How a brain tumour can look like a mid-life crisisby Paul Broks / July 20, 2000 / Leave a comment
Published in July 2000 issue of Prospect Magazine
Monday afternoon. I am standing before 100 or so undergraduates in a cavernous lecture theatre at Birmingham University. Ten minutes to go and I am going to round off my lecture with a story. We can discuss it next week. I scan the auditorium. The students are still listening attentively, pens at the ready. One in the front row, a pale girl, has a small tape recorder and reaches into her bag for a new cassette. A pigeon settles on the sill outside one of the high windows and, watching the pigeon, I forget momentarily what I was about to say. Then it comes back to me: Robert’s story. One day, in the foothills of his middle age, Robert took a look at himself in the mirror. He saw that life was running out and he was going nowhere. He was going stale: bored with his job, out of love with his wife, stifled by family life, disenchanted with himself. But what gripped him and shook him to the core of his being was the thought that he was literally going nowhere. The thought that, at the end of this dreary line of days, there was oblivion. It was time for a change, and changes there would be. That same day on his way to work he stops at the newsagents, as usual, to buy a newspaper. He pays for the paper but on the way out, he takes a chocolate bar from a shelf and slips it into his pocket. This little act of theft is curiously energising. His senses feel stripped and raw. He is engulfed by a feeling of elation and drives faster than he should. But instead of going to work, he travels 300-odd miles from Yorkshire to Cornwall where, by early evening, he finds himself sitting on a beach in the face of a warm sea breeze. Robert is profoundly happy. The sun sets, it grows dark and chilly, but there he stays all night, conceding to sleep only as the sun began to rise again. He returns home the next day with no explanation except the truth, and spends another sleepless night placating his distressed wife who demands a more plausible version of events. What were you thinking of, she says. He says he’s been thinking about everything and has put a few things straight. Life reverts to routine for some weeks. Then, driving home from work on a Friday evening, he switches on the car radio and hears an interview with Julian Bream, the classical guitarist. At one point the interviewer asks Bream what he thinks of electrically amplified guitars. The electric bass is fine, he says, but otherwise he’s not impressed. What does he think of Jimi Hendrix as a player? Robert detects a note of condescension in the interviewer’s voice at the mention of Hendrix but thinks it’s a good question, one he himself would have wanted to put. He waits for the reply. Don’t let me down, Julian, he thinks. There is no let down. He was brilliant, says Bream, leaving the interviewer momentarily flummoxed. Robert gets another burst of energy like the one he had when he stole the chocolate bar. He turns the car round, heads back into town at speed and pulls up outside a musical instruments store. The shop is closing and the staff are cashing up. He tells them he must have a Fender Stratocaster, the guitar Hendrix played. They oblige. He buys an amplifier to go with it and a book containing note-by-note transcriptions of Hendrix songs. This comes to nearly ?700. But Robert, says his wife when he gets home, you can’t play the guitar. He says he is going to learn. But that night all elation has drained away. He lies awake until the early hours in a state of agitation, tormented by thoughts of annihilation, of fading into nothingness. He is close to panic. It’s coming, it’s coming. Changes there would have to be. The next day, out of nowhere, he announces to his wife that their marriage is over, and he leaves her, the house, the children and his new guitar, never to return. He goes back to Cornwall, where he finds a bar job, grows his hair, cultivates a tanned and weathered look, and becomes, in effect, someone else. Two years later, living alone in a threadbare bed-sit in the suburbs of a northern city, he can scarcely recollect any of the Cornish interlude. There are fragments of memory, images from someone else’s memory almost, but they don’t cohere-a blue lampshade, a rainy, windy night somewhere, the shiny stainless steel surfaces of a hotel kitchen, a woman (Jackie? Jenny?), a fist fight, the sea. In fact, he is finding it hard to pull together his thoughts from one minute to the next. He feels nauseous and experiences a strange, feathery sensation rising from the pit of his stomach to his gullet. Looking into the bathroom mirror, the reflected face seems empty, drained of any meaning-almost the absence of a reflection. He stands there for a while, staring, then turns on the washbasin tap, turns it off, turns it on again, turns it off, turns it on, before crashing to the floor. His limbs stiffen briefly then jerk fiercely for several minutes and a spreading patch of urine darkens his trouser leg. He sleeps. It is Robert’s third seizure this week. The next happens in a supermarket and, afterwards, he’s taken to hospital. The doctors are concerned that, despite recovering from the fit, he has remained for days inert and disoriented. They investigate and find on the MRI scan a large mass just behind the eyes in the orbitofrontal region of the brain, extending back into the anterior temporal area. It turns out to be a meningioma. This is a tumour, intrinsically benign, which has invaded the outer coverings of the brain. It has been growing for several years, distorting the frontal lobes of Robert’s brain in the process, so that the very person he felt himself to be was being pulled out of shape. Post-surgically, tumour excised, he asks his nurses most days: when are my children coming? Can I go home now? My lecture seems to have gone well enough. These neurogothic tales generally do. “Robert’s story” is an embellished account of a real case. I have tinkered with some of the biographical information and, of course, the patient’s name, but the clinical details are faithful. This man really did leave his family on an impulse, following several episodes of uncharacteristically eccentric behaviour, including acts of petty theft and spontaneous trips to seaside towns. He really did spend sums of money he could ill afford on luxury goods like musical instruments (which he could not play) and expensive clothes (which he might, or might not, subsequently wear). He was a Jimi Hendrix fan, too. A large, iconic image of the great man stared from his bedroom wall at the rehab unit. That, at least, remained constant in his life. Whether or not he stood looking into the mirror in the way I describe, I have no idea. I threw that in. Perhaps, somewhere, I had in mind the image of Jekyll standing before the mirror as he watches his transformation into Hyde, and then, at the end, perhaps it was Dracula, bereft of soul, bereft of reflection. I don’t know. It’s only just occurred to me. After the operation he really did expect to return to his family, unaware that they had long since moved on. That slow tumour: when did it take root? How long had it been growing, heaving its bulk into his frontal lobes, insidiously recalibrating his personality? A meningioma like Robert’s can take years to develop. The brain can accommodate, up to a point, a slow-growing mass without betraying significant clinical signs. It depends on the rate of growth and where it is located. Some people grow old and die, never knowing that for years they were harbouring a benign brain tumour. I once saw a man in his seventies, admitted to hospital after a stroke, who turned out to have a tumour the size of an orange nestling in the parietal lobe of his brain. God knows how long it had been there, but it had nothing to do with the stroke and, apparently, wasn’t giving him any trouble. Perhaps Robert would have left his wife and children anyway. Perhaps he was restless and bored, or depressed. A mid-life crisis. Could it be that the tumour just hastened the process or even had nothing at all to do with his impulsive decision to pack his bags and go? Maybe. We can’t rule this out, but I think not. Impairments of social judgement, impulsive behaviour and the rest are a typical consequence of damage to the frontal lobes. Unlike the man with the stroke, Robert’s tumour was causing him trouble. He developed epilepsy. But suppose he hadn’t? Would there have been any grounds for saying that his behaviour was, in itself, pathological? Not necessarily. You would say it was a mid-life crisis. Despite my undisguised haste to draw my lecture to a close there are several questions from the students. Some are theoretical, but mostly they are about the story, as a story. Fair enough. Have you ever considered all this from a Christian perspective, the pale girl at the front asks as, finally, I gather my notes. No, not really, I say a little briskly, but I have a train to catch, perhaps we can discuss it next week? Then she asks: but what happened to Robert, in the end? He became profoundly depressed, I reply. I spare her the information that after being discharged from his rehab hospital, there were two botched suicide attempts before he eventually succeeded in killing himself. Third time lucky. I have this image of Robert hanging himself with Hendrix playing Voodoo Chile in the background: “I don’t need you no more in this world/I’ll meet you on the next one/Don’t be late.” As far as I know it did not happen that way. My train is delayed. A two-hour journey becomes three, and I have a couple of beers. I think about the pale girl. She seemed genuinely distressed by the story and I regret not allowing her more time. But when finally I get home, I feel deeply content to be there, immersed in my family. Secure, immutable, invulnerable, immortal. As Robert once felt, perhaps.