Tag Archives: memories

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Like madness, is the glory of this life

My grandmother was old when she died -very old, in fact: she died on the morning after her 100th birthday party. Her congratulatory letter from the Queen -or at least someone official claiming to speak for her highness- came the day before. I’m not so sure it was congratulations, really -more a recognition that a member of the United Kingdom, albethey an émigré, had still remained loyal to her majesty and her dominions for a century.

My grandmother seemed to enjoy the party we held for her -she was all smiles and although she also seemed a bit confused by it all, she was delighted by the letter. It spoke to her of another life, I think -one that whispered the secrets of a little girl growing up in an English seaside town with a shingled beach and an amusement pier that offered tempting glimpses of a world across the sea -a world she couldn’t know would become her own for most of her life.

We all have lives like that -the present we currently occupy pales in depth, in colour, and even in meaning to the worlds we have tasted in our incomparably longer past. It only seems appropriate that when our brains tire of sorting through the tyrannies of the moment, we default to the myriad memories of what we lived. The past can be a comfortable place to rest -familiar, at the very least.

I loved visiting my aging granny -even in the hospital where she spent her final days she was always full of stories, full of wisdom, and full of wonder. And although often confused about current events, or what she’d had for breakfast that morning, her eyes would light up when I asked her to tell me about, say, her train journey across the country when she and grampa first arrived in the boat from England.

She would chuckle when she told me of the pioneer stoves they used to cook their food enroute, and how each time the locomotive stopped to fill the water in its tank, everybody would make a mad dash from the railway coaches to find wood and occasional supplies from the little stations along the way. Her eyes would twinkle as she relived the flavours of whatever food they’d had, and she would laugh at the difficulty of cooking on the ever-moving stoves. She had no trouble remembering how everybody helped each other -she even remembered some of their names after more than eighty years.

So whenever she seemed confused at my visits or flustered by my questions about her health, I would smile and settle in a chair beside her and ask her what she remembered about ‘the old days’ as she decided to call them. After all, I think she lived there most of the time -it seemed a place where she was happy. At any rate, it seemed to calm her, and allow her to speak to me as if she were still in the summer garden she’d loved to show me on my visits years ago to the house she and her husband had built near Vancouver. There seemed to be no disorder in the garden, no anxious  search for a constantly fading identity, nothing forgotten there -just flowers all around us, and birds singing in the bower of trees she’d planted so long ago.

She loved to speak from there, and even then -especially then- I was happy to sit there with her in her past. I lived happily in the two worlds, and she enjoyed meeting me there; like lovers we would float from dream to dream, escaping from the bewildering clatter of a crowded hospital ward. Who would not prefer her floral ‘then’ to her sterile ‘here-and-now’?

The staff told me of the problems with her confusion, and how she would sometimes wander off looking, as she told one of them, ‘for the garden’. And all the while around us, there were often moans and shouts, and irritable reactions to attempts to tame the ward. Sanity lay somewhere in the past -their patients’ past- but the department seemed hastily conceived as a holding area until beds became available in community nursing homes. Hospital was perhaps the wrong place for most of the elders -they were not sick except, perhaps, for home… or for something that reminded them of home, at any rate.

I have to say that I was pleasantly surprised to come across an essay on retrieving the autobiographical memory of demented seniors in Aeon: https://aeon.co/ideas/the-self-in-dementia-is-not-lost-and-can-be-reached-with-care

It was written by Muireann Irish, an associate professor of psychology at the University of Sydney. ‘Our autobiographical memory… seems crucial to weaving a life story that bridges past and present, and permits us to extrapolate how the future might unfold, all within a meaningful and coherent narrative. So what happens when the tapestry of memory begins to fray, and we lose access to defining memories from the past?’

There are many types of neurodegenerative loss -Alzheimer’s among them, of course- and it is progressive. ‘Gradually, as the disease spreads, more distant memories are affected, leading to patchy recall of self-defining events, such as one’s wedding day or the birth of one’s children.’ And without our memories, who are we…? ‘There remains a recalcitrant perception that in parallel with the progressive pathological onslaught in the brain is the inevitable demise of personhood, akin to a ‘living death’.’

But, viewing dementia like that is not only depressing, but incomplete, according to the author. ‘While the illness is devastating, not all memories are obliterated by Alzheimer’s, and much of the person’s general knowledge and recollection of the distant past is retained. There remains a vast repository of life experiences, personal history, stories and fables that endures, even late into the illness. At moderate to severe stages of dementia, activities such as art, dance and music therapy provide important nonverbal means of communicating and fostering social interaction even when, on the surface, many core capabilities might seem to be lost… As the disease progresses and their self-concept becomes more rooted in their past, people with dementia can feel increasingly divorced from their current surroundings, which no longer make sense or feel familiar. This is the catalyst for behaviours that are commonly couched as ‘challenging’, such as agitation, wandering, attempts to leave a care facility to ‘go home’.’

Irish suggests that instead of confronting the dementia with an enforced ‘now’, ‘a positive approach could be to create a ‘memory box’ in anticipation of the days to come. This could form a repository of photographs, keepsakes, newspaper clippings, objects with personal meaning, even fabrics and smells, that resonate with the person and provide an external memory store. Conversations regarding music and songs from the person’s formative years, and the memories that these tunes evoke, could inspire personalised playlists that foster social interaction and the springboard for reminiscence. For care staff, a memory store of this nature would be as important as taking a detailed medical history.’

As for my grandmother, I was happy to sit with her in her garden while she happily regaled me with stories of her past. And I’d like to think that after she received that letter from her queen, she retreated to the garden to read it again and again as her life washed over her like a cooling summer breeze, and the flowers whispered sweet nothings in her ear.

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The Cloth of Words

Sometimes I wax nostalgic. Sometimes communication itself seems drab, with none of the makeup, none of the panache that identifies it as the look of someone I have grown to know.  Emails, like strangers in standard-issue suits, knock at my door then talk from the other side of the threshold, neither wishing nor invited to enter. They were hired for the job -messengers only; they do not expect a handshake or a hug, only an acknowledgement of delivery. And whether or not you are thankful for their service, or acquiesce to whatever their graphemes convey, is nothing to them.

It is everything to me, however. Often, if I cannot look into the eyes of whoever writes, I do not know their thoughts -there are too few clues to allow me into their head. A typed sentence, however thoughtfully composed, can disguise a world of difference, hide be-clothed thoughts, and without a face, is no more helpful than a dictionary.

Perhaps it is just my age that asks for more than words… and yet maybe there is more to know about a word than how it is defined, or whether it is polite. I do not care so much about the grammar or whether it is properly spelled, as I do about its intent. Information is more than message; it is often more than just the tapped collection of recognizable phonemes strung together across the screen. ‘Words, words, words’, Shakespeare’s Hamlet answers when asked what he is reading by Polonius. There are times when that’s all they are -hardly more.

But at least in those days, they were likely handwritten in cursive, marred by hasty smudges, the ink itself affected by whatever visible trembling the message caused. Readable as much by appearance as by content, in other words. That the writer actually touched the page as they felt the emotion they’ve conveyed, is one of the ineffable attributes of a handwritten note.

Recently, while cleaning out a cardboard box stuffed in the corner of a little-used closet, I found a wrinkled envelope written with now-faded ink in a hand that made a chill run down my spine. It was a letter written to me just after I first went away to university a thousand years ago. The writing was unmistakably my mother’s, with her carefully tailored ‘b’s and precisely dotted ‘i’s, the loop of her ‘q’s a set distance below the line to precisely match those of her ‘y’s and identical in length to the downward stroke of the ‘p’ -Grade school exactitude, like she had taught me and her students so many years ago.

In those days I had required lines to guide me horizontally across the page without any hint of slope -it’s how we were marked. It’s how she marked, at any rate. But, of course, she no longer had need of lined paper after so many years… and yet, lines were how I remembered her notes to me. I always assumed they were reminders of proper form: Address at the top right hand side of the page, and then the ‘Dear’, one line below that on the left (or sometimes two lines, as if she were granting me that styles were changing).

Maybe that’s why this letter was so unusual: it was unlined, and her customary measured loops and dips were erratic, although still readable. At times they seemed hurried -like she needed to get to what she wanted to say, but had to prepare things first. Prepare me…

She had surrendered to custom and was using a ballpoint pen by that time, but even though the ink flowed freely from its tip, I could see areas on the page where she had dug it more deeply into the paper as if she had been tempted to underline a word for emphasis, but had thought better of it.

I suppose anyone else simply glancing at the page would have judged it neat, and yet I could tell as soon as I opened it that there was something wrong. Everything was in the correct order, and in a quick peek at the bottom of the page, I saw the reassuring ‘Love, Mom.’ in its designated place, but with far more than the requisite number of ‘xo’s lining the space below the ‘Mom’.

And she still used my childhood nickname, but it looked forced, artificial -as if the news she was about to tell me demanded an adult name, an adult tone. I was, after all, a grown-up now in university, and no longer living at home. I sensed she hesitated over her choice, but wanted –needed– to maintain a mother’s reassurance to her little boy. We were still a family, no matter where I lived.

‘I tried to phone you several times,’ it started, ‘but I suppose you are at evening classes a lot, and there’s been nobody around to answer the phone in your room. So I decided to write.’ Her words were becoming hurried, I could tell, because the spaces between them were decreasing. She even forgot to dot an ‘I’ which, as I’ve suggested, is almost anathema to her.

I raced through the letter, more and more distressed by what I saw.

‘You know how much we all loved Boots,’ was when it hit me, and the tears started. The past tense! The dog I had grown up with, slept with, taken with me on innumerable walks, the dog who was as much ‘me’ as my reflection in the mirror, whose warmth I could still feel, whose eyes forgave me whatever I’d done -the dog whose tongue I can still feel all these many years later… Past tense!

‘He had been slowing down, remember, sweetheart? You used to carry him up the steps to bring him inside.’ There was something resembling a smudge on the page, but I couldn’t be sure -ballpoint ink doesn’t readily smear- but nonetheless, I remember touching the page in that spot just to check.

‘Dad put him on his blanket a few nights ago, and he must have died in his sleep, because he was gone when we woke up the next morning.’ Then she started a new line, so I’d understand how important it was. ‘His face was wonderfully peaceful, and he looked the way he used to when he had just fallen asleep as a puppy: relaxed and happy that things had gone so well.’

Even now, reading the wrinkled note, I felt the tears welling up again. Some things you just can’t help. Some things are more than just the words. More than just the message…

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Presume Not that I am the Thing I Was.

We are all stories, aren’t we? But as I slip further down the years, I wonder about my story. Some of it I suppose I don’t remember, and yet what I do might still be suspect –a revision I make even as I think about it. Memory doesn’t reproduce the past so much as create it. And therein lies the problem. There was a time when historical validity was only accredited to its witnesses –a first-hand account told by someone who was actually there, someone who experienced it. But we’re long past that now…

When we are dead, we become fictions; when we can no longer speak for ourselves, what we might have thought, what we might have been, is merely interpreted, as the historical fiction writer Hilary Mantel has said. And even modern historians, scrutinizing the same evidence, will often differ in their explanations of the past. Who is to choose among them –and why?

So, history isn’t fixed, as we often assume, and it certainly isn’t static –it changes with new evidence, or transmogrifies according to the prevailing Weltanschauung. As Mantel sees it, history is not the past –it’s a method we’ve evolved to organize our ignorance of it. It’s what’s left in the sieve when the centuries have run through it.

I think that what occasioned this reminiscence was a short feature in the BBC news about a fifteen-year old toilet sign found in Italy at a farmhouse B&B: http://www.bbc.com/news/blogs-trending-40936110. The sign was attempting to use emojis to indicate that the toilet was not restricted to any particular sexual orientation. It had three symbols –one of a man, one of a woman, and one of a gay person. Unfortunately, the latter is depicted as a rather flouncy individual who is clearly neither male nor female, but rather an amalgam of them both, I suppose. Why it was felt necessary to suggest that ‘gay’ belonged to neither group is unknown. At any rate, the LGBTQ community reasonably complained of the sign’s confusion of sexual orientation with gender identity and the (new) owners obligingly removed it, even though it had apparently been covered up when they bought the property, and had remained so. They had meant no offence.

Things change. Sensitivities change. And signs are expected to reflect that… I, too, am caught up in the current ethos and find the sign unfeeling, and ill-informed, but things were different then, I think. The world was a different place for sure; the Umwelt itself was less evolved. But nonetheless, it makes me wonder whether we can ever understand the lived-world of another era. Whether even I can ever understand my own historical self, and so continually amend what I can remember of him –and continually rewrite the story…

I was waiting for a bus on the outskirts of town the other day, and sought the tiny shade afforded by a small wooden bench. Two older ladies arrived and seemed more in need of shade and rest than me, so I offered them the only gift I had –the bench. But it was in a covered structure and under a tree, so I stayed nearby in its cooling shadow.

They were both in their eighties, I would think, and both wore loose floral-print cotton dresses like I think my mother would have favoured. They wore their hair like her, too –short and manageable under almost identical blue hats. In fact, the more I looked, the more like her they seemed –they could all have been sisters, although my mother was an only child and died many years ago. It’s strange how often older women seem similar. Men do too, I suppose, but I notice the women more. Age homogenizes their faces, and memory standardizes their appearance… Blends them together into vague familiarity like apples in a crate. Fish in a tank.

I contented myself with leaning against the tree and staring idly down the street lost in thought… Okay, I was listening to them; I can’t resist an argument and they’d been going at it even before they sat down –some sort of family thing.

“You have to admit that father was ahead of his time, though, Thea…” The only difference between them I could detect was the colour of the flower pattern on their dresses. It was the red flower who was talking.

Thea, the blue-flower, sighed loudly. “What on earth makes you say that, Flo?”

Flo promptly crossed her arms and glared at her sister. It was hard to tell from where I leaned, but I think she rolled her eyes because it pulled her lip upwards and something rattled in her mouth. “Remember? He encouraged her to work outside the home, and told everybody about how women should have the same rights as men. Nobody thought like that in those days.”

“What house did you grow up in, Flo? He wouldn’t even let me work in that restaurant, remember?”

Flo shrugged at the memory. “You were too young, Thea. He was protecting you…”

“Then why didn’t he protect Ronny? He had a paper route when he was even younger.” Thea seemed pout for a moment. “And anyway, he didn’t encourage mom to work until he lost his job that time. And even then, she had to clean the house and cook the dinners for us when she got home.”  She stared at Flo. “That’s not equal rights and it’s certainly not ahead of the times…”

Flo stared at her sister with a slight tilt to her head. “Well, how about when Ronny came out? Father welcomed him back into our house…” I could sense that Flo was a bit hesitant to speak about her brother, though.

Thea sighed loudly again, but this time contemptuously. “Only after five years, Flo! And even then, it was because mom kept phoning Ronny and inviting him over. Father had nothing to do with it! And remember, the only reason Ronny agreed to come was because it was a family dinner –their anniversary- and yet, Father wouldn’t even speak to him at first. He totally ignored him at the table.” She shook her head sadly and looked at her sister. “Ronny was so hurt. Remember he even left the table and went to sit in the living room until mom convinced him to come back? And then, years later, Father had the gall to tell everybody that he’d never harboured any grudges against homosexuals? That he’d always accepted them?”

“Father’s last boss was a homosexual, wasn’t he?”

Thea glanced my way and her eyes strayed onto my face for a second, as if fleeing from her sister’s naïveté. “Father always pretended to move with the current, Flo. But deep down, he was a man of his time. That was the way things were when he was growing up. There’s no sense in applying today’s values to another era. It took slow and painful steps to get here…” She touched her sister gently on the shoulder. “It’d be like blaming the doctors in his day for not having discovered penicillin.”

Flo looked down the street and saw the bus approaching. “You certainly remember a different Father from me, Thea…”

Thea shrugged as she fished around in her purse for the fare. “We’ve always seen the world through our own eyes, Flo. It’s a puzzle, eh?” she added as they both boarded a bus that was not mine.

I moved to the bench, now in deeper shade, and thought about what Thea had said about their differences being a puzzle.  I remembered fragments of a thought Alan Watts, had written back in the sixties. It was something about there being a difference between puzzles and mysteries: puzzles are meant to be solved, but mysteries are meant to be enjoyed. Wondered about. Tasted. I think I’d prefer to think of the past as a mystery, you know. That we each taste the world with different eyes; there’s no one history that satisfies us all… And therein lies the wonder.

 

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A Flicker of Hope

It’s interesting what catches our attention when we surf the apps on our smartphones nowadays. Some of the more provocative articles have dubious sources, of course, but with a little digging the original study can often be found and the claims checked. The problem, however, is that even these results need to be reproducible in case either the methodology or the results were unreliable –and also the conclusions drawn from them. That’s why it’s often unwise to believe everything you see reported –or, on the other side, to report everything you want to believe… Fear and Hope are wonderful incentives, and so the issues in the study need to be thoroughly researched and vetted for bias and innuendo and references to the original study need to be included.

Perhaps because I am now retired, any article about time-related changes catches my eye more easily. So I find myself particularly interested in studies that suggest progress is being made -not with respect to age itself, but more the evolving process of aging: the gerund. It was with considerable interest that I read the BBC news on the use of flashing light therapy for Alzheimer’s http://www.bbc.com/news/health-38220670

I also attempted to read the original paper from MIT (entitled Gamma frequency entrainment attenuates amyloid load and modifies microglia) published in the December 2016  issue, of the journal Nature should you wish to struggle though it, but I have to confess that for me, even the title was difficult…

At any rate, the article suggested that flashing light in the eyes of mice that were genetically engineered to have Alzheimer’s-type damage in their brain, ‘encouraged protective cells to gobble up the harmful proteins that accumulate in the brain in this type of dementia. The perfect rate of flashes was 40 per second – a barely perceptible flicker, four times as fast as a disco strobe.’ And ‘Build-up of beta amyloid protein is one of the earliest changes seen in the brain in Alzheimer’s disease. It clumps together to form sticky plaques and is thought to cause nerve cell death and memory loss.’ Research has focused on ways to prevent this plaque formation using drugs, but with limited success so far. If a non-invasive method like a flickering light can activate the immune system to do it by itself, so much the better. ‘The researchers say the light works by recruiting the help of resident immune cells called microglia. Microglia are scavengers. They eat and clear harmful or threatening pathogens -in this instance, beta amyloid. It is hoped that clearing beta amyloid and stopping more plaques from forming could halt Alzheimer’s and its symptoms.’ Fine with me.

I did, however, initially wonder about how bothersome the flickering would be –news reports on television usually caution their audience whenever even flash photography is found in the report, presumably because of the risk of triggering epileptic seizures. But, as the article discussed: ‘For the patient, it should be entirely painless and non-invasive “We can use a very low intensity, very ambient soft light. You can hardly see the flicker itself. The set-up is not offensive at all,” they said, stressing it should be safe and would not trigger epilepsy in people who were susceptible.’ Better and better! It’s just preliminary stuff, of course, but at least it opens up new pathways and ideas for further research.

As if even reading about the concept was in itself therapeutic, the article immediately triggered what, at first blush, would seem to be a non-sequitur memory of a patient I saw many years ago. The issue as I recall was not so much about mental aberration -although the patient herself was apparently suffering from paranoid schizophrenia- but more about her speculation on the possible effects of flickering light on mental function.

I was, I think, in my first year of residency training in the gynaecology program and was doing a rotation in one of the older teaching hospitals in the city. In those days, things were very busy on the wards and so our tasks were apportioned according to our seniority, the senior residents doing the lion’s share of new consultations, while we juniors were given those jobs that, while important, required less experience -pap smears, usually.

My senior’s name was Sara, I remember, and she decided I should be the one to go to the psychiatric ward to do a pap smear on one of their more ‘unusual patients’ as she said to tease me.

“What do you mean ‘unusual’?” I asked. Sara didn’t like to go onto that ward, for some reason, so she usually made some excuse.

She stared at me for a moment before answering, I remember. “Oh, you know, she has paranoid delusions and hallucinates, or something…” But it was clear that Sara really had no idea why our department had been asked to do the pap, nor had she any intention of doing it herself.

I was beginning to suspect this was merely another sluff. Sara fancied herself a consultant now and able to delegate things she didn’t want to do. “But if she’s paranoid and hallucinates, wouldn’t it be better if the doctor doing the pap smear was female?”

Her expression turned angry at that point, and I recall her almost attacking me with her eyes. “Oh for god’s sake, there’ll be a nurse there with you the whole time… Or maybe they said two…” she added, uncertainty softening her glare, but not her resolve to send me to that ward.

I showed up at the psychiatric area and was allowed in only after identifying myself via the phone just outside the door. Then I was led to the brightly lit nursing station, and a rather large matronly nurse handed me the chart of the woman needing the pap.

“She hasn’t had a pap smear in years,” the nurse said in a soft voice, so it couldn’t be heard in the corridor outside of the station. “And her voices told her she has cervix cancer…”

“Her voices?” I should have been more professional, but I was already feeling a bit apprehensive about being inside a locked ward. “I mean, shouldn’t we wait until she’s feeling a bit better before we…”

“We can’t seem to find any good medication for her yet,” the nurse interrupted. “The doctor thought that we could at least calm her by checking her cervix.”

Greta –I still remember her name- was already in the examination room, sitting in her gown on a little table that had a set of rickety old metal stirrups at one end. They’d apparently had to borrow everything from another ward for the job. As soon as I entered with the nurse, Greta examined me from top to bottom with suspicious eyes.

“You’re a man,” she said before we were even introduced.

The nurse, whose name I forget, walked over to Greta and held her hand. “You remember we talked about this, Greta,” she said in the same soft voice she’d used before. “And you said it was okay…”

Greta nodded, smiled and lay back to put her feet in the stirrups. “They said I should show you my cervix,” she said, the italics staring at me between her knees. “Not the one with cancer, though…  I’m supposed to keep that one hidden.”

“Her voices,” the nurse quickly whispered in my ear as I sat on a little stool they’d also borrowed for the occasion along with a light on a long, flexible metal pole. It looked as old as the stirrups.

I got the speculum and the pap smear paraphernalia ready as the nurse readied the light. The bulb kept flickering, though. I fiddled with the bulb to see if it was loose, but it seemed tight enough. And it was obviously plugged into the wall. On, off, on, off… the light was beginning to annoy me. I snapped the switch a few times, but still, it insisted on flickering. On, off, on, off…

“I’ve got a flashlight,” the nurse said, but when she turned it on, it was so weak, I knew I wouldn’t be able to see cervix high up in the vagina with it.

“Well, maybe I can do the pap smear with the flickering light,” I said and shrugged.

Suddenly Greta raised her head and stared at me again. “Sometimes the prongs don’t make good contact in the wall. Everything’s so old in this place,” she added, shaking her head. “Take the plug out and squeeze the prongs.”

By this time I had the speculum in my hand, so I nodded to the nurse to try Greta’s suggestion. Sure enough, squeezing the prongs stopped the flickering.

Greta was still staring at me through her legs. “I may be crazy, doctor, but I’m not stupid…”

I put the speculum down on the medical tray I had on my lap. I sensed Greta wanted to explain something. “It’s a signal, you know.” I didn’t think I should reply. “The light’s always trying to tell you something –sometimes it’s angry, but more often it’s just trying to help…” Her feet still in the stirrups, she raised herself onto one elbow and continued. “It gets right into the brain to help, you know. It doesn’t stay there long enough, though, and that’s why it has to keep going in and out, in and out… And each time it tries, it flickers…” Then she stopped talking for a moment and stared at the nurse with an amazed expression on her face. “That’s what the doctors should be trying –not all those horrible pills…”

Maybe that incident stands out because it was the first pap smear I’d ever done. I don’t remember the result in Greta’s case –I was near the end of my rotation in that hospital- but I do remember Sara asking me what I’d done with that patient.

“Why?” I asked, afraid Greta had accused me of doing something improper.

“The ward told me that your patient seemed much calmer after you left and she apparently kept telling everybody you’d come up with a new treatment, or something…” And then I remember Sara smiling condescendingly at me, as if to say that junior residents could never do anything of the sort.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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The Unfallen Yellow Leaf

‘Age, with his stealing steps, hath clawed me in his clutch,’ as the gravedigger in Hamlet says. I’m not so sure I agree –he was speaking about a skull, after all- but I have to admit there are times when I do feel old, and shipped ‘into the land as if I had never been such’; when I do wonder if whatever I have done has gone as unappreciated as a shadow from the moon, as unnoticed as an owl in the night.

I used to think that ‘Aged’ was just a word –but an adjective, not a noun; a descriptor rather than a described -somebody else, in other words… And that makes a difference, even when it is not mentioned in your CV but, rather, implied in the later stages of your career. I prefer to see the years as a kind of parliament where habits, and opinions and experience, all cohabit equitably, calmly debating the memories they were each elected to serve, sifting through them, perhaps, to decide if any merit publication.

And I’m sure there are some memories out there where my face is almost discernible in the background; where at least my voice was recognizable at the time. ‘What you lose as you age is witnesses, the ones that watched from early on and cared, like your own little grandstand’, John Updike wrote in one of his ‘Rabbit’ novels. He’s right, of course –and yet… Sometimes it can happen that you forget the very ones that watched from early on; you forget they cared.

Janice sat giggling in the corner of the waiting room, watching a little child toddle across the room towards her, his legs bowed around bulging diapers, his progress uncertain but determined. I could see her eyes from the reception desk; they glowed with excitement and her head seemed to bob in time to every tottering step. Her entire face became a smile, an expectation living vicariously as the little boy approached, followed closely by his beaming mother.

The consultation request from her GP said she had been referred for antenatal care -as if the rapture in her eyes, and the glow on her cheeks could be mistaken for anything else. Some people wear their pregnancies like jewels. It’s why I love obstetrics.

As I walked across the floor to greet her, she suddenly jumped up and extended her hand. For some reason I had the impression that she wanted to hug me, and would have under different circumstances. Not that I don’t enjoy being hugged, but it did seem unusual from someone I’d never met before. Pregnancy can be an unpredictable gem, though, and I have learned to appreciate its various rewards over the years.

“I’m so happy to finally meet you, doctor!” she bubbled as we headed down the little corridor to my office. “Pregnancy opens so many doors,” she added, smiling at nothing in particular with her eyes.

Indeed, she spoke as much with her eyes as with her mouth as she glanced around the room like a tourist in Paris. They pointed like children in front of each picture hanging on the walls, flitting from pictures to plants and back to pictures again -excited hummingbirds. They finally came to rest on a little terracotta begging lady I’d placed on an oak table in the corner. Pennies dripped from her little bowl, mute testaments to her longevity in the office.

“Where on earth did you get the pennies?” Janice whispered, this time rolling her eyes.

I had to shrug; it was a long story.

“I Googled you before I came, of course, and all your patients seem to mention the begging bowl… Now I see why,” she added shaking her head with what I took to be admiring disbelief.

“And there’s the carving of the woman holding the child and hiding behind the leaves!” she said, excitedly pointing to the little, pot-bound Areca plant on my desk. I was beginning to feel a bit like an employee at a Disney resort.

But then she calmed a little and instructed her eyes to leave the office thermals they soared and perch on my face. I could actually feel them, heavy on my skin, their prey firmly captured. It was almost as if I should understand that they had come back to roost; that mine was the aerie they had once called home. And throughout that first visit, I thought I felt her disappointment –a father finally seen after many years away, that no longer recognizes his child. I could sense a hope for reminiscence, a need for demonstrating familiarity, sharing secrets I couldn’t possibly possess.

Indeed, I got to know her quite well in that pregnancy, and the initial expectation of acknowledgment she had worn, soon blended imperceptibly into an easy friendship. Who once were strangers, now were allies in the weeks, then days, before delivery. But there was always something in the background that I sensed she was disappointed I hadn’t recognized. Something she was now holding as a surprise; something I should have known from the start.

And then, a week before her dates predicted she should deliver, I saw her sitting in the waiting room with an older woman. She’d told me her mother was flying in for the delivery and seemed excited that I was finally going to meet her. I could even feel the italics in the word.

I saw the two of them whispering excitedly in the corner seats Janice always chose, glancing secretly at me as I greeted other patients with earlier appointments. I thought I heard them snickering once or twice, but sometimes people do that when they’re nervous.

They both stood up and glanced mischievously at each other when I approached them. Her mother was a short matronly woman with greying hair that was precariously balanced on top of her head like a silver hay-stack. Her face, though wrinkled, held a pair of familiar eyes that strained at their cage doors just waiting for liberation.

It’s an interesting thing about faces: no matter how much they change, they stay the same… Or is it just the eyes –roses by any other name…?

The waiting room by then was empty, and there was nothing to stop Denise from hugging me, followed, as if on cue, by her daughter.

“So now do you recognize my daughter?” she said, her face an imp, her eyes laughing silently as they flew towards me.

“She’s changed a bit…” I stammered, still flustered by the secret, and admittedly a little embarrassed at being old enough to deliver a patient I had already delivered so many years before…

 

 

 

by

Forget it?

Memories are tricky things. Sometimes they’re not around when you want them, only to arrive later, when you don’t; sometimes they surround you, pester you, like wasps at a picnic. And other times you can’t find them at all no matter where you look. But the really tricky ones are those that never happened and yet they stand up and wave at you from the crowd as if they’ve known you for years. Sometimes they convince you…

The idea of false memories –or let’s be kind… mistaken memories- is not a new one, but several well-publicized instances recently have brought it to public attention. In the age of social media, of course, the cases are instant hits. Take the hyper-publicized example of Brian Williams, the popular NBC news anchor who claimed he remembered being shot down in a helicopter in Iraq 12 years ago. When this was disputed by veterans at the scene, he was forced to step down from his job. http://www.bbc.com/news/world-us-canada-31220600

Because most of feel we can rely on our own memories, the feeling was that he had obviously lied –perhaps to enhance his own role and bravery in the combat, or because of the notorious ‘fog of war’ –that state of confusion that arises in states of extreme stress and chaos on a battlefield.

So which was it? Fog, or lie? Or maybe post traumatic stress disorder (PTSD)? Well, the matter is more complicated than it might seem on the surface. There has been a lot of work done on ‘false memories’ of late –how and why they form. For example: https://blogs.brown.edu/recoveredmemory/files/2015/05/Loftus_Pickrell_PA_95.pdf  Memories, as one of the psychologists explained, are not like videos recorded on a DVD –the same pictures, the same information each time you play them. They are more like the material on Wikipedia –able to be modified or even changed completely depending on the need or as a result of any new information that might come along. They are, in a word, mutable. Unreliable.

And yet, unconfronted, the memories seem infallible and in most of our experience it seems counterintuitive that they would be otherwise. After all, why have memories if we can’t rely on them? I suppose the simplest explanation is that if we remembered everything that happened throughout the average day –let alone a lifetime- there would be insufficient storage to say the least. Our brains must pick and choose relevance, perhaps adding or subtracting things for efficiency or continuity as information and situations change… It used to be termed ‘retrospective falsification of memory’. Or, as the authors of the above mentioned paper describe it: ‘Relatively modern research on interference theory has focussed primarily on retroactive interference effects. After receipt of new information that is misleading in some ways, people make errors when they report what they saw. The new post-event information often becomes incorporated into the recollection, supplementing or altering it, sometimes in dramatic ways. New information invades us, like a Trojan horse, precisely because we do not detect its influence.’

This type of situation is certainly not unknown in the medicolegal kingdom. In the course of frightening and unexpected events, there is sometimes a variation of perception –especially if the event is associated with injury or seems to be the result of negligence or incompetance. Totally understandable, obviously, and yet there are often variations of what actually occurred that are remembered.

But the issues are not always of putative malfeasance. Sometimes they have a more personal tone.

I hadn’t seen Joanna for several years, the computer said. I have to admit that nothing about her was familiar. I had no record of seeing her for the pregnancy, but apparently I’d delivered her baby so I must have been on call for consultations that day for my colleagues. She’d not come back for a post partum check, so I assumed she had simply gone back to her regular doctor or midwife. And now, six or seven years later, she was sitting in the waiting room staring at the wall. She didn’t look at all happy to be there. The referral letter said she just wished to talk about a problem. Referral letters are not always helpful…

I smiled at her as I crossed the carpet to where she was sitting and extended my hand. The one that reached out to me was sweating, limp, and tentative –as if, given a choice and not witnessed by the others in the room, it would have stayed rooted in her pocket. Joanna was a small woman with short, tightly curled black hair, held in place by a yellow ribbon so tightly wound around her forehead that the skin in the immediate vicinity seemed blotched and ill. I wondered for a moment if that was why she didn’t return my smile –she couldn’t. It only let her frown.

In the office, she sat in the uncomfortable captain’s chair across from me like a post with knots for eyes. They didn’t move, but instead seemed fixated on something half way across the desk. I tried to put her at ease by asking her how she was but was met with a wooden silence; not so much as a splinter moved. I let the silence lie fallow for what seemed an eternity and then, feeling her anger, asked her as gently as I could, why she’d come back to see me after all these years.

The knots on her face moved upwards a few degrees, and the post shivered. “This is not easy for me, doctor. I didn’t want to come, but my family doctor said I should talk about it with you…”

I leaned my forearms on the desk to show I was listening, and asked her what she wanted to talk about.

She sighed and shifted uneasily in her chair. Suddenly the knots became eyes and they stared at me like the barrels of two guns. Her face tightened and her jaw clenched for a moment. “The delivery!”

I waited, but she remained silent. I wasn’t sure what she wanted me to say. I couldn’t remember it at all, although my secretary had been able to get the delivery note I’d dictated. I skimmed through it quickly, but apart from a ten pound baby and a vaginal tear as she apparently pushed it out before I could control it, I could find nothing else. “Was there something about the delivery you wanted to ask me?” I said when it was clear she was waiting for me to comment on it.

Her eyes grew larger and angrier. “The forceps! I told you I didn’t want forceps! My first baby was large and I didn’t need them for her…” She was almost shouting and little strands of saliva escaped with every word. “I told you..! And then because of the forceps, I got that tear in my vagina that took weeks to heal. We couldn’t have sex for almost 2 months!” Suddenly, tears appeared and ran down her cheeks. “I told you I didn’t want you to use forceps! I told you… But you wouldn’t listen. You kept telling me the baby’s heart was too low and she had to be delivered right away.”

I could see her clenching and unclenching her fists as she talked. “My secretary has managed to find the report I dictated on the delivery. I’m sorry I don’t remember more, but let me read it again…”

“I’ll bet you don’t remember it!” she said between clenched teeth. “The nurses told me about you before my midwife consulted you. Apparently you like forceps and are pretty good at it…” She shook her head sadly and looked at her lap for a moment. “But I told you I didn’t want forceps and yet you went ahead and used them on me!”

I pulled up the delivery report and read it carefully. I’d been exceptionally detailed in my dictation that night, so perhaps I had been concerned that the baby’s condition might have warranted it. I’d been called by her midwife in the middle of the night because she had been pushing for three and a half hours without much progress. The head was not coming down the vaginal canal and the baby’s heart rate was beginning to show signs of distress. I had examined her, explained the situation, and then told her the options: continue to push, although I didn’t recommend this because she hadn’t made any progress after all that time, and the baby’s heart rate was beginning to show decelerations indicative of distress; caesarian section; or trial of forceps (a concept meaning if the forceps weren’t successful after a reasonable try, that caesarian section would be the fall-back option.) She hadn’t wanted a Caesarian, so I’d asked the nurse to get the forceps ready –just in case. Then, when the nurse had entered the room with the forceps, Joanna had become angry and said she would not accept forceps for delivery.

There followed a sudden, profound, and prolonged fetal heart rate deceleration and something had to be done to help the baby right away. The situation demanded an immediate judgment call, and that meant the forceps. But just as I was reaching for them, she gave a mighty push and delivered the baby. Unfortunately I’d been unable to control the head on such unexpectedly short notice, so she’d sustained a vaginal tear. It hadn’t been terribly large, and I’d been able repair it without much difficulty. Baby seemed fine, and there were smiles all around.

As I was finishing reading the report, I could hear her voice repeating again and again “Why did you use the forceps, doctor. I told you not to use them…”

I forced a smile. “I didn’t, Joanna. The baby was in trouble and I needed to get her out quickly, but I didn’t get a chance to use them. You pushed her out as I was turning to get them ready.”

“But I heard them! I heard them clanking…”

Forceps are metal and as the two sides are assembled they often make a metallic clanking noise. (They superficially resemble salad tongs, although unlike tongs, they don’t actually squeeze the head in anything like the same way. They fit more like a helmet over the head and guide it down the vaginal canal like a dilating wedge in front.) I shrugged politely. “It was an emergency for the baby. She needed to be delivered right away, so I was probably getting them ready when you had that really strong push.” I chuckled at something and she stared at me. “Sometimes I think that just the threat of using them is as good as using them. Nothing motivates stronger pushing than clanking the forceps!”

First I saw her teeth and then a smile worked its way slowly into the space around them. “But I distinctly remember you putting them on… I think…” Her eyes wandered to the window behind me for a moment. “Can I see your report?”

I smiled as much in relief as at the dissolution of the tension in the room. “Of course.” I punched a couple of keys and the report chugged its way out of the printer. I handed it to her and sat back while she read it. Actually, she must have read it several times, each time shaking her head in steadily diminishing disbelief. Finally she folded it up and put it in her purse. “All this time…” Her eyes sought mine and I could see they had softened from birds of prey, to… the prey itself. “But I remembered it so differently…”

“Would you like me to see if I can get a hold of the nurses reports as well?”

A large, genuine grin spread across her head dividing her eyes from her chin as she shook her head a final time. “I’m so sorry, doctor… All this time…” Suddenly a thought occurred to her. “Tell me one thing, though.” She tore her eyes away mischievously and they flitted briefly about the room. “Were you wearing an earring that night?”

I must admit I blushed at the question and nodded my head. “It was a phase,” I added quietly.

She giggled and reached for my hand. “Well at least my memory didn’t screw everything up…”