November 9,2018 – Prompt – circle,cliff, jewel,paper and lamp

Five Innocuous Words
Lloyd Rain Yuma AZ 11/9/18

(Based on Prompt “Circle, Cliff, Jewel, Paper, Lamp”

True story; however, the five words above have been changed from those used in the original interview.

My short-term memory has been failing for several years. This became most noticeable as I turned 80 years old a few weeks ago. Even though I had taken an Alzheimer Test about three years ago, now it was time to get serious about it – take another one and see if anything has changed.

The session went like this. My family doctor’s nurse at YRMC (1) sat in an interview room with me. At the beginning of the assessment she told me she was going to give me five words and would ask me to repeat them sometime later during the interview. No tricks, no subterfuge, no circumlocutions, no pranks. Just memorize five common words and repeat them a while later when asked. She pronounced them slowly and distinctly – Circle, Cliff, Jewel, Paper, Lamp. I used my own memory ploys based upon years as an air force pilot memorizing ten if not hundreds of checklists and then memorizing various lecture templates when I was a university professor some years later.

Checklists for everything especially when flying high speed jets were the essence of survival. They had to be known and, when necessary, activated instantly. Pre-start, Start-up, Warm-up, Radios, Nav instruments, Pre-taxi, Brake checks, Pre-take-off, Post take-off – some of them ten or twenty items long, each of them just to get the aircraft off the ground. Then a slew of others; Control-alignment, Under-carriage-stuck, Bomb-rack release, Speed brake checks, Fire-warning lights, engine failures of various kinds, and on and on and on. No sweat. Five little words. I had them locked within a few seconds, but just to make sure, I used three extra memory enhancement techniques. They were:

1) I repeated them aloud about five times so regardless of their meaning, simply the memory of the sounds, just as if they were a foreign language, would embed them in my memory.
2) I then visualized a picture of a circular butte-like cliff topped with a jewel printed on paper under lamp.
3) I quickly made a sentence containing all five. (“I circled the cliff with my jewel on paper under a lamp.”)

All this only took perhaps ten or fifteen seconds and I nodded to my nurse, “Done.” knowing that I probably wouldn’t forget those words for at least a month.

We went on with the interview as she asked me a variety of standard cognitive tests (I was later to discover that these were called the “30-question test”, standard initial trials to ascertain if more comprehensive tests should be done). Easy stuff. Other typical questions; my birthdate, seventeen plus 19, day of the week, name of a ship that had sunk, my middle name, 43 times two, graduation year from high school, the last movie I saw, last book I read, recite a short nursery rhyme, and a bunch more, all of which seemed innocuous – geared for the mind of a five-year-old.
And then we were through. But just as she was gathering her paperwork to leave, she said, “Oh, and by the way, what were the five words I asked you to memorize at the beginning of our chat?”

So, I said to myself, Ah-ha. Easy as pie. And I rattled them off as if I were reading them right off the page…except when got to the fourth word…it was gone. It was totally gone. I was stumped. I asked for more time. Placed my head in my hands closed my eyes and repeated the word sentence that I had constructed. Nothing. I mentally repeated the five words in order but the forth was gone. I couldn’t believe it. I tried to recall the mental picture I had concocted. Nothing there either. It was as if someone had reached into my head and plucked that work right out of my brain. I smiled weakly at the nurse and ask for another minute. She said, “Certainly, no hurry. Take as much time as you wish.” By this time my skin was clammy, bordering on perspiration. I stood up and turned circles as I recited “Circle, Cliff, Jewel, Lamp. I’m missing one, aren’t I.” I pleaded. But it was gone. It was as if I had only been given four words, not five and they were all there in perfect order – except for one. I tried standing, sitting, looking at the ceiling, tapping my foot, mentally repeating the first line of the French National Anthem, my very first truncated pre-landing check in a conventional aircraft, gear-fuel-carb-mix- pins-flaps-brakes-seatbelt-radio-lights, Mary had a little lamb, – my fists were tight by this time from gripping my hands. Nothing came. That word was just gone. GONE. Nothing but silence. Finally, I gave up. I told her there was another word but I just couldn’t recall it at this moment. She smiled, thanked me, said goodbye and left the room.

I sat there alone, fuming, angry, devastated. Suddenly I realized that I was now waiting for the bad news. I knew I’d remember the word by the time she came in. But I couldn’t. It seemed like an hour but it was only five minutes later that my Doc came in to discuss my condition. All was well, she said. Nothing to worry about. But I was sitting there rigid waiting for the other shoe to drop. And it did. But not exactly what I was expecting. Not disaster. But not pleasant either.

She never even mentioned the missing word. What she did say, was a question. She asked, why did you want to take this test? And I spewed out a litany of my current memory failures. Walking into a room a forgetting why I went there. Forgetting where I left my coffee, my car keys, my phone. Forgetting to close a window at night, forgetting to take out the garbage. All small stuff but irritating. One time I even switched the last four digits of my address for the last four of my phone number (my phone number last four are 0405 and of my address is 4067, and after I had given what was supposed to be my call-back number, I realized that I had actually said 782-4067! Same thing had happened one time when I gave my social security “last four” as the “last four” of my phone number.

She then gave me the good and bad news. I had scored 30 out of 30 three years previous, and my score today was 27 of 30. Not bad. But definitely worth following up. I asked, based on that scale, what kind of score would indicate a serious deficiency. The answer, anything less than 24 would require additional consideration. Perhaps a more intensive test.

In the final analysis, she said there is nothing to be done at this time. Live your life, be happy.

She diagnosed me as having age-related, mild cognitive decline. “(Stage 2 on the 7-Stage CGS Scale (2) – if you need to know the numbers).”
“But,” she said, we’ll do the test again in a year or two and see how you’re doing. In the meanwhile, use notes. Mostly Post-It notes and put them in those places where you think they’ll probably be of the most use.”

A few more words and that was it. We hugged “goodbye” (our usual substitute for a handshake) and agreed to meet again in six months.

Now, every time even the tiniest memory lapse appears, I attribute it to age-related cognitive degeneration. One time I forgot to feed the dogs for a couple of hours. When I realized that I hadn’t fed them I was mortified. Note on cupboard. Note to watch SNL – Note to buy a John Le Carre book – note on computer to look up keyboard replacement. Notes everywhere: buy toilet paper, Tina’s birthday, dog shot appointments, buy gas, must see movie, check on public record request from Washington, return book to library, call daughter re Korea trip, checklist for leaving house on garage door (wallet, phone, gum, glasses, address, etc.). And on and on. It helps. But it doesn’t make me happy.

Fifty-five years ago, I crashed a jet aircraft due to pure stupidity. No harm done. (except a multi-million-dollar aircraft up in smoke). Now I wouldn’t trust myself to memorize a simple three-item check for fire-warning-light display because when that happens you don’t have time to walk around a room with clenched fists trying to recall a simple patch process. You either know what to do instantly or you’re dead. Now I barely trust myself to drive. Now I know that the devasting day I have to turn in my driver’s license is creeping up from behind and it could grab me at any moment.

And writing. One of my strongest skills – the English language. My use of the Thesaurus and Word Web and Rhyme Zone are increasing noticeably. And there’s not a damned thing I can do about it. Yep, that word recall day and that driver’s license day, which used to be way beyond the horizon, are now just around the corner.

And every day I’m watching for them. Watching very closely. Constantly looking over my shoulder.

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