Anterograde

Anterograde Jared Williams

“Mrs. Henson’s in room five—why don’t you go ahead and see her?

Sweet old lady, she’ll be a great practice interview. The only new thing I see is a

little vitamin B 12 deficiency.” In her room, I recite the incantation: “Hi-I’m-a-second-year-med

student-at-UNC-mind-if-I-ask-some-questions-before-the-doctor-comes-in?” “Sure, go ahead.” As the room comes into focus, I see an elderly woman with what looks to be her daughter. They’re both smiling at me. There’s a calendar on the wall behind them featuring a B-21 stealth bomber. It prominently features the logo of the local VA hospital, and the caption underneath the photo reads, “The greatest casualty is being forgotten.” “How are you all doing today?” I venture. “Pretty good, not too much has changed,” the younger woman replies. “I’m Barb—I’m not actually the patient today; that would be my mom, Barb Senior. But I’ll help out where I can.” I turn and address her mother, “Okay, great, tell me about your health conditions.” “Well, I have the COPD but that’s been pretty good recently. I had to go to the hospital for it a couple years ago, but now I got my face tubes for my oxygen tank at home and an inhaler for when I go out, so I’m pretty much set up.” “Oh, you should see her with those little tubes on her face,” Barb says. “She looks like a crazy person!” They both laugh, and after a second, so do I. “You’re awful young to be a doctor, aren’t you?” asks Barb Sr., eyes narrowed in joking mistrust. “Not too young to figure you out!” I return, now engaged in light flirtation. “Well then you better just ask me some more questions.” My mind is now completely blank, so I just ask, “Do you have any other kids?”

do, just one other son. He’s pretty much 100% disabled, from the army. It’s the

PTSD. But they take good care of him—we’re not too worried.”

I stammer, “Oh I’m…so sorry to hear about your son. I’m glad you can

all support each other though, that’s so important.”

Right the B 12 thing. Strafing the awkward silence, I turn and fire off a list of symptoms.

“Any pins and needles in your hands or feet?” “No, not really.” “Shortness of breath?” “Well, I have COPD.” “Right, right, next question: any confusion or dizziness?” Her daughter answers for her, “She’s never dizzy, but she gets confused all the time! Isn’t that right, Mom?” “Just a tiny bit, but I always figure it out in the end.” “Oh, it’s a little more than that,” Barb jumps in. “It seems like she can’t remember anything these days—what day it is, where she lives, where she needs to go.” “Are you still driving?” I tentatively ask Barb Sr. “Oh yeah, I’m totally fine. Why are you asking me all these questions anyway?” She’s still smiling, but it’s strained. “Just a few more, then I’ll stop bugging you. Let’s start by doing a little word recall. Can you repeat after me—'Eraser, Sunset, Daylight’—and then remember these words for later?” Smiling, Barb Sr. shoots back: “Eraser, Sunset, Daylight.” “Can you tell me today’s date?” She pauses. “I’m…I’m not totally sure. Is it the 11th of March?” “Oh, I’m not sure I even know either.” I write down an X that only I can see. “Can you tell me what state we’re in?” “North Carolina—now that was an easy one!” She’s smiling again. “What year is it right now?” The pause is longer this time. She looks down at the floor sadly. “2009?” Another X. “It’s actually 2019.” Her face falls. Am I supposed to correct them?

a piece of paper?”

Her hand slowly spells out: “Isn’t. It. Time. For. You. To. Go?”

I manage a laugh with Barb at this purported joke, but Barb Sr. is not

smiling.

“Alright, talking to y’all has been great—thanks for helping me practice. I’m going to leave now and talk with the doctor. We’ll be back in just a minute.”

When we return a few minutes later, he turns and says to me, “Why don’t

you take the lead on this one?”

Yeah, just great. The Barbs both smile up at me. It seems we’re friends

again.

“Well, good news, Mrs. Henson. You have a condition that’s super easy to

treat, a deficiency of vitamin B 12 . You just need to come in and get a shot once a week—“

“I have to get shots now? What are you trying to do to me?” she laughs.

“—Just for four weeks, then you should honestly be feeling a lot better.” “Alright, fine, I guess I’ll do it—just for you though.”

“Tell her the possible good news this could mean,” my preceptor

prompts.

She’s only 20 points below the normal B 12 value and has no other symptoms. This is clearly early dementia, but I guess I’m supposed to give her some false hope now—need a good

evaluation after all. I take a breath. “I don’t want to promise anything, but you could even get back some of your memory. This condition can affect some of the nerves in your brain, and fixing it can give them a boost.” “Is it...likely?” Barb Sr. asks. I’m the one pausing and looking away this time. “I...” If I suspend my disbelief for long enough I can almost convince myself that I see the stealth bomber on the calendar moving. I wish it would fly off the wall and take all four of us far away. It would soar beyond the mountains that this town nestles in, somewhere where there’s no false hope and no decay and nothing is lost and nothing ever ends. “Eraser, Sunset, Daylight."