquire about my meals. Besides the headache, the other major symptom has been a persistent nausea—a weight on my abdomen that kills all appetite, gastric or otherwise. The headache and nausea of meningitis don’t amount to a cleansing sort of pain. They don’t clarify anything, like quitting coffee or fasting for a day might. They only blunt vitality and magnify every awful feeling, physical and mental, until any trace of cheerful confidence is scraped clean. The spirit, irradiated.

When lunch arrives, I’ll lift the metal lid from the tray to find a pile of pasta drenched in cream sauce. I’ll immediately cover the tray and put a hand to my mouth, heaving several times until nothing comes up. The administrator will arrive after lunch, the covered tray of food still sitting on a cart behind her as she addresses me:

– Do you not like the food here?

– I can’t eat.

– I will talk to the chef.

– I’m too sick to eat.

– We can change the menu.

– I’m throwing up an empty stomach all day.

– Would you like to try some Korean food?

– I can’t eat.

It will go on like this until a half-formed feeling fizzles inside me. A feeling of wanting to grab her and make her understand how I feel and shake her until she knows exactly how it is. Like I want to do to everyone who comes to see me. The empty stomach and the pounding head will preclude any action, or even quibbling, on my part. I will continue to not eat, save for some homemade yogurt one of the teachers from my school brings me. They will eventually have to start a nutrition IV and weigh me every few hours. And that’s how it will go for the next few days. Everyone will continue urging me to eat. But they don’t get it. And I don’t get how they don’t get it. And none of us will get it.

6.

It’s late Wednesday night. It’s early Thursday morning. Mrs. H has come to stay with me for a few hours. She retrieves a small cloth from the wardrobe and soaks it in cold water under the bathroom faucet and leans on the edge of the bed to press it against my forehead. She stretches out on the short sofa against the far wall and falls asleep. I remain awake trying not to move. She wakes up and asks me if I’ve slept. When I tell her no, I haven’t, she takes the cloth from my forehead and goes into the bathroom to soak it in cold water again.

Mrs. H is a teacher at the elementary school where I work as an ESL instructor. We didn’t meet for the first time until almost a year after I had arrived in Korea. She’s in her early thirties and seems to be filled at all times with a vibrant and persuasive enthusiasm.

There’s a reason I didn’t meet Mrs. H until many months after arriving in Korea. During that time, she herself was a patient at Ajou University Hospital. I picked up the details of her illness in bits and pieces after she returned to work. I was never able to assemble a complete picture of what had happened to her. But I’m reasonably confident about the following: Mrs. H had an operation at Ajou University Hospital; there were post-op complications; the exact nature of the complications remains unclear, just that they were very serious; Mrs. H spent several months recovering, both in the hospital and at home. After I’m discharged, Mrs. H will describe her experience to me in some detail. She will tell me about the medication she was given every day, several times a day, to relieve her pain. She will describe the stabbing sensations that afflicted her whole abdomen day and night, as if her organs were simultaneously riven from the inside. She will convey the sense of the pain by miming the gnarled contortions to which her body succumbed. She will note how the effects of the medication disappeared after only a short while, leaving her in a fit of panicked anguish. She will tell me how she thought she was going to die and received visitors in a fog of misery and occasionally asked them will I die? in Korean. She will not mention how, or if, they responded.

I will wonder, many months after leaving the hospital, if it is useful, or even possible, to remember my experience of meningitis in any faithful way. Why would I even want to reconstruct so rigorously a painful memory like that?

It seems obvious to say that imagery is the most vivid form of memory. I can recall so many indefinite images—the AUH Emergency Room; the red-soaked shirt; the spinal needle; Mrs. H’s evanescent face—that collectively suggest an entire world. The other senses can usually be inferred from the images—the low hum of the fluorescent lights; the cold of the cotton bed sheets; the needle’s sting. For this same reason, imagery is also the most hazardous form of memory. Imagery seduces us into a facile belief that we have found a clear and definite route to the past. It makes the act of remembering accessible and, therefore, prone to error. Perhaps the more compelling provocateur of memory is smell. Smell perplexes because it cannot be conjured so freely and confidently as imagery. A forgotten smell has to be located again in a real encounter with the world, where it hits the individual unawares and throws him into a strange oblivion between past and present. And it evaporates in equally swift and furtive form—a whiff that rebuffs any attempt at expression. Smell does not seduce. It confronts the individual with a nagging suspicion that the past is only ever ephemeral and cannot be known again exactly as it was.

I straighten my legs and neck but do not sit up. The resident tells me I must remain horizontal for the next six hours. It’s not clear why. Perhaps I am liable to lose my balance and fall. A nurse places the call button in my hand. My head is pointed towards the foot of the bed. Other than the clock on the far wall, there is almost nothing to observe.

According to my parents I was a blue baby—an unnatural blue tinge colored most of my little newborn body. The cause was a congenital heart defect called Tetralogy of Fallot that would eventually require open-heart surgery. The surgery was performed just before my first birthday. It was the only other time before moving to Korea that I had been hospitalized. Not a single trace of the surgery or recovery remains in my memory. I know it happened because there are other traces—the accounts of my mother and father and other relatives who were present at the time; the long scar running the length of my sternum and the two smaller scars just below it; the scar on the underside of my right wrist and the one above my right clavicle running over the carotid artery; a handful of photographs. There is ample evidence for me to consult, but no memories. Perhaps the past is so bewildering because it suggests a paradox. In one sense, the past is always with us; there is no way to completely separate oneself from what came before. In another sense, the past has nothing to do with us; it is, by definition, never present. Always gone. There is no perfect analogy for the past, no unadulterated version. Memory provides a connection, but a tenuous one and always flirting with oblivion. Even the same experience repeated—like another case of meningitis, perish the thought—would be different. The context, the surroundings, will have changed at the very least. The present feels like this. But the past was that—that open wound; that inflamed tissue; that pounding under the cheek or inside the skull in the membranes around the brain; that pain and anger. That and no other.

7.

It’s Thursday morning. A resident will arrive shortly toting a bag of tools. He will insert a spinal needle into the middle of my back and extract fluid from my spine. The entire procedure will last about twenty minutes. Despite the unnerving image of a large needle puncturing my spine, I am looking forward to the procedure. It was something the specialist said to me not long after I was admitted: because a spinal tap draws fluid from around the inflamed tissue, the procedure can potentially relieve some of the pressure on the brain and diminish the headache.

At ten o’clock, the resident enters my room. He instructs me to lie down on my right side, pull my knees up to my chest, and scrunch my body into a ball. The position, appropriately fetal- like, helps to spread apart the vertebrae and make room for the insertion of the needle. He says it’s important to keep still throughout the procedure. It’s okay to yell if it hurts, just don’t move. The part about the yelling isn’t reassuring. When the needle goes in, a sudden sharp pain is followed by numbness. The needle stops at a precise spot, then continues, then stops again when it reaches the fluid that surrounds the spinal cord.

The fluid, which will be tested to confirm the initial diagnosis, is called cerebrospinal fluid. No one ever says lumbar puncture or spinal tap. They all just keep referring to CSF in that peculiar language, partial to acronyms, of hospital-speak. Once the resident has collected enough CSF, he places a bandage over the spot where the needle went in. I straighten my legs and neck but do not sit up. The resident tells me I must remain horizontal for the next six hours. It’s not clear why. Perhaps I am liable to lose my balance and fall. A nurse places the call button in my hand. My head is pointed towards the foot of the bed. Other than the clock on the far wall, there is almost nothing to observe.

8.

Friday morning—one week has passed since I first felt the dull pain in my armpit. The headache has retreated. My appetite has returned. A couple of teachers from my school escort me to the basement floor where the food court is located. We pass a Burger King and end up at a little cafe called SANDRICH where one of them buys me a sandwich.

I have been in the hospital for four days and will remain for another three. Mrs. H’s sister, who works as a doctor here, has come to check on me every day and will continue to do so until I leave. We were introduced on Monday evening a few hours before I was admitted. On Wednesday, she came to my room to discuss something that she said had been weighing on her. It was her opinion that I should be transferred to the Neurology department so that I could be under the direct care of a neurologist. My doctor, the specialist of Infectious Diseases, seemed confident that I would recover on my own without complications. As far as I could tell, he saw no reason to move me to another department. Mrs. H’s sister never explicitly contradicted his judgment. But her concern for me suggested that she did not entirely agree with him. The situation is more delicate than it might seem. My doctor is technically her boss. And in Korea there is an unspoken, but rigid, protocol when it comes to the chain of command. In coming to me directly, Mrs. H’s sister had potentially subverted that protocol. She was taking a risk in going over the head of her superior. She did what she thought was right at the time. After I recover and am discharged, she will apologize to me for, as she put it, letting her emotions get the better of her. She seemed to feel that her personal connection to me, however thin, had clouded her judgment. After the apology, I will think to myself how unnecessary it is. Her actions were not unseemly but admirable.

The truth is Mrs. H’s sister had a good reason to be emotional at the time. It’s the same reason Mrs. H was at the hospital the night she slept on the couch in my room. Their father is a patient at Ajou University Hospital. That night he lay in the Oncology ward, just a few floors below my room, dying of cancer. I was aware of this fact at the time and insisted more than once that she go back to his room. But she declined. Perhaps she was glad to have an excuse to leave his room and forget the weight of her feelings, if only for an hour or two. Their father will pass away not long after I am discharged from AUH. I will attend the funeral with the principal and a handful of teachers from my school. In a large rented van, we will drive to Mrs. H’s hometown more than two hours from Suwon. It’s spring, so the air will be clear and cool. We’ll drive straight through the evening as the sun goes down. The light will strike the hills at shallow angles, and the steep hills of ash and pine and the road ahead of us and the tunnels, one after the next, propelling the van like a spring-loaded toy, will be washed in the pallid light of a nascent blossoming. At the service, I will want to offer Mrs. H and her sister some condolence, a word or an embrace to repay their generosity. I will want to say the right thing. Why is there always a trace of self-indulgence in sympathy? You almost feel more sorry for the sad guests, searching desperately for something meaningful to say, than the bereaved family. But why should anything be said? Nothing can fix the condition of death or the ruins it leaves behind. It’s as if the act of consoling, apparently directed at the grieving individual, reverses course and returns to the actor. Finally, it is himself he consoles, his own anxiety over the fact of death, so nakedly on display, a fact to which he and everyone else are obliged to witness. Blessed are those who have already passed. When the moment arrives, no words will come. I will stand with the other teachers facing the funeral display—the wreaths of flowers; the burning sticks of incense; the photo of the dead man—and offer my sympathy in silence.

 

Tyler Arndt was born and raised in the Pacific Northwest. He graduated from the University of Washington, Seattle in 2005 with a bachelor’s in English literature. Since 2012, he has been working on a memoir of the years he spent teaching ESL in South Korea. In September 2015 Tyler stayed at the Vermont Studio Center as a resident in nonfiction writing. His writing has appeared in the Rappahannock Review. He lives in Seattle with his books.