Brain On Fire

The post-op treatment Cahalan must endure is brutal, but she tolerates it with quiet humility. She returns to NYU for a follow-up assessment with some of her former neurologists. The song, “California Dreamin,” by the Mama & the Papas, plays on the radio as Stephen drives Cahalan home. For a brief moment, Cahalan recognizes this song and sings along with Stephen with the same energy she had before her illness. This is one in a series of signs that Cahalan’s recovery is genuine.

Cahalan has recovered enough where she begins to have questions about the time in the hospital she cannot recall. She begins watching DVDs of footage of herself during her time on the epilepsy floor at NYU. The Cahalan on the screen is ghastly and afraid. The recovering Cahalan experiences disconnect because she has no recollection of this person, or these moments. She expresses the desire to help herself: “The video self hides her face under the covers, clutching the blanket so hard her knuckles turn white. ‘Please,’ [Cahalan] sees [herself] plead on the video again” (175).

Cahalan visits family and friends outside of the comfort of her childhood home for the first time. These are awkward moments for her. She visits Stephen’s sisters and their kids. Cahalan is still unable to socialize at previous levels and experiences speech delays.

Cahalan’s brother, James, comes to the house and sees her for the first time since before she was sick. Their reunion is scary and heartfelt, with Cahalan noting how James is suddenly a man, and James seeing his sister as “a grotesque hybrid of an elderly woman without her cane and a toddler learning to walk” (179). Cahalan is moved by his sympathetic reaction.

Cahalan’s family members begin taking turns spending time with her in the outside world in a collective effort to help her readjust to life after her time in the hospital. Cahalan spends of a lot of quality time with James, during which she wanders off into a salon. Patrons and employees of the salon are rude and insensitive, gawking at Cahalan, who sits in a chair and drools.

While Cahalan shoe-shops with her mother on the Upper East Side, an employee of the shop treats Cahalan as though she’s mentally impaired, and Cahalan’s mother is offended and angry.

Cahalan continues to show progress in her recovery. She is tethered to Stephen. They seem to be very good for each other. They attend a friend’s wedding, and again Cahalan and her family experience awkwardness; people who know about Cahalan’s illness avert their eyes.

Though Cahalan is hardly back to normal, she drinks champagne and dances with Stephen, which pleases her mother greatly. Her parents continue to fiercely defend her to callous family and friends.

Cahalan is subjected to the examinations of a new set of doctors. The results of her examinations have mixed results—she shows vast improvements in some areas but fails in others. In the letter-cancellation test administered by Dr. Bertisch, Cahalan’s scores are in the borderline impaired range: “[Cahalan’s] speed, accuracy, and concentration were dismal” (191), though, “[Cahalan’s] verbal functioning was now ‘superior,’ in the ninety-first percentile” (192). Her self-awareness of her problems is deemed a good sign. While she is pleased to show signs of improvement, knowing exactly the areas that need development turns Cahalan off to further exams: “these sessions only highlighted my inner disunity, and I was loathe to continue. I never returned for a follow-up” (193). She regresses into some old, bad behaviors, hiding from her health results because she is scared to have self-knowledge.

Cahalan shows signs of despondence. Her self-awareness of her limitations becomes heartbreaking to her family. Dr. Najjar calls Cahalan’s mother to say Cahalan needs to return to NYU for a second round of IVIG treatment. Cahalan perceives the second round of treatment and a hospital stay as steps backwards. She is catatonic again. She tries to find joy in life’s simple pleasures, including a backyard BBQ with her family and listening to music with Stephen.

The Cahalan family is still struggling to cope with Cahalan’s recovery and changes. Cahalan and her father have become closer than ever before, to the point that it makes others insecure, including Giselle. Cahalan’s relationship with her mother has been strained since Rhona took care of Cahalan during her psychosis. The tension is broken between Cahalan and her mother over shared memories Cahalan is able to recollect. Cahalan’s father gives her his private journal and medical log to give her some insights and to communicate things too hard for him to say. Rhona’s journal, by contrast, attempts to diminish the severity of Cahalan’s problems.