“You’re seventy-nine. Nearly eighty.”
“Am I? Am I? I’m not. I’m not eighty. Am I?”
“Yes. Nearly.”
“Oh my god. That’s right, is it. I’m eighty.” She laughs nervously. I consider taking her to the mirror but then think better of it.
“Yes. Do you remember living in Edinburgh?”
“That’s where I live. Edinburgh.”
“Do you remember the apartment by the canal? Feeding the moorhens and the swans with bags of bread?”
“No. I don’t remember that.”
“Do you remember going to work, your little car, your rack of navy blue suits and shirts? Doing your nails every night?”
“No. Not really.”
“Do you remember the children? Getting the children, the babies?”
“No. No.”
She looks at me as if hopeful that the two of us might be in this mess together.
“That was forty years ago, more. You’re retired now and you live with us. With your son and his family. Morris is here, too.”
“Is he?”
“Yes. He’s the man sitting through there.”
“Can I see him? I’ve been wondering where he was.” She starts to cry again.
“Come on. Quickly. Come and see him and give him a kiss.”
We go through the kitchen and up the step, through the second door. When she sees him, Nancy goes into reverse, trampling my feet.
“No! No, no. You’re wrong. That isn’t Morris.”
“Of course I’m Morris,” Morris says.
Nancy turns to me. “That. Is not. Morris.”
“Yes, it is. That’s Morris. He’s got old, just like you. And he’s disabled. His legs don’t work, remember?”
“You’re all mad. You’re all mistaken. That isn’t Morris. You think I don’t know who Morris is? Well, I do and that isn’t him.”
All this is horribly upsetting for Morris, and his confidante has been counseling him at length in the mornings. The rejection is hard for him to bear. Nancy seems so hard-hearted, so impermeable suddenly. Morris tries to talk her round, to jostle her memory, insisting on the truth.
“But darlin’! It’s me! You must know me! You must!”
“I most certainly do not. You’re all liars.”
“Nancy, please. Please don’t say you don’t know me. Please.”
She goes and sits on the edge of her bed for hours and hours, refusing to eat or drink, sitting looking hopeless in her cold bedroom; me going in from time to time and trying to coax her to come back to the fire. Sometimes I find her in bed fully clothed, the duvet pulled up over her mouth, her shoes sticking out the other end, flat on her back and deeply asleep. Sleep is good. Sleep is her friend. The event is wiped clean away. As long as I don’t use the words Morris or husband when I reintroduce her to her sitting room, things are fine for a while. If only Morris could resist asserting himself and conjuring up their shared history, things would stay calmer for longer, but he can’t.
The rages spill out of the sitting room. There begin to be rumblings from day centers. They cope well at the Tuesday one, where they are trained to deal with Alzheimer’s old folk and have others with dementia attending. Dementia’s meat and drink to them. But the Thursday club, held in our own village, is a different matter altogether. It’s a social club for over-sixties. They are kind, good-hearted people, the people who run the Thursday club, and they try diversionary tactics first, before they call. If Nancy’s stroppy, somebody takes her out for a walk. They might go to the shop and get her an ice cream and go look at the boats in the harbor. If diversions don’t work she’s brought home early, delivered to the door, she and Morris alone in the bus, Morris embarrassed. “She’s not had too good a day today,” the helpers say. “Not too happy today.” Sometimes she comes home wearing borrowed underwear and I am full of admiration for the volunteers who deal so stoically with that.
In May, we experience the first of the major Thursday club upsets. It’s heralded by a phone call after lunch, from one of the helpers, who happens to be the mother of one of our doctors.
“I’m afraid Nancy’s in a terrible state,” she says. “Do I have your permission to take her to the surgery?”
“What on earth’s going on?”
“She’s … well, she’s just in meltdown, really. We can’t do anything with her and I, um, think she might need medical intervention.”
“You mean she’s having a tantrum, she’s upset? Is she being rude to people?”
“You might say.”
Everyone’s far too nice to be explicit. I have visions of Nancy going at the other members with a hail of china-saucer-fire, a volley of cutlery artillery, kicking old men in the groin and felling them with karate chops. Nancy is whisked off and given emergency sedation. They keep her there until it kicks in and then she is driven home, arriving monosyllabic and irritable. The doctor rings me later. “That was quite something,” she says. “I’ve never seen her like that before.” A frank conversation follows. Nancy is prescribed a mood-improving drug to add to the galantamine, the blood pressure drug, and the aspirin in the dosette box. Though we don’t give it to her beyond forty-eight hours, as its principal effect seems to be to tranquilize her in the daytime and make her more restless and agitated than usual at night.
Can I cope with this? Should I be trying? These are the questions that whirr in the brain at five in the morning when the long, gray summer days of the far north dawn early. We are already way out of our depth and we’ve been here for less than a year. How much longer will this go on? How much longer can I stand it?
Internally, I’m fervently apologetic to all those unknown, anonymous people I ever maligned for dumping. Dumping their parents in nursing homes, when they should have been clasping them to their familial bosoms, for better or worse. Movie grannies, with their crumpled-and-smoothed tissue-paper faces and gray plaits worn Heidi-like across their heads, and tea dresses and crochet cardigans—the kind of grannies who are pliant and hygienic, who dispense old-world wisdom to the children of the house, and are amusingly direct—they have a lot to answer for. Movie grannies don’t refuse point-blank to clean their teeth. They don’t yell obscenities at their grandchildren or accuse their daughter-in-law of stealing all their money or tell outsiders they’re being kept a prisoner. They never pull down their trousers and touch their toes and ask you if their bottoms are clean, or get sent home early from the Thursday club for disruption.
I am out in the garden tackling the weedy borders and planting new shrubs quite a bit of the day, having abandoned the novel, again. It isn’t something I’m happy about. It’s not been a matter of choice, but writing isn’t possible with Nancy on the rampage and the constant interruptions. Nor is writing possible when so much unhappiness is at large. Nancy’s. Morris’s. My own. So instead of struggling on, there will be reading and gardening and strategies for psychic survival. Weeding is good for impotent rage. Old neglected borders full of grass and dandelion are gone at with energy. I take Nancy into the garden with me for part of the day and try to filter out her wittering, and try to be calm about her standing in the middle of the flower beds, trampling new plants. Her white skin is sun sensitive and burns in a trice. She is dressed in her customary elastic-waist slacks, a long-sleeve cotton shirt, and a wide-brimmed hat. She smiles, when she’s outdoors. There’s Nancy in the photographs, flushed pink and grinning. It’s indoors that she hates, the terrible boredom of indoors. Outside, she gets all my attention. And maybe it’s more than that. Perhaps it’s Nancy who’s found a relationship with the Sublime.
Clinging to the idea that we ought to make her days as fulfilling as possible, and having given up on work for now, I try to include her, like mothers of preschoolers do, in the daily domestic tasks. It’s exhausting work: “Now here’s your peg, here’s the sock—see, you open the peg like this and put it on the line and when you let go it grips it. See? No, don’t put them all on top of one another, they won’t dry. Ah no, see, y
ou’ve got the peg upside down, that won’t work.” On Mondays, when Morris is out at the day hospital, I make a special effort. Then, having spent five unbroken hours together, I put her in her chair and go to make her a coffee and when I get back she is purple-faced with rage.
“I’ve been left here all day on my own! People have been going by and not speaking to me! If I’m not wanted here you had better just say so!”
I’ve been reading a book that claims to explain consciousness and its neurological mechanisms as something entirely animal. The writer pulls off the disarming logical trick of spending the entire first chapter disparaging Descartes, and the rest of the book coming face-to-face with a series of pro-Descartes (Cartesian) scenarios—suggesting in their various ways that there is a ghost in the machine, operating the machinery—and dealing with them, one by one, by pointing out that since Descartes must be wrong, because his ideas are preposterous (a favorite authorial word), there must be some other explanation. It is, weirdly, a book that seems unconsciously to be prey to subconscious tides pulling its conclusions in opposite directions to those intended.
I also come across some rather startling research to do with the electrical impulses that carry information between neurons. Apparently, studies of the action potentials have found that they fire up before we decide they should be doing whatever it is that we’ve asked of them: for instance, to turn a page or flip a fried egg or pick up a stone on the beach. Experiments showing this to be true were begun by the research scientist Benjamin Libet in the 1970s, and continued in 1985 in a scientific trial done with people who flexed their wrists at will and signaled the moment of deciding by marking the position of a rotating disk. Extraordinarily, it was discovered that the appropriate neurons fired up a full half second before the moment the subjects “decided.” The interval is known as Libet’s delay. In terms of the speed of the electrical impulse, a half second is a very long time. What seems to be happening is that something below or aside from consciousness is making decisions before we think we are making decisions. Something else in us, backstage of our deciding, appears to be deciding before we decide. It reminds me of a British TV series called Yes Minister, in which civil servants manipulate a member of the government, convincing him that he’s in charge when the truth is that the real decision making is going on elsewhere. In April 2008, an experiment using fMRI scanning not only confirmed that Libet’s delay exists, but went further, showing decisions can be predicted up to ten seconds before deciders “decide.” (Of course, it’s possible to argue that these are ten seconds in which the subject is observed in readiness, preparing to do something as instructed by the experimenter.)
I DON’T KNOW what all this has to do with Alzheimer’s. Probably nothing. But it increases the sense of there being some other self beyond the one we’re confident of living within, that feels contained and definite—an alternative self that in our more exhausted moments, in my mother-in-law’s case, we’ve taken to calling Nancy’s evil twin. The interesting question, for me at least, is whether this new Nancy’s simply a part of Nancy that’s always been there, long suppressed and now unleashed by loss of inhibition, or is it something properly new? The validation thesis suggests that it’s the former: that Nancy’s self is still intact; it’s just that we’re seeing a different part of it now, one kept at bay previously by the frontal lobe but given liberty by dementia—the rise of aspects from her subconscious, perhaps. It’s quite a Cartesian idea when you think about it, the idea that Nancy’s self is still intact but trapped within failing machinery, and it’s just her superficial way of dealing with the world in the old way that’s been lost (if thinking can be said to be superficial). But my own suspicion is that it’s something new—that the amygdala and more primitive parts of the brain, dedicated to survival, selfish and aggressive, are being allowed to come forward and create a new self; one that, in the circumstances, we can only continue to call Nancy. I’d always hoped, until recently, that I had a soul that would survive me, but I see now that I will have to locate it somewhere hidden from consciousness, unknown by what I think of as my self, if what I know now about the consequences of brain damage isn’t to have the effect of extinguishing that hope. Reading about caregivers’ experiences of looking after loved ones—husbands and wives, but particularly husbands—who have suffered catastrophic head injuries in accidents or assaults and have become different people isn’t reassuring.
The weather’s quite outstandingly foul for May. A hailstorm in May seems like the end of the world. Though the gloom is mitigated by being offered more paid help, by one of the other aides. After a brief crossover period the first aide bows out, Morris’s confidante, citing tiredness and illness; I’ve no doubt that Nancy’s sniping was the cause of both. It’s difficult (that’s putting it mildly) to find people who can work with Alzheimer’s sufferers and not become short-tempered, bewildered, bored, exhausted, or demoralized. Our second aide is one such, someone who doesn’t and isn’t. She’s cheerful, assertive, robust, and unoffendable. But she also has young children, a farm to run, is the school cook, and caters for weddings. We squeeze extra hours out of her when we can but that’s the most she can offer.
There are seasonal signs of hope in the garden. The wood is teeming with bluebells, thousands of them in a purple haze, and a melancholy bluebell scent drifts up the garden. People have been along in their cars to visit them. Nobody thinks to ask us if it’s okay to wander in there, but we don’t mind too much, at least not until we see, one late afternoon, somebody standing on the drive with his hands on his hips, looking up toward the house, standing guard it turns out, while his accomplice is at work. They see me at the window and retreat. But when I go down there, the earth has been disturbed in several areas under the trees. It was the whole plant, bulb and all, that they were after, and they’ve made off with armfuls.
Chapter 20
It’s a poor sort of memory that only works backwards.
—LEWIS CARROLL
ELSEWHERE I DESCRIBE MEMORY BANKS AS A LIBRARY that we can visit in our heads. That’s the traditional way of seeing it, but it isn’t remotely accurate. Memory is an activity and not a vault. The brain stores different aspects of any one memory in different parts of the brain. What was seen, what was heard, the smell, touch, taste, the emotional input—all are contributed by their specialist areas. Visual memory’s called up from the occipital lobe, auditory memory from the temporal, working together in a synchronized way. It’s not a place, but a process, and a process not unlike music made by an orchestra. In short, it works in just the same way that consciousness does.
Why do some people have good memories and others bad? My sister has an extraordinary memory for our shared childhoods, which puts me at a disadvantage, when I’m quoted at age eight in a fight over an ice-cream scoop. Partly, the reason some people retain the “film” of the past in such vivid detail is that they use their memories more. To keep a memory you have to keep having the memory, revisiting the memory, using it, so as to keep that collection of neurons imprinted and those synaptic connections in place. If they’re not used, then they wither. To remember things you have to go through the process of remembering them again. You make a new memory each time you remember, revisiting the route from neuron to neuron. Researchers have discovered that there is an actual anatomical change in the laying down of long-term memories. The axons grow new synapses and new proteins are made in the nucleus of the neuron. There’s a change at the cellular level, something that doesn’t occur in the making of short-term memories. In his book In Search of Memory, Eric Kandel, who was awarded the 2000 Nobel Prize for medicine, elaborates on this idea that in order to convert a short-term memory into a long-term one, we need to care about it enough, whether for happy or unhappy reasons, and that our caring has physiological effects. One hit of neurotransmitter and the synapse is improved. Five hits and the cell is alerted to this (whatever it is) being something important. It sends the information, via a protein, to the nucleus that t
riggers the genetic switch for the growth of the new synaptic port. There are two ways in, it seems, via quantity or quality: either via repetition, thinking about something over and over, or by means of the intensity of a shock or equivalent emotional event.
The things that stick aren’t always the obvious things. Odd, oblique, incidental, tangential things stick. As the writer Elizabeth Bowen said once in an interview, “The charm, one might say the genius, of memory is that it is choosy, chancy, and temperamental: it rejects the edifying cathedral and indelibly photographs the small boy outside, chewing a hunk of melon in the dust.” Montaigne, in the sixteenth century, was more succinct but less alluring, as is his way, in writing that “[t]he memory represents to us not what we choose but what it pleases.” What you care about isn’t necessarily what you think you care about.
When you remember, it’s a memory of the memory that you’re having. You don’t go into the library of your memory and pick up the book and read your past. In a sense, you write the book all over again. And research shows that if you don’t take the trouble to rewrite the books, the books disappear. It’s rather like those wardrobe nannies who insist that anything not worn for twelve months ought to be put in a bin bag. You haven’t thought about this for years so I’m chucking it out. It sends the nanny in and chucks, and it’s only when you open the wardrobe that you discover your fake fur jacket/caravan holiday memory is missing. Or, to use another analogy, we need to keep digging out paths in the snow. If we don’t, snow eliminates them. Get out there and dig those paths. Maintain them and you can keep walking on them. Don’t maintain them and they are gone. How does the brain do this? The nanny in question’s an enzyme called PP1 that removes the phosphate from the target protein and deactivates it, in effect wiping a particular memory from the slate.
There are four levels of memory. The first, sensory memory, isn’t really memory at all. It’s stuff that the eyes see, that the brain may know (far more goes in than is retrievable), but the conscious self doesn’t notice. Take the scene in front of my eyes just to the side of the laptop, right now, for instance. The books and papers, used coffee cups, the tin of salted almonds, the box of old photographs waiting to be put into albums, the postcards, pens, mobile phone, plus the jewelry and homework the children left there—everything that’s spread on the coffee table beside me as I write this—made a brief sensory imprint in my mind, but hadn’t been processed any further until I turned my attention tableward. Perhaps a probe could find it in my head, if probes and scanners grew that sophisticated. Perhaps I might be an unwitting witness to a crime that my eyes saw but I didn’t register, while looking out of the window in the city at the cherry blossom on a busy street, where among the traffic and pedestrians, somebody was quietly and efficiently killed with a knife. I saw it but I didn’t register it. It was among the things my eyes were seeing while I was concentrating on something else. That’s the first level of memory.
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