72/M

He was brought to the emergency department by his daughter after he wandered away from his aged-care facility.

He had fever and loose stools. A nurse had found him asleep in his own feces and called his daughter, who collected him and drove him across the city to us.

He seemed, against expectation, remarkably well.

He denied the fever and the diarrhea. When I asked what had happened, he regarded me with a mild, almost courtly irritation, as though the entire episode had been inflated by others beyond any reasonable proportion.

He had Alzheimer’s disease.

His daughter supplied the history while he sat quietly on the bed, watching the two of us with the detached attention of a man observing a performance he had not chosen to attend.

Then he looked at me.

“What’s your name?”

I told him.

“Where are you from?”

I answered.

He turned to the resident beside me and asked her the same questions, with the same unforced curiosity. When she said, “Mangalore,” his face lit up. “I studied in Mangalore,” he said. And after a brief pause, “I like Mangalore girls. They’re beautiful.”

We laughed. He laughed at our amusement too.

The glare and clutter of the emergency department dissolved, for a few seconds, and the place became an ordinary room in which three people had just met.

We began the ordinary work. Intravenous fluids, blood tests and supportive care. He continued to talk while we worked. He asked my name again. I told him. He asked where I was from. I told him.

A few minutes later, the questions returned, identical in wording and tone, carrying no sense that they had already been asked and answered. By the third or fourth repetition, I understood there would be no sudden recollection. The question would simply return. And each time, he really meant it.

I stopped trying to force continuity upon the conversation. He asked and I answered. Then he forgot.

Minutes passed.

He asked the same questions again.

We are accustomed to thinking of memory as a ledger of the past, a more or less faithful archive of what has already happened.

It is more than that.

Memory allows one moment to belong to the next. And without it, every encounter stands alone. A person appears. The person disappears. Then, inexplicably, the same person appears again, as if for the first time.

For him this seemed simply the arrangement of the world. Yet there was no great emptiness. He remained interested and laughed easily. He remembered Mangalore: a feeling, a preference, a lingering fondness for beautiful girls from a particular city on the southwestern coast.

I found myself wondering what remains of a person when that machinery begins to fail. The careful architecture we spend a lifetime assembling: names, dates, faces, the long narrative threads of identity. Maybe those are the first structures to collapse.

What survives can be smaller and stranger: the capacity to be amused, to recognize beauty, to meet a stranger with curiosity. His memory could not hold my name, but something in him could still make a joke.

His fever settled. The investigations were reassuring. We discharged him on oral medication, and his daughter returned. As they were leaving he turned toward me once more.

“What’s your name?”

I told him.

“And where are you from?”

I told him.

What unsettled me was not the forgetting itself, but the recognition that meaning does not require permanence. Why do we believe a moment matters because it will be remembered?

The daughter smiled at me, and took his arm. They walked towards the door. I watched them disappear.

He would forget me.

But I would not.

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More soon.

Another moment.

Another reminder that we are still, somehow, human in all of this.

Yours,

Adarsh Nath

Letters from the ER