permanently amnestic for the events of the entire game.”
Similar memory losses had been reported by boxers who could remember only a few rounds of fights that had gone the distance. Clearly, it is possible to perform at a high level during an amnestic event, but you might keep calling the same play, or, in a similar vein, get stuck driving round and round a traffic rotary.
By the following morning some of Godfrey’s memory had returned, but in a Swiss cheese fashion: there were significant holes in both retrograde and anterograde memory. This is not consistent with transient global amnesia. If Godfrey did not in fact have TGA, he was then, like the silver fox, in serious danger of losing a significant chunk of his past memories, along with his ability to form new ones. The clock was winding down. If I couldn’t come up with something, I would have to discharge him at noon.
TGA is highly stereotyped. It varies little from person to person. It is one of the few neurological syndromes that has inviolate borders, and Godfrey’s form of memory loss was too spotty, going backward and forward, to fall within those borders. There was also the issue of his awkward gait. I began to worry that low blood flow to his temporal lobes was the true underlying problem, and that he might be at risk of losing a divot out of his brain with a stroke.
In the twenty-third hour of observation, the nurse called me and said that Godfrey’s speech had become slurred, and the pieces fell together. I knew instantly that he was having a stroke. When I walked in, his speech was indeed slurred. He was compos mentis, but when I asked to see him walk, I saw that his coordination had completely fallen apart. Godfrey had an occlusion, an atherosclerosis, a garden variety arterial blockage from a cholesterol plaque upon which a clot had formed. As the clot accreted, it had caused decreased blood flow to the temporal lobes, resulting in an evolving stroke instead of a sudden one. It had most likely started to evolve back in Philadelphia around the time he got into his car.
Godfrey’s story had a happy ending. We gave him an anticoagulant and an agent to raise his blood pressure, and shipped him up to the ICU. He would be fine, and he left with minimal memory trouble. Had I not held him for observation, the stroke could have cost him much of his long-term memory.
“Be very careful about what you call a TGA,” I told the residents that morning. “You’re looking for anything that doesn’t sound right for a fixed period of complete retrograde amnesia and complete anterograde amnesia.” My guess is that few of them had read Dr. Fisher’s paper. That’s why I brought it up along with Godfrey’s story.
If Godfrey came into the hospital today, the awkwardness of his gait might have been enough to earn him an MRI (which did not exist back in his day), and the stroke might have been evident. Even so, an inexperienced or untutored resident or intern might just say, “No MRI for him. It’s just TGA. Let’s move him along.” Godfrey’s was an uncommon condition that mimicked a common one. In the end, it’s not really the scan, but the painstaking examination, done Fisher-style, that tells all.
As for the Colombian woman, the residents held her in the Emergency Department for a few hours, but having no memory of why she came, and no awareness that anything was wrong, she insisted onleaving. When Hannah was convinced that her anterograde memory had returned, that it was nothing more than TGA, she discharged her. The hole in her memory would remain, and with it, all memory of her sexual encounter. Fortunately, she had another one scheduled for the following Thursday.
5
What Seems to Be the Problem?
A politically incorrect guide to malingering, shamming, and hysteria
Her name is Lauren H, age twenty-three, white, brunette, five foot seven inches, 129 pounds. Born in North Carolina, she came to Boston as a student at age nineteen, and is currently
Similar memory losses had been reported by boxers who could remember only a few rounds of fights that had gone the distance. Clearly, it is possible to perform at a high level during an amnestic event, but you might keep calling the same play, or, in a similar vein, get stuck driving round and round a traffic rotary.
By the following morning some of Godfrey’s memory had returned, but in a Swiss cheese fashion: there were significant holes in both retrograde and anterograde memory. This is not consistent with transient global amnesia. If Godfrey did not in fact have TGA, he was then, like the silver fox, in serious danger of losing a significant chunk of his past memories, along with his ability to form new ones. The clock was winding down. If I couldn’t come up with something, I would have to discharge him at noon.
TGA is highly stereotyped. It varies little from person to person. It is one of the few neurological syndromes that has inviolate borders, and Godfrey’s form of memory loss was too spotty, going backward and forward, to fall within those borders. There was also the issue of his awkward gait. I began to worry that low blood flow to his temporal lobes was the true underlying problem, and that he might be at risk of losing a divot out of his brain with a stroke.
In the twenty-third hour of observation, the nurse called me and said that Godfrey’s speech had become slurred, and the pieces fell together. I knew instantly that he was having a stroke. When I walked in, his speech was indeed slurred. He was compos mentis, but when I asked to see him walk, I saw that his coordination had completely fallen apart. Godfrey had an occlusion, an atherosclerosis, a garden variety arterial blockage from a cholesterol plaque upon which a clot had formed. As the clot accreted, it had caused decreased blood flow to the temporal lobes, resulting in an evolving stroke instead of a sudden one. It had most likely started to evolve back in Philadelphia around the time he got into his car.
Godfrey’s story had a happy ending. We gave him an anticoagulant and an agent to raise his blood pressure, and shipped him up to the ICU. He would be fine, and he left with minimal memory trouble. Had I not held him for observation, the stroke could have cost him much of his long-term memory.
“Be very careful about what you call a TGA,” I told the residents that morning. “You’re looking for anything that doesn’t sound right for a fixed period of complete retrograde amnesia and complete anterograde amnesia.” My guess is that few of them had read Dr. Fisher’s paper. That’s why I brought it up along with Godfrey’s story.
If Godfrey came into the hospital today, the awkwardness of his gait might have been enough to earn him an MRI (which did not exist back in his day), and the stroke might have been evident. Even so, an inexperienced or untutored resident or intern might just say, “No MRI for him. It’s just TGA. Let’s move him along.” Godfrey’s was an uncommon condition that mimicked a common one. In the end, it’s not really the scan, but the painstaking examination, done Fisher-style, that tells all.
As for the Colombian woman, the residents held her in the Emergency Department for a few hours, but having no memory of why she came, and no awareness that anything was wrong, she insisted onleaving. When Hannah was convinced that her anterograde memory had returned, that it was nothing more than TGA, she discharged her. The hole in her memory would remain, and with it, all memory of her sexual encounter. Fortunately, she had another one scheduled for the following Thursday.
5
What Seems to Be the Problem?
A politically incorrect guide to malingering, shamming, and hysteria
Her name is Lauren H, age twenty-three, white, brunette, five foot seven inches, 129 pounds. Born in North Carolina, she came to Boston as a student at age nineteen, and is currently
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