What You Don’t Know About Memory Loss and Urinary Tract Infection
“I don’t know why I’m here.”
“”You’re here because you don’t know why you’re here.”
“Did you drive”
“I did.”
“I don’t know why I’m here.”
On Wednesday afternoon my wife, Mary, woke from a nap unable to keep a memory for more than twenty seconds.
I had asked her about an upcoming visit from her sister; she was puzzled, verging on angry, as she had no memory of that visit. After wrestling with that issue to no conclusion, I asked if she remembered calling her sister about the visit. Again, what the hell was I talking about? I then asked if she remembered going out for lunch. Nothing. Did she remember the Memorial Day picnic with friends? Nothing. Blank.
I’d seen movies and read case studies like Oliver Sacks’ “The Man Who Mistook His Wife for a Hat”, but nothing had prepared me for an exchange with my wife, who was absolutely herself, sharp, funny, logical and at the same time unaware of anything beyond the most immediate conversation.
She quickly agreed to a trip to the Emergency Room, confessing that she felt somewhat muddled, perhaps half way between sleep and full consciousness. She repeated that observation throughout the trip to the hospital. Caught in a loop. On the other hand, when I said we were on our way, she immediately asked me to go to the more sophisticated of our local hospitals. When she had dressed, even as her condition was increasingly obvious, she took off her ring, apparently anticipating an MRI.
“Where’s my ring?”
That question joined the pronouncement of demi-sleep and hope for the better hospital. She couldn’t summon the name of the hospital she preferred, but recognized it when I identified it.
We were hustled into an examination space at the more sophisticated hospital’s Emergency Room and as I finished the paperwork, she was wheeled off for a CT scan. Mary was unruffled by the flurry of activity, frequently laughing at the absurdity of her inability to connect with the present moment. I was terrified that cancer might have returned and metastasized to her brain.
The scan was clear. A chest x-ray was clear. No answers forthcoming.
She was admitted to the hospital, but no rooms were available, so she was hooked up with wires and an IV port and left on a bed in a supply room at the back of the ER. We spent the next five hours repeating the same conversation again and again.
“I don’t know why I’m here.”
“Your memory seems to be impaired.”
Laughter. “No kidding.”
“Where is my ring”
“You took it off before we came.”
“Is there metal in my scrunchie?”
“No, it’s fine.”
“Don’t they want to test me?”
“You had a CT scan.”
“No, when?”
“When we first arrived.”
“Did you drive?”
“I did.”
“Is this the hospital?”
“Yes.”
“Did you drive?”
And so on.
She was in a great mood. Joking with doctors and nurses. Telling a doctor she wouldn’t remember him the next time he came by. Telling another doctor she might remember his name because it was the same as an artist she admired. Forgetting that the doctors had stopped in. Announcing that she used to be an EMT. Apologizing then telling me that when she had a concussion as a girl, she apologized over and over. Announcing she used to be an EMT. Apologizing.
She was in every way herself, aware that her memory was compromised, but not anxious, simply perplexed. Amused. Smart.
A nurse checked her vitals and told us that her tests had revealed a urinary tract infection.
“How did they get my urine?”
“You walked to the bathroom with a nurse.”
“How did they get my urine?”
About five hours into our stay, a third neurologist stepped in to question Mary. I’d noticed what I thought was a slight improvement in that she referred to events and conversations with more fluency. The doctor took her through the stroke protocol again (“show me your teeth.”) and was quick to see that she had no symptoms.
“What day is it?”
“Wednesday.”
An hour earlier she could not have answered that question.
“What month is it?”
“I don’t know.”
“Do you know where you are?”
“At the hospital.”
“What month is it?”
Mary looked at me.
“Don’t look at him,” the doctor joked. “His memory is fine.”
“Maybe June?”
Again not possible an hour earlier.
“We gave you an antibiotic about an hour ago. There is a possibility the urinary tract infection is the issue. If we don’t see improvement, we’ll move to the MRI.”
The conversation with the doctor lasted about ten minutes, and I thought Mary might have been slightly more responsive than she had been when we arrived.
Hope. Guarding against hope.
I left Mary at the hospital and returned home to take care of our two dogs. Didn’t sleep much. In a stunning turn of events, I woke the dogs rather than their waking me and spent some time feeding and exercising them before leaving for the hospital again.
I have a friend whose advice about worrying has always been, “Why don’t we wait until we get there?” Great advice, but it’s not easy to keep from projecting a dark future. On the drive to the hospital I wept imagining Mary unable to do what she has loved doing. She trains dogs, and owners, explaining dog language and gestures, helping owners connect with their dogs. Many of her clients have found training for dog agility competition, a wonderful pastime and a great way to bring joy to their dogs while they become more skilled in handling their pets. Mary’s always been a teacher, no matter what the situation might be, and she has a particular gift in her ability to understand how each student learns, adapting her instruction to each distinctive challenge.
I couldn’t imagine how she could do what she loved without memory.
I also couldn’t imagine not having our conversations. I know a lot about where her feelings are, and she understands me in a way that allows me to share myself as I cannot with anyone else.
“Wait until we get there.” Hope.
When I walked into the ER very early the next morning, Mary was back.
There were a few glitches, very much like those of a person coming out of deep slumber, but she was able to remember everything I told her about the previous day, and able to remember which clients were due to arrive for training and how to make contact with each of them.
“Where’s my ring?”
“You took it off before we left the house.”
I must have worried about getting an MRI.”
“You took off your earrings too.”
“I wasn’t wearing earrings.”
“Ah.”
“I hope I made you drive.”
“You did.”
“I’m glad we came to this hospital instead of the others.”
“You asked for the more sophisticated hospital.”
“I couldn’t remember the name, but I knew I wanted to be here.” She looked around. “This reminds me of the room the doctors on Gray’s Anatomy use for a quickie between operations.”
Mary is still taking the antibiotic. She’s exhausted and physically a bit wobbly, but she is entirely herself with a memory now restored to minutes before we had the conversation that convinced me that something was wrong. It happens that I had been teaching a course in which we spent some time talking about brain activity. I’d made the point that we can put electrodes in a region of the brain and observe activity, but we don’t know how we fall asleep, why we sleep, why we dream, what sleep actually does. I’d said that almost all of what we guess about the brain we guess because something has gone wrong; a man mistakes his wife for a hat.
It turns out that among women over the age of sixty, urinary tract infection and dehydration can bring on short term memory loss. I say ,”over sixty”; articles describing the phenomenon use terms such as “senior” or “elderly”. Mary is over sixty but not to my mind elderly. Of course, I’m ten years older than she is, so my perspective could be skewed. The good news is … well, there is a ton of good news, the most obvious being that although she had amnesia, Mary is not suffering from dementia. It could have been much worse; I have discovered that in some cases, a person can hallucinate or become angrily paranoid.
Oh, and modern medicine cannot explain why the urinary tract infection affects the brain. The immune system system is compromised, they say. Ok, but urinary tract to brain?
Mine is not to wonder why but to simply be grateful that two tablets a day have returned Mary to me and to the many people who consider themselves lucky to know her.