August 10, 2013

Who Am I? I Really Want To Know

Imagine a child, about seven or eight years old, going with his mother to Boston Children's Hospital. He  has done this many times before, so such a trip is not unusual. This visit is different. He is taken into a room and told to sit in a chair, the kind a dentist might use. The child sits quietly while the doctor prepares his instruments. Now imagine the doctor taking something that looks very much like a very thin knitting needle and inserting it slowly into the child's nostril, pushing it in for what seems to the child to be a very long time. This process is repeated in the second nostril. After a few minutes, the rods are removed. A pat on the head, and off you go.

Sounds like an experiment Dr. Mengele might have conducted in a concentration camp. In fact, it was considered to be cutting edge stuff at the time. The procedure is called Nasopharyngeal Radium Irradiation, or NRI. The rods were tipped with cylinders of radioactive radium sulfate, the purpose of which, in my case, was to shrink adenoidal tissues. In addition to treating anywhere from 0.5 million to 2.5 million children with various ear and nasal conditions, nearly 8,000 military personnel in the Navy and Army Air Force also received this treatment. According to one source, the "procedure was repeated three or four times, at two-week intervals, for a total radiation dosage equivalent to 10,000 dental X-rays."

This was in the late 40s and early 50s, right after the invention of the atomic and hydrogen bombs, when little was understood about the long-term dangers of exposure to high levels of radiation.  To fully understand the insouciance with which researchers undertook to explore the affects of radiation, consider the experiment where dozens of children at the notorious Fernald School in Waltham, Massachusetts, were fed radioactive oatmeal in an experiment sponsored by MIT. The goal of much of this research was to find ways to protect soldiers from the effects of radiation.

My mother told me the reason they used this procedure on children had to do with the polio epidemic, another poorly understood medical phenomenon at the time. The thinking was that surgery may be linked somehow to polio, so doctors looked for ways to treat medical conditions in non-surgical ways. Radiation was known to shrink tissues, so what better way to shrink adenoids that were blocking nasal passages.  Curiously, polio and radiation have been linked together for decades. There are some who believe that the polio epidemic was caused by radiation from nuclear tests in the 1950s and that the Salk vaccine was intended to prevent radiation poisoning as well as polio.

Much of the emphasis on possible side effects of this treatment has been on cancers that might have been caused by the high levels of radiation. How high? A few years back, I had surgery on my right ear. The surgeon was startled to find that my right ear drum was like a piece of burnt toast, no doubt from the NRI procedure. So, yeah, we're talking some serious radiation here.

What isn't discussed much is the impact this radiation could have had on nearby brain structures. If my ear drum was so severely affected, would it not be reasonable to suppose my brain would also be affected. Here's a quote I found in my research: "In the brain…different topographical regions may have varying susceptibility to ionizing radiation. …gamma nerve fibers are more sensitive…reflexes are more radioresistant than motor coordination..indicating that radiation mainly affects the functions of the subcortico-brainstem formations of the brain."

Two important elements of the subcortico brainstem are the hippocampus and the amygdala. The Wikipedia article on the hippocampus notes that this brain structure "plays important roles in the consolidation of information from short-term memory to long-term memory." The Wikipedia article on the amygdala notes that it has "a primary role in the processing of memory and emotional reactions."

Where am I going with this? Well, let's just say that as far as I am concerned, this explains a great deal. My inability to recall autobiographical events is well-documented. Just ask my wife. It's important to note that autobiographical memory is just one type of memory. The fact that I might correctly recall the capital of Bolivia with little difficulty has no bearing on my ability to remember what happened, say, in high school. At my recent 50th reunion, there were many there who had vivid and detailed memories from those years, whereas for me it was mostly just a single undifferentiated lump of memory called "high school."

It took me a few decades of adulthood to realize how starkly deficient I was in my ability to recall events in my life. The fact that some of the after-effects of Vietnam no doubt amplified the problem wasn't helpful. It was only after my ear surgery that I began thinking hard about the NRI treatment and wondering about possible damage to brain tissues. The only way to know for sure will be for someone to examine my brain after I die, just as the only conclusive diagnosis for Alzheimer's is post-mortem examination of brain tissues.

Am I saying that the radiation made me who I am? Possibly, but there really is no way to know. I came to see that my year in Vietnam did not transform me so much as take certain existing behaviors and make them dominant among the range of behaviors that made me ... well, me. The radiation treatment may have acted as an eraser, simply wiping away certain vital connections needed to transform short-term memories into long-term memories. The fact that I do have some memories, mostly of the snap-shot variety, makes it hard to define the extent to which I may have been affected, if at all.

In the end, it doesn't matter. This is who I am, or more to the point, who I have become. There is no point in complaining about it. I have learned to live with the good, the bad, and the ugly of me. In fact, some of these perceived weaknesses I have come to see as strengths.My mother once told me I have a knack for seeing things as they are. I think this is in part due to living in the present and not letting the past dictate how I judge the future. And partly as a result of Vietnam and maybe as a result of the NRI treatment, I find it easy to remain relatively calm in a crisis ... most of the time, anyway. We all have our moments.

We are all a cocktail, one part inheritance, two parts experience, shaken and stirred. Maybe I would be who I am if I had never had the NRI treatment. Maybe I would have been very different. Maybe I would have been that guy who remembers the names of every one's kids, their birthdays, and their favorite colors. I don't really need to be that guy, so it's okay. On the other hand, maybe the reason I don't need to be that guy is the NRI treatment. Oy! Either way, as Popeye would say, "I am what I am, and that's all what I am."

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