In the bleak midwinter

Every year, an emotionally difficult time of the year: Ann Daingerfield Zwicky’s death day is 1/17 (this year a Sunday, today), and my man Jacques Transue’s birthday is 1/22 (a Friday this year). When Ann died, in January 1985, it was in fact extraordinarily cold and bleak in Columbus OH; and then of course Jacques’s birthday was pretty much swallowed up by the aftermaths of Ann’s death (including a memorial service at St. Stephen’s Episcopal Church, on the Ohio State campus).

This year, I’m in Palo Alto CA, where midwinter is normally wet and cool (though not truly cold), but also green and graced by many winter-blooming flowers. In fact, this year it’s unseasonably dry and what counts as warm for winter here (high temperatures near 70 F., at least for a while), so the edge has been somewhat taken off my midwinter funk over my lost loves.

Into the midst of this have come some touching photos of J in his later years, as he was sliding towards death (which finally came in 2003) — a contrast to the photos of him that I’ve been posting here recently, photos of a strong, vital, handsome younger J.

The course of their leaving. The end games were quite different for Ann and for Jacques.

Ann had breast cancer, a mastectomy, and chemotheraphy. The treatments were apparently successful, but then on a routine exam in August 1984 it was discovered that the cancer had metastasized aggressively to her liver and was beyond any treatment other than palliation; she was given about six months to live, and indeed lived only six months, virtually to the day. So the end came swiftly; Ann used the first part of her final time to say goodbye to family and friends and to rearrange family finances in such a way as to smooth things for the rest of us — showing both love and stern practicality. Then she slipped away quickly under the ministrations of Sister Morphine.

Jacques had a very fast-moving form of brain cancer, treated by surgery and then a truly harrowing course of radiation therapy — which, as it turns out, set him up to later develop radiation-caused dementia. The end came with agonizing slowness, spread over 12 years, during which one alarming neurological disorder after another afflicted him. (These are summarized in a brief JHT medical history on my blog.)

It would have been cruel to take photos of Ann as she disintegrated (if she had asked, we would have, but fairly quickly she found her own image in a mirror distressing, so she had no appetite for documenting her decline). Things were different for Jacques, especially since he rapidly fell into anosognosia — a condition in which he was unaware that he suffered from any kind of disability and rejected any evidence that he was. So daily visits to J from me and Elizabeth Daingerfield Zwicky (who’s a serious photographer) and various mutual friends were natural occasions for snapshots of these gatherings, with J’s willing participation.

Two photos. In the first, J seems to be scowling; in the second, he is sweetly smiling. But to fully understand the photos, you need to know something about his afflictions.

(#1) To appreciate the photo, view the two sides of J’s face separately

(#2) Also asymmetric, but more subtly so

Start with #2. All the muscle action in J’s facial expression is on the right side of his face (on the left in the photo); the left side of his face is entirely relaxed. But on the right side, we see: a raised eyebrow, with accompanying wrinkling in his forehead; smile lines at the corner of his right eye; and the right corner of his mouth raised in smiling, with accompanying grooving of the adjacent cheek line (the nasolabial fold). Look only at the left side, and you see a completely neutral face; but look only at the right side, and you see a sweetly smiling face.

Now go to #1. The left side of his face is not merely relaxed, it’s drooping. Again, almost all the muscle action is on the right side of his face, and what’s going on is consistent with his staring intently at the viewer, but it looks even more like a half-smile; certainly, it’s no scowl.

It turns out that this asymmetry in J’s facial expressions — one side inert, the other with active musculature — is characteristic of the condition called Bell’s palsy (and of some other conditions as well). So: two stories about Bell’s, from my 11/6/14 posting “Bell’s palsy”:

First event: Jacques. From my man Jacques’s brief medical history:

early 1992, Bell’s palsy on the left appears suddenly (and, atypically, never passes away); resultant inability to close left eye, ultimately threatening the cornea in this eye and eventually requiring surgery

It took a little while to be sure of the diagnosis, since Jacques had so many neurological conditions going on at the same time.

Afterwards, I irrigated his eye several times a day with liquid tears, but it was not enough. So eventually a surgeon inserted a small weight in his left eyelid — a very cool bit of minor surgery, at which I assisted — and the threat of blindness was averted.

Second event: me. Some years later, after Jacques had died and I was alone, I woke up one morning drooling some. I paid little attention to that — hey, people sometimes drool a bit in sleep — until I went to the bathroom and saw myself in the mirror: face drooping on the left. I looked like a classic right-side stroke patient (with symptoms on the left side of the body).

But no panic. I knew enough about both stroke and Bell’s palsy to realize that this was just Bell’s — annoying, but not serious. Two considerations: first, the symptoms were facial, with no involvement of other parts of the left side of my body (in particular, no left-arm or left-leg weakness; except for the facial droop, the left side of my body worked just fine); and second, there was no cognitive impairment, as I checked by, among other things, talking to myself for a little while, to reassure myself that I had no aphasic symptoms (and, of course, I was thinking clearly enough to reason through a quick diagnosis).

So I didn’t call 911, but merely waited until my doctor’s office opened and I could ask for an immediate appointment, explaining that I had just experienced the sudden onset of Bell’s palsy but wanted to check things out with my doctor. Got an appointment right away, my doctor appreciated my reasoning, he checked for other left-side symptoms and for cognitive impairment, and sent me on my way with sympathetic and soothing words.

Alas, I had a crucial departmental faculty meeting that day, concerning the progress of our graduate students, so I couldn’t just hole up at home. I assured my colleagues that, despite appearances, I was just fine. By the end of the day, I’d gotten notes from a number of colleagues who’d had Bell’s; I was impressed by how common Bell’s seemed to be, and variously soothed and alarmed by the stories: sometimes it passed away in a few days, sometimes it persisted for many months.

… My own Bell’s passed away in a couple of days.

Jacques’s, however, appeared in 1992 and never went away, so that he lived with a lopsided face for the last 11 years of his life.

(The causes of Bell’s are not known. We just assumed that in J’s case it was some consequence of nerve damage due to the radiation in 1980 — because it came along with a suite of other parlous conditions associated with radiation — but it could in principle have been an independent event.)


3 Responses to “In the bleak midwinter”

  1. arnold zwicky Says:

    1/16/20: At the rim of the Mournful Valley, singing:
    with a section on the Christmas carol “In the Bleak Midwinter”

  2. annburlingham Says:

    Bell’s palsy on both sides (one falling days after the other) was the triggering symptom to get me to an emergency room for the ultimate diagnosis of sarcoidosis, in this case, manifesting in my nerves.

    The right side of my face regained its nerve use, but it was a full year before I saw signs myself that I could move anything on the left. Three and a half years later, I still see incremental improvement.

    I also forget, looking out, that my face is lopsided, and that others can see it (less so with a face mask on in these COVID times), though chewing and drinking can still be affected.

    And though I know Jacques’s face well, I find I had forgotten his droop, too. It’s utterly familiar in those photos, but not in any mental image I hold.

    • arnold zwicky Says:

      Thanks for these notes. I considered talking about your (complicated) case, but wasn’t sure of the details.

      Meanwhile, it’s wonderful that you’re still seeing incremental improvements.

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