‘Mem, Mem, Mem’

After a stroke, a prolific novelist struggles to say how the mental world of aphasia looks and feels

Hiroyuki Takeda/Flickr
Hiroyuki Takeda/Flickr


One day in June of 2003, my husband, Paul West, lay in a hospital room in Ithaca, New York, watching the sun’s hallelujahs beyond the sealed window and aching to go home. He’d already been there for three weeks with a kidney infection that became systemic, one of those rootin’-tootin’ staph bugs older than sharks or ginkgo trees, and I’d camped out with him, lest he trip over several leashes and the two lines dripping fluids into or out of him. Struggling from bed, he made his way to the bathroom. The next morning he would be heading home at last.

A few moments later he walked back out and stood at the foot of the bed, eyes glazed, his face like fallen ice. Paul had had a massive stroke, one tailored to his own private hell. The author of more than 50 stylishly written books, a master of English prose with the largest working vocabulary I’d ever encountered, a man whose life revolved around words, he had suffered brain damage to the key language areas of his brain and could no longer process language in any form. Global aphasia, it’s called — the curse of a perpetual tip-of-the-tongue memory hunt. He understood little of what people said, and all he could utter was the syllable “mem.” Nothing more.

Many doctors, tests, and frantic days followed, and his prognosis was grim. The brain cells were dead in Broca’s area and some of Wernicke’s area, he could no longer swallow food without choking, and, worst of all, it was a left hemisphere stroke. I’d just published a poetics of the brain, and I knew that the left hemisphere processes positive feelings, the right negative ones; unopposed, the remaining right hemisphere could spark dark angry emotions for the rest of his life.

But Paul had a couple of important traits going for him. Because he had wordsmithed for seven decades, he had forged dense thickets of brain connections for language. Also, he could be diabolically determined.

After three weeks in the hospital’s rehab unit, he was able one day to say proudly: “I can talk good coffee,” but little more. Still, it was a complete sentence. I took him home, hired speech therapists, who, alas, weren’t able to help him move beyond simple utterances. Whenever he spoke, the wrong names for things tumbled out. Aphasia is, above all, a sorting disorder. And, with short-term memory clobbered, by the time he got to the second half of a sentence he had forgotten the first half.

“You know, dear,” I said to him one day, about two months after the stroke, when he was feeling mighty low, “maybe you want to write the first aphasic memoir.” He smiled broadly, said, “Good idea! Mem, mem, mem.” And so he began dictating, sometimes with mountain-moving effort, and at others sailing along at a good clip, an account of what he’d just gone through, what the mental world of aphasia felt and looked like. Writing the book was the best speech therapy anyone could have prescribed. For three exhausting hours each day, he forced his brain to recruit cells, build new connections, find the right sounds to go with words, and piece together whole sentences. Going over the text the next day helped refine his thoughts and showed him some of aphasia’s fingerprints in the prose.

Now, three years later, he has just finished writing his first novel since the stroke, one with Westian characters and themes. During a three-hour window of heightened fluency in the middle of the day, he can write in longhand, make phone calls, lunch with friends. He has reloomed vibrant carpets of vocabulary, and happily, despite the left hemisphere stroke, he seems happier than before, and I think his life feels richer in a score of ways.

What follows is an excerpt from The Shadow Factory, the aphasic memoir Paul dictated with such struggle and resolve, “forcing language back on itself.” In it, he recalls life in the hospital’s rehab unit, what he felt and thought, and explores some of the all-too-real tricks the mind plays to save itself from the tomb of lost words.



The difference between my own refracted gaze of the world and Diane’s is that she sees the world in all its detail, squirming into the needlepoint alleyways that leopards reject, and mine is to look on the offered scene as a species of broadcloth identified mainly through its ribbons and Tam-o’-Shanters. This sharing the load usually means that between us we cover the waterfront, missing a few mouse holes and locked jaws here and there, but getting the plurality right.

It may not happen that the skills of either of us would often be brought into play, cutting us off in different ways from the charming scene about us, but when you are dealing with something that neither of us has ever seen before, not in bulk, anyway, the situation is profoundly different and likely to fall off the universe for not trying hard enough.

One way of trying extra hard is to imagine one dimension of the universe coated in either black velvet or a blue that no one has reported outside the province of Baffinland. This same needling eye one imagines as bringing reports of blancmange, mince pies, jam tarts, cream pies, chocolate éclairs, Odwalla bars, chocolate chip cookies, ice cream, and all manner of other delicacies to the invalid’s bed.

However you spell the word invalid, you are either invalid because not valid, or invalided out. Or you disentangle the least bit of wiry fluff that has been haunting your tongue for half an hour, and assign it to the unwilling project of the human mess. These rank as contributions in some way or other, but the assorted confectioneries are too massive to eat, and the strand of henpecked fluff is too narrow, which makes them both second-rate substitutes and sees them out. What I’m trying to say, in language ever more oblique, is that the human psyche can sometimes see evidence of what is not present to the senses.

“Bosh,” one hears you exclaim, “this man is writing about nothing!” But is he? It could be that he is writing about something somebody said to him after he had regained his senses, or that he regained these senses for himself, and detected shreds of rabbit fluff here and there. Imagine a man coming round after five days in the human tank that denatures us all and finds no memory worth talking about. I suspected as much from my 10-day immersion in whatever I was immersed in.

I say this in the most tentative manner because there isn’t a great deal of difference between what’s roiling and not rolling. You could easily miss it for the whole of the 10-day period. Nonetheless, I think it was there for human consumption, and I am content to identify it — if that is not too canonical a word — as a lump of Lot’s wife going nowhere, or what Samuel Beckett, in one of his wilder notions identifies as Arsène going the unerring rounds on his bicycle, even when he has nothing to deliver.

Clearly we are dealing with shadowland at its bleakest, and should not expect too much. It is not likely to reward us with any vision of something discernible. You always have a chance to say “I saw nothing” or “I saw something.” And it is not enough to say “I saw Versed or chloroform,” because that would generate far too much reportorial weight. To recognize that we are not dealing with much of the known hardly delights anybody, but just imagine how much of the unknown is out there among the dark clusters of stars and the dark matter of which we know nothing. We may think that we are dealing with the nonstop hodgepodge of daily life, but we are also dealing with the opaque mysteries of the universe itself.

Cabbage served twice means death. So says one of the older Greek proverbs, though it goes no further into the lethal lineage of cabbage. I was becoming accustomed to these devil servings, mainly of the mythic cabbage, as distinct from the real one. But how to divest yourself of the mythic one, when the real thing offers itself up? I long ago decided to opt for both, lest I for some reason lose one or the other, whether bull-rushing into a dead end, or having the real thing played out on my skull for days.

Was it indeed days? Or merely a squawking interim in the full gamut of time, no more than an hour? I settled these and other questions for later on when I had got the better of my bearings. For now, there was the serious business of interpreting my condition, as far as decency would allow. First, was the matter of my jaw, affixed to my head in the certain manner of a Greek wrestler and extending right through my head with no give in it at all. Some things were happening not for the first time, and I experienced serious reluctance to pursue the matter further. If a locked jaw was any indication, things had already gone from bad to worse and could not be trusted.

I addressed myself next to my temple, which, seeming in no way to have enlarged, felt for the first time brittle and temporary. Could it be that some of it was missing, obliged by some demented operator with a fretsaw to have given doughty service? Certainly it didn’t feel right, and slowly I cruised the surface area, waiting for a mishap, or the plain bald gap where something had been and was no longer. So let us say that between one jaw null and void and the other there was a temple that was highly suspicious, and would remain so for the duration.

I turned my thoughts next to the ghostly hand that dangled uselessly at my side, paler than it had been, and with an odd look of failure about it that I had not noticed before. Could it have withered during the process? Stranger things have happened to a victim of a stroke. It was the same inert apparatus, but somehow more useless, as if it had been ratcheted down a peg or two. In the tremendous lusting ovation of the stroke proper, I rapidly formed an adverse view of my jaw, temple, and hand, wishing them all far away and put to the good uses of someone else who was not too proud of what he brought to the human encounter.

There was a bewildering assortment of false starts and incomplete sentences for the mind only. I no sooner thought of something to say to myself than I forgot it, and I was lucky to get beyond the second or third imagined word. Of course no one in his right mind overheard any of this, the dumb speaking to the silent in a reverse image, so no one was upset. But if this happens 50 or 60 times, one wants a little revenge of some sort. Of course, one was in all probability speaking no kind of written English, so this meant that whatever you said was relevant and you could not say anything irrelevant.

I formed the habit of forcing language back on itself, beyond even its failure to communicate anything at all, to see what was there. Language, at least as we know it, had ended, and I was left there on countless occasions, with something like a white sheet of dental floss or a carnivorous absence. There was nothing beyond. So I cheered myself up by taking as my starting point the notion that all I had to do was pass the zone of no known language and automatically be speaking English once again. These are mental compensations to be sure, but they serve superbly in times of need.

So, groggy, weak, and famished, I take my plight on the chin. Milling around me there are all sorts of verbal alternatives both nonsensical and full of meaning, to some of which I have permanent access without speaking. I wonder if one can safely execute a lifetime using the language of dumb show. I know of one woman in New York who has successfully done it for years. It is a matter of the breaks. I would, of course, prefer to speak the English that I know and revere, but I think I can see past gobbledygook to a pure and vivid English, instead of starting every sentence five or six times, writing sentences that lose heart halfway through in a futile clutter of grossly amalgamated syllables.


Others have told me how I raced through several doorways in pursuit of an exit. Either I sidled through or worked the door in a long blast of would-be freedom. For, remember, I was still the owner of a good pair of legs, thinned out as you would expect. Sometimes I caught the two auburn-haired sisters who officiated as guardians off-guard, and managed to go all the way. Sometimes, thanks to these same sisters, I was trapped before I had begun. Sometimes, on at least one or two occasions, I penetrated the major hallways and then spent the few minutes of my precious freedom looking in vain for a door that would lead down into the outside world. The sisters quickly got used to my midnight forays, and became adept at cutting me off before I reached the outer anteroom, either trapping me with a palliasse or running me to ground in one of the lavatories. It was a jaunt for the full body. In one way I looked forward to being captured and restored to my bed, and told for the umpteenth time to stay there or they would not be responsible for my safety.

One day, I continued on my vagrant ways, and suddenly found that somebody had removed all of my clothes. I was a naked runner and maybe gained an extra inch or two of speed from that as I saw it. I was fit enough to run, although naked, and in good enough condition to escape with a military salute, the next destination all the way home where my books and other treasures awaited me. Clearly some renegade part of me was still tinged with lunacy: I saw problem as only extending between the way out and the way home. There were many hurdles in between that I would have to learn one by one. The mad dasher over the parquet floor was to become the sagacious intellect of floor B7. I am sure now that the impulse to dash madly about was inspired by the lull between 5:00 a.m. and breakfast time when there was nothing to do and all kinds of forces were arrayed against you. Had that not been the explanation, I would not have risked all those incomplete early morning adventures, either sliding to a gliding halt or cannoning to a stop above either sister’s iron-hard bosom. They never caught me anyway. I did not find the entrance to the way out, and always they returned me, with wagging fingers and nagging expressions, to my bed.

It was vain to point out to me the dangers of it all. I had certainly not been blank during any of this, but there were all kinds of things going on in my system, and these the staff pointed out to me. I was mute still, and had no business scooting around the halls, either naked or clad. And I was further reminded of the 11 or 13 chemicals that wandered about in my breast, some of them impervious to what I put them through in my nightly excursions, some definitely not. I decided to be a good boy, and work my passage outward as good boys do.

For contemplation’s sake, I took to reviewing my body at its most wholesome. Legs, arms, and maybe even some portions of my afflicted eyes would serve as a beginning. I considered it not bad to have survived with these and, for a change, decided to write in big letters the bits of my body that had survived. A pleasurable excursion, no doubt, to which I could return. It was a matter of looking always on the bright side, until you were looking no longer; in this way, unless you were singularly unfortunate, you always had something to admire. But, of course, the satanic and brooding always ousted the healthy and auspicious perhaps because in the fullness of time we merely tired as a nation of the life-affirming. Which strikes me as utterly extraordinary, considering the amount that people have wrong with them. I have always been fascinated with the dark side of humanity, maybe because so many maligned works of infamous subjectivity therein repose.


Much was going on behind my back about my condition, but my feeling was that it was now more hopeful. I could not give chapter and verse on these discussions, however, because I was not privy to them, but was included in some talks as a matter of courtesy, except when the talk was grave. I heard my assorted fate clearly expounded or strategically whispered and garbled; in fact it didn’t make a lot of sense.

It’s true that friends and doctors busied themselves around me, almost successfully persuading me to eat or to take my pills like a gentleman. Diane, who had been not only visiting me, but sleeping alongside me in those terrible nights, had now changed schedule to one of morning visits and evening visits, and for the time being at any rate, slept at home where she got enough sleep. So, actually I had more free time on my hands, either to entertain myself in the dark between the hours of 3:00 a.m. and 7:00 a.m., which was difficult, especially for a visionary such as I who had horrible memories of meeting himself going back and coming forward all at the same speed, to no purpose.

I never thought the merest smidgin about music in all the time I’d been in rehab. Now it burst forth, from my micro-mini set, like a noise I’d never heard before, recognizable but impossibly weird, like something Delius might have written in one of his most romantic moments crisscrossed with something by Schoenberg. I listened, rapt, for some time until I was awakened to go and play skittles, which, when I got there, turned into a game of soccer without warning with two of us instead of eight, the only two patients with competent legs. Such a clash with Delius-Schoenberg was unthinkable, and I heard the strains of both above the usual football noises.

I soon got back to the music and played the radio intermittently until Diane arrived with dinner, sacrificing me on the altar of another piece of blameless salmon. The only dishes I deigned to eat were a chocolate pudding and fried bread, with occasional pumpings of hot, pudding-thick cocoa. Even water had to be thickened. And the debate about my increasing loss of weight was driving at least two of my doctors into the finer recesses of their discipline. I had been warned, however, about the dangers of swallowing food at all, little though I understood that, and the message had stuck. Into the bargain, I thought it might give the simian people who were attending my fate an extra incentive to send me home from the esoteric wasteland called rehab.

You see I still had various brands of hope, coming from several sources. The situation would get better, would it not? And I would once again be launched on the world as a fully speaking ogre and a man whose right arm could be pirouetted to an amazing height above the element it soared in.


So the days went by, always repetitive, and short of sleep. The skies were a bright blue and seemed to promise a liquid form of themselves, a brighter blue than ever. Was this the sky I dreamed about in my crèche, warning me of days to come in my solid, leaden state as I brooded on the primrose and other summer flowers? The world, in which I half heard the cry of Inderal as if it were a crow, was promising to be a better place. A securer, more reliable, and trustworthy place. My senses kept me in an emotional, nearly ovational state.

So there was some logic, as I fancied, in my imagining the sky as a potent blue. It was seeping out, this blue, to all prismdom, it had been arranged for me on a personal basis as a choice exhibit of the universe at its most rigid and controlled. There was something imaginative in this twin, something that I had not been aware of before, and something that I welcomed as one of the first samples of grace.

I must expand these notes to show how strange it was to feel the relief coming off of me. Horror and devastation, with me cruising along at no speed per hour, and in the process being hurled from one nightmare to another. I will not pretend that all was well during this indeterminate period, but I can best illustrate it when I say that I heard a cry of Inderal pretending to be Cozaar, and of Cozaar pretending to be Inderal. (Or even of Cozaar pretending to be Cortázar!) The prevalence of one drug over the other didn’t matter. Perhaps they were interchangeable, perhaps they were not. But why, if they were interchangeable, were there two of them? The sense I had of either’s being a leaden, sultry, bivalve lingered on. I had discovered the interchangeability of matter, or close to it, and somehow it made things better than before. I report here only that the mere association of myself with these beings, whatever they were, had a brightening effect, too long held in abeyance.

I associate this sense of quickening with the equal thought of being tired; I tired quickly, although in a kind of ecstasy, from which I rose tired again though just as ecstatic. Perhaps this was the dead end of the world that you survived eminently. Fortunately, it seemed wise to accept this kabbalistic sign as one of those sedate warnings from history: not to expect too much, but to be content with nothing going wrong.

I remain unsure whether this was an old muddle or a new muddle. I was content to leave it at that for the time being anyway. It was clear to me that in its hazy way, a message had been vouchsafed to me, and what was positive in it would have to do. Indeed there was the matter of fending such messages at speed, they were over so quickly that you might spend the rest of your days waiting for the next one, or vexing the one you had, worrying lest you had misinterpreted. I confess to having misdiagnosed it in a state almost of uncustomary levity, arguing with myself that a maligned organism would not have sent in any bad news in the first place. Such, you see, was the extent of my knotty porings over my cosmic fate, reducible always to a quick swat, but also convertible to a bright, almost blistering bugle of human matter.


One of the more entertaining diversions was to be ferried along the interminable corridors of several buildings to a pokey little room that was introduced by its owner, Rebecca, as myroom. Once we had settled in, and once she had given me a half cup of what was rapidly becoming my favorite drink, pudding-thick lemonade, we got to work. But not before she had supervised my mouth in its troubled consumption of the lemonade, which spilled half out. The object of our attentions was the snappy little machine with lots of counters and electric displays. I was marvelously impressed at the outset with such a engine, for in my total ignorance of computers, I thought the display was something aeronautical.

I was rather disappointed to learn that it was my old alien nemesis, the computer. And further chastened when Rebecca, whose zeal was now feeling the full thrust of power, explained to me that this machine would help me to talk. I hasten to inform the reader that I still had not said a recognizable word. I burst out laughing at such a suggestion. Surely she did not associate a man in my condition with such an elaborate machine, although in her bright, impetuous way, she looked capable of handling any refractory machine, or even Roy’s circus lion who had — or had not — mauled him.

“It’s simple once you know how,” said Rebecca.


Visibly she was baffled by my wolverine reply. But like any well-trained speech therapist, she was consecrated to try, and try she did, coming up with a bewildering assortment of suggestions, none of which even approximated what I was trying to say, because I wasn’t trying to say anything. I was too daunted by the presence of the computer and still prey to helpless laughter when I considered the enormous minified array of its keyboard.

She pointed to some arcane feature of the machine and said something about the ease with which I could teach the damn thing to write. But I could not see the numbers and letters. The orthography was not even in the accustomed order, but was a ramble away from my trained eye.

What I’d tried to say, with only usual hectic babbling, was, “I could not cope with this in a month of Sundays.” But I stopped short. I had just discovered something leaning on my awareness for one or two days, which now was coming into what I presumed was the open. I was hearing, albeit silently, and with a sluggish droop, a high-toned music of the mouth, learned probably in some seminar of Matthew Arnold’s years ago, which served me as a kind of language. I could hear a comradely chirrup.

She, having heard nothing, still looked like she expected me to utter some words, however disheveled they were, and put her out of her misery. Again, I tried in my voiceless way to communicate, but it was of no use. Instead I resorted to shaking my head violently at the machine and turning thumbs down at its procedures. She got the point, and closed it up.

She was not a bad girl if you wanted speech therapy presented in a quite broad critical vocabulary and with a charm nobody denied. Her lucid elaborations of some point or other had been worked out time and again, and she was convincing. And was indeed being invited to decamp to a rival institution. She would not be here for long, I judged, and so long as I did not let her persuade me into trafficking with her typewriter-machine, all was well.

The comical, grievous, side to the conversation was, now that we had dismissed the adding machine, we had nothing to talk about. I was dumb and she was prolix, which made for a bad and humiliating mix. She could lecture me on all kinds of speech subjects without my saying a word, and I had been, one way or another, doing too much of that of late. We might entertain bright repartees before she left for her new job, though she gave the impression of trusting me only so far, divining perhaps that I might at some point flash out with a Corybantic dither.

Let us say that she reserved a silk eye-burst for me that would see me through even worse situations than I’d already encountered.


The chatter of A. J. Morpurgo’s little feet sounded again along the brittle hallway. This inspector of men and women, usually so benign of aspect, was supposed to take them far and wide in the perambulations of his domain, leaving nobody out. Properly executed, this maneuver would have cost him four or five hours, so some visits had to be shorter than others, customarily devoted in a nondenominational way to the dying and the half-dead. The sight of his bow tie and unwrinkled shirt always gladdened my heart because he seemed to bring good tidings with him, and human society that much nearer.

On this occasion he did not stay long, perhaps because he faced once again the mute ghoul who stared at him. With each visit he had some new beneficial novelty to impart. He must have tired of this one-way conversation early on, for apart from wishing me the “top of the morning,” he withdrew and went pattering down the hallway to his next visitation. I never grieved for very long, because I would in all probability see him on his afternoon rounds when, just as dumb as before, I would find him in a more gladsome mood. To me this round of his seemed a perfunctory preliminary, although it was executed at the same speed as his morning one, maybe even a little faster. Either way, Morpurgo was on his rounds again, and could be relied upon, until the end of time, to execute his sublime quick-step and fox-trot rhythm.


I have already referred to the “Mem…Me…Mem.” But I grew eventually out of that to a slurred punctuation of such a simple word as scare, advancing to a triumphant statement such as “it’s simple.” This was so huge a feat on my part that contemplating it made it actually go away, and I could not remember it until someone recovered it for me. How singular to be marooned on an ice floe with a solitary word in my vocabulary, unable to remember it, and depending on friends to revive the jubilee of its memory. Double superintendent of my own mouth, with its silent opening, whenever I tried to formulate a sentence or word, some malignant force took over and reduced all I said to ashes. For instance, “Ble-, Ble-.” Was this some gorgeous prelude to “Bleat, Bleat”? Or something of my own devising along the lines of “Bless”? It could mean nothing to anybody, not even the doughtiest researcher, and it reposed ever afterwards in the noxious dictionary that held as well the litany of another aphasic who said “CASH” incessantly, and only that.

To grow, but the outward motion is melismatic, and one has no notion where to grow next. A generous observer might review the situation in these terms: growth has taken place, that’s all, otherwise the situation has not changed.

During the first five days of my own case, I was convinced that something was changing between my lower jaw and upper mandible. What came later amounted to a simple relaxation of that, implying without demonstrating, that one of those days it would go somewhere. For all I knew, it was free to go back, recovering the route it traveled on, or sideways, leaving me with another problem, another outreach of the mouth to be concerned about. Fortunately, this selfless journey from mere outward movement toward mere outward movement that might go somewhere, moved into something else. Was this in fact D. W. Griffith’s A Birth of a Nation? Or something even more profound, for the force gave every evidence of at last growing into something, maybe only the first letters organized in the wrong order like “slurply” for “syrupy,” but definitely promising.


My main related exploit was to, in the language of the dumb, indulge in sequences of utterly incomprehensible pseudowords. I was saying baffling things in the language of the dumb, only very occasionally breaking into what I recognized in my delirium as rational speech. But this was a language of silence that now and then promised also to be a language of shadows and dumb show. You cannot ask too much of the babbling dumb, but you must if we are going to get anywhere at all. My habitual pseudolanguage of “Pell. Pell. Pell” led nowhere at all, and clearly, when I managed to propel my mouth into the ugly grimace that accompanied these sounds, it would profit from some kind of restoration to the straight and narrow. How often was it that I retained enough motor control to utter nonsense for half an hour, which does not make for an interesting conversation, especially among those who have been accustomed to the high jinks of intellectual performance.

Reading, at which I used to be no slouch, now gave me the most incredible, disheveled experiences of my print-bound life. Now print jigged toward me, then it hung back. The one part of it that was readable swam backward or forward to render the reading experience at best incomplete, or subject to the vilest, maddest vagaries of a proofreader’s nightmare. When would it end? The list of possible insults to my body, already some 35 pounds lighter than usual, was extending to mop me up, and I could see the day not-so-distant when West, against all his better judgment in aesthetic affairs, would be lowlier than a bagman. I would become the Ratman of Paris I had invented for a novel!

My sight would get worse, either waning away altogether or producing those scintillates of light that give hope to the persons blinded in the wars and prompt visions of something or other where there is no vision at all. I declined to enter the subject further. Morbidity is usually its own reward, and I could not for the life of me see how things could get better.

Whatever was being done to me behind my back, and under my front, it amazed me that so much attention was being paid to respective parts of my body, so much energy being applied in different ways. To be sure, they had left a great deal out, but they had also left a great deal in. Once again I felt the shady conundrum of life as we know it. First producing a PEM-umbra of what you have and then producing the penumbra of what you have not.

Some kind of trumps to be sure, but which is which? I never reconciled myself to this idyllic-evil switch, knowing in my heart that I would choose neither and so be left with nothing at all. It was like having to choose between the Hound of the Baskervilles and Jack the Ripper, or some other combination playing into one another’s hands. I can never get over the way in which the relevant pieces appropriate to each body come piping through, and I look forward to the day when the miracles of nature, such as stem cells, will officiate as the guardians of our composite bodies. All you would have to do is choose.


It begins abruptly with a loss in the zone peculiar to Broca’s brain. You expect not to be without it. You are. It goes on, it begins, as far as I remember, with a distorted vision stretching on the right side of my face and jaw, a closed space where nothing seems to enter. Whether people find this apparition offensive, I don’t know: But of course the air is breathing in all the time. It felt like a weight perched on my brain. And it was no good my saying anything else. Unless you pass out.

There is more to add to this record. The right side of my ear felt florid, which is to say that a dozen times a day the tympanum would release a dissonance that sounds both 10 times louder and effectively cuts off communication with the trenches. I found this change even more disconcerting than my local outer swelling. It was like being half a man with a nagging habit of probing his ear in full view in the hope of snagging the offending portion. Whatever it was persisted.

Many people would be forgiven, I think, for relegating such an individual to the trash heap of history as someone who had failed and been found wanting, or who had achieved a brief prominence and then sunk into the ruck. Who is this, they would utter, who once was so demure and now is so dreadful? Is he human at all with his crossbow eyes and his elephantine stance? Is he deserving of pity or some other outlandish emotion, or should we pass him by? Not exactly an Elephant Man, he goes some small way to being one. What is wrong with him? We would prefer not to know. Despite whatever agony he feels, we would seek the company of happy convivial people rather than molder in his crude animal sedan.

I’m proud to relate my legs were almost intact, and I walked on them with brittle ease. No doubt they would break down at the first sound of the trumpet. I walked on them notwithstanding, proud for them because they were proud of me. I would one day soon be deprived of these hostages to fortune, but not yet.

One nurse, professing to want me to shave, made such a fumble of the toothbrush, razor, hairbrush, lather that she had me in and out of there before I even got to the brush. These encounters in the toilet reminded me of an antique civilization in which nothing was to be complete. Whether your destination was the toilet or the toilette, you always had the sense someone was overlooking you with maximum disapproval and urging you on to complete whatever you were doing before you finished. Here the doings of the rehab unit remained in permanent disarray, nurses being the nourishers of life’s feast.

I should perhaps explain that for days I was incognizant of what was happening, but I was at one point consigned to the geriatric floor, and then as suddenly removed. I was unaware of this shift, or of any other, to my knowledge. This made me a nocturnal visitant in both places.

The voices in my head. There is a voice of rhetorical artifice in which I can say just about anything I want without fear of contradiction and another voice that I fear is much of a blur. When I’m on form, the two, while staying separate, overlap.

When I am out of control, and should be asleep, there is this out of control voice that savages anything I want to say. In almost every circumstance it provides the wrong words and even exerts a deadly compulsion to say them incessantly. And nothing you can do will correct it, so you might as well shut up shop and go to sleep because you are not communicable on the human level at all. For me there still remains the voice of rhetorical artifice, which enables me to make slow but intelligent conversation with my coevals. This enables those who are lucky enough to be writers to survive. I feel very grateful for it because I don’t think it’s a unique gift, but it’s precious as rubies to me.

Do you see the difference? It’s bowlegged but it’s legible, whereas the other is mostly nonsense.

The second day in the rehab unit I heard the voice of pellucid, articulate reason droning on in the absence of any sound and I knew at once that I was going to be all right even then, in spite of the evil-seeming things that had been happening to me. I mean that though I hadn’t tried to speak yet and the whole world was some kind of abstract fanfare waiting to be fed on or off, I would be all right because I could still think language even though it led to an immensely private universe decorated with the full panoply of speech.

So that side of him remains! I can turn it on whenever I want to speak. It’s very eerie. You might say: It is almost like having a second language forced upon one, one the lackadaisical, partly formal voice of the BBC announcer, the other, the rapscallion Calibanesque language of a substitute. No need to say which one I prefer.

Three voices really. One, the faint intellectual voice of the speaker who didn’t know whether he existed or not. The second, the somersault-executing virtuoso of my three hours daily, if I’m lucky, of joyous harmony. The third is that speaker you already know too well for his far-flung, defiant nonsense.

Permission required for reprinting, reproducing, or other uses.

Paul West , who died in October 2015, was the author of more than 50 books of fiction, poetry, and essays.


Please enter a valid email address
That address is already in use
The security code entered was incorrect
Thanks for signing up