Chapter I
It started on a Tuesday. I had just finished a surreal job interview, Programme Manager role, and my brain was already in pieces. I held it together long enough to get to the emergency room.
One hand I could no longer use. It was seized by myoclonic contractions. My tongue too, flagellated by reflexes so violent my voice had become something frightening, even to me.
Hospital de la Santa Creu i Sant Pau · urgencias
For two weeks before the ER I had been hearing voices, threats, sounds that weren't there. I hadn't told anyone. When the neurologists finally asked whether I had experienced anything psychiatric, the relief of being able to say yes was almost physical.
Two neurologists tried first. They failed. Then two small, quiet anesthesiologists arrived and solved it on the first attempt. I have thought about those two women many times since. They came in, fixed what needed fixing, and left without ceremony.
mesial temporal involvement — HSV suspected
They spoke carefully. That is how you know it is serious: when doctors stop being casual, when every word is chosen, when they look at each other before they look at you.
Chapter III — The Ward
After the first shower in the ward, all the steam covered the large mirror.
I picked up the small tube hairdryer and aimed it roughly where my face should be.
And slowly, my face appeared, coming out of the indefiniteness.
It was a quick, symbolic moment. Something that helped me process what was
happening and find myself, somewhere, somehow.
I had been wearing an oversized hospital gown and trousers, too big,
with a completely alienated expression. I looked like a psychiatric patient
from the 1950s. I felt like one too.
Chapter IV — Deliriums and Visions
the otherSpotify playlist · San Pau
The only moment of release was the shower, despite being almost a torment in itself.
I loved to come out of the bathroom, soaked in humidity, and sit on the small
visitor's couch with music in my ears. It was a small dose of energy.
The right arm was useless, the balance was wrong, the walls came up to meet me.
But the music held.
Buckley's version was the soundtrack of those days. Magnificent.
The word feels inadequate and also exact.
It goes like this, the fourth, the fifth
The minor fall, the major lift
The baffled King composing Hallelujah
Chapter V — Recovery
Recovery is not a line. It is a fog that thins unevenly.
Some mornings sharp, some weeks unreachable.
You stop waiting to feel normal and start building
something from what is left.
I am told I will never fully know what those first three days were.
Not foggy memory: no memory. A clean cut.
Before, and after, nothing between.
What is this
Encephalitis is inflammation of the brain. In autoimmune encephalitis,
the immune system — which normally defends the body against infection —
mistakenly attacks the brain itself, targeting proteins on the surface of
neurons. The result is swelling, disrupted signalling, and a cascade of
neurological and psychiatric symptoms that can appear within days and are
frequently mistaken for psychosis, epilepsy, or a drug reaction.
The limbic system — the seat of memory, emotion, and behaviour — is
often most affected. This is why the first signs are so often psychiatric:
paranoia, hallucinations, personality change. The brain is on fire. It
does not look like a brain on fire.
Common symptoms
Memory loss · psychiatric symptoms · seizures · movement disorders · reduced consciousness · speech difficulties · autonomic instability. Onset can be acute, over days, or subacute over weeks.
Diagnosis
MRI, EEG, lumbar puncture with CSF analysis, and antibody panels. Anti-NMDA receptor encephalitis is the most common autoimmune subtype. HSV encephalitis — the viral form — is the most common cause overall and requires urgent antiviral treatment.
Treatment
Antivirals (acyclovir) for HSV. Immunotherapy — steroids, intravenous immunoglobulin (IVIG), plasmapheresis — for autoimmune forms. Recovery varies widely. Cognitive sequelae can persist for months or years.
Chapter VI · Madrid · ongoing
December 2020
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