Writing on Water

December 29, 2013.

It was still dark as I was walking the unlit path to my friend’s house for our weekly meditation meeting. Suddenly, my feet went out from under me. For a moment, I was horizontal in the air. Then I crashed down onto the pavement, landing on my back. Thank god, I had the reflex to clench my neck tight and hold my head forward. I could’ve landed on the back of my head and cracked it open like an egg. I looked down at the sidewalk. I’d stepped on a patch of glassy black ice. For the next couple of days, my body was sore from head to toe, but at least I didn’t seem to have the symptoms of concussion.

January 2, 2014.

“Talking about my anger now doesn’t seem right to me,” Sheila said angrily. The session was going poorly. Slowly but surely I was being dragged into battling with her about our therapeutic plan, which I was actually having difficulty remembering clearly. I thought she was supposed to be opening up to her husband Bob about her accumulation of angry feelings. She was resisting, and I was pushing despite feeling a little lost about why it mattered so much.

Why aren’t I adjusting? Why am I forcing this? I wondered.

“I understand, Sheila,” I said to her, “but I think there are always reasons to postpone, and I’m wondering if perhaps we should move ahead anyway. What do you think, Bob?”

“Actually, I’m with Sheila on this,” he responded. “I don’t think you’re really hearing her.”

Now he was annoyed with me, too. I didn’t know what was going on with me. I usually know better than to try to impose my plan on a couple united in their resistance. I fumbled through the rest of the session, feeling really off my game.

January 11, 2014.

I opened the door and there were two couples sitting in my waiting room. With exaggerated courtesy, I bowed to them both, and they laughed. Then I stepped back into my office and closed the door. I quickly checked my appointment book and then emails. Sure enough, I’d double-booked. We all do it every once in a while, but this was my third scheduling error in as many days. Despite a smiling veneer of playful fallibility and an offer of a free session to the couple I had to send away, I was thoroughly shaken.

January 28, 2014.

I received an email from a client that read, “I think you sent this to me by mistake.” Below was a note to a friend of mine. My mistakes were showing up everywhere, and they weren’t insignificant.

January 30, 2014.

The next time Bob and Sheila came in, they were still upset by our prior session. My only goal was to reconnect to them and repair our relationship. Sheila said that I was so “not with it” in the last session that she actually wondered whether it was symptomatic of early-onset dementia. I knew she was still angry, but she was also a geriatric social worker, who knew the signs—which amplified my concern about what was going on with me.

I’ve been through a lot of serious health issues, including stage-4 cancer, a stroke, and heart bypass surgery. But this was actually much more frightening. For a month, I’d been screwing up my logistics: double-booking clients, confusing dates, not returning phone calls, and losing emails. That was bad enough, but worse was being muddled in a session or, as with Sheila and Bob, not being able to stay emotionally and mentally present. It wasn’t like me. Maybe Sheila was right. I had to do something, but I dreaded it.

February 5, 2014.

“Honey, why are the eggs in the freezer?” my wife, Kate, asked in a teasing way. I froze.

“I don’t have a clue, and there’s nothing funny about it,” I barked. We both knew I’d put the groceries away the day before.

It was happening at home, too: an increase in forgetting, misplacing things, losing my train of thought, entering a room and not remembering why I was there. All the normal symptoms of a nearly 70-year-old brain were becoming increasingly frequent. But eggs in the freezer? I was anxious and embarrassed about it, which made it even worse.

Many of us of a certain age live with the fear of early-onset dementia, cognitive impairment, Alzheimer’s—call it what you will. Incrementally becoming a vacant body to be tended, fed, changed, pitied was my worst nightmare.

Lying by my side in the dark, Kate said firmly, “You know, we have to get this checked out.” The egg episode had freaked her out.

“Well, what about the fall?” I said. “Even though I didn’t smack my head, my brain might’ve snapped backward against my skull, like whiplash in a car accident.”

“Maybe the MRI will show some post-concussion effects,” Kate replied, “but we have to consider everything.”

I knew what she meant by “everything,” and I knew she was right. I needed to find out whether this was transitory or progressive, whether I should even continue to practice, and if I did, how to do so safely and responsibly for my clients. I was scared.

February 23, 2014.

“I can’t even concentrate on my breath for a second when I’m meditating. I literally feel like I’m losing my mind,” I complained to my meditation teacher, Narayan.

She responded with a kind and gentle smile, and said, “Now is the time to remember that we’re not our mind.”

I nodded in my best imitation of humility and acceptance of the conventional Buddhist wisdom, but I felt like screaming at her, “Wait until this happens to you! You have no idea what this is like!”

March 12, 2014.

“There are three microbleeds that show up on your MRI,” Dr. Goodman said. “It’s impossible to tell whether this is from your fall or your heart surgery. There aren’t any indications of postconcussion effects, but they might have already resolved. From the look of the neuropsych testing you had last week, you don’t have any signs of a progressive disease like Alzheimer’s, but you do have quite a few deficits that you’ve probably always had in the nonverbal/spatial areas.”

“I sure have,” I interjected. “I’ve always called it my Swiss cheese intelligence. The big chunks of cheese are premium grade, but there are definitely holes.”

He chuckled. “Yes, well, it’s unclear whether these microbleeds or a concussion have exacerbated that part of your mental functioning, which could help explain all the errors with your calendar. As to a diagnosis,” he went on, “I’ve coined a term for this pattern: subjective cognitive impairment. The therapy sessions where you weren’t your normal, clinical self and the rash of double-booking happened in the weeks after the fall. Confusion is a normal postconcussion symptom, and it seems like that’s mostly cleared up after the first couple of weeks. But it also seems that you’ve been acutely aware and self-conscious about each “senior moment,” even though they’ve been mostly of the normal, aging variety. Your anxiety has been extremely high, and that’s probably intensified the symptoms. Intense fear about mental errors tends to increase them.”

“I do feel assaulted by an army of senior moments,” I said, trying to be light. “But does this mean that it’s okay for me to continue to see my clients? I don’t want to do them any harm.”

“Well, from what you said, it seems like the quality of your clinical presence has returned,” he replied. “So I’d cautiously continue working and regularly check in with a colleague for a few months. You should also develop a variety of mnemonics to help you stay on top of your appointment book.”

“Believe me, I’ve already started that,” I said. “Now when I confirm an appointment, I write or say, ‘It’s in my book’ and then I double-check my book to make sure it is. So what’s next?”

“You might consider medication for your anxiety and a repeat neuropsych exam in the next six to nine months.”

“I’m willing to try some medication for a bit, but I’m not sure I can do that test again,” I told him. “Finding areas where I totally flunked was really disturbing.”

“I understand, but if there’s anything progressive, the retest would probably show it.”

My stomach twisted into a knot. “Great, this plan is doing wonders for my anxiety. Can I have some medication now?” I muttered, only partially joking.

March 29, 2014.

When I had cancer and, later, heart surgery, my illness was obvious, and I talked openly with my clients about it and the impact on them and our therapy. But now, nothing about my condition or what to tell my clients was obvious.For folks I knew had been affected, like Sheila and Bob, I explained that my postconcussion confusion had contributed to my screwups with being fully present in session. I reassured them I’d been fully evaluated and didn’t have any detectable dementia. I gave some folks free makeup sessions for botched appointments or scheduling. For the rest of my clients, I stayed on high alert but didn’t say anything explicitly unless my limitations showed up in our work. Fortunately, I was able to tell when I was off, and I could gather myself. Also, I enlisted a good friend and colleague, Barry, to talk cases over with me. And I stopped taking new clients. I knew I had to work less hard.

April 5, 2014.

“So how’s it been with your clients this week,” Barry asked at the beginning of our weekly check-in. He’s an old, dear friend but now it felt a little like he was serving as my probation officer. I found myself wanting to reassure him about how on top of my cases I was in order to extract some measure of reassurance back from him.

I started to respond to his question and then stopped. I looked out the window. I felt the sting of tears. “I don’t know,” I admitted. “As time has passed, I’ve begun to get used to a simple truth: one of two things will happen. Either my functioning will improve with extra efforts, I’ll be more reliably present in my sessions, especially now that I’m cutting back, and I’ll make peace with having a less-reliable memory—or my mind will progressively slip more and more, and I’ll have to learn how to live in the shadows of myself until there’s no me left to notice that I’m not here.” Tears rolled down my cheeks.

Barry leaned toward me. His eyes filled with concern. “You must be pretty freaked out,” he said.

I sobbed, then suddenly, felt a wave of surrender and acceptance come over me.

March 16, 2015.

It’s been about a year. Thank god, I’ve gotten better. Not all the way—I still have to be a zealot about scheduling accurately—but by cutting back my clinical hours to half of what they used to be, the quality of my clinical presence and concentration has returned. My connection to my clients and passion for our work is fully back, and somehow, I’m beginning to be less anxious about not being as sharp and quick as I once was. Now I can look my clients in the eye and say, “You know that I have to write that down because my aging memory isn’t as good as it used to be.”

But despite doing better, this past decade of health crises has taken its toll. I’ve had a crash course in what all of us will face in one way or another as we age. Cancer, heart surgery, and this terrifying bout of cognitive impairment have brought home the fact that we all live on borrowed time. I knew that, yet somehow I didn’t expect to feel so diminished by it, to feel so suddenly and truly old, a little like the grizzled guy who stares into his bathroom mirror every morning and says, “I don’t know who the hell you are, but I guess I’ll shave you anyway.”

April 1, 2015.

“You have to understand, Maureen, that Jack’s irritability is because all day, every day, no matter how hard he tries, he forgets something, or gets confused. It’s crazy-making,” I explain. “Here’s a guy who was one of the best surgeons of his time, and now he forgets how to open a locked door. Of course it really pisses him off.” I turn toward Jack. “Am I getting it right, Jack?” I ask with a smile.

“Couldn’t have said it better myself,” he said, the old twinkle in his eye still gleaming despite the increasing effects of his Alzheimer’s.

Well, here’s one clinical population I can really help, I thought to myself. Indeed, more than ever, I really “get” how assaulted by aging some of my clients feel and how frightened they are. I’ve walked a mile in their shoes and appreciate even more deeply that there’ll be more of those miles to come.

April 28, 2015.

“Do you remember saying to me last year, when I was a complete mess about my cognitive impairment issues, that I wasn’t my mind?” I asked Narayan.

“I sure do,” Narayan smiled. “As I recall, you were pretty bothered by that comment.”

“Gee, I thought I’d hidden that,” I winced. “I was trying to be a good student.”

“I could see it in your eyes,” she said gently.

“Well, I’m better now. I see that what you’ve been teaching us all these years is the simple truth of being fully present with what is, no matter what it is, even a declining mind.”

“Yes,” she said. “It’s the heart of our practice to learn to embrace the final stages of life and all its challenges. Even in the face of our death, we learn to bow and even smile at life’s unfolding. It’s now that we can truly see and accept that our lives are, and always have been, simply like writing on water.”

I drove away from the meditation center, hitting snarled stop-and-go traffic. Normally it would’ve made me agitated, but today I felt calm, peaceful, thinking of it all being “like writing on water.”

Suddenly, I remembered when I sailed across the Atlantic alone in the summer of 1982. Each day I’d use my sextant to track my course and mark my tiny X on the great North Atlantic Ocean chart. One day, I put my X in the middle of the chart and paused. I was truly a speck in the vast sea. I was more than 1,000 miles from land, from anywhere. For a moment, I felt trapped and panicked. I knew a strong gale was inevitable, and at sea, you never know if you can ride out a storm.

So too, this past year, I’d felt consumed by my fear. There was no place to run, no place to hide. There still isn’t. But now, I feel calm and steady. Now, when I see that old guy’s face in the mirror—my face—I just smile and say, “Well, I guess I’m going to shave you today.”