As an emergency doctor, one thing I cannot take for granted is whether or not a patient is fully oriented. To assess this, I ask four basic questions: What is your name? Where are we? What is the date? Who is the president of the United States? If the person knows all four answers, they are said to be “alert and oriented to person, place, time, and POTUS.” When they get one of the answers wrong, it is good practice to reorient them.
Just by the math of it, several times per week, a patient of mine answers the POTUS question incorrectly. Jimmy Carter seems to be a favorite. Last week I had a patient tell me that Obama was the president. When I told him that Obama’s term was up, he wanted another guess. He went backward to Bush.
All kinds of things can cause these lapses in memory, from chronic dementia to a temporary head injury. So, some patients are alert, conversant, and are otherwise “with it” enough to understand the gravity of the news I end up breaking to them. It’s actually a fascinating moment, and I have become deeply curious as to what each patient’s reaction will be. Each time now, I stop, take a big breath, look them squarely in the eyes, and then I reveal to them the full, undeniable truth of the situation: The president of these United States is Donald J. Trump. I pause. I do not break eye contact.
For the most part, it isn’t pretty.
One elderly woman let out a startling moan, the kind of sound I would have expected if someone had told her that her cat had died. Another blinked twice when I told him. “Really?” he said, in disbelief. “Come on, doc, you’re shaking my leg.” One patient accused me of playing a trick, although I have not yet been accused of bringing fake news.
Amnesia is a mysterious entity, especially when a patient is otherwise cognitively intact. Newly processed information is often reacted to and experienced sincerely, without an iota of self-consciousness. It provides a fascinating window into the soul. For instance, there is a famous case of the British classical musician Clive Wearing who, because of encephalitis, is said to have the memory span of a goldfish. Whenever his wife enters the room, he perks up and lets out tears of joy and applauds, as if he had not seen her in years, even if she had left the room only a few moments ago. It is a stunning testament to love and a memory-free life.
A similar sort of candor seems to be afoot with the Trump voters I’ve seen. While I’ve been waiting for someone to say “Great! Did they lock Hillary up yet?”—it just hasn’t happened. Instead, I’ve heard more philosophical responses along the lines of “Wow. I voted for him, but he didn’t really win, did he? That’s really something.” Regardless of political affiliation, my patients’ reactions have shown that they find the truth to be far stranger—and more surprising—than fiction.
But in a time when many people find it increasingly difficult to take a mental break from the pace of the news, some of my patients demonstrate an almost enviable indifference. One gentleman guessed that the current president was Al Gore. When I told him that Gore had ultimately lost 17 years ago after a famous Supreme Court appeal and that the man with the nuclear codes is currently, in fact, Donald Trump, he raised his eyebrows, shrugged his shoulders, and whimsically said, “Whatever!”
Ah, to be him for a day.
Disclaimer: The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.