Learning with a damaged brain after radiotherapy: brain damage following radiation therapy

Learning with a damaged brain after radiotherapy: brain damage following radiation therapy.

Sunday 30 July 2006.

Before I underwent radiotherapy for brain cancer back in 2005, the radiation oncologists warned me that, in all probability, I would suffer brain damage, particularly short-term memory loss. And so it has proved.

The radiotherapy finished a bit over a year ago, and I definitely have a damaged brain. In particular, my short-term memory is shot, and I cannot hold a telephone number in my head. I need to have the number written on a bit of paper and I need to be able to see both the paper and the telephone's keypad at one and the same time.

This is doable, easily, with the new phone we have upstairs, the phone which two-year-old daughter Cornucopia has now discovered, and sometimes demands to play with. The telephone is always forbidden to her, so, naturally, on such occasions she heads rapidly in the direction of screaming.

The numbers on the new telephone are huge, and, what's more, each speaks aloud to identify itself when it is pressed. Admittedly, it speaks in Japanese, but I have no problems with Japanese numbers in the zero to nine range.

Some years ago, maybe nine years back, while studying at Auckland University, I had a part-time job with Page One, a call center company. At the time, the company was located in Grafton, the area in Auckland in which I was living, and I could walk to work in less than ten minutes.

I got the job because I was a male who could touch type and who was happy to do the graveyard shift, something none of the mostly female staff liked doing, because you were all alone in the building for most of the night.

Some of the women who worked at the call center were of the opinion that quite a few callers, realizing they were coming through to a call center, deliberately spat out take-this-message telephone numbers at a pace intended to be impossible to process.

But there was no way to overwhelm the heroes of the call center. Even I, with less experience than the others, soon became invincible in the realm of six and seven digit numbers.

Now it would be impossible for me to do that job because my brain has been wrecked to the point where strings of even four to five digits have become problematical.

Unfortunately, for my current job, teaching conversational English at Waniguchi Gakko in the city of Tokyo, I need to get a grip on the student file numbers on the computer-generated schedule which is pinned up on the wall of the teachers' room.

These numbers I transcribe into the notebook which I tote around at work, and I have had trouble finding files, sometimes because I have mistranscribed the number.

Realizing this problem, I decided to make a habit of checking every number. But, occasionally, seven so, errors still slipped past.

The simple cure for this is to check twice.

Once you have faced up to the problem, there may be a work-around, and checking twice seems to be working.

Additionally, speaking of the difficulty that I have in finding the files that I need, at Waniguchi Gakko there is a special problem with certain files, a problem which is really too complicated to explain.

A simplified version of the truth is that certain files have succeeded in escaping into unknown locations in n-dimensional space. These files, which have absconded, cannot be located by ordinary means.

Fortunately, the Japanese staff who keep the school running, and who handle all the administration, can provide you with the secret locations of the otherwise unfindable files, and the location for each missing file is written on an alphabetical list.

This list, the list of otherwise unlocatable files, is pinned up against the wall. In theory, you can glan ce at it and swiftly know where to look for any unfindable file.

Unfortunately, the list is incomplete, and, up until Wednesday, many handwritten annotations were at the bottom of the list, none in alphabetical order and not all particularly easy to read, since writing by hand on a sheet of paper pinned vertically to a wall is not easy.

There was also, up until Wednesday, the drop box problem. The few files which are needed for the day's teaching are retrieved from the thousands and are placed in a box called a drop box.

At Waniguchi Gakko, this was, up until Wednesday, two drop boxes, each divided into three compartments, the first compartment in the first box holding the files for students at two different levels and the last compartment in the second drop box holding the files for the two or three topmost levels.

The first drop box was marked with colored stickers indicating the level, and I was hard put to identify the colors against the dark plastic of the drop boxes. But the labeling of the second drop box I could not see at all.

I told one of the teachers that I could not see the labeling on the second drop box, and I was told that the compartments in the second drop box were not labeled. You just had to know what levels went into which compartment.

This struck me as exceedingly silly, because visiting teachers from other branches are sent to our branch to help out, so there are always newcomers who do not know the secret of the unlabeled second drop box.

(Before they show up at our branch, by the way, the teachers from other schools are already aware of our unlocatable files problem. Waniguchi Gakko has become notorious in the system, at least amongst the teachers.)

Wednesday, the Western woman who manages a group of the company's schools, including ours, dropped by. She had scheduled time to talk with me, particularly about the problem I have in finding files in a timely fashion, something the Waniguchi Gakko manager, who I will call Marcus, had picked up on.

("Marcus" after Marcus Aurelius, the Good Administrator. Which he is. Very professional and knows what he's doing.)

Marcus, too, is a Westerner, because the company that I work for, like most English-teaching outfits in Japan, has a Japanese staff, who handle customers and clients, and a Western staff who (a) teach and (b) manage Western teachers.

Japanese managers are not, as a rule, very good at managing Western teachers, who are not as disciplined as the standard Japanese worker, so things work out better if the manager who manages Western teachers is a Westerner.

I will call the woman who scheduled time with me Nimroda, naming her after Nimrod, the boss's invigilator who features in the novel THE RAGGED-TROUSERED PHILANTHROPIST. In the novel, Nimrod is a great hunter, and the workers can never be sure when he will show up. Nimroda, likewise. Quite properly, I must add, because it is her duty to know what is going on, which she certainly does.

Nimroda knew that I had file-finding problem, and she asked me about this. I took a two-pronged approach.

First, I told Nimroda that I was improving, which was true. Second, I complained about the messed-up list of missing files with its barely legible unalphabetical handwritten additions. (At this point my spell-checker supplies the word "unalphabetized", which is a new one on me, but which is the word I needed to find.)

Face to face with Nimroda, I slagged off at the unalphabetized additions on the all-important list of otherwise unlocatable files.

And I also pointed out that having the compartments of the second drop box going without labels was silly, because teachers who are not from our branch do not know which compartment holds which files.

I complained, then.

As a cancer patient, I have become particularly good at two things. One is putting in eyedrops, and I was glad when, some weeks back, I was prescribed ophthalmic steroids following laser surgery, because it allowed me to employ a skill which I had spent a lot of time and effort in mastering.

The other thing I have gotten good at is complaining.

Before I became ill I did not, as a rule, complain. But, as a patient, I learnt that systems tend to be screwed up in ways large and small, and I came to believe that it is important to complain both loudly and promptly.

Which I did when Nimroda and I came face to face. She said the two problems which I had raised would be addressed.

That was Wednesday.

Friday, I came to work and found the former two subdivided drop boxes had been replaced by one set of drop boxes. All standing side by side in the same location. All labeled clearly in plain English. Plus the list of otherwise unlocatable files had been updated.

And I heard Marcus saying, to everyone in earshot, that the otherwise unlocatable files list was now perfect, and would remain so.

I was impressed.

Nimroda, obviously, is someone who gets things done.

Wednesday I had my face-to-face with Nimroda, chiefly about my file-finding problem, and Thursday I met her again, at one of the company's branches near one of the railway stations on the Yamanote Line which encircles the heart of Tokyo. I was there for follow-up training and she was one of the two instructors.

Follow-up training was very simple, because the skills it tested were my teaching skills, and these are rock solid.

The training was well done.

One thing they told us, right at the start, was not to make notes. There would be time in breaks to fill in the worksheet provided. This was a good move, since I am usually busy scribbling notes, but this time I was under orders not to, so I gave my full attention to the training.

One thing that was emphasized was concept checking. This was something I was taught on the Cambridge/RSA Certificate in English Teaching to Adults course that I did at Dominion English Schools in the opening stages of 1997, the year in which I came to Japan and started working for the company which I have now rejoined.

I got taught concept checking on the Dominion English Schools course, but I must say that I almost never used it. However, Friday, the day following the workshop at which Nimroda was one of the two instructors, I was concept checking like crazy.

I would say, then, that the training was effective.

The challenges, such as they were, turned out to be exceedingly easy.

I had been afraid that I might find myself in a murky room in which it was impossible to see, but it turned out to be the company's standard working environment, a clean well-lit place with bright overhead neon lights, the same lights that I work under at Waniguchi, lighting which makes it easy for me to see the textbook's text, sharp black against a white background.

On the challenge level, things were easy. For example, toward the end, each teacher had to throw out a term for another teacher to explain, and the one I got was "changing room".

"It's, for example, a room at a beach which you go into and take off your clothes and then change into a swimsuit, or something like that."

I got the easiest question that anyone got, but I then gave the hardest question in the dictionary to the computer guy from Texas, who attended the same three-day initial training session which I attended at the end of June.

"What is a check, as in you can pay by check?"

A tough one, because Japanese banks do not offer personal checkbooks, and nobody in Japan pays anything by cash. You go to the ATM and pay by sending money from your account to someone else's account, or you pay by cash at the convenience store (where you can pay a range of bills including bills for utilities). Or you pay by credit card.

Travelers checks are known, but what is the check that you can pay by?

Well, it's a kind of letter that you give to someone, and they give it to their bank, and their bank gives it to your bank, then your bank sees if you really have that money in your account, and then ...

You can fumble your way toward a shorthand explanation, but there is no efficient way to explain "check", at least that I know of.

Back when I first started teaching Waniguchi Gakko, which I did for two years from 1997 before leaving to do other things, there was one lesson which you could not teach without confronting the problem of what a check was. The students would demand to know. This lesson was in one of the highly unsatisfactory textbooks which we were using back in those days.

How do you teach the meaning of "check"? I solved the problem, to my own satisfaction, by simply never teaching that particular lesson.

So I threw the toughest question I had in the direction of the computer guy from Texas, and he, to his credit, took a brave stab at it and did, all things considered, pretty well.

He hadn't taught English before coming to Japan, but had evidently picked up the basics quickly. A fast learner.

Unlike me.

Though I once used to think of myself as one of the smarter people in the room, the painful fact is that I have joined the slow learners brigade.

This fact was brought home to me when my wife, painstakingly, trained me in the routines for taking my daughter to the daycare center.

Amongst other things, there are two aprons which you have to put into the two apron boxes, and three towels which go into the three towel boxes.

And, as I have written elsewhere, the fact that there were TWO aprons but THREE towels was a problem for me.

The daycare kids get one lunch and also have oyatsu, ie snacks, twice a day. It's clear how three meals requires three towels, but I don't understand how three meals requires two aprons. My wife did explain to me why, in this case, three requires two, but I, unfortunately, have forgotten the explanation.

[Later: I became curious about the two/three problem, so my wife patiently explained again. There is one meal and, when widgets eat, things tend to get messy, so on meal demands one apron. Snacks, however, are not as messy, so the second apron serves for both the snack breaks. Three towels because hands are washed afresh for the two snack breaks and the one meal.]

We have now been back in Japan for three months, and I have just realized, just this week, that there are some daycare things which I have failed to pick up on in those first three months, though they should have been obvious at the outset.

I noticed, early on, a sandpit in the playground, but I did not pick up on the fact that the entire playground is itself one big sandpit. One day this week, I saw the older kids playing outside, digging sand, and that was when I realized the whole playground was, in its entirity, a sandpit.

Also this week I realized how to find the door to get in when I return in the afternoon to pick up my daughter. Usually only one of the doors will be unlocked at that time. But which one?

Finally, just this week, I realized how you can tell. A whole bunch of shoes will be parked outside the door which is open, because parents who are picking up kids will have shed their shoes before entering the building.

Plainly, I am not in the Sherlock Holmes league.

The daycare center can be a confusing place, with assorted oddments scattered all over the floor, these oddments including small plastic toys and little kids, oddments which it is very easy to step on and crush out of existence.

On top of this, initially I kept getting attacked by the kids, who would swarm over me, unzip my bag and steal the stuff I was sorting through.

Two things helped me manage the swarming kids problem. First, the initial panda effect wore off. I became, as time went by, a familiar face, no longer the visiting panda which all the kids wanted to gawk at and swarm. Second, I learnt to keep my backpack close to me and zipped up.

Then, this week, after three months, I realized that I could park my backpack up on the shelves at one end of the daycare room to which I deliver Cornucopia. There, it is well out of reach of the four-limbed widgets which go scurrying around the room gleefully expressing their individuality.

Having figured that out, finally, I thought I was pretty sharp. But then, Friday, I forgot to uplift my daughter's swim suit. The kids swim, apparently, in some kind of inflatable pool, but I'm not sure how big this pool is, as I have never seen it, and neither has my wife.

Forgetting to uplift the swim suit is part and parcel of the brain damage deal.

As far as I can determine, the radiation-induced brain damage that I have suffered has the following results:

1. I cannot navigate in the dark, because I get lost in an unlit house, even if I know it very well;

2. I can't take a map displayed vertically at a bus station and match it to the surrounding streets, even if I know the area well, since my mind simply fails to compute the spatial problem;

3. My short-term memory is shot;

4. I forget stuff;

and

5. Although my skill set for things that I learnt in the past is solid, I find it painfully difficult to learn new things, like the daycare routine.

Mastering the file setup at Waniguchi Gakko was another problem which, initially, pretty much defeated me. My manager, Marcus, acknowledged that the Waniguchi file system is less than perfect, but said that, even so, I was proving to have an unusual amount of difficulty in finding the files.

Perhaps because I am brain damaged, it took me a few days to realize that my file-finding problem was partially attributable to brain damage. Once I realized that, I became more confident, since my experience with the daycare routine shows me that, yes, I can learn new stuff, given time.

Initially, however, I was badly lost amongst the files. They are divided into different levels, some on one side of the room and some on the other, and the textbooks are also in little clumps in separate places, according to level.

When I went to training on Thursday July 27 near the center of Tokyo, I noticed how clean and logical the textbook layout was at that particular school, all the textbooks in one place in a book case.

Wednesday 26, the day before training, Nimroda came by, and, as noted above, had scheduled time with me, specifically to discuss the file problem.

"It seems you have difficulty seeing," she said.

So how was I to answer this?

I decided that honesty was the best policy, so I gave an honest answer. I can read everything in the textbook, even the smallest print, with my spectacles, which are optimized for reading.

However, since they'd obviously picked up on the fact that there was a problem, I gave her some more of the truth, and told her that I was not equipped for a hunter-gatherer existence, and, for example, could not find the dark ball that fell onto the dark carpet in the cubicle into which a child student lobbed it.

I said, and, again, this is true, that I don't generally face hunter-gatherer challenges at Waniguchi Gakko.

And I also told her, and, once again, this is true, that was improving when it came to finding files, and that I expected to improve further.

This, too, was true, and, Friday 28th July, I found all the files, except one, but that one particular student did not show up for class, so, in the end, that missing file was no problem.

What I did not say was that my file finding problem was an inevitable consequence of brain damage. I am confident that by now I am far enough up the learning curve for my performance on the file finding front to be more or less acceptable, and I expect to continue to improve.

The following day, Thursday, I was surprised to find that Nimroda was one of the instructors at our workshop. So I made sure that I switched on and concentrated.

"And?" she said, at one point, indicating a word on the whiteboard, a word I was supposed to supply as one of the key elements of feedback.

"Praise," I said, reading the word indicated, and reading it easily without spectacles, because I don't need spectacles for anything further away than my outstretched arm.

I was right under Nimroda's nose for the entire session, so she was ideally placed to observe, if she wished to, that I could read when it was necessary for me to read the small print on a role card.

And, of course, anything teacherly that I was required to do I could do.

My take on brain damage from radiotherapy, as I have experienced it, is that it is something I can live with, although there have been, as indicated above, some rocky moments at getting started on my new job. Or, more exactly, my resumed job, the job I quit back in 1999, fully expecting never to return.

Well, I'm back. Back with the same company and back teaching at exactly the same school.

I returned home on Thursday with more homework to do as a follow-up to the training session.

The homework presented me with a challenge to my confidence. One problem involved sequencing, and I came to the conclusion that one of the examples provided by the directing staff was wrong.

But I'm brain damaged, right?

So how can I be sure of this?

And if I show up saying "This is wrong!" then I'm going to look very, very silly if, in fact, it is correct, and Marcus gently points out to me why it is correct.

For the exercise, you read a text then have to sequence a series of steps which relate to the text. You are given a timeline which is marked with points starting at A and running through to F, and you have a list of six steps which you have to put into chronological order by writing the appropriate timeline letter against the correct step.

The two steps already sequenced by the directing staff are something like "A. The man unexpectedly acquires a widget thanks to a trip which his wife takes to hospital", and "E. The man takes his widget to the daycare center for the second time."

The relevant text reads something like "At the daycare center, they hadn't realized the widget's delinquency before because every time the man had taken the widget to the daycare center he had left the widget's handcuffs on."

The step which has to be F, the final step, is the one that reads something like "The daycare center discovers the true horror of the widget's delinquency."

Another step which has to be plugged in is "The man forgets to put the handcuffs on the widget."

The way I figure it, certain steps must be in the following order:

i. The man takes the widget to the daycare center for the second time.
ii. The man forgets to put on the handcuffs.
iii. The daycare discovers the widget's true nature.

Item iii must be F, the final step, and item ii must be E, the penultimate step.

I tried doing the homework assignment on the train heading back to where I live, and E seemed to be out of sequence, but I couldn't tell quite how.

Then, Friday, coming home from work, I took another shot at it.

The widget's delinquency is discovered on the final occasion on which the widget is delivered to the daycare center, the occasion on which the man fails to leave the widget in handcuffs.

My analysis was that this final occasion cannot be the second occasion because the words "every time" force the meaning "more than once." You don't say "Every time I've been to this restaurant the food is lousy" when you've only ever been there once before.

That's my logic, and that's the case I'm going to argue. But before I hand in my homework I'm going to meticulously dissect the text.

Of course, if one of the sequencing examples provided by the directing staff is wrong, this means that many bright, intelligent university-educated teachers have let the error slide past them without practice.

But I have been taught, and still believe, two things:

First, just because someone has written something down on a piece of paper, that does not mean it is true. (That was a lesson which one of my linguistics lecturers back at Auckland University kept hammering home, and it stuck.)

Second, despite everything, despite the fact that I can't avoid acknowledging that, in at some respects, I have joined the slow learners club, I am, nevertheless, of the opinion that, in some ways, I am still one of the brightest people in the room.

That said, as I finish this, I'm finding certainty elusive. My thesis is that "every time" forces the meaning "more than one time". But can I prove this? Efficiently, economically and beyond rebuttal?

Finally, to my shame, I fell back on, of all things, a Microsoft product, the Microsoft dictionary which was part of the package of disks which came with my latest version of Word. No entry for "every time" but "every" was defined as "used to indicate each member of a group without exception", and I think it is fair to say that "one", as in "one previous time", cannot be "every", as in "every time."

My thesis, then, is that the word "every" cannot be used to mean "one" in native speaker English, and so, if E is the penultimate step in a sequence of prior events described with the words "every time", it cannot be the "second" visit.

The words "every time" cannot be used to mean "only one other time" unless we take Humpty Dumpty's position, which is that when I use words they mean exactly what I want them to mean.

In my job interview, in the phase in which you have to analyze your own weaknesses, I came up with intellectual aggression as one of mine. And, yes, the old red-jawed crocodile is most definitely there. Up and at 'em, and take no prisoners.