When I enter the room in question I find a junior doctor, two nurses, and Mr. Davidson’s forty-year-old son standing impotently by as the bedbound Mr. Davidson continues to shout, his voice quavering at the assembled group, tears rolling softly down his tired, crinkly face. All heads turn to me as I enter. The lanyard does its thing.
The junior doctor throws me an imploring look, his expression telling me he’d be more than happy for me to take over. I give him a nod. This is, after all, why they paged me.
Mr. Davidson’s screaming and the general vibe in the room make it clear that an impasse has been reached. Mr. Davidson doesn’t want to be touched or manhandled.
“Good morning, Mr. Davidson,” I say brightly, trying to top his energy.
There’s a slight break in the rhythm of his yells. He looks at me, surprised, and I continue with his full attention. “My name is Dr. Lewis. Do you remember me, Mr. Davidson? I’m your doctor. Emma Lewis.” I give him a reassuring smile as if to say, Of course you remember me, we’re old friends.
He clings to my smile, seduced from his train of thought, and his yelling finally subsides. He gives me a tentative nod. Not fully invested in the idea that we know each other just yet.
“Can you tell me what’s wrong, Mr. Davidson?”
His tearstained face uncrumples as he struggles to unpick my question.
“Are you in pain, Mr. Davidson? Whereabouts do you feel it?” I nudge him on. He looks away from me now, toward the window.
It’s hard to tell to what extent Mr. Davidson recognizes me, if he does at all. Howard Davidson has problems accessing and storing memory; I’ve been treating him for three weeks, ever since he was admitted. Recognition is a complex neurological process and humans are very, very good at masking the absence of it. People adapt around memory losses. They rely on other things—visual cues, social cues—they get good at reading people, situations; they find ways around things until an answer presents itself. But regardless of whether Howard Davidson recognizes me, he trusts me, he’s stopped shouting, and that is definitely progress.
I approach his bed cautiously. He turns to look up at me with his big wet eyes, curious, and exhausted. I gently place a hand on his arm as reassurance.
He peers down at my hand, his chest rising and falling as he fights to get his breath back to normal. He doesn’t pull away from my touch, he doesn’t lash out. Patients with memory disorders can often become uncharacteristically aggressive, physically violent, but when his gaze floats back up to me it isn’t hostile, it’s entreating.
“Where exactly are you feeling the pain, Mr. Davidson?” I ask again, softly.
He takes in air in great heaves, not a huge surprise—he’s been yelling continuously at the top of his voice for quite a while to a confused and frankly deeply concerned audience. As he stares up at me, gulping in snatched breaths, he looks like a man lost in a foreign country.
He taps his chest. His heart. That’s my answer. The answer to my question. That’s where he feels the pain: in his heart.
I nod and give his arm another gentle squeeze.
I understand.
Mr. Davidson nods back solemnly, and promptly bursts into a cataclysm of coughs.
There’s nothing wrong with his heart—well, not physically, anyway. What’s physically wrong with Howard Davidson is his brain. As far as Howard is concerned he’s a thirty-two-year-old man trapped inside the body of a seventy-eight-year-old. He woke up three weeks ago with no memory of the last forty-six years of his life. In his mind he left his house in 1973 and woke up here, an old man. What’s wrong with Howard Davidson is visible only on a scan. Large sections of his neocortex have atrophied, died. All the memories stored in those areas are gone; a huge portion of his life, to his mind, never happened. Three weeks ago, he was fine, pottering around his garden, walking his dog, reading, deep in the flow of his own life, enjoying his retirement, but that old man is gone now.
Howard Davidson was found wandering down the middle of a four-lane highway near Shepherd’s Bush, and brought to the emergency room. After we ascertained from his relatives that he had no history of Alzheimer’s, that up until that morning he had apparently been quite happily enjoying the life of a retired MP, an MRI scan was taken.
The atrophy present in the brain scan was found to be indicative of vascular dementia, specifically single-infarct dementia. A single stroke had instantly killed off a massive portion of his hippocampus.
Forty-six years of life and memories erased in the blink of an eye. He has no recollection of having had children, or running for office, and he still believes he lives with his young wife, Ginny, near Goldhawk Road. All long-term memories end there.
I pour him a glass of water from the jug beside his bed. He takes it with a shaky hand. Then I turn to face the ragtag lineup behind me, looking for some kind of explanation for Mr. Davidson’s current state, although I already have my suspicions.
His son catches my eye. Simon Davidson and I have met before, briefly, on the day Howard was admitted.
I’ll let you in on a secret they tell us at medical school: Sometimes things can’t be fixed. Sometimes things must be lived with. Adapted to. Simon Davidson didn’t want to hear that.
I’ve been in this profession long enough to trust my instincts in situations like this, and right now my instincts are telling me that Simon is almost definitely the issue at fault here. Doctors and nurses don’t tend to make grown men cry. Well, not in a professional setting at any rate. So I give the medical team a nod and they shuffle, gratefully, out past Simon.
“Simon, would it be possible to talk to you outside briefly?”
Simon’s eyes widen slightly at being the only person singled out. “Er, yeah. Yes. Sure.” He gives me a pragmatic nod and starts to leave.
“I’ll be right with you in one minute.” I offer him a reassuring smile as he pushes out the door, but he’s frowning, unconvinced. However, I need to settle Mr. Davidson, my actual patient, before I can deal with his son.
I watch the door softly puff closed behind him.
“Who was that horrible young man?” The voice comes shaky from behind me.
I turn and take in Mr. Davidson’s frail form, his crumpled features, his kind eyes. I feel an ache of sadness in my chest. He means his son, of course. But the thing that really gets me is the caution with which he asks me the question, the caution for me, in case he offends me, in case the horrible man is a friend of mine.
“It’s all right, Howard, it’s just me and you now,” I reassure him. I move back to the bed and take his delicate wrist in my hand, counting off his pulse. Elevated but fine. “Did the man who was just in here upset you, Howard?”
I know the answer already. This isn’t the first time this has happened since Mr. Davidson’s been here, not by any means, nor is he the first patient who’s reacted in this way.