Two days ago I experienced an episode of transient global amnesia (TGA). It is a most curious syndrome.
A part of the brain is disabled so that one’s immediate memory is permanently lost during a limited period of time. Yet, another part of the brain is aware of this sensory loss. During this episode I kept asking my wife Eva (as she later told me) why was I here, why was I holding a bag of gardening tools, and other questions regarding my immediate environment and circumstances.
This approximately thirty-minute episode occurred while Eva and I were returning from work in our small plot in the communal garden, walking toward the entrance to the building containing our apartment. My memory stops around 100 meters from the door of the building until I was talking with an EMT in the ambulance, parked outside. According to Eva I was aware the ambulance was coming and I left our apartment to wait for it in the driveway.
My robot had taken over.
G.I. Gurdjieff was of the opinion that we should try to remember oneself. He believed that during most of our lives it is the machine or the robot who sees and experiences whatever is there.
Gurdjieff … asked, “Why should we experience so much, only to forget it immediately afterwards? Half our experience rolls off us like water off a duck’s back. Yet experience is food, whose purpose is to enable is to evolve.”
Lots of what we do is carried out without proper thought, almost with robot like routine. I realised this (recently) when I had been out somewhere in my car and then for a moment wasn’t too sure where I was on my journey. I had no awareness of having driven a certain distance. (Source: Mike Perry)
I was examined by the EMT in the ambulance, and then by the emergency department physician at the Akutmottagningen of Sankt Görans Sjukhus. I had become mostly conscious by the time I underwent the EMT exam (that is, able to retain most of my current experiences in conscious memory), and felt the trip to St. George’s Hospital and my examination there to be an interesting adventure. Eva accompanied me the whole way, including during the CT Scan of my head and its contents.
I seemed to be in no immediate danger, but the protocol is to observe the subject (now a hospital patient) overnight, and to await the results of the scan. Eva left as I was escorted to the observation room (No. 11) of the Neurology unit on the fifth floor, to cohabit with three other patients. It was a comfortable enough bed, but I was restless and spent most of my time in the cafeteria across from the nursing station. Good food, snacks, juices, and coffee were available, and in the traveling library bin there happened to be a thriller in English I could read (Children of the Revolution, by Peter Robinson).
I was admitted to the Neuro Unit after the day shift had gone home, so there was late-hours staffing until 0700 the next morning. I was aware of several others as mobile as I, but we kept to ourselves until breakfast time in the cafeteria.
TGA can be viewed as an illness of transient hippocampal insufficiency. It is a clinical syndrome with no clear aetiology identified. Most symptoms are transient and resolve within a few hours. The incidence of TGA is approximately 2.9 to 10 people per 100,000 worldwide. It typically affects patients between 50 and 80 years of age, at an average age of 61. [Note: I am in my 81st year]
The clinical presentation of TGA is anterograde and partial retrograde amnesia lasting less than 24 hours without any other neurological or congestive symptoms. Most cases show complete resolution of symptoms within a few hours from onset of symptoms. Brain CT scan and conventional sequences of MRI brain show no abnormalities. The underlying cause of transient global amnesia remain unknown. There appears to be a link between transient global amnesia and a history of migraines, though the underlying factors that contribute to both conditions aren’t fully understood. [Note: I experience migraine auras without headache periodically and, perhaps significantly, more than usual for 36 hours around a week before this TGA incident].
As alluded above, after the day shift began two other patients under observation gathered at the table where I was eating my breakfast. They were men, one between 65 and 70, the other perhaps nearer my age. Both were world travelers with many stories to tell. We told each other about our condition and experiences, and complimented members of the staff who visited us for services (food, medications, information—they unexpectedly gave me my daily dose of blood pressure medication which I had not brought with me.)
After some waiting for the doctor to attend the more seriously affected patients, we were, one by one, told we could go home. One fellow, however, was told to return the next day for an ultrasound examination of his carotid arteries, which indicated to me that he was suspected of having, not TGA, but TIA.
A transient ischemic attack (TIA) is like a stroke, producing similar symptoms, but usually lasting only a few minutes and causing no permanent damage.
Often called a ministroke, a transient ischemic attack may be a warning. About 1 in 3 people who have a transient ischemic attack will eventually have a stroke, with about half occurring within a year after the transient ischemic attack.
Of course, I hope that the ultrasound scan will rule out such a possibility for my new acquaintance. He has said he will contact me by email to invite me to his place in the country for some Mosel wine and conversation. The other fellow seemed interested in reading one or more of my blogs and I may well hear from him also. I hope so.
This experience has brought home to me some notion of the mysteries which remain about the brain and its functions, despite marvelous advances in the various medical sciences. Also, I now have direct evidence of the “robot” that G.I. Gurdjieff identified and warned against relying upon–that is, to be consciously awake to everything one does. (Read Colin Wilson’s “G.I. Gurdjieff: The War Against Sleep).
In addition, I am more alert to possible memory lapses, no doubt overly much right now, to be alert to my aging neurological functions.
As one ages, one’s thought processes may appear, to younger people, to be slow or faulty. Willa Cather had an answer to that notion in her book, Death Comes to the Archbishop:
Sometimes, when Magdalena or Bernard came in and asked him a question, it took him several seconds to bring himself back to the present. He could see they thought his mind was failing; but it was only extraordinarily active in some other part of the great picture of his life–some part of which they knew nothing.