Fossils and feelings.

Do you know where you're going to?
Do you like the things that life is showing you?
Where are you going to?
Do you know?

Do you get what you're hoping for?
When you look behind you
there's no open door
What are you hoping for?
Do you know?

Once we were standing still in time
Chasing the fantasies
That filled our minds

You know how I loved you
But my spirit was free
Laughing at the questions
That you once asked of me

Now looking back at all we've planned
We let so many dreams
Just slip through our hands

Why must we wait so long
Before we'll see
How sad the answers
To those questions can be?

~ from the Theme of Mahogany 

_____________________________________________

I saw this man the other day who was losing his memory. He was in that stage where he remembered enough to know that what he didn't remember was a problem. Showers running for hours because he forgot he'd turned it on. Locked out of the house because the front door closed behind him and he couldn't remember the garage door code.

"I lost my wallet last week," he told me while looking down at his hands. "All my ID and my social security card, too. It's getting bad."

"I'm sorry," I said. Because I was.

"I know it was some place just under my nose. But for the life of me I just couldn't figure out where I had put it. To anybody else, it wouldn't have been lost. For me, though, all it takes is a minute for me to lose the idea."

"I know that's super frustrating. Have you been taking the medications?"

"Yeah. I don't see that much difference but I do take them. My sister make sure that I do."

"Okay." I leaned onto the desk and waited to see what he wanted to talk about next. Mostly because I knew that even though his memory was shaky, his insight wasn't. He knew that developing premature onset Alzheimer's dementia was a crappy hand to have been dealt.

We both knew. There was no secret that, although there were medications and behavioral interventions that could potentially slow things down, that this thing could and would progress. We'd both heard of the research underway and the advances that scientists were fighting to make. But as of now? We knew. Both of us had seen it play out before--him with his own mother who slipped away right before his eyes and whose mind floated high into the air like a feather on top of a gust of wind. The kind that occasionally swirls close enough for you to grab but then--just like that--goes skyward and out of grasp.

I'd seen it, too. Once in a great aunt and many more times with my own patients. Vacant stares and disconnected thoughts interrupted by tiny flickers of who was once there. Here for a moment then--zoom--gone in a flash.

But this? This was different. I had never really witnessed this kind of dementia in evolution. Most of the time I showed up after the memories had long since gone. This patient was vacillating between everything and nothing. Something eerily similar to those times that you feel a dentist's tools because you weren't numbed enough. Then all you can do is brace yourself in fear of breaking through the novacaine again.

And a life filled with breakthrough pain and bracing yourself kind of sucks. So yeah. That's where he was. Exactly where he was.

I was glad to be seeing him for the third time with the resident doctor in clinic. He'd specifically asked to see "the lady doctor with the short hair cut that saw me last time" and, according to my resident, even pointed me out when I passed by the room.

"Can I ask you a question?" he finally asked.

"Sure, sir."

"Okay, so what does it mean if you can remember stuff from a long time ago but then you can't even remember whether or not you put some toast down in a toaster?"

I did my best to explain the difference between short term and long term memory. My resident chimed in and the patient nodded in acknowledgement that he understood. I think he did.

"I don't remember nothing. Unless it happened twenty plus years ago, I just don't remember nothing in no detail no matter how hard I try." He slumped his shoulders and went back to staring at his hands. "It took me a minute to get myself back on track as to why I was even here. See? I don't remember nothing."

I could tell that all of this was breaking his heart. Not even sixty years old and struggling with his memories in a way that was unusual for his age. All of the reversible causes had been explored and also ruled out. We were stuck with the diagnosis of exclusion: progressive dementia.

I wished I could do something to make him better. Or at least encourage him. Then something popped into my mind. He had remembered something.

Me.

"Sir? You know? You do remember some things. You do." I smiled at him and tried to get him to look up. "It's been five whole months since we saw you last. And you know what? You remembered me."

His eyes met mine and some part of them looked hopeful, somewhat lifted. Then they traced a jagged line over my shoulder and down to the lapel of my white coat where my badge was clipped. He mouthed my name and then said it aloud. "Kimberly Manning. Miss Kimberly Manning. I did remember you. But not your name. And I hate that 'cause when I just seen your ID tag and read the name your name . . . .didn't even ring a bell."

There was the most complex look on his face. This restrained wince connected to a pain so deep that exaggerated expressions of pain wouldn't suffice; it was hard to explain. Something about the complexity of it hurt me, too.

I reached out and touched his hand. My fingers and palm over his weathered knuckles, welcomed by his closing grasp. I tightened my own in response and in concert with my words. "But still. You remembered who I was and asked to see me. You did remember something. You did and that counts." His complicated wince now replaced by an antalgic smile. Now I could feel his hand shaking from squeezing mine so tightly. "So thank you for remembering me today. I'm so glad you did."

"You are?"

"I am. I really, really am." 

He paused for a moment, loosening the vice on my hand. I could see him sifting through his mind for the right words. He found them. "Miss Manning? I remembered . . . I mostly remembered how you looked at me and talked to me."

I felt my breath hitch. Now I was the one holding his hand in a vice grip. And the one shaking.

He shrugged his shoulders. "That's something I always hold on to. How somebody treat me and how I feel when I deal with certain people. Good or bad, that part always stick. No matter what."

I was so, so glad for that moment. To be right there, right then with my hand on his hand listening to this good word. Damn, I was.

And that was pretty much how the visit ended. We refilled his medication and made sure he had an appointment in the Memory Clinic. And that was about it.

Yeah.

Honestly? I'm not really sure why I even felt the need to tell this story. But something about that last thing he told me made me take pause. I knew that I needed to stick that one on a mental post-it note for later. Something tells me that I'll need to return to those words again and again. And you know? I couldn't even tell Harry this entire story without crying. (I'm sure he cried, too--just on the inside.)

Seriously though. . . .cognitive impairment and memory loss sucks. Royally and unequivocally, it sucks. But how amazing is it that the way we treat people and how they feel when dealing with us happens to be one of the few things that fossilizes in their minds? How awesome is that?

Wait.

The way we treat people and how they feel when dealing with us happens to be one of the few things that fossilizes in their minds. . . .

Whoa.

***
Welcome to Tuesday, my friends. What are people remembering about you?

Now playing on my mental iPod. . . .from one of the first "grown up" movies I ever saw--Mahogany with Miss Diana Ross and Mr. Billy Dee "Colt 45" Williams himself. Love this song . . . I ask myself those questions all the time.