By Carol and Dave Ochs
Special to The Washington Post
Tuesday, September 1, 2009
What Carol remembers: I didn't think much of it when, one Thursday a few months ago, my husband asked me where he kept his vitamins.
I thought he was joking when he asked me where he worked.
What sort of annoying game was this, when I was scrambling to make breakfasts, pack lunches, feed the dog and get the kids to school? I didn't have time for 20 Questions.
But then Dave asked again. And again. There was panic in his voice. "Where do I work?"
It wasn't a joke. My husband was losing bits of his memory.
* * *
What Dave remembers: My day had started like any other in our house. I got dressed to work out, headed downstairs, rode the stationary bike for a half-hour or so, and then did some weight and resistance work. I remember doing abdominal crunches, and for some reason they were unusually hard that morning. I'd been an athlete, trained to fight through when the body struggled to find its rhythms, but this was tough and I was straining. That's the last memory my brain would make for the next six hours. I don't remember the end of my workout. I don't remember returning upstairs to ask for my vitamins. I don't remember panicking. I don't remember. Not then, not today.
* * *
Carol: I told him he worked for the Fairfax County Park Authority, but all I got was a blank stare. So, I started asking questions.
"Where do you think you work?"
"The Associated Press," he replied.
"And who's your boss?"
"Dave Lubeski," he confidently answered.
He would have been right three years ago. We headed to the emergency room.
A neighbor took the kids to school. I kept peppering my husband with questions. He felt no pain, no numbness or weakness. His speech was fine, but we both suspected he was having a stroke.
* * *
Dave: There's an occasional history of stroke and heart issues in my family and, like any guy of 57, I get scared as the dickens when I look at the obituary page and see the people who haven't made it as far as I have. So I assume I was frightened, terrified of what was happening to me, but I have to imagine it. I only have my wife's word for it.
* * *
Carol: At the ER, Dave was taken right in. They, too, suspected a stroke. He passed a CT scan. No signs of bleeding in the brain. Good news, but the doctor explained this could be a TIA (transient ischemic attack), or mini-stroke, which is often a precursor to the real thing. She asked him more questions.
When she asked what month it was, he guessed January or February. Close -- it was March. When she asked who the president was, he thought for a moment and came up with Bush and Quayle. Then Clinton. He didn't recognize the name Obama.
* * *
Dave: Carol tells me that as the doctor, nurses and technicians buzzed around, I kept asking questions: How did I get here? Where am I? Did I come by ambulance? How did this start? I repeated them endlessly because I forgot the answers as soon as I heard them.
* * *
Carol: Nothing new was sticking in his brain. It got particularly maddening when he started asking over and over, "Am I being repetitious?" A nurse tried to lighten the mood by quietly saying to me, "Don't you just wish you could hit the reset button?"
Doctors still weren't sure what was going on. They decided to transport him to Inova Fairfax Hospital's stroke unit and give him an MRI. About five hours after this all began, he'd been admitted and was settling into his hospital room.
* * *
Dave: Everything to this point is Carol's experience. It's as if I were 1 or 2 years old. People tell me these things happened to me, but even though I was conscious and an active participant, there's no memory, no context. The first flash of my own memory happened on the ambulance ride to the hospital. I have one photographic image of looking out the back window of the ambulance. Nothing more.
A few months after this happened, I spoke to someone else who'd had a similar experience. Steven Seplow, a retired Philadelphia Inquirer editor, told me he'd been riding a bike through Philadelphia's Fairmount Park in the mid-1980s when he hit a bump. "The next thing I remember is being two miles up the road in a pay phone calling my wife. How I got from one place to the other, I have no clue," Seplow said. He was wearing a helmet and apparently hadn't crashed. "It was just weird. I mean, I was just here, then I was there." Seplow figured his memory hadn't been blank for long because no one at home was in a panic when he called.
* * *
Carol: At the hospital, Dave's questions started coming a little less frequently. He now remembered where he worked and was concerned about whether I had let his boss, Cindy, know why has wasn't there. He now remembered sledding with our girls two days earlier, a memory he hadn't had in the ER. He knew the president was Obama. He kept telling me his head felt heavy and foggy, but I could see a clear difference. Dave was coming back.
* * *
Dave: Two o'clock. I remember the hands on the clock in my hospital room reading 2 o'clock, and I knew it was in the afternoon because the window curtain was open. It's the next memory I have. I don't remember feeling surprised to be in a hospital room; I do remember the heavy feeling in my head. Something inside was starting to work, my brain was rebooting. Before this, it was about 8 in the morning and I was working out. In between, six hours defined only by a window in an ambulance door.
Seplow told me about his first return to normal memory function. "Somehow I got to this path, got to the pay phone. Don't remember any of that. The first kind of recollection I have is actually being on the phone, not dialing it or anything like that, and saying something like, 'I don't know how I got where I am, I guess you better come and pick me up.' "
* * *
Carol: By early evening, Dave's nurse practically kicked me out of his room. She assured me he was doing fine at the moment and said it could be an hour or more before his MRI and hours more until the results were known.
"Go home and take care of your kids," she said. "We'll take good care of him."
* * *
Dave: Much of this I remember. Sitting up in bed, joking with the hospital personnel, talking with Carol, listening to what I'd been up to on my six-hour vacation from day-to-day life, and the MRI. It was the MRI that tipped me off to the stress I'd experienced. I needed a drug to calm my panic in the machine. I'd had no problem with previous MRIs, so this discomfort surprised me.
* * *
Carol: I picked up our daughters at the neighbor's house, got the kids in bed, then started cleaning up the breakfast dishes that were still on the table and counters. There were phone calls to return. Near midnight I started surfing the Internet to see what I could learn about what might be happening to Dave. On the Mayo Clinic Web site, I found something that fit his symptoms and condition perfectly: transient global amnesia. I printed the page to show to Dave the next day. The ER nurse had mentioned amnesia hours ago, but I hadn't really taken it seriously. That only happens on TV shows, doesn't it?
When I got to the hospital in the morning, Dave was undergoing an EEG to check his brain patterns and a sonogram of his heart. Afterward, the neurologist on the case, Suneetha Manem, assured us that Dave was doing fine physically and said she thought he might have . . . transient global amnesia! Dave showed her what I'd printed off the Internet. "Yes, that's it," she said.
Transient global amnesia is "a temporary, short-term memory loss," Manem told Dave some time later, and "there's no clear-cut cause we know." It appears to be triggered "by a lack of blood flow from brain structures, especially from temporal lobes or the thalamus, which has the sensory relay information. We think this lack of blood flow or lack of oxygen could be provoked by extreme strenuous activity, anxiety or some exertion."
By evening, she proclaimed Dave ready to leave. He was cautioned to take it easy for a few days but encouraged to get back into his usual workout routine.
* * *
Dave: That took a while. It was two weeks before I did my full, normal workout. Four months later I'm still hesitant to do a sit-up. I was aware of what had happened, anxious about physical exercise and gradually tested myself to make sure I still worked.
* * *
Carol: They tell us that transient global amnesia can strike again, but it's very unlikely. Dave will never get those six hours back, but that's fine -- I wish I could forget those hours, too.
The Mayo Clinic Web site describes transient global amnesia as "a sudden, temporary episode of memory loss that can't be attributed to a more common neurological condition, such as epilepsy, transient ischemic attack, stroke or head injury." The site describes Dave's experience perfectly:
"During an episode of transient global amnesia, your recall of recent events simply vanishes, so you can't remember where you are or how you got there. You may also draw a blank when asked to remember things that happened a day, a month or even a year ago. You do remember who you are, and you recognize family members and others you have known for a long time, but that knowledge doesn't make your memory loss any less disturbing."
Seplow, the Philadelphia editor, told us he also went through all the tests at the hospital, and eventually got the same diagnosis. "There was nothing physically wrong, there was nothing mentally wrong. I was alert when I was in the hospital, I wasn't badly injured at all, and that was the end of it, so I told people and I laughed."
* * *
Dave: My wife has the memory. To her, the experience was frightening. To me, it's more like something I read about, or heard from a friend. Like, "Hey, guess what happened to me?"
There were follow-up visits to make sure I had no more symptoms.
The experience was not like being asleep or being intoxicated. "I sort of came to," Seplow said, "sort of like a boxer, I guess, who gets knocked out and comes to and the manager's slapping his face."
In my case, it's not that a page of my life is blank. It's that the page isn't even there. It's the closest I've come to understanding the concept of nothingness.
Carol and Dave Ochs are writers who live in Springfield. Comments: firstname.lastname@example.org.