The man who mistook his wife for a hat (5 page)

   A full and interesting early life, remembered vividly, in detail, with affection. But there, for some reason, his reminiscences stopped. He recalled, and almost relived, his war days and service, the end of the war, and his thoughts for the future. He had come to love the navy, thought he might stay in it. But with the GI Bill, and support, he felt he might do best to go to college. His older brother was in accountancy school and engaged to a girl, a 'real beauty', from Oregon.

   With recalling, reliving, Jimmie was full of animation; he did not seem to be speaking of the past but of the present, and I was very struck by the change of tense in his recollections as he passed from his school days to his days in the navy. He had been using the past tense, but now used the present-and (it seemed to me) not just the formal or fictitious present tense of recall, but the actual present tense of immediate experience.

   A sudden, improbable suspicion seized me.

   'What year is this, Mr G.?' I asked, concealing my perplexity under a casual manner.

   'Forty-five, man. What do you mean?' He went on, 'We've won the war, FDR's dead, Truman's at the helm. There are great times ahead.'

   'And you, Jimmie, how old would you be?'

   Oddly, uncertainly, he hesitated a moment, as if engaged in calculation.

   'Why, I guess I'm nineteen, Doc. I'll be twenty next birthday.'

   Looking at the grey-haired man before me, I had an impulse for which I have never forgiven myself-it was, or would have been, the height of cruelty had there been any possibility of Jim-mie's remembering it.

   'Here,' I said, and thrust a mirror toward him. 'Look in the mirror and tell me what you see. Is thata nineteen-year-old looking out from the mirror?'

   He suddenly turned ashen and gripped the sides of the chair. 'Jesus Christ,' he whispered. 'Christ, what's going on? What's happened to me? Is this a nightmare? Am I crazy? Is this a joke?'- and he became frantic, panicked.

   'It's okay, Jimmie,' I said soothingly. 'It's just a mistake. Nothing to worry about. Hey!' I took him to the window. 'Isn't this a lovely spring day. See the kids there playing baseball?' He regained his colour and started to smile, and I stole away, taking the hateful mirror with me.

   Two minutes later I re-entered the room. Jimmie was still standing by the window, gazing with pleasure at the kids playing baseball below. He wheeled around as I opened the door, and his face assumed a cheery expression.

   'Hiya, Doc!' he said. 'Nice morning! You want to talk to me- do I take this chair here?' There was no sign of recognition on his frank, open face.

   'Haven't we met before, Mr G.?' I asked casually.

   'No, I can't say we have. Quite a beard you got there. I wouldn't forget
you,
Doc!'

   'Why do you call me "Doc"?'

   'Well, you are a doc, ain't you?'

   'Yes, but if you haven't met me, how do you know what I am?'

   'You
talk
like a doc. I can
see
you're a doc'

   'Well, you're right, I am. I'm the neurologist here.'

   'Neurologist? Hey, there's something wrong with my nerves? And "here"-where's "here"? What is this place anyhow?'

   'I was just going to ask you-where do you think you are?'

   'I see these beds, and these patients everywhere. Looks like a sort of hospital to me. But hell, what would I be doing in a hospital-and with all these old people, years older than me. I feel good, I'm strong as a bull. Maybe I
work
here … Do I work? What's my job? . . . No, you're shaking your head, I see in your eyes I don't work here. If I don't work here, I've been
put
here. Am I a patient, am I sick and don't know it, Doc? It's crazy, it's scary … Is it some sort of joke?'

   'You don't know what the matter is? You really don't know? You remember telling me about your childhood, growing up in Connecticut, working as a radio operator on submarines? And how your brother is engaged to a girl from Oregon?'

   'Hey, you're right. But I didn't tell you that, I never met you before in my life. You must have read all about me in my chart.

   'Okay,' I said. 'I'll tell you a story. A man went to his doctor complaining of memory lapses. The doctor asked him some routine questions, and then said, "These lapses. What about them?" "What lapses?" the patient replied.'

   'So that's my problem,' Jimmie laughed. 'I kinda thought it was. I do find myself forgetting things, once in a while-things that have just happened. The past is clear, though.'

   'Will you allow me to examine you, to run over some tests?'

   'Sure,' he said genially. 'Whatever you want.'

   On intelligence testing he showed excellent ability. He was quick-witted, observant, and logical, and had no difficulty solving complex problems and puzzles-no difficulty, that is, if they could be done quickly. If much time was required, he forgot what he was doing. He was quick and good at tic-tac-toe and checkers, and cunning and aggressive-he easily beat me. But he got lost at chess-the moves were too slow.

   Homing in on his memory, I found an extreme and extraordinary loss of recent memory-so that whatever was said or shown to him was apt to be forgotten in a few seconds' time. Thus I laid out my watch, my tie, and my glasses on the desk, covered them, and asked him to remember these. Then, after a minute's chat, I asked him what I had put under the cover. He remembered none of them-or indeed that I had even asked him to remember. I repeated the test, this time getting him to write down the names of the three objects; again he forgot, and when I showed him the paper with his writing on it he was astounded, and said he had no recollection of writing anything down, though he acknowledged that it was his own writing, and then got a faint 'echo' of the fact that he had written them down.

   He sometimes retained faint memories, some dim echo or sense of familiarity. Thus five minutes after I had played tic-tac-toe with him, he recollected that 'some doctor' had played this with him 'a while back'-whether the 'while back' was minutes or months ago he had no idea. He then paused and said, 'It could have been you?' When I said it
was
me, he seemed amused. This faint amusement and indifference were very characteristic, as were the involved cogitations to which he was driven by being so disoriented and lost in time. When I asked Jimmie the time of the year, he would immediately look around for some clue-I was careful to remove the calendar from my desk-and would work out the time of year, roughly, by looking through the window.

   It was not, apparently, that he failed to register in memory, but that the memory traces were fugitive in the extreme, and were apt to be effaced within a minute, often less, especially if there were distracting or competing stimuli, while his intellectual and perceptual powers were preserved, and highly superior.

   Jimmie's scientific knowledge was that of a bright high school graduate with a penchant for mathematics and science. He was superb at arithmetical (and also algebraic) calculations, but only if they could be done with lightning speed. If there were many steps, too much time, involved, he would forget where he was, and even the question. He knew the elements, compared them,

   and drew the periodic table-but omitted the transuranic elements.

   'Is that complete?' I asked when he'd finished.

   'It's complete and up-to-date, sir, as far as I know.'

   'You wouldn't know any elements beyond uranium?'

   'You kidding? There's ninety-two elements, and uranium's the last.'

   I paused and flipped through a
National Geographic
on the table. 'Tell me the planets,' I said, 'and something about them.' Unhesitatingly, confidently, he gave me the planets-their names, their discovery, their distance from the sun, their estimated mass, character, and gravity.

   'What is this?' I asked, showing him a photo in the magazine I was holding.

   'It's the moon,' he replied.

   'No, it's not,' I answered. 'It's a picture of the earth taken from the moon.'

   'Doc, you're kidding! Someone would've had to get a camera up there!'

   'Naturally.'

   'Hell! You're joking-how the hell would you do that?'

   Unless he was a consummate actor, a fraud simulating an astonishment he did not feel, this was an utterly convincing demonstration that he was still in the past. His words, his feelings, his innocent wonder, his struggle to make sense of what he saw, were precisely those of an intelligent young man in the forties faced with the future, with what had not yet happened, and what was scarcely imaginable. 'This more than anything else,' I wrote in my notes, 'persuades me that his cut-off around 1945 is genuine . . . What I showed him, and told him, produced the authentic amazement which it would have done in an intelligent young man of the pre-Sputnik era.'

   I found another photo in the magazine and pushed it over to him.

   'That's an aircraft carrier,' he said. 'Real ultramodern design. I never saw one quite like that.'

   'What's it called?' I asked.

   He glanced down, looked baffled, and said, 'The
Nimitzl'

   'Something the matter?'

   'The hell there is!' he replied hotly. 'I know 'em all by name, and I
don't know
a
Nimitz
… Of course there's an Admiral Nimitz, but I never heard they named a carrier after him.'

   Angrily he threw the magazine down.

   He was becoming fatigued, and somewhat irritable and anxious, under the continuing pressure of anomaly and contradiction, and their fearful implications, to which he could not be entirely oblivious. I had already, unthinkingly, pushed him into panic, and felt it was time to end our session. We wandered over to the window again, and looked down at the sunlit baseball diamond; as he looked his face relaxed, he forgot the
Nimitz,
the satellite photo, the other horrors and hints, and became absorbed in the game below. Then, as a savoury smell drifted up from the dining room, he smacked his lips, said 'Lunch!', smiled, and took his leave.

   And I myself was wrung with emotion-it was heartbreaking, it was absurd, it was deeply perplexing, to think of his life lost in limbo, dissolving.

   'He is, as it were,' I wrote in my notes, 'isolated in a single moment of being, with a moat or lacuna of forgetting all round him … He is man without a past (or future), stuck in a constantly changing, meaningless moment.' And then, more prosaically, 'The remainder of the neurological examination is entirely normal. Impression: probably Korsakov's syndrome, due to alcoholic degeneration of the mammillary bodies.' My note was a strange mixture of facts and observations, carefully noted and itemised, with irrepressible meditations on what such problems might 'mean', in regard to who and what and where this poor man was-whether, indeed, one could speak of an 'existence', given so absolute a privation of memory or continuity.

   I kept wondering, in this and later notes-unscientifically- about 'a lost soul', and how one might establish some continuity, some roots, for he was a man without roots, or rooted only in the remote past.

   'Only connect'-but how could he connect, and how could we help him to connect? What was life without connection? 'I may

   venture to affirm,' Hume wrote, 'that we are nothing but a bundle or collection of different sensations, which succeed each other with an inconceivable rapidity, and are in a perpetual flux and movement.' In some sense, he had been reduced to a 'Humean' being- I could not help thinking how fascinated Hume would have been at seeing in Jimmie his own philosophical 'chimaera' incarnate, a gruesome reduction of a man to mere disconnected, incoherent flux and change.

   Perhaps I could find advice or help in the medical literature- a literature which, for some reason, was largely Russian, from Korsakov's original thesis (Moscow, 1887) about such cases of memory loss, which are still called 'Korsakov's syndrome', to Lu-ria's
Neuropsychology of Memory
(which appeared in translation only a year after I first saw Jimmie). Korsakov wrote in 1887:

   Memory of recent events is disturbed almost exclusively; recent impressions apparently disappear soonest, whereas impressions of long ago are recalled properly, so that the patient's ingenuity, his sharpness of wit, and his resourcefulness remain largely unaffected.

   To Korsakov's brilliant but spare observations, almost a century of further research has been added-the richest and deepest, by far, being Luria's. And in Luria's account science became poetry, and the pathos of radical lostness was evoked. 'Gross disturbances of the organization of impressions of events and their sequence in time can always be observed in such patients,' he wrote. 'In consequence, they lose their integral experience of time and begin to live in a world of isolated impressions.' Further, as Luria noted, the eradication of impressions (and their disorder) might spread backward in time-'in the most serious cases-even to relatively distant events.'

   Most of Luria's patients, as described in this book, had massive and serious cerebral tumours, which had the same effects as Korsakov's syndrome, but later spread and were often fatal. Luria included no cases of 'simple' Korsakov's syndrome, based on the self-limiting destruction that Korsakov described-neuron destruction, produced by alcohol, in the tiny but crucial mammillary

   bodies, the rest of the brain being perfectly preserved. And so there was no long-term follow-up of Luria's cases.

   I had at first been deeply puzzled, and dubious, even suspicious, about the apparently sharp cut-off in 1945, a point, a date, which was also symbolically so sharp. I wrote in a subsequent note:

   There is a great blank. We do not know what happened then- or subsequently . . . We must fill in these 'missing' years- from his brother, or the navy, or hospitals he has been to . . . Could it be that he sustained some massive trauma at this time, some massive cerebral or emotional trauma in combat, in the war, and that
this
may have affected him ever since? . . . was the war his 'high point', the last time he was really alive, and existence since one long anti-climax?*