March 11 - Temporary Global Amnesia

My parents arrived in Kingston on Friday while I was still in Cambridge. On Saturday morning I began a long journey home, lengthened by the crowds moving towards the carribbean for their spring vacations. In Miami I met up with Leila (my sister) and Donnel (her friend) and got on a plane with about 200 Christian high-schoolers doing a sort of one-week mission in Kingston. Back in Kingston we had a nice dinner and my parents dropped me, Wayne, Leila and Donnel off at our apartment. In the morning they called at about 8:30 to make plans for the day (Sunday) and we agreed that they should change for a larger rental car and come get all of us and we would drive up into the blue mountains and do some sightseeing. They were to pick us up in an hour.

An hour later we were finishing breakfast and getting ready to go. Two hours later we were quite worried. At about 11:15 or so my mother called our cell phone. She said they were at the Hilton (for the rental cars) and described that at the Terra Nova (their hotel) she had come back to the room from having breakfast. My father was sitting there in a chair and reported that he was feeling disoriented. Not making anything of it, they drove (he actually drove) to the Hilton to change the rental car. She left him at the rental car counter to rent the new car, where he apparently actually went and inspected the new car they'd arranged to rent. She went to buy a hat. She said when she returned she showed him the hat, but he still seemed disoriented and confused and said he couldn't drive the car. He said he just wanted to sit for a minute, so she sat with him. Then he said he wanted to walk. Then he said he wanted to sit again. He didn't want her to go call us even though time was passing and she knew we'd be worrying. Even on the phone with me describing all of this, she didn't actually seem worried, except that they couldn't come pick us up because he couldn't drive and she didn't think she could drive in Kingston either. I told her I thought it sounded very serious and that we should go to the hospital immediately. She got off the phone.

Leila agreed that we should get him to a hospital right away and that for some reason my mother wasn't seeing it that way. (It seems to me that at first his expression of disorientation might not have seemed so odd, considering that he was physically fine. After that, it seems to me that the prospect of something being seriously wrong must have been so scary to her that she just didn't believe it was happening.) We immediately called a cab to go over there and on the way also called Trevor to get his advice on which hospital to go to and to find out Camella's number to get more help. We found that we should take him to the UWI hospital.

When we got to the Hilton, they were standing just outside the entrance. My father was happy to see us. He reported to my sister that my mother was acting crazy and he was fine. She asked him what had happened during the morning. He looked puzzled for a minute and then said that he couldn't remember. He knew he was at the Hilton Hotel, but couldn't remember how he got there or why he was there. My mother, my sister and I got in the cab with him and headed up tot the hospital with Wayne and Donnel following in another cab. In the car he asked my mother, "Just recount for me the events of the morning." She got upset and said, "You've asked me to do that 10 times already. I just told you 5 minutes ago." Asked that nevertheless we comply and tell him. I recounted, "At about 8:30 you called us on the phone and we made plans for you to change the rental car and go to the mountains, you arranged the new rental and drove to the Hilton to get it, and since then you've been at the Hilton Hotel asking mom to tell you the events of the morning over and over again." He wasn't particularly responsive to this, though he listened closely and was clearly lucid. A few seconds later he asked again for someone to recount the events of the morning for him. My mother asked "Do you remember that we just did that a few seconds ago?" He said no. She asked, "Do you know where we are going?". He thought about it and said no. He asked her to tell the story of the morning again, but she was fixated on asking him to tell what he did remember (which was absolutely nothing from the very recent past.) Through all of this he was quite cheerful though a little confused at all of us being so upset and my mother being so frustrated. The cab driver helpfully offered that a couple of Appleton&Pepsi's would probably cure it.

When we arrived at the emergency room it turned out to be a nightmarish third-world-country hospital experience. Because he looked totally healthy, we could not convince anyone to see him. My mother got quite angry at them about it, which only caused them to become more set in their conviction that he should wait his turn. Leila and I were worried that he'd had a stroke or something of that nature that might need some kind of immediate treatment to avoid really permanent damage. (We were already quite upset that so much time had passed since he had first reported the feeling of disorientation to my mother.) Between the three of us (with the support of Wayne and Donnel) we managed to keep at least one rational head at a time. My mother and Leila stayed with my father while I went to try to register him and persuade someone to see him. There was something awful about us being in Jamaica, so far from doctors and a medical system we knew and trusted. But then it was quite amazing that we were all together for this experience and able to help each other through it. Leila lives in Durham, North Carolina. I live in Kingston, Jamaica. My parents in Cambridge, MA. We are together only a few times a year. To have this happen at one of those moments was a wonderful thing. It also made a huge difference that Wayne and I had been here for months. We knew who to call to find out where to go. We had a cell phone and new how to make contact with the people we needed to talk to in the States. Even the little things like knowing where to get some food, who to call to get a cab quickly, or a little bit of how to negotiate the system were a big help.

As we waited for him to be seen, the situation continued with him seemingly with no improvement. I recounted the events of the morning a very large number of times. We could get through the conversation far enough for him to understand that something had gone wrong this morning and he had stopped remembering. A few seconds later he would have forgotten again. At some point his question changed to wanting to know what was the presenting symptom: how had we first known something was wrong. At the time this didn't look like progress to any of us, but now looking back on it, it seems that this shows that somehow the train of thought had moved one step forward. Next his question changed to "I've been lucid the whole time, just discontinuous?". To this I could say yes. He was entirely calm, happy, and rational throughout all of the conversations we had all morning, they just could only last through a few thoughts before they had disappeared from his head again.

We got Richie Waldhorn and Carol and David Hatch (doctor friends and family members) on the phone from the U.S. to get their help in figuring out what tests should be done and what treatment given. We got Camella to get a Jamaican doctor to call and speak to the head nurse. We cried a lot and tried to keep it together.

At about 2:00pm my mother came out to us and recounted the following interaction which I find quite amazing:

Dad: Do you have a pen?
Mom: Yes, why?
Dad: Draw a mark on my arm.
Mom: o.k. (draws mark)
Dad: Do you have a pen?
Mom: why?
Dad: Draw a mark on my arm.
Mom: (lifts his arm and shows him the mark)
Dad: (starts to cry)

In spite of their rules about only letting one of us in at a time, Leila and I went in to him then. He was happy to see us. We asked how he was doing. He said he knew it was happening because mom had just proved it to him with the mark on his arm. Leila and I looked at each other in amazement. He should have forgotten that entire event already. We asked him what he remembered. He said he thought he remembered everything from the time he'd come into the little area where he was currently lying. Though it wasn't really true, he seemed to be gaining some purchase on things. He wasn't repeating questions. He was remembering some things from the very recent past. The mark--his own brilliant idea from within his muddled state--seemed to have helped to snap him out of it a bit. In a moment of essential dad-ness, he constructed his own proof method for himself. It was like a ray of light for us. Suddenly the vision of being caught with him in this state perpetually started to recede.

As he went through the CT scan, chest x-ray and EKG, things seemed to improve a little bit. Though the doctors and nurses showed a nastiness and callousness towards us that I find almost inhuman, after taking their sweet time and brushing us off a lot, they seemed to provide adequate care. In the examination by the neurologist he struggled to remember a list of three words (book, pen, toothbrush) that she'd told him a minute before, but did identify me and tell her my birthday (amazing on any day) and count backwards by threes from one hundred so fast that she couldn't tell if he was doing it right. Throughout it all he acted just like himself: he wanted to be told the facts of the situation so that he could piece it together to draw his own conclusion about it. His reasoning was as acute as ever, only his ability to keep the facts together was sketchy.

The tests came back clean. There was no bleeding in his brain or evidence of a stroke at all (though sometimes it doesn't show up right away.) That meant it wasn't the bad kind of stroke, at least. The chest x-ray was normal. The EKG was normal. They moved him to the private wing of the hospital for an overnight stay in case anything went wrong. They and our doctor consultants at home all thought it sounded like something called Temporary Global Amnesia. No one seems to know the cause. They think it can be caused by some kind of physical strain or trauma, but of course he can't remember any. They said it does not seem to have any lasting physical effects, nor is it particularly likely to repeat. It is not progressive. It was the best possible outcome, it seems.

At home again, I was exhausted and weepy. Not that I hadn't been crying all day, but there was something about working to keep things in control there that helped me to keep from breaking down while we were at the hospital. All day, especially when he had no memory at all, it seemed so important to me that we not seem to upset or too angry because there was no way for him to understand it. At about 8:30 Wayne and I were in bed, my crying on his shoulder even though it seemed now like everything was going to be o.k. By 9:30 we were asleep.

Last night, after he'd been discharged from the hospital and had had some time to relax, we all went out to dinner. We toasted to surviving an experience that gave living in the moment a whole new meaning.