Sunday, June 18, 2006

"Tell me, who is the president?"

"The president?" The patient's eyes grew wide. She was ninety-two years old, and her memory was "not the best, dear."

We had just met. I'd quizzed her gently, and she'd responded with bemused indulgence...until now. She looked directly at me, and scowled. "Here it comes," said her daughter. Here it came, indeed! A stream of bitter disapproval...

It was 1998, and we had all just heard of Monica Lewinsky.

At times, we must try to learn if our patients are aware of a larger world, beyond their own surroundings and circumstances. If a patient is forgetful or disoriented, how severe is the impairment? There is a long tradition of asking, "Who is the president...and the one before him...and the one before him?" Unsurprisingly, the question can bring the larger world thundering into my office. The interview stops, and I learn exactly what the patient thinks of the old so-and-so, even if they can't quite remember his name.

When Clinton was president, people tended to forget the elder Bush. It was "Clinton, Reagan, Carter..." That changed when Bush, Jr. assumed office. It became "Bush, Clinton, Bush's father." Now, people are unsure about Ford and Carter. The younger the patient, the greater the confusion about where to place Nixon and Johnson. But the quality of memory depends on the nature and context of the information. (A man with mild Alzheimer's could not recall Clinton's name, but called him "the sex guy.")

In the last few months, the emotional impact of this question has again intensified. I don't need polls to tell me what our community thinks of its leaders.

I do have to be careful, though. One elderly lady unleashed a torrent of opprobrium about the president. But her son stepped in: "Mom, what president are you talking about?" It was Herbert Hoover. Now, that's an impressive long-term memory...

5 Comments:

Blogger Fallen Angels said...

I had a little fun with the president question when I had my disability eval a few years ago. I got all the way back to Nixon with no error and the guy wanted to know who was president before him. My answer was..."Oh come on! That clumsy guy...I wasnt even born yet!" What's really sad though is that I couldn't tell him who the current Vice President is...I actually had to ask my partner on the way home.

Can you tell me what the deal is with serial 7's? That one really messed me up! :P I HATE math...any math...I freeze when asked to do something simple.

I really thought I had done pretty well with most of the questions... but I guess I didn't do as well as I thought. My disability was aproved one month later, on the first go around. NO ONE is aproved on the first round. I was glad to be aproved so quickly...but it made me sad at the same time.

7:49 AM  
Blogger On the Same Page said...

I suppose your's was a bit more in the ballpark than the young man who told me, caged and wearing a "spitbag" over his head, that the President was Trick-or-Treat. It was, after all, late October. He knew that much. And so it goes...

4:28 PM  
Anonymous Anonymous said...

I hope they don't ask these questions to judge memory of first-generation immigrants. My memory only goes to Carter; before that I heard of some of them but not in any order... except for the really famous ones though.

7:54 AM  
Anonymous Kim said...

I'm so freaking old. I was born during the Eisenhower administration, can name every president after him and the two before him before I have to think a bit.

But I can tell you James Buchanan was president before Lincoln! Now wait...I better go look that one up....

LOL! I think it's because I'm so up on politics - which leads to agreement with your post....ask me who the president is and you'll get my opinion...no matter WHO I think it is!

10:44 AM  
Blogger Joel said...

Sounds like you were treating my wife's grandmother....

6:06 PM  

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