The Little Man: Through the Cognitive Ether
The Little Man: Through the Cognitive Ether
He is staring at the wall-mounted TV when I enter his hospital room and it is not clear to me that he knows I’m there.
“Hello, Mr Smith. I’m Dr Haney."
His head slowly swivels in my direction and he nods, “Hi.”
“How are you feeling today?” I ask.
A pause, “Okay.”
“What brings you to the hospital, Mr Smith?”
A long pause, “A stroke?”
A question from a question.
I see many patients with cognitive deficits in my line of work, people suffering from dementia, delirium, psychosis, stroke, intoxication, or withdrawal among other things. Mr Smith is typical—that is to say he is elderly with multiple medical issues and on multiple medications. He doesn’t fully hear, see, or understand what is going on around him, yet there he is, talking to me in his own limited way.
Looking at him and allowing my mind to wander a bit (he doesn’t seem to notice or care), I imagine there’s a little man inside his head. The little man sits in a little chair somewhere just back from the eyes and maybe in line with the ears. It is dark all around him but to the front some light gets in through the eye holes. Sounds come to him from a distance, muted, like in a heavy fog at night. If too much sensory information reaches the little man, he becomes overwhelmed and confused. He is tiny after all.
The scene repeats itself, but now I am able to share the little man’s perceptions as he sits there patiently in the dark.
A shadow passes the eye holes but is ignored. Then a sound comes slow and low like speech in a slow motion reel. The little man leans forward to see what is making the noise. Out of the corner of the eye hole, something is blocking the light from the window. The head rotates and he can see someone standing there. “Hi,” he says.
Now that he realizes a person is next to him, he leans towards that ear. “How are you feeling today?” the shadow person asks. His answer is automatic, socially conditioned, and short—but it still takes some time to be expressed, “Okay.”
Another question makes its way through the cognitive ether, and he prepares to give it his full attention this time. “What brings you to the hospital, Mr Smith?” When it finally gets to him sitting in his little chair it requires some sifting through recent memories. They’re jumbled and not well organized, like things accumulated pell mell over the years and stored in the attic. The lights of an ambulance flash in the darkness around him as a result of his search and he answers, unsure of what he’s found, “A stroke?”
I bring myself back into my own present reality and am relieved to find I am inhabiting my body fully. The muddle and delay are gone, my senses are sharp, and the grasp of my situation is immediate once again. I realize my mind and body may very well be burdened with these limitations in the future, but instead of becoming somber or morose, I remember my grandmother’s voice from my childhood: “How’s my little man?”
This could be read as pretty demeaning to people who are actually suffering from these debilitating conditions.
How can we presume to know what they're actually experiencing, particularly is they have trouble articulating what they're going through?
How about this Kelly Cherry poem as a counterpoint?
Alzheimer's
He stands at the door, a crazy old man
Back from the hospital, his mind rattling
like the suitcase, swinging from his hand,
That contains shaving cream, a piggy bank,
A book he sometimes pretends to read,
His clothes. On the brick wall beside him
Roses and columbine slug it out for space, claw the mortar.
The sun is shining, as it does late in the afternoon
in England, after rain.
Sun hardens the house, reifies it,
Strikes the iron grillwork like a smithy
and sparks fly off, burning in the bushes--
the rosebushes--
While the white wood trim defines solidity in space.
This is his house. He remembers it as his,
Remembers the walkway he built between the front room
and the garage, the rhododendron he planted in back,
the car he used to drive. He remembers himself,
A younger man, in a tweed hat, a man who loved
Music. There is no time for that now. No time for music,
The peculiar screeching of strings, the luxurious
Fiddling with emotion.
Other things have become more urgent.
Other matters are now of greater import, have more
Consequence, must be attended to. The first
Thing he must do, now that he is home, is decide who
This woman is, this old, white-haired woman
Standing here in the doorway,
Welcoming him in.
Copyright © 1997 Kelly Cherry
Hi, This reminds me of a poem that a lady who is experiencing dementia wrote. It's a little long - but well worth a read. Cheers, Ruth
There's a strange little man who lives in my head,
who comes from 'Cloud Cuckoo Land' somebody said.
He wears a white suit and looks very small,
and lives in a room with white stretch and grow walls.
The walls are all filled with invisible slides
that allow him to grab my thoughts passing by.
They open and shut with no whisper or sound
'one minute right there 'then can't ever be found.
He steals such strange things with no visible reason,
- no pattern or system, no predictable treason.
This time it's a name, or maybe a face,
or sometimes a message, or even a place,
or where I put something,
or who I should see,
or why I am here when I get ….. where should I be?
He opens the slide, and snatches the thought,
and hides it forever, no matter how sought.
The fact that I need it doesn't move him one bit,
and he gives not a hoot - lets me look like a twit.
His choice indiscriminate, not caring at all,
can make the results quite enormous and tall,
or totally stupid 'so trivial and small
'just so hard to accept as I stumble and fall.
I forget where I went, or what I did last,
or why I was going, or who I just passed.
I forget what I started, so don't get it done,
and then some time later, get scared by the sum
of things not completed 'not even half done.
I can't work out maths, and forget what I read,
and my thoughts start off straight
and end jumbled instead.
I try to absorb what's important and new,
but it's like someone has turned all the lights off there to.
It's frustrating for all those who just cannot see
why I dither and muddle, and can't get myself free
to be lucid and sharp, and efficient when pressed,
and to cope like I used to, when put to the test.
If they think that I just don't try hard enough now,
and don't WANT to try, or just don't care how,
they should stand at my back and THEN try to see,
how much more frustrating it all seems for ME.
I know how it feels to be sharp as a tack,
and keep up with the thinking and not have the lack
of the logic and recall that makes things so sane,
when a well oiled machine runs so smoothly again.
And I feel just how scary it is when I KNOW
that that stage has now passed and there's nothing to show
for the gaps and the holes in the thoughts that I think
and the actions I take that no longer all link,
and the things that I DON'T do - that makes my heart sink.