blogsfromtheedge

A Short Term Memory

Nancy Deming-May

October 2012

The other day I told my husband a story.  I’d had lunch with a friend that day and we ended up talking a lot about our mothers.  Hers had died earlier in the year and I shared with him her family saga surrounding the event.  She was one of seven children from New Jersey – six surviving – a twelve year old brother had died of leukemia in 1965.  There was another, estranged, brother, who would speak to no one in the family – she and I had laughed at how every family seems to have one of those.  (Funny how laughter is such a wonderful substitute for tears as we age.)  There were several nurse-sisters in the family, one of whom had the medical power of attorney.

The mother was ninety three and in relatively good health.  She lived in her own home still, with a full-time nurse’s aide.  We compared dementia levels – her mom’s was pretty low – she still sounded pretty sharp – could tell a good story and kept up with things.  Though, of course, the nearby siblings were much more bothered by mom’s forgetfulness and repetition than the daughter who lived out of town.

Last winter my friend received a late night phone call from her sister telling her she needed to get home right away.  Mom was quite disoriented and seemed to be going downhill fast.  They’d found her collapsed on the floor.  As my friend made the distraught seven hour drive, she tried to find out what had happened and what was wrong with mom.  No one was quite sure; they just knew it wasn’t good.  The POA nurse-sister was refusing to take her to the hospital or call an ambulance because of mom’s DNR (Do Not Resuscitate) order.  One of my friend’s nurse-friends asked during the seven-hour drive on a cell call, whether it might be a UTI (Urinary Tract Infection).

Once my friend arrived to find her mother incoherent, the other siblings equally distraught, and the POA sister adamantly refusing any kind of medical care, she used her best lawyerly skills to rationalize at least getting her mother looked at.  She figured if there was a chance they could have her back the way she was, she wanted to try.  So, a subset of siblings took her to the hospital while the POA sister refused to accompany them.  Once at the ER, and blood and urine tested, it proved to indeed be a UTI.  POA sister still refused to come to her bedside, nor would she sign for the necessary antibiotic treatment.  After much familial thrashing and cajoling, the majority siblings prevailed, antibiotics were administered, POA sis rejoined the clan, and their mother recovered – at least for a while.

She lasted six more days before her body shut down for good – long enough for the family to rally and bond around her and share their tender farewells.  Her transition, however, brought on new challenges.  This time it was about her burial plot.  When her 12 year old son had died in 65, she and her husband, both military veterans, had bought a family burial plot with four plots at a nearby veteran’s memorial cemetery.  Her husband and son were there, so there were two empty plots left.  All so simple and appropriate until the funeral director called about the burial arrangements and was told that the cemetery was full and no longer accepting any admissions.  Multiple calls and questions, then pleading, then begging did not change the response.  Disbelief led to shock, which quickly rippled through the family causing a grief-laced uproar and emotional meltdown.  This was finally my friend’s chance.  Through the years she’d traveled around the world serving as a military lawyer, missing many family events and carrying her own guilt for not being able to carry the “mom-load” more equally with her siblings.  This was something she could help with.  Her first phone call was to a good friend, a Congressman she had met in law school, who gave her the number of another Congressman who could help.  He was from her mother’s district and just happened to chair the Congressional sub-committee on VA Cemeteries.  She talked with his staffer and then the Congressman himself called her back later in the day.  They talked for twenty minutes.  Both had been in Afghanistan when the Afghani soldier opened fire in a meeting, killing eight US soldiers and one US contractor – a tragedy that served to seal their bond.  This Congressman had already made some phone calls and found some answers.  It was very simple; the VA representative had made a mistake – their burial plots were indeed still their burial plots and the involved parties were very sorry for the error.

So the beloved mother was buried properly, next to her cherished son, the family was able to spend precious time her in that last week, the children worked through their disagreements (though the estranged brother stayed at the back of the room during the viewing) and they now feel a sacred sense of satisfaction that they honored their mother well.

A good, fairly complex story with a satisfying ending.

I paused at the end and reflected to my husband, “You know, my mom couldn’t tell that story.  She can’t tell any current story anymore about what happened today, or what happened last week – unless it was really dramatic (like when her neighbor fell in the hall and broke her hip recently and they wouldn’t let her stand out there and stare at the commotion).  She can only tell stories from long ago and I feel like we’ve heard them all.  She speaks with trite phrases because her brain doesn’t allow her to make new connections and come up with fresh ones.”

We don’t realize how important our short term memory is to us until we’re faced with the lack of it.  A recent study led by Susanne Jaeggi at the University of Michigan, provided evidence about fluid intelligence or the ability to reason and solve new problems independently of previously required knowledge.  It can indeed be improved based on training with a demanding working memory task (think “short term memory” here).    In other words, working to improve your short term memory can improve your fluid intelligence.  So does that mean that a loss of short term memory lowers intelligence?  At least fluid intelligence?  It sounds like it.

So what if your short term memory is shot?  It’s not just a matter of not getting that Mensa invite, it makes it very difficult to be fresh and witty, and tell good stories that not only have folks not heard before, they find interesting; to remember the logical order of things so the plot holds together.  The lack of a short term memory forces us to fall back on sayings we’ve heard or said so many times, we can still remember them – and probably feel GOOD when we do.

According to another recent study cited in the Yale Daily Press, short term memory is also considered essential to impulse control.  Associate Professor and co-author of the study, Colin de Young said, “[The results] showed that the brain activity that predicted how well someone does on working memory tests is explained by the association between intelligence and self-control.”  De Young also said that those who were more capable of delaying gratification consistently showed higher activity in brain areas that are known to control working memory. ^{(Gellman, 2008)}

So not only can we not remember enough things to put together a decent story, we lose our self-control such that we make impulsive decisions regardless of the long-term consequences.  Hmmm.  Not a lot to look forward to.  As the daughter of a mother in the throes short term memory loss, it’s pretty much torture – I hear the same things over and over again and I’m expected to laugh as if they were still funny.  Then I have to clean up after the impulse behaviors – soothing the hurt feelings due to the insensitive remarks, cancelling the three-language learning programs ordered, (Why learn just one language, when you can learn three?), explaining over and over again why match.com might not be a good idea at this stage in life.

Understanding the brain function relationships helps with understanding the behaviors.  The incessant repetition is a result of the lack of short term memory impacting fluid intelligence.  The callous remarks are attributable to the dementia-driven lack of impulse control.  Hopefully, this knowledge will help me and others to be better prepared if and when my brain gets “there”.  Prepared in the sense of understanding my family’s frustration when I just told what I thought was a witty story, and they tell me they’ve heard it a hundred times.  Prepared in the sense that maybe I can apologize for myself ahead of time – that I don’t mean to, but sometimes I just blurt out whatever comes into my mind and I’m sorry if it seems insensitive and callous – I can’t help it – it’s just my deteriorating brain.  And just maybe I will have learned this long enough “ago” to remember it when my short term memory degrades, and perhaps still be able to apply it to my every day life.