Medical mistake renders author ‘locked-in’ in ‘Will & I’


NONFICTION

“Will & I: A Memoir”

by Clay Byars

Farrar, Straus and Giroux

192 pages, $14

The droll and metaphysical "Will & I" stands as an edifying account of Clay Byars' recovery from a "massive brain stem stroke" at the age of 20. The outcome of a slipshod medical procedure, the stroke leaves him disconnected "from the eyes down," even as his higher functions remain intact.

“Will & I” confronts two decades of the author’s rehabilitation, which resembles stages on a path toward enlightenment. Along the way, he explores the mysteries of “twinship,” as if being a twin somehow gives Clay an edge to survive his predicament, which indeed it does.

Raised in a comfortable upper-middle class Birmingham family, the Byars brothers, Will and Clay, enroll at Tennessee's University of the South in Sewanee in 1994. Barely into his freshman year, Clay sustains multiple injuries in a deadly car crash. A concussion and broken jaw mend accordingly, but his right arm, except for his hand, is "just a dangling extremity." He submits to a risky surgery — a complex nerve transfer — to repair the damaged brachial plexus in his right shoulder.

During the operation, Clay's vertebral artery, accidentally cut, is only partially repaired, which leads to a blood clot, and, consequently, something called "locked-in syndrome": "My body and brain had come to have nothing actively to do with each other."

In essence, Clay is little more than thought. His identity and observational powers stay strong, but he lapses into indifference: “I no longer cared what happened to me … illusory control transformed into a kind of meditative contentment.” Motivated by “the fear of staying the way I was,” however, he overcomes his apathy, communicating with his family and therapists by blinking: “One blink yes, two blinks no.” Applying this elementary semaphore, he spells out Nietzsche’s famous quote: “That which does not kill me makes me stronger.”

In due course, a program of physical therapy returns many of his motor powers, and the brain, with its "plasticity," pitches in, as well, "[evolving] new pathways and strategies for communicating with the body, adapting itself around a traumatic event." His speech, restored, takes years to improve: "The sound coming out of my mouth … wasn't coming from someone with a direct line to a neural past." His father buys him the communicating machine made famous by Stephen Hawking through which Clay mutters an occasional profanity in a robot-like voice.

Under the tutelage of his remarkable singing instructor, Dewin, he builds his confidence and learns to be understood more clearly. “Encouraging, but disciplinary,” Dewin sculpts Clay like … clay, suggesting, for instance, that he sing with a plastic knife between his teeth. (“The tongue is a rudder,” Dewin observes; “Set it right and the body will fall in line.”)

“Will & I” is a study of the human mind as a resilient, though often unaccountable, instrument. Clay finds it “possible to feel the stroke as part of the larger surreality of some exotic experience.” He suffers odd olfactory sensations: a paramedic’s cologne induces fear; the smell of home makes him nauseated. People who think of him as brain damaged repeat introductions of themselves, so he loses “the habit of remembering names.”

His return to Sewanee is "eye opening and miserable" — he rejects the roles of "mascot" and "silent sidekick." He relearns to type by "dragging my one hand around like a Ouija board pointer." He cultivates his writing skills, though his first stories seem "lifeless … just clever cuts into the surface, and sometimes not even that … I tried to locate the problem everywhere but within me." Nevertheless, his literary pursuit becomes, "the beginning of a new life, one in which I would no longer talk myself out of reality."

Clay’s sullen, imperial moments are among his best, especially when it comes to the Byars’ domestic drama, which, as his parents decline, he calls a “Theater of Blame.” He’s shockingly rude to his mother (“Thanks for life and money,” he tells her), but then, with equal derision, targets himself as his “mother’s retard son.”

“It is not the irreversible I discover in my childhood,” wrote Roland Barthes, “it is the irreducible.” For Byars and his brother, that singularity is their lifelong consciousness as twins: “There was a moment before Will and I split apart that we were literally one being … As babies, Will and I would stop crying only if our parents put us in the same crib … Every stage of life we’d gone through not just together but as a unity.” They are a club of two, a “symbiotic organism,” male-male monozygotic twins, “the most identical,” with all of the phantom puzzlements so bewildering to outsiders.

For Clay, there is further oneness. In the hospital after his stroke, he experiences an out-of-body, or, rather, in-body, realization: "There was no longer anything separating me from anything else. I'd gradually stopped being aware of my unresponsive body, but now I was at the core of an infinitely expanded being … the biggest release of my life," which the author likens to something called an "orgasm," though "less concentrated" and "a thousand times stronger."

Byars summons the late Zen philosopher Alan Watts to explain this extraordinary sensation of well-being as “an experience [that] has a tendency to arise in situations of total extremity or despair, when the individual finds himself without any alternative but to surrender himself entirely.”

If, before the accident, their lives moved in direct counterpoint, the twins’ subsequent motion turns increasingly oblique as their relationship is “redefined.” Clay becomes more patient; Will, now prone to panic attacks, less so. In the immediate aftermath of the collision, Will makes a hurried exit from the hospital; Clay, without judgment, acknowledges his double’s flight as a way of separating himself, a survival stratagem: “At least one of us can get out,” Clay laments, coolly.

In the present, they are more open with one another and have found ways to appreciate their difference and to maintain the essential unity that saved Clay. “Because of Will, I still felt known. He could see the world through my eyes. This kept me from total despair.”