When Becky and I decided to build a house, it did seem a bit impulsive. We had just met. When Covid hit a few months later, the idea seemed suddenly improbable. Then impossible. Then, positively insane.

Our original plan was to do what most people do and just buy a pre-existing place—a used house, as it were. So, one very hot Sunday in July 2019, we decided to scope out neighborhoods just north of downtown Carrboro, North Carolina, where I lived.

Becky Broun and I had been dating for less than a year. Indeed, less than two months. Seven weeks earlier we’d met at Caffe Driade, a local institution whose name translates from ancient Greek to “place for online coffee dates.” It’s rather popular with the Match.com crowd.

I had an iced herbal tea, having given up caffeine some months before when I realized it was giving me weird bouts of vertigo. Unfortunately, what I’ve just explained here in 24 words I took several hundred to explain to Becky that day, just as we sat down, prattling on as if defending a research thesis. Another woman might have excused herself and raced off in her car. But Becky stuck around until at last I gave her a chance to speak, and by the end of our date we had each pretty much decided our online dating days were over. How we could be so sure, so quickly, is a story for another time.  

Now we were highlighting streets on a paper map so we’d know when to pounce if any of those houses went up for sale. The real estate market had cooled some as summer heated up, but only a little. It was still the kind of market where if you wanted a nice house you had to be there on the day it hit the market with a fat wad of money in each hand.

“Wouldn’t it be great to find a house in walking distance to Weaver Street? Or even better, to build one?” I said to Becky as I lurched my car through tree-lined streets, with one eye in the rearview for cars that might want to get by.

I was referring not to actual Weaver Street but to Weaver Street Market, the cultural centerpiece of Carrboro where people gathered to shop for groceries or fill plates at the food bar for dining under the giant oak trees out front. On Sunday mornings bands play live music there, and I wouldn’t be surprised to learn that more Carrboro residents go to Weaver Street on Sunday mornings than to church. I had worshipped there countless times over pancakes and Mexican scrambled eggs.

Becky agreed. “It’d be amazing to live so close to Benj and Rachel” she added, referring to her brother and sister-in-law who lived on a street just behind Armadillo Grill, another downtown Carrboro fixture. Becky and Benjamin are close. She’s the only person on earth allowed to call him “Benj” and I’m pretty sure they talk on the phone every day.

We’d arrived at Weaver Street and decided to hit the adjacent neighborhoods, slowing to take in the quant mill houses the town is known for: impossibly small structures—tiny houses way before tiny houses were a thing—built for Carrboro’s cotton mill workers at the at the start of the 1900s. Houses are packed tight around here, on some streets like cereal boxes on a store shelf, and the odds of finding a vacant lot are impossibly long. But this was our impossibly lucky day.

Someone else had managed to build a house on an empty lot in this neighborhood—I had watched it go up with envy. We were driving by it now. What I hadn’t noticed before is that the house took up only half of a double lot. But Becky noticed it right away. “There’s a For Sale By Owner sign!”

I slowed to the car to a stop and we both jumped out. The grass was nearly as tall as we were, so we couldn’t see the entire lot and hesitated to go romping through it just yet, but we took down the web address on the sign. As we drove away Becky tapped the URL into her phone, we texted the owner, and set up a meeting.

The next day we pulled up again at the lot and parked. There was now a path mowed in a giant figure eight through the tall grass, and shortly after we arrived a spectacled man with close cropped hair rode up on a small bicycle.

“Hi, I’m Chris.”

We introduced ourselves and thanked him for cutting the path.

“While I was mowing I found a dead deer back there,” he quickly offered up. “The smell was awful and I had to drag it to the curb myself so the town would come pick it up. I’m glad they got here before you did!”

As were we.

Chris had lived in the area for many years, so it didn’t take long for him and Becky, who grew up here, to identify people they both knew. He and his wife had bought half the double lot with the couple who now lived in the recently finished house on the northern half—the one I watched go up. There had been a 1950s brick house here, in bad repair, which the two couples tore down. When Chris and his wife decided to renovate their current house just a few blocks away, rather than build a new one on their half, they put the lot up for sale.

We strode around the path, listening to Chris tell us how great it was to walk to everything in Carrboro, especially the restaurants. “Some nights we just start walking toward Chapel Hill until we smell something that draws us in. It’s pretty sweet.”

Carrboro is adjacent to Chapel Hill, home to the main campus of the University of North Carolina. The college town is known for being one of the more liberal outposts in the southern state, much to the frustration of conservative politicians, of which there are more than a few. The legendary Republican Senator Jesse Helms, when the state was debating where to put a new zoo in the 1970s, is said to have asked, “Couldn’t we just build a fence around Chapel Hill?” Carrboro, just to the west, is even more liberal. “A little to the left of Chapel Hill,” a sign here once said. 

The next day, Wednesday, I called the town hall and spoke with zoning officer James Thomas. He confirmed it was a buildable lot but warned us there was a stream buffer along one side, on either side of a drainage ditch. “You can’t build within the buffer,” he stressed. We’d seen the ditch and didn’t think it would be a problem. On Thursday we gave Chris and his wife a cashier’s check and executed an offer to purchase.

It was done. Becky and I, eight weeks after meeting, and four days after first laying eyes on the lot, had committed to building a custom home, something neither of us had ever done before nor even dreamt we might. The next several weeks consisted of both easy things, like securing hundreds of thousands of dollars of financing and choosing a builder to entrust it to, and difficult things like convincing our families we weren’t out of our gourds.

We hired a local design-build firm to put a house our lot. In September, their architect, after just one meeting with Becky and me, produced plans we loved at first sight. It was a craftsman bungalow with a big front porch–we found ourselves looking at it several times a day. The firm’s owner, our “builder” in construction parlance, told us if they submitted the permit application by end of year then construction could start in February. Neither of those things, it turned out, would happen.

By early March we were growing more frustrated by the day. What could be taking so long? Then frustration gave way to the gratitude when an impossibly small creature, a coronavirus named SARS-Cov-2, began causing the infectious disease COVID-19. It had already wreaked havoc in China and was now grinding life on the rest of the planet to a halt. Restaurants closed (the Weaver Street lawn was eerily empty even on beautiful Sunday mornings), college students all came home, and toilet paper disappeared from grocery stores. I began working from home and set up a desk at a window that looked out on the local health clinic, where I watched them erect a tent for drive-through screenings. Seemingly overnight, life had turned upside down and outside in.

Nobody knew how bad this was going to get. Becky and I had to wonder, if we started construction now, could we finish? Would workers be available? How about all the materials? We had visions of a half-built house rotting in the sun for months. Or years. And what if one or both of us lost our jobs? All that cash we were about to pour into a house might come in very handy.

We put the project on hold. “I’d probably do the same,” our builder offered up glumly when we called him with the news. We told him we were postponing for two months, knowing it might be much longer. It was depressing, pulling the plug like that. But, we decided, it was better to be sad than scared.

Then, with the pressure off, we took a few days to size up the situation. Yes, if the worst of our predictions all came true, then Becky and I would be, as a learned economist might say, really in the shit. But it might not be so bad. There was uncertainty.

There was no uncertainty, however, on the likely effect of pulling the plug on spending hundreds of thousands of dollars. Construction workers would need to look elsewhere for work. Our orders of cinder blocks and two-by-fours and everything else would be cancelled. The national economy was facing its worst crisis since the Great Depression, and we had control over just this tiny little bit of it. But it was our bit.

We might get hurt if we proceed but others will certainly hurt if we don’t. Fuck it, we decided. We called our builder back not two weeks after postponing. Let’s build this thing, we told him, full speed ahead. We could hear his sigh of relief. “This will be one special house,” he said.

To us it already was.

Nearly three years ago, something weird started going on inside my head. The chief symptom was spontaneous vertigo. Some dizzy spells were barely noticeable. Some were accompanied by deafness and profuse sweating. Some sent me crumpling to the ground in spinning agony.

My only comfort was in thinking my symptoms were so striking, and so consistent, that my doctor would pinpoint their cause in no time. Man was I wrong about that.

In October 2017 I was 54 years old and divorced, with two kids off in college, and single as a dollar. To improve my chances on the dating front I decided to get serious about losing the few extra pounds around my middle. So, one Monday I hatched a plan to go two solid weeks living the healthiest life possible. I would choose meals with extra care, get lots of sleep, and double my running and hiking routine. I dubbed it my “fitness fortnight.” By Friday, my thrice-weekly run had grown from three miles to six, and on days between running I took long hikes through the woods behind my house at the fastest clip I could muster. It felt great.

One Saturday morning, sitting at my writing desk and looking out at the birds at my feeder, I felt as if something were gently squeezing my brain. It lasted just a few seconds. An hour or so later it happened again, feeling more intense this time but still lasting no more than half a minute. I had one more spell that day, again out of the blue and slightly more intense than the last.

The next morning, I was just waking from a good night’s rest when I heard a whooshing sound I attributed to the dishwasher running in the kitchen downstairs. But then I remembered just emptying it the day before. It must be something outside the house, I figured. When I heard it again later that day I went to the window. There was nothing there. That’s when I realized the whooshes were whooshing at a familiar tempo. I pressed a hand to my neck and realized the whooshing was tracking my pulse perfectly. I was hearing my blood.

I decided to see my doctor first thing Monday morning. I also decided, reluctantly, to hold off on running. My fitness fortnight had become a fitness four-night.  

My regular doctor was out. His replacement was not the least bit alarmed. “I get two new vertigo patients a week at your age,” he told me. I hadn’t even thought of this as vertigo, as so far I hadn’t experienced any spinning, only these brain-squeezes. But apparently there’s such a thing as non-spinning vertigo. And what about the whooshing, I asked? “Let’s work on the vertigo,” he said, then prescribed a drug called meclizine.

I had had seven spells by then. That evening I had my eighth, while standing in my kitchen making dinner, and this one came with a new feature. When my brain squeeze came on, I held onto the edge of the sink to steady myself. It wasn’t enough. Suddenly I was unable to remain standing, as if my brain had shut off all instructions to the muscles that allow hominids to stand upright. I dropped to the floor.

I remember once playing with a toy doll made of hollow wooden limbs held together by wires. When you pressed a button at its base, the wires went slack, causing the little man to crumple into a pile of body parts. The experience in my kitchen that night was just like that. Something pressed that button. I would later learn these are called drop attacks, and the one that night would be the first of many.

I decided to work from home the next day, fearful of having a severe episode while driving to my office some 20 miles away. I had another episode that day, and another at night. That one woke me from a deep, dreamy sleep and I had to sit up and steady myself until it passed.

Early the next morning, back at my writing desk, I noticed the birds outside my open screen door went suddenly quiet. Turning to look, I realized my hearing had gone out in my left ear—just as my brain felt the familiar squeeze and, this time, for the first time, the world began to spin. It was textbook vertigo. I laid both palms on the desk and looked out the window as a great wave of nausea came on. I was on the verge of vomiting, sucking in that one last deep breath as my stomach prepared to spew forth its contents, when the spinning stopped and my hearing came back. As I exhaled, I noticed beads of sweat on the hairs up and down on my forearm and shivered as a light wind blew across my wet skin. I was so drenched I had to change my shirt.

I called my mom, who had had some experience with vertigo, and learned that her doctor had also prescribed meclizine. But she had never experienced episodes quite like mine. She recommended I begin logging the episodes, in order to have solid data to share with my doctors, advice I began following right away.

The meclizine was not helping. I called my doctor’s office to get an appointment with an ENT, and got one, but would need to wait four weeks. With each episode worse than the last, I was pretty sure I’d be in the ER way before then. Fortunately, the next episode was slightly less intense. And the one after that was even milder. I decided I could wait.

I went two days with only the mildest of spells and so began driving to work again. The whooshing episodes also subsided. I was hearing my pulse only once or twice a day, for five or ten minutes at a time. Interestingly, the whooshing spells never coincided with the dizzy spells. They were on their own random cycle.

___

Ten days after my first episode, sitting at my desk at the bank where I work, I heard a ringing on the right side of my head. Then my hearing went out in my left ear and the world began to spin. It spun for less than a minute, not as badly as it had before, but when it stopped, I again noticed my forearms wet with sweat. I made an appointment to see my regular physician the next day.

“You need a brain scan right now.” My doctor’s face had gone slack when I described what was going on. His alarm, though, was oddly reassuring. I’ve been seeing my primary care physician for more than a decade and was glad that he too saw this as being something truly weird. Other than an argument over how to pronounce tinnitus (I’d always heard it tin-EYE-tus and he insisted it was TIN-i-tus, which I think sounds silly) my doc and I were on the same page.

While waiting for the results of the emergency MRI of my head, I went online to see what my doctor might be worried about. It didn’t take long to find a condition whose symptoms lined up with mine, a non-cancerous tumor called an acoustic neuroma. This was it, I thought. It was an awful thing to have, but weirdly I took some comfort in knowing what was probably going on. My mind turned to my son and daughter and how I would break the news, explain the condition, and assure them I would be fine once the tumor was removed.

I learned by email that the MRI came back negative. There was no tumor or other sign of anything unusual. My first reaction was disappointment at having to go back to square one. Then I remembered that learning one does not have a brain tumor is actually not a bad thing.

___

Thus began something of an odyssey, which consisted mostly of waiting for appointments with specialists of various stripes, all the while experiencing random waves of vertigo of varying intensity. It was like a gremlin had taken up quarters in my head, tormenting me at random moments of his choosing. Sometimes he’d sleep quietly for two or three days, then come out 30 times or more in a single day.

My first stop was the otolaryngology or ENT department at Duke Hospital where, over the course of several weeks, a team of ENTs ordered a hearing test, a test of the vestibular functions of my inner ear, additional MRIs, and a CT scan of my brain. Between appointments I began scouring the internet to learn about my hearing and vestibular system, and basically to see what the hell might be going on.

The space between your earlobes and brainstem is home to a remarkable bit of machinery. Consider just the semi-circular canals, three hollow rings positioned on opposing axes like the rings of a gyroscope and filled with tiny crystals floating in liquid. Moving your head in any direction disrupts the flow of those liquids, disruptions transmitted to your brain by the vestibulocochlear nerve. As its name implies, this nerve, also known as the eighth cranial nerve, also transmits signals produced by air pressing on your cochlea, or eardrum. The mechanisms are magnificent. And as a software engineer I can only marvel at the complexity of the “code” inside the brain that has to interpret the data coming in via this key pipeline of information on either side of our heads. Wrapped all around the hearing and vestibular organs is a web of blood vessels large and small, equally marvelous it its ability to get blood in and out of impossibly compact nooks and crannies.

There are any number of things that can go wrong in this part of the head, all of which would need to be considered in my case. Doctors call this process of elimination differential diagnosis. So far, only the tumor had been struck off my list. That left things like Benign Positional Vertigo (whose cause has to do with those canal crystals not moving around as they should) and Meneire’s Disease (an inner-ear disorder that can cause random vertigo spells like mine). To be considered on the vascular front were things like aneurysms (blood bubbles), stroke (blood clots or bleeding), stenoses (vessel narrowing), fistulas (abnormal connections between arteries and veins), and dissections (blood vessel tears). The whooshing, I learned, was known as pulsatile tinnitus.

When I asked my senior-most ENT about a condition I had run across called vestibular paroxysmia (VP) caused by a blood vessel compressing the vestibulocochlear nerve, and whose symptoms seemed to line up with mine, he responded as if I’d insulted him. “I don’t believe in that,” he snapped. His umbrage made me feel like I’d just suggested voodoo. He hadn’t seen it in 25 years of practice, he continued, and when I pressed him for more he said if such a condition were real it would cause much more severe hearing loss than what I was reporting. He clearly knew what he was talking about. I decided to let the doctors do the diagnosing.

___

One of the doctors suspected a vestibular migraine, whose typical symptoms include dizzy spells, and suggested I go on a migraine diet for two weeks. But removing nuts, cheeses, processed foods, soy products, and olives from my diet had no apparent effect. Nor did abstaining from alcohol. And thank God for that.   

The battery of testing ordered by the ENTs gave no clue as to what was going on. My hearing was fine, except for a slight deafness on my right side, which I’d had since I was a teenager, when a firecracker went off in my right hand after waiting too long to throw it. My vestibular organs all seemed to be functioning properly. I didn’t qualify for Meniere’s, whose spells need to last 20 minutes or more, whereas mine typically lasted 15 or 20 seconds. And none of the brain scans—not the MRI, MRA, MRV, nor CT—showed signs of a dissection or other obvious vascular disorder. One scan did find an aneurism, or blood bubble, deep inside my brain. But its size (thankfully quite small) and location ruled it out as a culprit.

The apparent lack of vascular disorder baffled me for two reasons. One, pulsatile tinnitus by definition is due to blood flowing where it shouldn’t, i.e., where your cochlea can pick it up. Two, my symptoms came on after the most intensive cardiovascular workout of my life, with long runs or fast hikes every day. Rather stupidly, in hindsight, I had clearly let my heart rate go way into a danger zone. Wasn’t it reasonable to assume I had torn some vessel up there? Perhaps. But the testing showed no sign of it.

The ENTs concluded that a central nervous system disorder should be considered next and referred me to neurology. And the referring doctor told me to expect the neurologists to order a lumbar puncture, or spinal tap, which quickly brought two words to mind: oh shit. If there was one medical procedure I had feared more than any other it was a spinal tap. Fortunately, the very first neurologist I went to saw no reasons to indicate a central nervous system disorder. “You don’t need a lumbar puncture,” he told me. I nearly hugged the guy.

He still suspected a vascular issue and referred me to a neurologist who specializes in those. When I told her about another symptom that had come on a few weeks before onset, a stiff neck whenever I ran, she ordered MRIs of my neck to expand the search for a vascular disorder in that area. Nothing.

___

Meanwhile the episodes continued. In April, I crumpled to the ground after drinking one beer at the Ponysaurus Brewing Company in Durham, where the other patrons no doubt assumed I had had way more than one. In May, waiting in baggage claim at the airport, I noticed the loud ringing on my right side, which I had learned by then signaled the onset of a drop attack. I headed for a bench not ten feet away but didn’t make it. I dropped like a rock onto the cold, tile floor. Leaving Duke’s imaging facility one day, passing by the cancer center, I put both hands on its stone exterior when the ringing began, thinking wrongly that I could remain standing. A second later I was on the ground, rehearsing what I would say to the passersby who I knew would soon be coming to assist. Actually none did.

One thing I noticed about my drop attacks is that my body seemed to always fall to the left. Wanting to confirm this, one day I hurried to my bedroom when I felt one coming on. Standing next to my bed and a safe distance from any hard furniture, when this one came on I offered no resistance. Sure enough, I fell not slightly to my port side but directly, as if someone twice my size were standing to my right and pushing with gusto, their invisible hand toppling me right over.

It had been seven months since this gremlin made a home of my head. By mid-April 2018, I had logged 853 episodes, including 28 drop attacks—one per week, on average.

Duke Hospital is a world-class medical facility with a well-deserved reputation for superior medical care, but it appeared my condition had them stumped. I decided to look elsewhere for help and started, of all places, on Facebook. There I found a group of pulsatile tinnitus sufferers and began looking for names of doctors in their posts. Because my PT had begun on nearly the same day as the vertigo, I figured there was a good chance they had the same underlying cause. If I could diagnose the PT, my thinking went, I might simultaneously diagnose the vertigo.

I went to see two doctors who specialize in pulsatile tinnitus, one in New York and one in Baltimore. Looking at my scans, the New York doctor, a neurointerventional radiologist, saw some indication of stenosis but could not say that was causing my symptoms. The Baltimore doctor was equally baffled, until the day after the appointment when he placed a phone call that changed everything.

___

I was driving to work one morning and saw a call coming in from Baltimore. The ENT had woken up that morning with a new idea, he told me with a hint of pride. I was just thrilled he took the time to call. He suggested my symptoms might be due to something called intracranial hypotension due to a cerebral spinal fluid leak. I thanked him profusely and pulled over for a quick bit of googling. The condition, I learned, would seem to explain every one of my symptoms.

I was ecstatic. After seven months of riding this disturbing roller coaster, finally a doctor had the combination of curiosity and caring to point me to the most promising path I’d yet encountered. Incredibly, one of the three major centers in the US for treating CSF leaks, I learned, is none other than Duke Hospital. Why my Duke ENTs, neurologists, and radiologists did not think of sending me down the hall to their CSF colleagues I cannot say. In any event, I went back to Duke.

After reading everything I could find on CSF leaks, a plausible story nearly wrote itself. It was plausible to me, anyway, and it went like this: Our brains are suspended in a bath of clear liquid that extends down our spinal column. On one of my intense runs back in October, I had caused a tear that CSF was leaking out of, causing my brain to sag onto my vestibulocochlear nerve, in turn triggering either the pulsatile tinnitus or vertigo, depending on where it sagged. The whooshing was the result of something called the Venturi effect when blood is forced to flow through a constricted space—just as a running water hose hisses when you kink it.

Two things supported my story. First was the fact that from time to time, with no symptoms of a cold, I would find a thin clear fluid dripping from my nose—I read this was a common symptom. I also decided to test the saggy brain theory. One day when I felt the pulsatile tinnitus coming on, I got down on all fours, hunched up my hiny and let my head dangle upside down. The whooshing stopped. When I stood up, the whooshing came back. I repeated this test dozens of times with same result.

It was a lead-pipe cinch, quod erat demonstrandum, and a total no-brainer: my spinal fluid was leaking.

Waiting three months for testing to confirm a CSF leak (I’d become accustomed to waits of weeks or months between stops on my journey to diagnosis) I read that caffeine was known to reduce symptoms of intracranial hypotension. I happily increased my morning consumption from four cups to six. A lifelong coffee drinker, this was a silver lining, albeit slim, to the gray cloud of dread that hung over me waiting for the test they would use to detect a CSF leak:  a spinal tap, while lying on the bed of a CT scanner, to inject dye into my spinal fluid, dye that would show up on the CT scans when it leaked out.

The spinal tap turned out to be not the least bit painful. Just a bit of pressure against my spine. “Do want to see what I see?” asked the friendly technician who had patiently explained everything beforehand, setting me at complete ease. “Sure!” He positioned the CT screen so I could watch as a needle entered the space between the bones of my spine. So the CT myelogram turned out to be rather cool. But it did not show any signs of a CSF.

“I know it’s disappointing to not know what’s going on,” the doctor told me over the phone a few days later. “But trust me, you don’t want to have a CSF leak.”

How could this be? I had fallen victim to something called confirmation bias, where you focus on evidence that supports a hypothesis you already believe to be true. It was the same as when I was convinced I had a tumor. So once again, a year into this odyssey, I went back to a familiar place: square one.

___

Until this time, my episodes of vertigo had come on randomly throughout the day. But now I began noticing a pattern. They tended to occur between 2:00 and 3:00 in the afternoon, when my recently increased morning caffeine infusion was starting to wear off. Might there be a connection? Over the course of ten days I switched to decaf, gradually mixing it into my regular coffee. It took all the will power I could muster. But the result was striking.

I went from having 50 or more episodes per week to having just a few. And none were severe. I missed the effect of fully caffeinated coffee but still enjoyed a lesser effect, from the residual caffeine in decaf, but was elated that my symptoms were now easily tolerable. A week went by with almost no episodes. Then two. Then four.

Still wanting an explanation, I went to see a neurologist in Chicago whose name I had seen on dozens of research papers on hearing and dizziness disorders. He examined my growing collection of images and ordered an all new battery of tests of my hearing and vestibular functions. Sitting with me in his office after several hours of testing, the friendly doctor (who looked remarkably like Steve Martin) patiently summarized nearly a dozen different conditions that could potentially explain at least some of my symptoms before choosing for his diagnosis the very condition my Duke ENT said did not exist: vestibular paroxysmia.

The cause of VP, also known as microvascular compression syndrome (MCS), is not known. It may be due to a weakening of the myelin sheath surrounding the vestibulocochlear nerve, which makes it susceptible to interference by a blood vessel running beside it. Such interference triggers sudden episodes, or paroxysms, of hearing loss, vertigo, and imbalance.  The impact of caffeine abstention made sense to my Chicago doctor given its well-known effects on both nerves and blood vessels in the head. He suggested that I stay off caffeine as long as that helped, and if the symptoms returned, there were drugs available known to help relieve VP symptoms.

I went back to Duke and found a neurologist who did believe in VP and who in fact was treating other patients for the disorder. But he didn’t think I had it. He told me it did not cause hearing loss, the exact opposite opinion of the Duke ENT who said it would come with severe hearing loss.

Three specialists were saying three different things about this vestibular paroxysmia: You have it, you don’t have it, and it doesn’t exist. I decided to just accept the uncertainty of my situation and get on with life. The only thing I knew for sure was that limiting myself to decaf seemed to minimize my symptoms to the point of irrelevance. I brushed off the two or three mild head squeezes per week, enjoyed my decaf, and learned to tune out the occasional whooshing in my ear.

___

Then, six months after my trip to Chicago, I was sitting at my desk at work when one of the mild dizzy spells came on. It wasn’t too bad, but something told me to head to the nurse’s office where I work. It was lasting a bit longer than usual. As I sat on the examining table explaining my history, the spinning accelerated and suddenly I could no longer sit upright. I rolled over in agony—the spinning had never been this bad—and began vomiting. It was the first time I threw up since this whole thing began.

The spinning and vomiting subsided for ten minutes or so, then came back. I texted my friend Elisabeth who rushed over and drove me to the Duke ER. The waves continued, thankfully growing less intense each time. Until that day, no episode had lasted more than a minute. This one lasted nearly four hours. The ER docs ordered a CT scan, reviewed my records, and sent me home at 6:30 the next morning. As expected, they had no idea what was going on.

At a follow-up appointment my Duke neurologist prescribed carbamazepine, known to be effective in treating vestibular paroxysmia, but I decided to try something else first. Learning that “decaffeinated” coffee can contain up to 30% of the caffeine of regular coffee (I think “low caf” is a better name), I went entirely caffeine-free. No decaf, no caffeinated teas, and no chocolate beyond the occasional nibble. For the next six months I still heard whooshing from time to time, but not a single episode of vertigo. Not even a mild one. The carbamazepine went into the trash.

I was symptom free. My gremlin, it appeared, loved coffee. And whenever I felt the urge to make myself a French Roast pour-over, or dash into the nearest coffee shop for a latte, I just thought back to that marathon night in the ER. Still, even still, I wondered if I might some day recaffeinate.

One day, months later, googling yet again for all the neurovascular disorders with symptoms like mine, I stumbled upon one with the weirdest name yet: secondary endolymphatic hydrops. Its symptoms are episodic vertigo and intermittent hearing loss that come on a response to some event or condition. When I read it might have something to do with the chemical balance of the fluid inside the inner ear, I got to thinking about the apparent dehydration effect of caffeine. There’s disagreement over just how dehydrating caffeine really is, but what if I was dehydrating just enough to mess with the chemistry of my inner ear?

I started drinking more water. Each morning I filled my one-liter Nalgene and made a point of emptying it at least once a day. After a week or so I treated myself to a decaf. Things were all good that day. And the day after that. Over the course of about a month, I worked my way up to a full cup of coffee every morning, always careful to empty the Nalgene at least once a day.

Fact one: I’ve been symptom free for six months. Fact two: I drink coffee, and plenty of water, every day. God only knows if there’s a connection between those two facts.

Was secondary endolymphatic hydrops the cause of all this bother? I don’t know. But learning about it, and thinking about what’s known about it, got me thinking about drinking more water and when I did so I could drink coffee again without fear of falling down. That’s all I can say for sure.

I still think I damaged something in my head during my ill-advised fitness fortnight, the extreme workout that immediately preceded the onset of symptoms. The coincidence is just too striking for me to believe otherwise. And if that’s the case, then maybe Mother Nature has now healed whatever I did. Or maybe, or maybe. Dot. Dot. Dot.

Truth is I don’t expect to ever know the real story. And I’m fine with that. These bodies of ours, I have come to learn, are complicated as hell. I’m just grateful as hell mine is working properly again.

By the age of three I had mastered such standard life skills as how to stack things, how to operate a toilet, and how to start a fire. Indeed, I nearly burned our house down. You’d think that such a traumatic experience at that age would make some impression on my developing brain, such that my childhood fascination with fires would stop. You’d think that.

When you’re the seventh of ten kids, the question of what to do with your free time is often up to you. Even the best parents to ever walk the face of this earth (e.g., my mom) have only so much time to spread around.

I’ve a memento from one of my very earliest attempts to entertain myself. Sitting on the kitchen floor, possibly still in diapers, I extracted cans of vegetables from the cabinets beneath the stove and decided to stack them as high as I could. After making a tower much taller than it was stable, I looked up just as gravity did what gravity does. The gash on my lower lip, from a can of creamed corn whose fall to earth was interrupted by my face, left a scar for life.

I found bathrooms laden with new and interesting things. The sinks and tubs were cool. And the toilet? Utterly fascinating. I made deposits far more frequently than was necessary, just so I could watch them disappear in that entertaining vortex of rushing water. With astonishing speed, I developed a fine grasp of the mechanisms involved in the essential bathroom functions, if not their correct names. Learning the verb “to pee” was easy enough. But when Mom referred to the other one as “moving your bowels” I thought she said “moving your bottles,” and that is how I referred to it for more years than I care to admit.

I was particularly bored one morning, at the age of not-quite-four, in the fall of 1966. School had just started so the house was relatively empty of kids. My sister Barb was home, up in her room getting over a bug going around, and Mom was busy tending to Marty and Kenny upstairs. I was downstairs in the kitchen, drawn to the stove and its magical feature: You don’t need matches to make a fire with this thing, I had observed. You just turn those knobs.

I couldn’t quite reach those knobs but solved that problem using those cans under the stove. Perched atop two giant cans of Hawaiian Punch fruit drink, it took me no time at all to light a little blue ring of fire. Couldn’t I make it any bigger, I wondered? Why yes, I could.

Mom stored leftover bacon grease in a paper milk carton with the top cut off, right next to the burners. I bellied myself onto the countertop to reach the grease carton, tipped it over, and took in the comforting smell of bacon grease as it oozed onto the stove before transforming into a most impressive flame. But then came the smoke. It was black, and heavy, and it made my eyes burn. I stepped off the Hawaiian Punch cans then ran upstairs to where Mom was changing Kenny’s diaper.

I did not report what was going on. Cloaking myself in nonchalance, I meandered to the open window, looked onto our backyard below, and after a relaxed moment or two turned and pointed outside. “Look at the smoke, Mom.”

She did as instructed, only to see a tower of inky black smoke pouring out of someone’s window. Ours. “Barb!” Mom yelled to my sister. “Get out here!”

Mom looked into the kitchen as she hurried us all to safety. A glance at the Hawaiian Punch cans and toppled grease carton were no doubt all the clues she needed to know what had happened. The flames were now climbing the back wall of the stove and licking the wooden cabinetry above. The black smoke was clinging to the entire first-floor ceiling of our house, like a heavy blanket defying gravity. Dad and my older brothers had painted those ceilings, indeed every wall in the house, just days before.

Barb took us into the garage and into the car while Mom tried to turn off the stove. That’s when the miracle happened. A volunteer fireman, clearly following careful instructions from God because how else does one explain this, had been driving up North Point Road just as smoke began billowing out of our kitchen window. He stopped his car and burst inside to find Mom in the burning kitchen.

“We need a blanket,” he told her, pulling Mom aside and switching off the burners. “A table cloth?” she asked, eyes burning. “Get it.”

Mom fetched the big green tablecloth, the nice one we only used for Sunday dinner, while the fireman ran water in the sink. Using the soaked cloth, they soon smothered the flame. As billows of white steam overtook the black smoke of a defeated fire, a crew of firefighters burst through our front door, the nozzle of a ready fire hose in their hands. Luckily for us they never turned it on. It saved the house from who-knows-what kind of water damage. The smoke, however, did plenty. It got into every room, every drawer, and every stitch of clothing inside those drawers.

Mom wasted no time in commencing a clean-up effort. She and Alice Albro, Mom’s neighborhood friend who had rushed over at the sight of the fire trucks, had buckets and sponges out in no time. They were wiping down walls when Warren Baker, the State Farm insurance agent who had sold us a homeowner’s policy just the month before, arrived at the scene.

“Girls, you can put down those buckets,” said Warren, who then delivered the news that State Farm would take care of everything, including putting us up in temporary lodging while they fixed up our house. So while Mom, Barb and my little brothers moved into Grandma’s house next door, the rest of us guys enjoyed a life of luxury at the Trailways Motor Lodge and Restaurant, complete with daily maid service, all-you-can-eat meals, and a different dessert every night.

“Eat up,” our dad encouraged his growing boys at the restaurant dinner table. “State Farm is paying for it!” Our last night at the Trailways, my brother Bob ate so much chicken and dumplings he threw up right at the dinner table. We didn’t stay for dessert that night.

Did the experience extinguish my fascination with fire? Hardly. Over the next few years, Mom was forever finding books of matches in my pants pockets—I swiped them whenever I could—and my older siblings nearly tired of ratting on me for my little grass fires in the yard. Mom and Dad certainly tired of telling me not to play with matches, and resorted on one occasion not to spanking or scolding but with something rather creative. They invited me to a movie.

The 1968 film Hellfighters starred John Wayne playing the real life oil well firefighter Paul “Red” Adair, who was famous for putting out gushing oil wells that had burst into flames. Mom and Dad took me to the French Village drive-in movie theater to see it. And they only took me.

I really liked the movie, at least the first 20 minutes or so, which is all I saw from the middle seat of the station wagon, perched on the big hump on the floor we called the watermelon, before falling asleep. Mom had brought grocery sack filled with popcorn she made at home and smuggled in. To hear the movie there was a speaker, a big gray metal thing with slits where the sound came out and a knob to adjust the volume, hanging inside a window.

If my parents thought the experience would get pyromania out of my system cathartically, by watching huge fires up on the huge screen, they were unfortunately wrong. I kept stealing matches and just got better at hiding them—I found my clean black socks a fine place. And one day I used them to again summon the Fairview firefighters.

Most of the lots in South Bountiful Heights had houses on them by the late 1960s but a few remained vacant. One was on Bountiful Drive not far from our house. The grass and weeds grew tall there, so a kid could crouch down and not be seen by passersby. One day I headed there with my matches. It was a very hot day and when the wind blew it was like opening the door of an oven. The dry grass crinkled at my ankles as I waded through it.

Depositing myself where the grass was tallest, I struck a match. The flame was a nice one and I held it close to my face, wondering why it was blue at the base and then turning reddish yellow. I made a mental note to ask my brother Steve. He could always explain stuff like that.

I didn’t need to feed this fire. It founds its own fuel and spread in all directions, indeed with alarming speed. When I realized the smoke might be visible to others, I sprang to my feet and ran off. It took no time at all for others to see the smoke and call the fire department. On my way home, the town’s little red fire jeep passed me by. It sped to the fire and began putting it out and was soon joined by pumper trucks, whose deafening sirens really got to me. Or something did.

When I got home I decided to stay quiet. Unlike the kitchen fire, the fire on Bountiful would never be credited to me. Had I brought it up, I’m pretty sure Mom and Dad would have figured out it was mine. And then I expect they would have done the only sensible thing and sent me off to reform school.

Fortunately, no such measure was needed because the Bountiful fire was my last. Never again would I set a fire I wasn’t supposed to. We moved to Washington, DC when I was ten, and our new house there had a fireplace where I helped Dad build lots of fires. I think that helped. So too did joining Boy Scout Troop 1092. On countless camping trips with those fellas I learned to build fires safely and, I might add, with rather some finesse.

Indeed, I got pretty damn good at building fires. Nowadays I can still get a roaring fire going with no more help than the sulfur on the tip of a match.  And I do so whenever I can. It’s still fun.