I Went to Grad School in Boston
Mr. M fell in the shower. His home caregiver found him on the floor. It was unclear whether he had hit his head, passed out, felt faint or short of breath, had chest pain, experienced an aura, or simply lost his balance. Mr. M has Alzheimer’s disease, and cannot remember what caused him to fall— not when the EMS asked him, or the ED doctor, or his medical team, or me, now, when it is finally my turn in the long line of people asking him the same questions.
Whenever I ask him a question, Mr. M stares at the ceiling for a few seconds, then looks at me in exasperation and says, “Well, I don’t know”.
“It’s okay if you can’t remember,” I add, after asking him if he recalled falling.
“No, it’s not okay,” he replies. “It’s not right that I can’t remember any of this stuff. I really should be able to remember.”
Here, I made a mistake. I asked him too many questions about his recent fall and reminded him about his memory loss. However, Mr. M can still remember many things and is quick to forgive. “I went to this great surfboarding school called Berkeley for college,” he says. “Although I was a bit of a class clown, my classmates elected me to be class president. After that, I moved to Boston for grad school, where I didn’t do too hot. Instead of studying, I ran around chasing this girl.” Here, he pauses for comedic effect. “And that girl became my wife!”
I laugh. “Well, sounds like it all worked out for you,” I reply. I ask to listen to his heart and lungs. He agrees. While I listen, he asks, “Doctor, do you think that I’ll be able to leave soon? We’re planning a trip down to Florida. We have a lot of friends in Florida, and I really want to go down and see them.”
Truthfully, I did not know when he would be able to get out of the hospital. Also, I’m not even a doctor, medical or otherwise. I was at a local hospital doing a clinical rotation as part of my degree program in Health Sciences and Technology. For the last 4 weeks, I have been seeing patients in an internal medicine ward, performing physical examinations, and taking patient histories. Mr. M was the first person I’d ever met with Alzheimer’s disease.
Before he could leave the hospital, we needed to figure out why he fell. Knowing the reason would help us and his caregivers take precautions for the future. Based on the information from his caregiver, it seems like he wasn’t eating well due to a respiratory illness and became dehydrated, ultimately contributing to his syncopal event. A neck angiogram (that is, an X-ray image of the blood vessels in his neck) also revealed that he had severe narrowing in one of the blood vessels supplying blood to his brain, slowing the blood flow, which could have increased his susceptibility.
So, for him to leave, he needs to pass an orthostatic hypotension test. This test monitors blood pressure upon standing. If your blood pressure drops too low upon standing, you can become lightheaded. He may also need to be transferred to a rehabilitation facility. And there is the possibility that he needs surgery for carotid artery stenosis.
“I think you’ll be able to leave in a couple of days,” I say. “We just need to make sure that you don’t fall again.” I don’t like using the words “make sure” with patients, but sometimes I can’t think of anything better to say. With some patients, I can never be completely certain that they will be okay. And I don’t want to promise unattainable outcomes.
“Okay,” he says. “Do you surf?”
I have never surfed, and I do not have a great drive to do so. I do like to run, though. This time of the year, the river is full due to the rain, and if I’m lucky, I might see a large heron or groups of cormorants glide on the water. I haven’t seen them catch anything yet, but I’ve seen schools of trout and bluegills on the bank of Charles, near the fountain on the Esplanade, so more fish must be around.
I am trying to notice things more often. I’m afraid of falling into a drift, swept from one deadline to the next, until I’m done with grad school, done with a postdoc, done with work, retired, and suddenly find myself in a strange hospital, unaware of how I got there. I am trying to be present.
One thing is for certain: I have no desire to surf, so I reply, “No, I haven’t surfed. There weren’t many places back home to surf.” He asks me where I’m from (Pennsylvania) and where I went to college (Bucknell University), and then tells me about his time at Berkeley, and how much he loved to surf, how he went to grad school in Boston where he spent too much time chasing a girl, and how that girl became his wife. We talked about surfing and how much he was looking forward to going to Florida.
Although he cannot recall his fall, Mr. M has a deep archive of memories from his past that he can derive joy from.
Mr. M reminds me that I’m building memories for later. Maybe I should spend more time surfing or chasing girls. Or at least the things that I like doing, like running, and baking, and running and baking with my friends. These things can be hard to balance in the middle of a Ph.D. I like the work that I do, but it’s hard to balance everything that I’m working on now while also preparing myself for future opportunities. There is pressure to extract as much as possible from every learning experience, be as efficient as possible, and not be distracted. But looking back, I don’t think my Ph.D dissertation is going to be the memory I reach for. It’s going to be the moments spent dancing at my friend’s wedding, running a marathon with my labmates, throwing tea parties with scones and cute little sandwiches, cooking deep dish pizza, and eating too much of it.
Mr. M asks what I do now. I tell him that I am in grad school. “I went to grad school in Boston,” he says. “But I didn’t do too well. I spent too much time chasing this girl around.” He winks at me. “She turned out to be my wife!”
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