I admit this’ll look like something I’ve made up – or borrowed from Oliver Sacks – but the only changes I’ve set out to make are to de-identify the patient involved. Yes, it goes back to my medical days, to 1988, when I was a junior doctor at a Brisbane hospital.
Some time that year, I was doing a Casualty term when an 85-year-old woman was brought in from a nursing home in a state of confusion.
Earlier that morning, she had screamed when a staff member had turned the TV on in her room. When asked why, she said that there were small men in coloured clothes in the corner playing cricket in a box. There had been a game the night before, and the highlights were being shown on the news.
She knew her first name, but couldn’t account for where she was, or much else. Until the day before, she’d been doing the cryptic crossword in the paper in under 20 minutes most mornings.
From the start, I sensed something different was up. I addressed her as Mrs Gardner and she said, ‘I’m not Mrs Gardner. Everyone’s talking about Mrs Gardner, and I don’t know who she is. I’m Margaret. I’m Peggy.’
So I called her Peggy and she gave me an odd look. I called her Margaret, and all seemed okay. I said my name was Nick Earls, and I was the doctor who would be assessing her. She said ‘Hello Doctor Nicholls’.
We talked about the men in the box playing cricket, and it was clear that she knew about cricket but not about TV. She answered my questions thoughtfully, even respectfully, as though she owed them more consideration than I was used to. I was 24 and to most of the patients I looked like a teenager. I was called a young whipper snapper often enough that year (and once, by another confused person, a young whipper snipper …). But Margaret was treating me as if I was older than her.
I checked the notes. She had come in with an MSQ score of something like 3 out of 10, which meant she was quite disorientated. I ran the questions again. I asked her who the Prime Minister was and she said ‘Mr Fisher, no, Mr Hughes’. I asked her the year and she said 1915. On the MSQ that’s a simple 0 out of 2, but the answers were consistent. I asked her how old she was. She said she thought she was 12. She was certain she was not more than 14, but said that if it was 1915 she was 12. 0 from 3 but, had it been 1915, 3 from 3.
I had stumbled, for the only time in my career, upon a Hollywood movie mental illness. My patient was stuck in 1915 and she was 12, and Peggy. Peggy to her family, but Margaret to old men like me who had never met her before. I had been too familiar in my greeting, too late-20th-century, calling her Peggy and mentioning my first name. I tried to think of all those Merchant Ivory films – A Room With a View, Maurice – and pitch myself accordingly.
Confusion wasn’t supposed to be like this. In real life it’s never this clear cut, as though the shutters have come down 73 years before and nothing since is visible.
She told me about her father, a boot-maker at Highgate Hill, and the rich man at the top of the street who owned a pony and sulky. She talked about the vegetables her family grew in their garden and the food her mother cooked. She told me about leaving England, and how scared she had been about the prospect of the sea voyage. But her father had fixed that. He’d taken her to see the start of the maiden voyage of a huge ship as it left Southampton for America.
She described a black hull with the ship above it painted white, and four funnels with black tops. The ship towered over her on the dock. It was the biggest thing she’d ever seen, and the three blasts it gave on its whistle were the loudest she’d heard from any ship.
I realised she was telling me about maiden voyage of the Titanic, 100 years ago today but, for her, only three years before that moment. I asked if she knew what happened next, and she didn’t grasp what I was fishing for. She told me she and her father had something to eat and went home. And she knew from that day that the voyage to Australia would be safe, and so it had been.
Somehow, her father had kept from her the news of the loss of the Titanic and to her, in 1915 and 1988, it was still the greatest ship afloat. I was talking to someone who had seen the Titanic, but had no idea it had sunk.
I spent far too long doing her admission. I wanted to hear everything I could. Mostly she was fixed in time, but when she looked at her hands they baffled her. They were the hands of an old woman.
She told me about men from her street going off to war. I asked who they were fighting and she said ‘the Kaiser’. Then she stopped, and checked herself before saying, ‘I almost said my son went to war and was a prisoner of the Japanese. But that’s not possible. I’m 12 years old. I can’t have a son. And we’re not fighting the Japanese.’ She shook her head, as if that might clear the idea. ‘It’s bad,’ she said. ‘I think something very bad happened. But I don’t understand.’ We talked about 1915 again, and that was better. Other than that one brief flicker of the 1940s – a memory that wouldn’t stay down – she was entirely a 12-year-old girl in Highgate Hill in World War One.
In the ward, they stopped all medication, and within two days she was her usual alert 1988 self. A new drug she’d been put on a week before had interacted with something she was already taking. In two days she had had to work through 73 missing years.
I visited her on a break, though I had no work reason to. She had the paper in front of her. She was doing the crossword.
‘Doctor Nicholls,’ she said when I walked in. She held up her arms and laughed. ‘I’ve grown into my hands again.’