Conduction

His face a mask of confusion, the older man sat down, easing his bulky upper torso carefully into the seat. He had walked in tentatively, shuffling in sandals, his feet and lower legs marked with accidental scuffs. Intimidated and alone, he looked around at us, apprehensive and not entirely sure what to do in this new situation.

The interview began slowly, the questions non-specific and general. He was in the hospital for memory loss, he self-reports, and we nod encouragingly. He told us he had trouble thinking. He would lose his thoughts. Each question came back with its own short answer, or merely a quiet request to hear it again, because he had forgotten.

We all looked at him, assessing his frame for signs of what had caused his problem. His barrel chest indicated potential emphysema. His swollen abdomen told us liver failure. It could be alcoholic damage, either direct or from hepatic emphysema. It could be alpha-1-anti-trypsin deficiency liver disease. We all sat there, thinking the mechanics through in our fact-sodden minds. Until someone asked him his children's age. For five long minutes he couldn't remember. For five long minutes we held our breath. He finally answered, his mind able to dig out the autobiographical information that should have resided right on the surface of his thoughts.

His dementia is conductive, the information of his life not gone, but inaccessible, blocked off behind a decaying network. He knows this, he can sense the absence of thought, the lack of interplay between his current situation and his wealth of acquired experience. He terrifies me, his condition a mirror to my worst fears. He lives in my nightmare, lost in his mind and completely aware of it. We have seen so many things, so much pain, and so much triumph. But this slow degeneration, this quicksand of conductive impotence, it cuts through the defenses. It makes me scared.