Oliver Zangwill Concluded

This morning, after a few more tests, I had my final meeting with Andrew. Beth came along too. They will we sending me a written report so this is from memory and may need correcting later.

Before I get onto the main thing that they have found there are two things that have come out which are more suspicions than anything else at this stage:

• The episode at the May BBQ which I discussed with Fergus last Wednesday may have been a seizure (and I may have had others too). Hence it's worth looking again at the medication I'm on.
   
• I get thumping headaches which analgesics only dull a bit and which last for hours. They're often associated with numbness on my face. Before I had my stroke I used to get migraines, but I only got the "light show" in one eye, I never got any other symptoms at all and certainly no headaches.

  Since I had the stroke I have had no migraines of this type, something which didn't strike me until they asked about this yesterday. Apparently something which often happens to people with brain injury who previously had migraines is that the pattern of the migraines alters. This could be what's happened to me and would explain the headaches.

The main thing the testing has found is that the "attention" system of my brain is damaged. This is the thing which lets us do things like pay attention to one person, allow ourselves to be distracted, or not be distracted, and stuff like that. Attention uses a lot of the brain but the pons, which is where I had the bleed, is a vital part of the system.

The consequences of having a broken attention system explains some of the symptoms I get. Things like:

• failing to notice when I'm overdoing it.
• being unable to read if a conversation is happening in the same room that I'm in
• coping with complex environments like noisy pubs or supermarkets

So, where do I go from here? They are suggesting a number of things. Firstly something which I've started already, which is setting my watch to beep every hour and using that as a reminder to check my mental state so I can try to spot fatigue in time and pace myself better. This seems to be working but hourly is not often enough so I'm looking around for other watches that can beep more often.

Secondly they are referring me to:

• a neuropsychiatrist to review my medication in the light of the suspicion of seizure at that May BBQ (the only drawback to this is that if we change the medication the clock resets on my driving ban)
   
• a neurologist about the possibility that some of the problems are in fact modifications to my migraine response
   
• possibly to a team at the Cognitive Brain Unit in Cambridge about some suspicion that I'm getting perception problems, although this is more for research purposes than for my benefit.

Finally they are recommending a course of Cognitive Behavioural Therapy (CBT) to tackle the issues which I discussed with Fergus. This may help me in social situations, and in other areas too. CBT can let me "re-program" my brain. As it happens Fergus is training in CBT at Oxford (one day a week) and as part of this is seeing two patients. It's a twelve week course and it ends in January 2004. So the tentative plan is that rather than having to find me a CBT person who I don't know and who doesn't know me Fergus would take me on as a patient in January. This benefits him, in that he gets someone he knows about already, and I get someone I've already met and have some respect for and hence some trust.

All in all it sounds very promising and I think it has been well worth doing. It has also, I think, provided some strong evidence to keep Swiss Life happy.