Encephalitis Cases
Becky
At this point I was sure Becky was at stake because her symptoms were consistent with Encephalitis. Since I worked in the field of neuroscience, I went to the phone and awoke a neurosurgeon from George Washington University hospital whom I knew.
"I have a problem. Becky is in the hospital and is having difficulty talking, swallowing, is confused and is showing bizarre behavior patterns. The doctors here are treating it as a panic attack. I need your help in getting her out of there." By the time she arrived at GW she was unconscious. Their first act was to try and get a spinal tap, but there were problems. The Haldol she was given was exactly the wrong drug for encephalitis or any disease that could induce seizures. As the doctors tried to perform the spinal tap, Becky began to fight and yell. Even with five very strong assistants, it was impossible to get the spinal tap they needed. They would have to wait for the Haldol to wear off and administer the correct drug to relax her.
It was twelve hours after the onset of her symptoms before the spinal tap could be performed, and what seemed like an eternity before the results were back: 96 white blood cell count in the cerebral spinal fluid presumptive viral encephalitis. In lieu of a brain biopsy, the attending physician, decided to begin treatment at once with acyclovir, intravenously.
Due to the late diagnosis and the delays in reaching a diagnosis, the doctor and a nurse assistant decided to personally undertake the IV hookup to Becky. This turned out to be hazardous since Becky was still delirious and put up a fight. After a struggle, and late that night, Becky was finally being correctly treated.
Becky survived and regained consciousness due to the prompt and decisive action. However, it would take many years to recover, and her recovery is still in progress.
To assist in her rehabilitation from a significant loss in physical coordination (to include speech), it was clear that a regime of physical exercise would be needed. I turned to tennis as an activity which might be demanding enough to help her regain confidence in her body and regain physical coordination. For a year I could only get her on the court for an hour before she would have debilitating headaches.
For three more years I would drag her from one pro to the next to see if I could get her to a skill level at which she would begin to have confidence in her body again. Occasionally, there would be a glimmer of hope, but it would quickly fade. During this time there were several pros who provided support and could get her skill levels up for a short time, but the skill she gained would always disappear.
As her procedural memory seemed to be affected by her illness, it became clear that I would have to undertake a more detailed study of how to convey tennis skills to Becky in a declarative form if they were to "stick." The problem was I did not know much about tennis myself. But my choices were to either give up on Becky's rehabilitation or to undertake a scientific analysis of tennis technique. The choice was simple. We went forward.
I chose a scientific approach to analyzing strokes since this was our background. To my surprise, this was no simple matter. The way the human brain is constructed posed a significant barrier to experimentation. This forced me into making conjectures (hypotheses) and testing them out.
So we began the process of hypothesis testing. There were many false starts, and often we both thought we would lose our minds fighting this uphill battle. This was a humbling experience: we had to work together as husband and wife because no one else could help us, and we could not afford to give up.
Through this terrible ordeal of learning, Becky fought tooth and nail to improve and reclaim control of her body. I will always remember one particular winter training session. It was an exceptionally cold winter on the east coast. We had settled on the hypothesis that Becky must build up her stamina and leg strength to improve her stroke production. It was at night, it was raining heavily, and the wind was blowing. The court had a roof, but no sides. She was drilling by running from side to side hitting a forehand and then a backhand. She would do sets of five, then seven, then nine, and so on until she reached over twenty. She was pushing herself so hard I began to wonder if we had completely lost our minds. How could anyone keep this up at any age, much less at age 36. It was clear to me from her determination and dedication that she would stop at nothing to recover her physical ability. On a personal level, I was frightened that she would collapse, but she would not stop.
Also, during this period, as a personal challenge, Becky had decided to begin playing local tournaments. She got rated as an NTRP 3.5 in 1998, but was unsatisfied with her goals. She decided to set them higher than local amateur tournaments, her conjecture being that she must set her sights very high to have any hope of achieving her goals. So she entered national USTA amateur tournaments where she lost easily.
During this time frame, we went to the Advanta WTA qualifying event in Philadelphia. From this experience, she decided she wanted to hit like the players she saw there, so maybe by being around them she would learn. . We entered the Hilton Head ITF/WTA $10K satellite and took off. Nothing changed, however. The problem of unstable procedural memory persisted.
She suffered through one disappointment after another, until the Baltimore $10K. She won the first round in over one hundred degree temperatures that took three hours and forced her to withdraw from the next round due to heat exhaustion. Becky won that match on sheer guts and intellect, but it was unrepeatable.
Many months later she played the Hopewell Junction $25K Challenger, where she won a first-round match, again on sheer guts and determination, but could not repeat her feat in the second round, where she lost to a seasoned professional. Another series of disappointments ensued until the Midlothian $25K, where she won another first-round match on guts and intellect, a mentally tough opponent. But it was not repeatable in the second round.
To our disappointment, the strength hypothesis proved to be false, and we were back at square one. I was personally at a loss. Every hypothesis I had made and tested proved false. I needed different approach. I conjectured that Becky must develop a highly precise declarative memory of tennis technique to stabilize her procedural memory. The problem with this approach is that to develop a declarative knowledge of technique, one must know exactly how strokes are produced. Clearly it is not possible to just observe professional players to obtain this information. Further, since most teaching pros and professional players have very little declarative knowledge of technique we needed an objectively measurable source of data which we found by using video. Video proved invaluable in that it began providing good scientific data to work from. Someone brought to my attention a website and the source of a high-speed video. It was our last hope since I was running out of options and time as I saw it.
I obtained all the data I could get and began analyzing it. Becky and I suspended tournaments and concentrated on getting the information right. With some luck and a lot of effort, we began to get it right as demonstrated by the fact that Becky began to reproduce her skill for the first time on her own.
Serendipitously, our work proved that declarative memory could improve and stabilize procedural memory. Further, it uncovered the basic stages of learning as a series of successive approximations each followed by a gestation period to stabilize the approximation. The approximation-stabilization process seems fundamental to all forms of learning. We further established that a key to learning tennis is the availability of accurate information. At last the skills started to become her property. While today she is unable to win a game against players ranked in the top 500 in the world, she is wining games against NCAA Division I players ranked in the top 20 in the Nation.
As we practiced at public courts, people began stopping to watch her. Some would come up to me and say how dramatically she had advanced in so short a time (her major advancement spanned less than one year). I would try to explain to them that I did very little compared to the enormous sacrifice she made to finally to be able to hit at a professional level two days in a row, but no one could really understand this without having been there.
Becky's training regime is still an essential part of her rehabilitation which is never ending. Also, it is an essential hedge against a relapse. When I think back over the past seven years, I wonder at how someone could be so determined to reclaim their body from a potentially deadly illness that they would stop at nothing, and that no amount of pain or sacrifice could hold them back from achieving this goal. I don't know if I could have done this. But Becky is truly a beacon of hope and a profound statement of the true power of the human spirit.
From this painful and sometimes seemingly hopeless ordeal, we discovered that to learn to hit like the pros in a short period of time you need good information. And if you have this information, an average player can excel to new heights never before imagined.
But Becky taught me a more eternal lesson: The true importance and meaning of the human spirit can be seen in it's ability to overcome misfortune, adversity, and tragedy. Ray
Virgina, U.S.A.
Posted: January 07, 2005
