The second level is the working memory. This is the material we hold in mind, temporarily, like part of a mathematical calculation we put aside while doing the second part, ready to add the two numbers together, or a phone number we need to remember that was given to us when we didn’t have a pen. It’s recited in the head and retained for as long as we need it. Then we forget it. Nancy is beginning to forget things that have just happened, things that have just been said to her, and how to finish a sentence she’s only halfway through speaking. She’s losing her working memory and is unable to hold things in mind. The man known only by the initials H.M., a neurologically much-quoted epilepsy victim—run over by a bicycle at age nine, and in his twenties at the time of being a research subject in the 1950s—with his temporal lobe function diminished and hippocampus removed, could still remember new things done or said for a few minutes. His working memory survived although his short-term memory, ordinarily the next phase in the process, no longer functioned.
Scientists classify short-term memory differently according to length. Neurologists tend to talk about it as short-to-medium term. The things we did yesterday, last weekend, even the wedding we danced at the weekend before that, can be described as held in short-term memory. The process of converting a select few of these into long-term memory, forming strong memories that survive, can take weeks, and it’s thought most of the work’s done while we sleep.
Memory making is a single-track road. To get from the sensory memory stage through working memory into short-term and thus into long-term memory is like going along one of those winding narrow routes that stretch out into the fingers of the coast of Argyll in remote western Scotland. There’s only one road from the village of Sensory to Long Term. To get to Long Term you need to go through the other three villages first. In other words, if there is a break in the road, a flash flood, say, and then a road slip, a section of the road sagging and tipping down the hill, and the road becomes impassable, nothing can get to Long Term. That’s what happens in Alzheimer’s. The short-term memory fails, is gone for good, and so nothing new can be processed into long-term memory. The poor old village of Short Term is obliterated entirely. The brain has an alternative route out of Long Term, though not in. Eventually it, too, will be obliterated.
Once you get into long-term memory, the road branches. Down one road there’s implicit memory, and down the other, explicit. Explicit further branches, into episodic and semantic. Implicit is another way of saying procedural memory, the one that deals with the things that we do as if automatically. Riding a bike, driving a car, knowing a dance, playing the flute: these skill memories are taken care of by the cerebellum in league with the basal ganglia, four clusters of neurons at the base of the brain that help initiate and control movement. Serotonin is the neurotransmitter of choice in the making of implicit memories, and dopamine in the creating of explicit memory. Researchers think that implicit memories are laid down while we’re in REM (rapid eye movement) sleep, in which our dreams are most vivid, and that explicit memories are made during non-REM sleep.
Explicit memory is the sort we need actively to call up, “thinking” in the familiar conscious sense. Episodic is autobiographical, and locates things in time and sequence: “I ate eggs for breakfast, went to the life drawing class in the village, and after lunch Nancy and I took the dogs to the beach.” That’s episodic memory. Semantic memory is encyclopedic, intellectual, for facts.
Alzheimer’s damages the episodic (autobiographical) memory first and worst. The semantic survives longer. Sufferers might know very little about themselves, nothing whatever about what happened ten minutes ago, and yet might be able to talk at length about the history, the battles, and the princes associated with a ruined castle visited on a Sunday afternoon outing, using long-term semantic memory. Alzheimer’s sufferers of a certain generation, taught screeds of poetry by rote at school, find they can still recite their twenty verses of Longfellow with perfect accuracy, until quite late in the disease.
Because memory is a process, relying on neurons to fire up in the same sequence each time we remember, memory can be wrong. Memory, indeed, is notoriously unreliable. Why should it be, though, when we rely on it for survival? Perhaps that’s the point. Perhaps our brains are more dedicated to our psychic health than to the truth. What we see, the way that we see it, and the way we remember it are essentially subjective. The process of making memories and then remembering them is both technical and personal. The synapses may not reproduce their original pattern. It’s like the old fable of the bad carpenter’s table, in which leg number two is drawn from leg number one (and is a bit out), and then leg number three is drawn from two and is even more wrong, and number four, drawn from number three, isn’t anything like the same length or shape as number one. Something we thought, imagined, doubted, added on one occasion of remembering distorts the memory for next time it’s called up. How then can I be sure of what I have done and experienced in my life? There are some slices of time, moments, collections of moments, from the deep past that are unlikely, eccentric, unaccountably preserved, and which I treasure. But are they accurate, or are they a story I tell myself for my own reasons? There’s no way of knowing for sure. Not only do you, the reader, perhaps suspect that not all of what I write about life with Nancy is exactly as it happened, but strictly speaking, knowing the mechanism to be emotional, I ought to suspect the same. Our memories of things are never objective. We interact with them and add meaning; highlight certain aspects and throw others into shadow.
The brain is selective about memory. Not only about the details, but about the quantity. This selection and editing is important in life having a shape. The truth of this is illustrated by the problems encountered by people who have too much memory. There have been neurological cases of people who can’t forget things. Their brains can’t filter out or edit and everything is retained. They can tell you in detail exactly what was said or done on this day last year. What happens to them is that they lose the big picture, a sense of perspective, and are overwhelmed by detail. No choices can be made, no judgments. Everything is of equal importance. Because of this, they don’t always function well as humans. So it appears that in principle and in moderation, forgetting is important. As Nietzsche wrote, “There could be no happiness, cheerfulness, hope, pride, immediacy, without forgetfulness.”
Chapter 21
Between the acting of a dreadful thing
And the first motion, all the interim is
Like a phantasma or a hideous dream.
—WILLIAM SHAKESPEARE
I FIND, ON A ROUTINE SELF-AUDIT, THAT I HAVE BECOME very low. Nancy is succeeding in sucking the optimism out of me, a strange new place to find myself in the middle of summer: flat in the heart, empty in the head, craving solitude and sleep. Peninsula sunshine is blinding, uninterrupted by geography, reflected and magnified by the sea, but I am peculiarly unmoved by the sun at the edges of the curtains in the morning. It’s worse, in a way, when the weather is good. On top of my own lowness is overlaid recrimination. Here it is, a summer day at last, and I don’t want to have anything to do with it. Worse, I don’t seem to be able to have anything to do with it. I can’t step into it and be warmed. The heat on my skin is an irritant, the warmth on my head provoking. It’s best if I keep my distance.
What I want is a sofa to myself. I want to be left alone to read, reassured by the sun pouring in at the windows, which is a novelty in itself, but Nancy’s reaction to the arrival of something like summer is an inability to sit still. Daily she wanders the hall. Up and down to the conservatory and back. Through one kitchen door and out the other, twenty, thirty times a day. Up and down from bedroom to sitting room. In and out of the bathroom with an absent expression, her mouth drooping, her eyes blank and hooded. She’s taken on what’s called the lion face of Alzheimer’s. But if sunshine makes her twitchy, it’s worse, far worse, on the bad weather days that follow, which come as we know they will, a wind and rain corrective. Seasons arr
ive and depart in self-contained daily chapters that seem to have little to do with one another or with the conventions of the calendar.
“Hey, you. Hey. What you doing?” I say cheerily. “Wandering again? Can’t we find something for you to do?”
The voice of doom speaks in monotone. “There is nothing to do. There is nothing at all to do. It’s just all meaningless. It happens again and again and it doesn’t mean anything.” She goes to the window, gestures out at the bay, the headland, the sea roaring and the wind howling in another midsummer gale. “Look. There’s nothing there.”
She’s right, I find myself thinking. We must get back to the city! Though it’s my mother-in-law’s thought, this Edinburgh-craving thought I’m having. I’m channeling my mother-in-law. She has possessed me and I am diminished.
After the gales recede there are days of gray mugginess, the midges gathering in clouds on the road beside the wood. Then there’s a cold snap, which coincides with the B and B booking of two women from New Mexico engaged on a European tour. They live in perpetual drought at home with a cactus garden, and though they say that they expected Scotland to be cool, their idea of cool is 68 degrees, a temperature regarded as sweltering hereabouts. The house isn’t warm enough for them, even with all of our inadequate heaters blasting on max. They huddle by their coal fire in three layers of thermal and fleece. One of them wears a bobble hat for breakfast. They go out on a cool June morning wearing all the sweaters and coats and earmuffs and scarves and gloves they could find in an emergency dash to the knitwear shop in town. Nancy meets them in the conservatory and makes a fuss of their itchy Fair Isle acquisitions. “Oh, that’s just brilliant!” I hear her exclaim. “Where on earth did you get it? Because I want one just the same! Can I try it? Can I? Can I if I’m extra nice?”
Written feedback arrives from Nancy’s April respite week. It seems that she was a happy bunny at the residential home. “She taught some of the other residents to dance.” She “only became distressed when the time came for her to leave.” Next, feedback arrives from the care manager, verbally over tea and biscuits. There’s bad news from the bed allocation committee. Our attempt to get Nancy onto the list bounced back with little consideration. “More help could be offered at home.” Seven words. Nancy’s not anywhere near eligible even for the waiting list yet. Meanwhile, following more day center shenanigans, and spurred on by this bounce back, one of our doctors writes a letter saying that in her opinion Nancy has already reached the point of requiring twenty-four-hour medical care. This cuts no ice whatever.
It’s getting more difficult to persuade Nancy to take her clothes off at bedtime. Underwear is a particular bone of contention. She’s physically as strong as ever and holds on tight to her underpants with both hands as they descend.
“Come on, you know you don’t wear underpants in bed,” I say.
“I’ve never heard anything so ridiculous in my life,” she thunders, Miss Jean Brodie to a T.
SHE BEGINS A concerted series of kitchen raids. She seems to be hungry all the time. This is explained when I go back into the in-laws’ sitting room one morning and find Morris eating Nancy’s cereal. He has a rabbit-stunned-by-headlights look when he sees me coming.
“Morris, you really shouldn’t eat Nancy’s breakfast,” I tell him. “I can get you another bowl if you’re hungry.”
“It’s not that. It’s just that she won’t eat it and she’s anxious about it, so I’m helping her out.”
“The thing is, we need to know how much she’s eating.”
“Okay, boss, I hear you.”
“It’s important that she eats properly. I can find her something else to eat if she doesn’t want Weetabix.”
“You’re the boss.”
He’s also helpful when she decides that she isn’t going to take her pills any longer. More than once, I approach their door and hear Morris saying, “Quick, she’s coming, give them to me.” I find them cupped in his palm, the five little pills that Nancy doesn’t want to take.
What does he think, that this helps Nancy? What does he think, that I’m the nasty matron who will insist on cod liver oil, and ought to be outwitted? That’s how it seems. His attitude produces a twin. Mine. Cast in the role of nagger.
“You have to be in charge of Nancy eating enough, and Nancy getting her medication,” I tell him.
“Uh-huh,” he says, not taking his eyes off the television.
“Morris! This is serious stuff. This is important.”
“All right, all right! I hear you!” he snaps.
When I leave the room, they mutter together. The word she begins to be heard a lot. I am she. She is me. The nasty matron.
NANCY’S DIET BECOMES difficult to manage. She is rejecting most of the things I present her with. Morris gets given them when I leave the room. Her breakfast cereal, her toast. Her lunch. She’ll eat the potato chips and the yogurt but not the sandwich. Morris gets first dibs on that, and if he declines, it’s offered to a passing dog, and if the dog turns his nose up, it goes into the fire. I find the evidence in the grate among the cinders—a jumble of foodstuffs, tipped and scraped. Sandwiches, grapes, baked potato, small heaps of rejected salad. I fill up the biscuit barrel on Morris’s side table every day, and every day it empties again. Every day, hungry, Nancy comes into the kitchen when I’m not there and carries out a snack raid. Things begin disappearing that nobody can account for. Packets of biscuits, packets of nuts, half-pound bricks of cheese, a bowl of strawberries, tomatoes brought in from the greenhouse and left in the colander. Things put out on the worktop ready to cook suffer random losses. An aubergine with give-away bite marks appears in the wastepaper basket. I come into the kitchen one afternoon and find Nancy standing in front of the stove, stuffing buns into her mouth. They’d been left out to cool on a rack ready for the children coming home. She has one in each hand and her mouth is full, working hard at another. There are four others missing from the tray. I’d been gone from the kitchen for ten minutes, gone to bring washing in. I’m beginning to understand what lies behind her constant opening of the kitchen door, and her retreat when she sees I am in there.
“Oh. Oh, there is somebody. Well, it doesn’t matter. I’ll come back.”
“Something you want, Nancy?”
“No, no. Just wondering if there was anybody here.”
“I’m here. Just reading the paper.”
“Yes, yes. Well, then. I’ll come back.”
“Sure I can’t get you anything?”
“No, no. It’s fine.”
Occasionally she’s caught red-handed. She’s defiant about the buns.
“Oh, Nancy—no. They were for later.”
Nancy (through a mouthful of cake, spitting liberal crumbs): “What’s it got to do with you?”
“I made them. For later.”
“Well, then. Well, then. Enough of your nonsense.”
She reaches for another.
“Nancy. Leave the buns just now. Go and see Morris. Here, take some peanuts with you. How about some cheese and crackers?”
Nancy ignores these offers. Her beady eye is fixed birdlike on the cakes.
“Leave the buns till later, Nancy.”
“I will not. They’re just as much mine as yours.”
“Actually, no, because I made them.”
“Oh. Oh, sorry.”
But when she leaves the kitchen she takes one with her.
She picks things up and inspects them even if she doesn’t eat them, which is worse in a way. Bathroom hygiene has been abandoned, so nobody else in the family wants to risk eating food that Nancy has touched. The fruit bowl becomes unpopular. Jack will only eat bananas and oranges, things that have to be peeled.
There are several alarming toilet incidents. The kind that make a person gag when called upon to deal with them. By “a person” I mean me. Chris is made of stronger stuff and this is chastening. I didn’t have any problem dealing with the children’s bottoms when they were little, after all. I
try to think of Nancy as a big stroppy baby—one shouting, “I didn’t do it! I didn’t do anything! It’s nothing to do with me!” But it doesn’t help. One morning we come down to find—and I’m sorry to be so graphic, but this account is only of any use if it’s honest—what can only be described as a trail, leading from the day bathroom out into the hall. The beige-colored carpet is smeared. Turds have been deposited at intervals and then trodden in. Opening the bathroom door, the floor is awash. Chris steps in and rolls up his sleeves and deals with it. I offer to go and have a look at the perpetrator. She’s fast asleep. The feet are easily sorted out, courtesy of a series of wet wipes and a supermarket bag, breath held and eyes averted. The carpet will never be the same.
It’s not a good month for bottom issues. Morris has been given a toilet aid, a mobile lightweight frame with a higher seat. One day when I’m cleaning, I move it away from the toilet in the day bathroom and forget to put it back again. Nancy, not able to understand the significance of its being moved, goes in and sits on the frame rather than the toilet, and pees gallons on the carpet. She’s getting enough to drink. That’s obvious. The kitchen door is often open in the morning and I suspect she’s sleep-snacking. Sleep-snacking and filing her nails. Having refused tea, coffee, juice, squash, or water all day, she’s possibly waking thirsty and going to the kitchen tap. But how? She can’t any longer manage a tap. Nor find a glass in the crockery cupboard. Nor find the cupboard, come to that. Not when she’s awake, at any rate.
Keeper Page 20
