It’s Friday afternoon, and that means clinic. It’s 1 p.m., and that means I’m walking to get Samantha from the waiting room for our therapy session. I take a deep breath before I open the door, and find myself looking forward to our session.
“Hello, Samantha,” I say, “I’m Dr. Hufford. Come on back.”
I always reserve the same room for our work, hoping that it will help her to remember that we’ve met before. Samantha and I have met many times before, but for her, every session is like meeting again for the first time. She is stuck in an unrelenting present, experiencing life about an hour at a time, before her anterograde amnesia — an inability to remember new events — sweeps the memories away, floating just out of her reach.
“Cognitive difficulties” is the way that her medical record describes it. A more sterile understatement is difficult to imagine. Samantha remembers everything from before about 15 years ago. She remembers going to college, having friends and ambitions, and falling in love. But her description of the accident is distant and clinical; a factual recitation of what she has been told happened. In a casual conversation you might not realize that you were talking to someone who would, only hours later, have no recollection of ever meeting you.
In clinical terms, her short-term memory is unable to be consolidated into long-term memory. To Samantha, she can sense that her memories are just out of reach, as though if she only tried hard enough they would come flooding back to her.
But the flood never comes.
Samantha’s clever, self-deprecating sense of humor was endearing right away. She reminded me of what one of my clinical supervisors used to say — being able to laugh at yourself is the best single indicator of mental health. But her self-deprecating joke from our first session was repeated in our second session, and then again, verbatim, in our third.
By the fourth session, I felt nauseous as she started it again. The joke is a mirthless reminder of what Samantha has lost, and what she continues to lose: With each passing hour, the amnesia continually washes over her, pulling her memories out to sea in an undertow of neurotransmitters run amok.
After each of my psychotherapy sessions, I dutifully make an entry into my patient’s medical record, choosing prepackaged dropdown phrases. ‘The patient [Choose one: Denied, Acknowledged] auditory hallucinations,’ ‘Mood was [Choose one: Euthymic, Elevated, Labile, Constricted, Flat], ‘Suicidal ideation was: [Choose one: Not present, Present but with no plan, Present with plan]’. Click, click, click, and I try not to think about the fact that my session notes for Samantha are all the same, the exact same.
Our hours together are spent oscillating between creating simple printed reminders for her to post in her room reminding her not to dwell on specific worries, to painful questions about an unfulfilled life, and whether I can please help. There is no place in the session note for her questions — questions not about the meaning of life, but the meaning of her life, about feeling lonely and wondering who would ever want to be with her. She thinks that she is broken, and wonders what kind of life she can ever have, unanchored from the past. She remarks how well I seem to understand her struggles, unaware that my prescient empathy is an accidental byproduct of her amnesia.
Psychotherapy is not my day job. Except for a few hours every Friday afternoon, my working life is spent in drug development, designing and running clinical trials of new medicines for psychiatric problems. That time speeds by, punctuated by meetings, teleconferences, reviews of scientific papers, and summaries of how a new drug compares to placebo in clinical trials of hundreds of patients. It is clean and tidy work. In contrast, the time that I volunteer on Friday afternoons is a chance to wade into the messiness of lives spent in poverty, and surrounded by loss, violence, and ugliness that is a world away from my office in La Jolla.
As the Fridays pass by, one day I hear that the famous neurology patient, H.M., has died. H.M.’s amnesia was remarkable, and decades of research into his deficits illuminated, among other things, that declarative memory (knowledge of facts and events) was separate from procedural memory (how to do things). In short, it is possible to learn something, and yet be unaware that you know it. Upon his death, his brain was sent to San Diego’s Brain Observatory for dissection and digital imaging. One morning, I log on to a website that is streaming live video of the transection of his brain. The automated surgical scraper takes another pass at his frozen brain as the lab technicians update the accompanying blog noting, “The ventricles can now be seen!” It’s neuroscience as performance art.
I close my browser before the next scrape across his brain and look out of my office window at a perfectly manicured line of palm trees. I wonder whether I could live Samantha’s life, dutifully waiting for a medical advance that has yet to come, while not even knowing how long I’ve been waiting. I am sure that I could not, drunk as I am on the good fortune of my life. I think of the expectant look on her face in the waiting room every Friday, as she sits there with grace and patience, surrounded by people impatiently waiting for their 10 minutes with a physician and a prescription for what ails them.
I have no pills for Samantha, and know that for such complex patients a single clinical trial is unlikely to ever be run – Samantha’s problems are too complex, and the rarity of patients with such disorders is insufficient for the business of medicine to ever work in her favor. I feel like an agnostic little drummer boy, dutifully drumming my drum while chastising myself for not having more to offer.
Am I helping Samantha? I think that I might be for that one hour every Friday afternoon, but the feeling is quickly swept away, floating just out of my reach. And then, busy with my work and happy life, another week is gone. It’s Friday afternoon again, and that means clinic. It’s 1 p.m., and that means I’m walking to get Samantha from the waiting room for our therapy session. I take a deep breath before I open the door, and find myself looking forward to our session. “Hello Samantha,” I say. “I’m Dr. Hufford. Come on back.”