Mind Games

I have of late been attracted to mind games –not, you understand, the one-upmanship power struggles that are reputed to go on in corporate businesses, nor even the more hurtful kind that used to happen in high school classes, usually initiated by those who sat in the front seats. No, I refer, rather, to the surfeit of programs available online that purport to improve cognitive function –or perhaps at least to preserve it- in the ageing brain.

There was a time when the idea seemed gimmicky –a superficially tenable effort to divert pension funds into other, younger pockets. Even I (yes) was a hopeful initiate during my presenescent days and religiously attempted some of the tasks presented until I realized that my scores were not improving. So I stopped -on the theory that the evil I don’t know is probably easier to live with than the one I do…

And yet curiosity, no doubt mingled with an overflowing cup of guilt, ensured that I continued to dabble on occasion -for fun of course, and on the proviso that if I didn’t perform well, it was obviously because I wasn’t taking it seriously. And, still, it didn’t seem to improve my ability to solve the Sunday New York Times crossword puzzles.

But I do keep my toe in the water, so to speak, and on a recent, albeit random, perusal of archival BBC News articles, I came across one that seemed to suggest that I should have been more careful in what I discarded. More sedulous, if I may borrow one of the rather problematic words from the Times’ puzzles:  http://www.bbc.com/news/health-34701907

Perhaps I expect too much of people, or maybe they just don’t read the same BBC articles as me, but by now I would have thought that I would have noticed a change afoot. No longer, should I have seen those uncomfortable seats in the suburban malls crowded with pensioners grimacing intently at their over-folded and crumpled newspapers trying to solve the day’s crossword puzzle, or glancing covertly at their neighbour’s Sudoku columns. There should have been a profligate display of tablets or laptops and the sound of gnarled fingers scraping their answers on a thousand screens. But, alas, I suspect that they, like me, were too busy using their older, well-worn neural pathways instead of garnering new ones.

Of course some of us are confronted with new realities on a daily basis. Sharon was a new reality, although at first glance, there seemed nothing amiss. An older woman, she sat quietly in the waiting room, neither glancing nervously around her at the confusion of other patients, nor pretending to be absorbed in one of the out-of-date magazines that somehow surface, unsubscribed, in every office. Rather, she sat staring out of the window, serenely confident in her persona as a silver-haired, matron, largely immune to the vagaries and vicissitudes that plague the rest of us as we shuffle through our mortal coils (sorry Hamlet).

I have to admit that I was intrigued by the tranquillity that persisted even in my office. And the sharpness; she didn’t miss a thing I did.

“I see you have performance anxiety,” she said, staring at my fingers on the keyboard of my laptop.

I managed an embarrassed smile and put my fingers down on the desk. “How do you mean?” I stuttered through a particularly deep and noticeable blush.

She blinked mischievously. “You keep hitting the ‘caps-lock key’ instead of the ‘shift key’.

“Oh…”

“And you hit the ‘z’ instead of the ‘x’ once.”

I sat back in my chair –I didn’t know what else to do at that point. “You notice things, don’t you?”

The smile she produced almost cracked her already wrinkled face. “You have to keep alert at my age, young man…” Another mischievous expression surfaced –this one in her eyes. She knew only a matriarch would dare to call her newly-met specialist ‘young man’, and she revelled in it. “For example, that man holding the baby in the black and white photograph hanging on the wall behind me is not smiling…” I moved my head slightly so I could look at the man. I had put it up to make the point that men also love little babies, but I have to say I couldn’t remember whether or not he’d been smiling. “He needs to change the diapers, but the photographer probably didn’t notice. Or care…” She said this with a raised eyebrow.

“That’s impressive, Sharon…” But as soon as I said it, I realized the statement was ageist. Patronizing. Like saying ‘How could a person of your age be that aware?’

She smiled, but carefully this time –as if she suspected a trap was being laid. “Do I hear an un-vocalized ‘but’ in that sentence?”

I blushed again. “Not at all… But I was wondering how you do it…” My blush deepened as the ‘but’-word tumbled unexpectedly from my mouth.

“Mind games,” she said simply, and shrugged as if I should have known that.

I was puzzled at her reply. “You mean you are trying for…” I searched for an appropriate, yet polite word for one-upmanship.

She chuckled and reached out for my hand before I could finish my thought. “Dominance? Heavens no. I mean those brain programs you download on your computer to freshen up the mind.” She sighed and closed her eyes for a moment as if she were searching for something inside her head. “Maybe it’s just the one I bought, but it seems to train you to look for patterns and discrepancies and even remember things… When they are presented to you as problems, at least…” It didn’t really seem like a whole-hearted endorsement. She sounded as if the program had missed something important.

In the silence that followed, I felt I had to say something; and I was beginning to wonder if the program would help me. I’d love to be able to glance at a picture and know if a baby needed changing. “I may look into that, Sharon,” I said, although somewhat lamely I think. So I tried it again: “Do you think it has made a big difference in your mental performance?”

She shrugged. “I suppose so… I mean I’m beginning to get better scores on the performance evaluations, at any rate…”

“You seem a little hesitant to recommend it, if I may say.”

She smiled and a little sigh escaped before she could prevent it.”Damning with faint praise?” A tiny shrug followed. “If you need to know how to recognize a Ford from a Toyota driving by, it’s great. If you need to know whether one alarm clock stayed ringing longer than another alarm clock –or a lamp, for that matter- by all means, download the program…”

“But…?” She was clearly unhappy with the results.

“But I still forget why I went to the fridge, or where I put my keys.” She looked out of the window behind me for a moment. “And I still remember things I would rather forget…”

I was immediately reminded of Macbeth as he talks to his doctor while preparing for battle:

Canst thou not minister to a mind diseased,

Pluck from the memory a rooted sorrow,

Raze out the written troubles of the brain

And with some sweet oblivious antidote

Cleanse the stuffed bosom of that perilous stuff

Which weighs upon the heart?

Perhaps there are reasons a mind should grow old; and maybe what we really need is a program that helps us to remember mainly the good things. I’m going to wait for that one.

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Performance Anxiety

I have recently developed performance anxiety -no, not the wide-eyed, heart-thumping, late night Viagra-requiring variety… although that does sound interesting. And not the more artistic type you would expect to get while standing behind the curtain backstage before walking into the spotlight to the expectant applause of a full theater. I don’t have that kind of talent. And anyway my more immediate concern there would be tripping. No, it’s far more… digital than that. Perhaps I should explain.

Ever since my days as a high school nerd, pocket protectors have epitomized my calling. True to the role, I tried to stay at the cutting edge of social ineptitude, but as I aged and morphed into an adult, I became aware that the plastic protector pouch looked silly and that, like a tail,  carrying too many pens was vestigial. The age of the nerd was ending and there seemed no one but me around who was at all nostalgic for it. It had become anomalous -a quaint but naive time in a world that had evolved beyond it.

I was able to keep up with the social awkwardness, however, thanks to my annoying habit of not watching sufficient TV to be able to talk sports at the parties to which I’m no longer invited, or by not using the latest slang expression properly -if at all- at work. I still can’t bring myself to say “No worries,” if someone bumps into me, and am more likely to excuse myself for being in their way. I have trouble knowing how to respond to a ‘high five’ gesture, and when introduced to someone new, have an amazing penchant for immediately garbling her name and then promptly forgetting it.

So it was with high hopes that I felt I would be riding a new and different wave with the Electronic Medical Records system I was reluctantly forced to install in my office. In spite of my hesitation, I felt I was about to reincarnate into Geek, the twenty-first century equivalent of my high school name.  I loved the word and immediately tried to parse it.

I have been writing for years on a computer, so I didn’t anticipate any problems with the transition. I do have to admit to a certain nostalgia for paper, though; crumpling it when you make a mistake is one of Life’s irreplaceable pleasures. Even the subsequent necessity of throwing it into some sort of receptacle -and hitting the target- is a form of release. A silent Cognitive Behaviour Therapy.

But I very much suspected that not having something to shuffle in front of me, to rumple up or underline with emphasis, not being able to free-hand a diagram with curved lines and arrows and otherwise describe difficult and obscure anatomical features in full view of a curious patient would prove disappointing. Nerds -extinct or not- have always been complex integrators -visual as well as cerebral. We didn’t just carry all those different coloured pens around for show. We used them -all of them- on different occasions, each with a purpose, like actors in a play.

And indeed, writing, drawing, and underlining while the written-about watched was part of the show. Part of the interactive play. By changing pens, or circling something scribbled on the paper, the person across the desk knew she had said something important. Something helpful. It encouraged her to continue, often with details she would not otherwise have supplied. And it’s a full eye contact game: the nodding head, the subtle but respectful smile, the slow reach for a lab requisition -all signs to the patient that she has succeeded in conveying her concerns. All boding well for an auspicious climax for the interview.

I had difficulty imagining that the clack -or lack of clack- of my fingers on the keys would elicit the same response. Somehow, restricting my interactions to a screen that only I can view seemed anathema to the relationship I was trying to foster. Since everything is printed and filled out in the secret bowels of the computer, there would be no moment of hesitation and then deliberate reaching for different coloured forms -each one invested with authority; no more wide-eyed admiration for the amount of  information I had been able to extract that she could see in her shared view of the chart from across the desk; and no more wonder at the ability of doctors to read their own handwriting -all part of the magic and method that is Medicine.

But when the moment came to transform the interaction from the smooth hiss of a pencil drawing a diagram, from the silent mating of pen on paper, from the sweeping elegance of an encircled thought, or an underlined, obviously critical datum -from, in other words, personal to digital- an unexpected problem arose. Something I could not have anticipated. Something not all the preparation, all the latest technology, nor all my previous experience with computers would have suggested: I simply could not type with another set of eyes staring at my fingers. I could feel the criticism with every pause to check the keys, the judgement whenever I slowed down, the silent mirth in her eyes whenever I chanced a look in her direction and made a mistake… And the more I thought about it, the clumsier I became. I typed like someone wearing gloves. I kept flashing back to the piano lessons I had as a child when I first discovered, to my shame, that I was distressingly ametronomic.

My older patients seemed to understand -I don’t think they even noticed my almost stochastic approach to the keyboard. They were too busy searching for my eyes. Feeling my pain. Like they had come to help me. No, it is the young who notice. But they are usually too polite to criticize openly, too amused at the unexpected levelling effect of shattered hubris to do other than smile. It is I who feel discomfited, I who feel I must apologize… And I who inadvertently delete the page trying to recoup my composure. Re-establish my rhythm.

Performance anxiety now has new meaning for me. It is the wave I am riding as I attempt to surf into the new époque. But I am philosophical about it, and I had a thought: could it be keyboard performance and not the other stuff that is really what separates the young from the grey? Something you don’t need a pill for because it improves with time? And hope sprung eternal… The golden age is before us, not behind us –as Shakespeare wrote, probably typing the whole thing without a mistake -assuming no one was watching from across his desk, of course…