THE CONFABULIST’S DAUGHTER | Lauren Burgoon
“I need to speak with you about an incident,” declares the director of the dementia facility where my mother lives. “Your mom reported her foot hurts and when I asked her what happened, she said you stomped on it yesterday on purpose.”
I start to chuckle—a reaction the director most pointedly does not share. I understand. For her, this is about protecting her resident, exploring whether she was hurt purposefully.
For me, this is just another confabulation, another tall tale woven in my mom’s confused, and confusing, brain and proclaimed with conviction. It’s just one among nearly three decades of sometimes outlandish stories.
There are times she tells everyone about my sister’s nonexistent back tattoo. Or that my nephew is starring in “The Man of La Mancha” on stage. She is always just back from a trip to Orlando or San Francisco. She’s seeing Billy Joel in concert tomorrow. Or, memorably, when I was 21 and she told my elderly grandfather I was getting inseminated next week and planned to have a baby: “Lauren is going to get ‘spermed,’” she announced to my aghast grandfather.
The root of these fictions are the aneurysms that ripped through her brain in 1996, leaving a trail of destruction. Aneurysm No. 1 went off like a popped balloon, the posterior cerebral artery finally giving way to building pressure, bringing my mom to her knees on the New Jersey boardwalk and the salty sea wind carrying away her peripheral vision for good.
Aneurysm No. 2 exploded the basilar artery and stole my mom’s balance and eventually her consciousness. Then the worst of the trio, aneurysm No. 3. Just before the clips and coils and shunts of neurosurgery were in place, the aneurysm cratered a hole in the anterior cerebral artery, flickering the lights to her prefrontal cortex. It was a farewell to social graces, to insight, to her short-term and working memory and almost to her life.
In the span of two hours, my mom’s future was stolen from her. Memory is what makes us who we are. Our triumphs and traumas, the little moments that shape who we are and the big moments that can change our life’s trajectory. It all relies on memory. When that was taken from her, my mom turned to the stories in her head.
At first, her long-term memory was intact. After nearly twenty years as a labor and delivery nurse, she could spout off telltale signs of fetal distress, how to calm nervous parents and the curriculum for her prenatal classes. She vividly remembered high school proms and her wedding day and my birth, and I could rely on these stories of the past even if I had to remind her not to have a second breakfast or to stop running the dishwasher five times a day.
But as her ability to form new memories stretched into years, her old memories started to contort. It snuck up on us, a fact exaggerated here, a new detail we knew to be false inserted there into stories. Soon, she was making up stories wholesale and our family had to confront this new reality of someone who lives primarily in the moment with little memory to guide her actions, thoughts and feelings. After a brain scan, we got our answer about why: the telltale signs of cortical atrophy and widened sulci of dementia. The saving grace of this cruel diagnosis is that my mom doesn’t remember it.
I recently made it through what we morbidly call The Year of the Aneurysm in my family. My mom was 42 when her life changed for good. I made it to 43 with no brain bleeds in sight, but a year instead spent on reckoning with what it means to lose yourself at such a young age. The introspection is heightened because this is the year I transition from resident to pediatrician, by far the oldest in my residency class and the next step in my second career.
There is a lot I wish I could ask my mom about this and so many other things. Was I a child who took big risks? What does she think of changing up my entire life for medicine? What does she think about the state of the country and our place in it? What does she think about her life now?
But I’ll never get the answers from my mom. She lives minute to minute as both ends of the spectrum of memory darken. To engage with her, I also have to drag myself to the here and now alongside her. Having the same conversation three times in the span of five minutes has built a well of patience. Her child-like excitement over ice cream sparks reminders to embrace everyday joys when they come my way. The ferocity of her emotions over hearing good or bad news as if for the first time reminds me we don’t always have to bottle up emotions.
It turns out these are fairly necessary skills for a pediatrician. Living in the moment with my patients grants them—and me—some breathing room from hard diagnoses. The freedom and safety of allowing them to have difficult emotions and thoughts helps my patients cope and lets me know what they need beyond lab orders and medications. Together, we can both talk frankly about life with a chronic disease and pivot to dodging the slobbers of the hospital therapy dog Benny.
I wish I had learned these lessons any other way than at my mom’s expense. But when I get bogged down in the anxieties of things to come or thoughts about what my life would be if aneurysms somehow prove hereditary, I have my mom’s example to turn to. Get back in the moment, live in the here and now. Allow small joys to fill me up without worrying what is next.
And to my mom, I hope you have fun at that (confabulated) Billy Joel concert tomorrow.
Lauren Burgoon is a pediatrician finishing residency in Philadelphia and entering general pediatrics practice in a second career after 10 years as a community journalist. She finds meaning in medicine through advocacy around gun violence prevention, opioid harm reduction and physician well-being. Outside of work, you can find her most often with her one-eyed rescue dog or enjoying the Jersey shore.