Grammar, Numbers, Emotions

Day thirteen.

Susannah has been in mental limbo for about a week now. The current medical narrative is that her delerium is mostly due to her serum sodium levels (as Anaïs says “Just salt? We're all that close to the other world?”). Another theory is that her liver and kidney issues have created a bottleneck of drugs that have psychoactive effects. And still another theory is that she is reacting badly to particular steroids. In any event, her cognitive state definitely seems to be linked to liver and kidney trouble, which, in turn, seems to be improving in the last 24 hours. The nephrologists have been talking abut dialysis for the last several days, but now they seemed to have decided it's not needed.

It's been morbidly fascinating to watch.

Initially, she went in and out of a very self-coherent otherworld, which she could describe in precise detail. Her contingency reality was also a hospital, but of a different kind: it worked on the soul as well as the body, and there was no clear distinction between patient and physician. It also seemed stocked with the culinary, aesthetic, and erotic possibilities that Brigham and Women's frankly is not. For about two days, she was capable of going back and forth to that place more or less consciously, and would become a little cross if the nurses worried about it. (At one point, she was discussing strawberries, and one of the nurses asked if she was feeling confused. “No,” she retorted, “I'm talking about my delusion of strawberries. I know there aren't any real strawberries.”) I am a lucid dreamer, mostly, and I have the impression from her descriptions that this phase of her delerium was a lot like lucid dreaming.

Subsequently, she was in Haiti, trying to help the children there. She drifted into Spanish for awhile, which I could follow, and then into French, which I was pleased to find I could still follow, though my French is very rusty. And since many of the staff speak either Spanish or French, this was all workable. But then she went into Russian, and we were all shut out.

For the last three or four days, though, there is no outward evidence that her delirium is in the form of some internally consistent, oneiric narrative. Instead, it seems to be just a flux of words and grammar and numbers. There is an underlying logic--she often makes her "don't patronize me" face if someone, well, patronizes her. But she changes case constantly, speaking of herself in the third person, or—more strangely—the second person. She talks about other people in the first person; she transposes past, present, and future.

Most of you probably are not aware of this, but I have spent a long time lately working on grammar-parsing algorithms. I cannot help but marvel at seeing the heuristic “subroutines” of this woman—whose mind I know so well, and who is so horrifically intelligent. It feels exploitative and inappropriate, but there it is.

My own heuristic subroutines, and those I see around me, are strangely familiar. Some years ago, Woody Dorsey hired me to work on a book about behavioral finance. In effect, we were interested in the empirical psychological research on why stock traders behave the way they behave, (as opposed to the neoliberal economic model of the same.) As I mentioned earlier, some of those studies are literally based on psychological reactions to medical events...colonoscopies and leg amputations, I think.

Like stock traders, the families of cancer patients are presented with a series of numbers whose meaning they often are not really qualified to interpret. And so we assign normative values: we believe in the virtue of a lower creatinine count, and a higher poly- count, even though we have only the vaguest idea of what these things really are: I'm not even sure what “poly-” is short for, in this instance. More to the point, we have no idea whether an 0.1 drop in creatinine over 12 hours is insignificant or earth-shattering or just normal fluctuation. We don't even know what units “0.1” is expressed in, and yet we have strong emotional reactions to this information. Based on the variety of our temperments and levels of exhaustion, we tend to read all these numbers as optimistic or pessimistic symbols, which, of course, they are not. And for every pair of numbers, we believe we have found a pattern, a trend line.

There is a strong parallel with stock traders talking about, say, gamma, vega, or charm. Or, again, with someone tuning in a station on a shortwave radio dial, who has no idea what all these meters and kiloHertzes are about. But it's so wonderful to hear a signal coming back through out of the static...