Phi­los­o­phy Lessons

Di­ag­nosed with MS at twenty-seven, I re­vis­ited the clas­sics for a way for­ward

The Walrus - - CONTENTS - By Mered­ith White

Di­ag­nosed with MS, I re­vis­ited the clas­sics for a way for­ward

In other brain-picture news, my neu­rol­o­gist re­cently told me that this year’s MRI was “[weighty pause] not too bad” whereas last year’s was “rather con­cern­ing.” “If you have another attack,” he said, “call our of­fice im­me­di­ately. In a case like yours, I’ll want to see you right away and put you on some­thing stronger. Auba­gio is an easy med­i­ca­tion, and it’s eas­ily tol­er­ated, but it’s not the most pow­er­ful op­tion.”

Then he paused and added, as a kindly af­ter­thought, “But of course, hope­fully, that doesn’t hap­pen.”

I got the feel­ing he thought it would hap­pen one day. In a case like mine, what­ever that means.

Four years ago, if you had asked me about my case, I would have said I had none. I had ex­tracted my­self from a PHD pro­gram in clas­sics that was feel­ing in­creas­ingly un­ten­able; moved back to Toronto from Cincin­nati, where I’d been study­ing; and made just enough peace with the fact that I would not be spend­ing the rest of my life study­ing Greek lit­er­a­ture that I could fi­nally sleep at night with­out pan­icked sec­ond-guess­ing. I’d started a job and found an apart­ment with a friend from high school. I had moved out of my par­ents’ base­ment. I had all these things, a whole ed­i­fice of cer­tainty around me. No more start­ing thoughts with if: “if I pass these ex­ams,” “if I com­plete my dis­ser­ta­tion,” “if I get a job, if I go on leave,” “if I de­cide not to go back.” I’d set­tled it, enough for me, at least. My life felt solid, full of state­ments. When I go to work. When I pay my rent. When I see my friends this Thurs­day. Then one day, I couldn’t see.

I should clar­ify: I couldn’t see prop­erly. The cen­tre of my vi­sion was missing, sort of, and when­ever I looked straight at some­thing, it would dis­solve, but I could see well enough around the pe­riph­ery. This wasn’t new to me; it seemed like the aura I typ­i­cally ex­pe­ri­ence be­fore a mi­graine. Usu­ally, I’d take an Advil and re­sign my­self to thirty min­utes of be­ing slightly spacey be­fore the aura would lift and the mi­graine would ar­rive. Only the aura didn’t lift, and the mi­graine didn’t come.

Af­ter a cou­ple of days, I was frus­trated but still san­guine about this cu­ri­ous de­vel­op­ment. A cou­ple more days and I was pan­icked, won­der­ing what was hap­pen­ing. I saw my fam­ily doc­tor, who re­ferred me to an oph­thal­mol­o­gist, who ruled out glau­coma and re­ferred me to a neu­rol­o­gist. This ap­point­ment was months away; af­ter about two weeks, my vi­sion slowly re­turned to nor­mal, and I slowly stopped wor­ry­ing. By the time I saw the neu­rol­o­gist I was stu­diously blasé, won­der­ing out loud if I should have can­celled the ap­point­ment. He wasn’t too con­cerned, ei­ther, and thought that it was some­thing he termed a “com­pli­cated mi­graine,” which is to say: a mi­graine that didn’t quite work prop­erly. “But there’s a tiny chance,” he con­tin­ued, “that you’ve had a stroke, so I’ll sched­ule an MRI to make sure we can rule that out.”

Then he added, “Of course, if any­thing else hap­pens, give my of­fice a call.”

Noth­ing else hap­pened. One night, three months later, I slid into an MRI ma­chine, a lit­tle ex­cited, a lit­tle bored, a lit­tle anx­ious. My primary fear was that I had some hid­den and un­known piece of metal in me that the mag­nets in the ma­chine would ex­cite out of my body in a painful dis­cov­ery. The ma­chine switched on, noth­ing hap­pened, and I ex­haled. Noth­ing hid­den, noth­ing mysterious. I set­tled in and lay as still as I could for the next forty-five min­utes while the MRI clanged, whirred, and clicked. To give my­self some­thing to think about, I re­cited po­etry in my head. In what may be the best ex­am­ple of dra­matic irony I will ex­pe­ri­ence in my life, a poem by Wil­liam But­ler Yeats came to mind: “I have drunk ale from the Coun­try of the Young / And weep be­cause I know all things now...”

Yeats’s speaker has gained prophetic vi­sion through shar­ing in the drink of the Coun­try of the Young — the land of the im­mor­tals, in Ir­ish myth. The speaker is un­done by this knowl­edge of what is, and what is not, to come. He seems para­dox­i­cally shrunken, his life con­densed to one mis­er­able fact: that he will never be with the woman he loves. Knowl­edge of what is to come, Yeats sug­gests, will not spare you from the ne­ces­sity of ex­pe­ri­ence.

Mul­ti­ple sclero­sis is a neu­rode­gen­er­a­tive dis­ease where the myelin sheath, a fatty in­su­lat­ing layer on one’s neu­rons, is dam­aged. Think of myelin like the rub­ber cas­ing on an elec­tri­cal cord: it shields the wire in­side from dam­age and thus also pro­tects the cur­rent that the wire car­ries. Spots of dam­aged myelin can al­low the elec­tri­cal pulses that run through our nerves to be­come scram­bled, re­sult­ing in loss of mo­tor skills, tin­gling, tre­mors, loss of sen­sa­tion in limbs, and vi­sion prob­lems. The spots where de­myeli­na­tion hap­pens be­come le­sions, or scle­rae, from the Greek word for hard. Mul­ti­ple sclero­sis is a brain cov­ered in these lit­tle scars.

In one type of the dis­ease, re­laps­in­gremit­ting mul­ti­ple sclero­sis, a suf­ferer ex­pe­ri­ences at­tacks, or flare-ups, when de­myeli­nat­ing ac­tiv­ity in the brain causes a sud­den neu­ro­log­i­cal symp­tom to man­i­fest — such as, say, be­ing un­able to see prop­erly for two weeks. When the attack sub­sides, the symp­toms will also sub­side, though le­sions will be left be­hind and the dam­age may not be com­pletely re­versible. Over time, a per­son with MS can ac­cu­mu­late small dis­abil­i­ties that build to­ward ma­jor ones, such as im­paired mo­bil­ity and lim­ited vi­sion. Other symp­toms are more in­sid­i­ous but still de­bil­i­tat­ing: fa­tigue, mem­ory loss, re­duced cog­ni­tive abil­ity. An es­ti­mated 100,000 Cana­di­ans have MS, mak­ing Canada a coun­try with one of the high­est oc­cur­rences of the dis­ease in the world.

Jean-martin Char­cot, a nine­teenth-cen­tury French neu­rol­o­gist, first iden­ti­fied the dis­ease in 1868, though the le­sions on the brain and spinal cord caused by de­myeli­na­tion had been ob­served in the decades prior. When Char­cot cre­ated his set of di­ag­nos­tic cri­te­ria, le­sions could only be ob­served through dis­sec­tion, and he re­lied on the out­ward man­i­fes­ta­tions of MS for a di­ag­no­sis. But now, med­i­cal tech­nol­ogy al­lows us to peer into the re­cesses of our bod­ies that have never been opened to the light. On MRIS of the brain, le­sions show up as lit­tle spots of white. And as much as it is peer­ing into the dark re­cesses it is also peer­ing into the fu­ture, be­cause it turns out that not ev­ery le­sion nec­es­sar­ily causes a neu­ro­log­i­cal symp­tom — they may sim­ply fore­tell a like­li­hood.

In my case, the good and ex­pected news was that my first MRI came back with no sign of stroke; the bad and un­ex­pected news was that my brain was cov­ered in de­myeli­nated patches. “Some­thing lit up,” as the neu­rol­o­gist told me. My sparkling brain. Two more MRIS fol­lowed, spaced six months apart each time to al­low my brain to change — if in­deed it was go­ing to change, which it did. It kept chang­ing; doc­tors re­marked with care­fully masked sur­prise on the num­ber of le­sions they found each time com­pared with the fact that I had ex­pe­ri­enced only one attack. Fi­nally, seven­teen months later, I heard the physi­cian at the MS clinic I had been re­ferred to say, with the awk­ward­ness with which one de­liv­ers bad news, “At this point, we con­sider the di­ag­no­sis to have been made” while flip­ping through MRI im­ages of my brain, cov­ered in pale dots. I was one of those 100,000 Cana­di­ans now. Af­ter over a year of wait­ing, it seemed the mo­ment of di­ag­no­sis passed by al­most with­out no­tice. If I get di­ag­nosed bleed­ing seam­lessly into when I got di­ag­nosed.

It turns out that be­ing di­ag­nosed with a chronic dis­ease does not chart out a clear path to the fu­ture, it only high­lights the risks in a way that is both use­ful and use­less at once. I take med­i­ca­tion to re­duce the rate of de­myeli­na­tion, an act that low­ers the risk of an attack while bring­ing its own set of at­ten­dant com­pli­ca­tions with it. (“In case of heart re­lated death,” the pa­tient in­for­ma­tion tells me, “stop tak­ing the med­i­ca­tion and see your doc­tor im­me­di­ately.” Noted.) But I can­not know with cer­tainty what is com­ing next any more than I knew three years ago, or five years ago, or yes­ter­day.

There are still days — like, say, when Ivisit the neu­rol­o­gist and he looks at my most re­cent scans anx­iously and re­minds me once again to call the clinic if any­thing hap­pens — when the ifs and whens start to blur in my head, when the threat of cat­a­strophic think­ing comes bar­relling to­ward me, sirens wail­ing, and at these times, it seems best to re­treat to what I know and do best with my trou­ble­some brain — to wit, look­ing up the et­y­molo­gies of words — and ob­serve that, in Greek, “di­ag­no­sis” means “dis­tin­guish­ing, dis­cern­ment; med­i­cal di­ag­no­sis,” but it also means, in le­gal writ­ing, “res­o­lu­tion, de­ci­sion.”

Res­o­lu­tion! De­ci­sion! That sounds like a level of cer­tainty, of when-ness, that I sus­pect many peo­ple with med­i­cal di­ag­noses wish they could achieve. Will it hap­pen again? Will the lit­tle scars in my brain make them­selves ob­vi­ous once more? What ought I to do? How can I de­cide the best course of ac­tion?

The -gno­sis part of “di­ag­no­sis” comes from a Greek root, -gno, which means “to know.” If you’ve read a bit of Plato you might have come across another fa­mous

I’ve won­dered, strug­gling through a bout of fa­tigue, if the fog in my brain and the weight in my limbs might never lift, and if this meant I had to give up my am­bi­tions.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.