Falling Down
One man’s secret to a dizzyingly complex medical condition? Accept the things you can’t control – then do your best to embrace it
This is a story that begins with me dying. On the night of 5 December 2018, I collapsed in a hallway with no warning or medical explanation, not even to this day. I fractured my skull in three places and suffered a massive brain haemorrhage. I was in a coma for two weeks, in the rehab ward for three more, and then I needed more than a year to recover at home. That’s the short version. A longer version exists in the form of a memoir that’s out now, The Night The Lights Went Out. But for this little exercise, let’s just go with the elevator pitch: I died, then I came back.
Although not without a few souvenirs for my trouble. Most of them remain with me to this day. There are the scars, of course. There’s my deafened right ear. There’s my sense of smell, which I lost when I fell, likely for good. And then… there’s the vertigo.
I didn’t know vertigo was coming for me, though I didn’t know any of this was before my accident. The first time I felt it was months after I had left the hospital. I turned on my side in bed, and something about that turn displeased my body. It punished me with a dose of sudden, violent nausea that was gone in less than a second, followed by another brief moment in which my sense of gravity fell away and I came unmoored: floating without floating.
Then the vertigo passed, and I was simply a man trying to fall asleep again. I went to my neuro-rehab doctor and explained the sensation to him. He told me that the nerve in my brain that controls nausea – not a nerve you want to piss off – may have been damaged when I fell and was perhaps the culprit. I asked him what to do. He said the vertigo might ease with time and the physical therapy (PT) I was doing after my collapse. And he was correct.
What he didn’t tell me was that, over time, I would get to know my vertigo so well that I not only liked it, I welcomed it when it arrived.
All In A Spin
Before I explain how that came to be, I have to describe vertigo first. If you’ve never suffered from this – or more accurately, if you’ve never been able to correctly identify the times you already have – you may know it only in the metaphorical sense. That’s actually useful for our purposes, because just as vertigo has more than a few poetic connotations, the real deal also spans a wide range of medical fields, clinical definitions, severities and root causes.
‘It’s not a disease,’ Iris Cohen, a senior audiologist at Mount Sinai Hospital in Manhattan, told me. Vertigo, Cohen said, is a symptom. And it can be a symptom of many different conditions. Vertigo is commonly caused by inner-ear trouble. One of the most well-known causes is when the crystals in your ears’ semicircular canals are knocked out of place. I’m not going all spiritual guru on you by bringing crystals into the equation here. The crystals are real, and you don’t want them fucked with.
But even if your crystal game is sound, you can still get vertigo from an infection or from being very drunk (ever get the spins? Vertigo), or from your salt intake, or from an errant football hitting you in the noggin. You can get vertigo from a naturally occurring vitamin D deficiency. Or in my case, you can get vertigo from suffering a massive concussion; fracturing the temporal bone in your skull; having that fracture shear your inner ear, which helps control balance, in half; and sustaining brain damage. All in one go. Any of those injuries, when isolated, can trigger it. When combined, they give me a sensation of vertigo that may be as unique to me as my fingerprints.
Someone who experiences vertigo may not know they have it until they’ve visited several different specialists. Because it presents in so many ways and has so many potential origins, getting a proper diagnosis may require a lot of testing and a trip to a specialist.
‘There is no pill,’ says Dr Maura Cosetti, who heads the Ear Institute
at Mount Sinai. ‘This is a very difficult concept for patients. And for physicians, in fact.’
There are prescription medicines such as meclizine that purport to control vertigo, but Dr Cosetti notes that those meds are often ineffective, especially when they aren’t combined with physical therapy and when the underlying causes of your vertigo are left untreated.
I never took any drugs for vertigo. I was never prescribed them, because vertigo was far down on the triage list when it came to my recovery. I was experiencing, at least in the beginning, what’s known as benign paroxysmal positional vertigo or BPPV. This is merely one species in the greater phylum of vertigo. There are others, including Ménière’s disease, central vertigo and vestibular migraines, which can manifest with symptoms of vertigo. Some of these cases can be debilitating. They can last hours. Days, even. And the nausea they trigger can, if you’re unlucky, be fully consummated in multiple rounds of vomiting.
In rare cases, some people with aggressive BPPV have to avoid certain positions entirely, be they lying down or upright, all the way to the grave. But despite everything that I suffered from my accident, the vertigo fairy was shockingly gentle on me. I never threw up. I never got it while standing up. The more I recovered – doing the PT and rehab work that treated my big-ticket problems – the more my BPPV settled, until, a year and a half after my haemorrhage, a wrong turn in bed didn’t trigger the nauseating rush at all.
Eventually, my symptoms became another kind of vertigo, and here is where a pattern formed that persists to this day. I lie down to sleep. After a while, the vertigo hits in two waves, each one lasting no more than a second or two. The first wave feels like a gentle spin, the second like a plunge. And I’ve learned that if I can just relax and let the one-two combo hit me, I will drift right off to sleep.
Holding Your Ground
The famous staircase scene from Alfred Hitchcock’s 1958 classic Vertigo does a fair job of conveying the sensation it can inflict upon you, but it’s still not my vertigo. Mine is a kind that only I can experience and, therefore, only I can know. But knowing the blueprint is helpful from a psychological standpoint and as part of the treatment.
‘There are some patients who will come to see me even before they have a full-blown vertigo attack because they could sense something does not feel right in their ear.’ That’s Dr
Enrique Perez, a neurotologist and an assistant professor of otolaryngology at Mount Sinai. I, too, can feel when my little dreamland vertigo attack is about to strike. In fact, I get oddly excited for it to arrive. And while that excitement may scan as the sentiment of a closet masochist, I’ll have you know that it actually means I have a kick-ass attitude and that my brain is leading the vertigo, rather than the other way around.
Why? The experience of vestibular therapy, according to Dr Perez, is ‘almost like exercising your cerebellum and your vestibular centres to process your place in space. Over time, that allows you to start compensating for perhaps a fixed vestibular loss.’ And I am compensating. I am processing my place in space. I have a slightly better handle on what that place is now that my brain exploded. And thanks (yes, thanks) to the vertigo, I know that place is not sedentary. It can move. But I can move, too.
People will tell you, ‘I know my body’, but that’s a lie. Your body keeps secrets from you. Many of them.
Vertigo is one such secret. But now that my vertigo has been exposed, I’ll be ready the next time the ground disappears out from underneath me.
People will tell you, ‘I know my body’, but that’s a lie. Your body keeps secrets – many of them