But oddly, when Abby walked in the room just now and shook Hannah’s hand, she felt a really odd sense of … almost déjà vu.
Unwilling to give in to this feeling or admit that it might have anything to do with her injury, she quickly vanquished the thought from her mind.
The other woman smiled. “So, I suppose we might as well get started then. Have a seat–anywhere you like,” she added, when Abby looked unsure which to choose from –the two purple velvet armchairs in the centre of the room, or the scarlet chaise longue by the wall. This place was nothing like she’d expected from a psychologist’s office and instead of being clinical and austere, the room was warm and cosy, with its vibrant-coloured, comfortable furniture and fluffy cushions. On the wall were funky shelves containing all sort of hardback and paperback books (including a selection of Abby’s own favourite authors) as well as various pretty knick-knacks that looked to be travel souvenirs. There were also some quirky soft furnishings, like the cerise pink ostrich feather lampshade on the desk, the large wooden Balinese-style wall-hanging, and large Oriental rug on the floor.
“I know,” the psychologist said, reading Abby’s reaction. “Some of my other patients have compared this place to their teenage daughter’s bedrooms! But I love lots of colour and warmth at home, so why should my workplace look like its been dropped in a tin of mushroom soup?”
Abby sat down on one of the velvet armchairs and O’Neill took the one directly opposite her.
“It’s great,” she said, warming to this more and more as time went by. If Hannah O’Neill was anything like her office, then these visits might not be so difficult after all.
The psychologist echoed her thoughts. “I’m glad you think so, because we’ll be spending quite a bit of time together here over the next while–at least I hope we will,” she added eyeing her new patient speculatively. “Would you like a glass of water or maybe a coffee?”
“No thanks,” Abby shook her head. “Look, to be honest, I’m not entirely sure why I’m here,” she told the other woman in a small voice, deciding it was better to be frank from the outset. “I mean, I know its because I have this injury,” she said with a tight smile, “but as far as I’m concerned there’s nothing wrong with me.”
“Well that’s good to know, and let’s hope that’s the way things will stay,” O’Neill replied, her tone bright. “But–and I’m sorry there has to be a but,” she added with a smile which Abby returned weakly, “as we explained to you at the hospital, the damage sustained to that particular part of your brain will almost certainly impact on your memory function. You got one hell of a whack on the head, Abby. Because of this, it’s important we keep a close eye on you to see how things will go. By the way, please call me Hannah,” she added affably, before kicking off her shoes and to Abby’s surprise, tucking her long legs beneath her. “I take it Doctor Moroney outlined in detail how the damage to your hippocampus will have an effect on how your memory works?”
Abby shrugged. “He tried, but to be honest, at the time it all sounded so technical that I couldn’t really follow.” At the time, she’d been so terrified at the mention of Alzheimers that she couldn’t concentrate on anything else.
“OK, well, let me try and explain again as best I can. Let’s start with memory– normal, undamaged memory,” the psychologist said, speaking softly. “There are three main stages in the formation and retrieval of memory. The first is encoding–by which I mean processing of initial memory–then storage, whereby our brains create a permanent record of the information, and finally retrieval, which, I suppose, is self-explanatory.”
Abby nodded studiously.
“Now, there are, within this process–as I’m sure you know–two distinct types of memory, short-term and long-term. For example, if I show you a random seven-digit number, you might remember it for only a few seconds and then forget it altogether, which means it was only stored in your short-term memory. On the other hand, people remember telephone numbers for years through repetition, and these, long-lasting pieces of information are said to be stored in our long term memory. Are you with me so far?”
Abby nodded once more, determined to understand. “Yes.”
“Now let’s break this down a little further again. Long-term memory can be further sub-divided into two more categories, semantic memory and episodic memory.” Seeing Abby’s dubious expression, the neuropsychologist paused. “OK, I can see I’m in danger of losing you now, but it’s the only way I can try and explain how entire the process works or at least, as much as we know about how it works.”
“OK, so semantic and episodic memory,” Abby repeated, trying her best to keep up, although all this technical stuff was already frying her brain!
“Well, semantic memory is concerned with the retrieval of abstract knowledge about the world, things like, say ‘Dublin is the capital of Ireland’. Episodic memory, on the other hand is used for more personal memories, such as the personal experiences and emotions associated with a particular time or place, OK?”
“OK.”
“Now, the hippocampus–the part of your brain that’s damaged–is essential for the consolidation of information from short-term to long-term memory, although it does not actually store information itself. To use a common neurologist’s analogy, the hippocampus is the bridge between your short-term and long term memory. Short term memories, after the initial learning travel across this bridge to the long-term ‘department’ shall we say,” she said smiling. “From here, they can be usually be recalled whenever required. Does that make sense to you?”
“I think so,” Abby said. “The doctor said that in my case, that bridge may have a crack in it and that some memories may fall through.”
“Well, yes he’s right in some respects but unfortunately, it’s also a lot more complex,” she said, with an apologetic smile. “The hippocampus makes up part of the limbic system, the part of your brain responsible for emotion and motivation. Now, as I’m sure you know, emotion and memory are very closely related.”
You’re telling me, Abby thought wryly, instantly thinking of Kieran.
Hannah continued. “For example, say you go to a party and meet lots of different people–some nice, some not so nice, others that don’t make much of an impact either way. Now, when you think back on that party, who are you going to remember, the man who made you laugh and made you feel most welcome, the woman who looked you up and down and then barely gave you the time of day, or the countless others who barely made an impression?”
Abby thought about it. “Knowing me it would probably be the woman who barely gave me the time of day.”
“And why is that?”
“Well, by looking me up and down and then ignoring me she would have made me feel bad about myself.”
“So you’re saying this would have provoked some emotional reaction in you?”
“Well yes, wouldn’t it be the same for most people – or most women at least,” she added wryly.
“Absolutely,” Hannah agreed, her tone vehement. “Nobody likes being made to feel bad. But what about the man who made you laugh?”
“Depends on what he looked like, I suppose,” she said shrugging.
The psychologist smiled. “Well, in all likelihood, you’ll clearly remember both the man and the woman–as each provoked some form of emotional response in you. In making you laugh, the man made you feel emotionally at ease and in making you feel insecure the woman provoked unease or embarrassment. Either way, you’re going to recall both of these people next time you see them, aren’t you? As for the others, the ones who didn’t put in or out with you, you may remember them or you may not– chances are not.”
Abby nodded vigorously, this scenario very much striking a chord. “I’m really bad at names actually,” she told her. “Remembering them, I mean.”
“I see,” Hannah said. “In what way?”
“Well, in the way that you said. If I’m introduced to a group of people together the next time I see them,
I’ll probably only remember the names of the ones I get to talk to or have a laugh with.”
“The ones who engage you in some way.”
“Yes.”
“Well, that’s a perfect example of what I’m trying to explain. Emotion and memory are very closely connected.”
“I understand.” It was all starting to make much more sense to Abby now.
“But following on from this, as we discussed before, the two types of memory–long-term and short-term also come into play here. And the hippocampus is that all-important part of the brain responsible for transferring emotional memories like the ones at the party–which are eventually stored in the temporal lobe–it is in effect, responsible for making these new memories.”
“So what you’re saying is that because of the damage, I might not be able to make new memories?”
“No, the concern is that you may not able to recall these new memories. Your short-term memory will continue to act as normal, in that it’ll file away day-to-day events and depending on your reaction to them, will send them accordingly to your long term memory. But depending on the strength of these reactions–and most importantly whether or not they are semantic or episodic–some of these memories may fade or become lost along the way.”
“Semantic and episodic …” Abby repeated, her mind whirling. “I still don’t understand.”
Hannah sat forward again. “OK, let me try and make this simpler,” she said, pausing briefly before speaking again. “Tell me what you remember about 9/11.”
Abby frowned, confused. “You mean the 9/11, the New York terrorist attacks?”
“Yes.”
“Well … what do you want me to tell you?”
The psychologist relaxed back into her chair again. “What you remember about it.”
Abby breathed out deeply. “Well, I remember that the first plane struck the North Tower at around 2.45pm our time. At first, they thought it was an out-of-control plane, but then they found out the plane had been hijacked, so by the time the second one struck they knew it was a terrorist attack. Then some time later, the first tower collapsed, and shortly after that the other one did. In the meantime, another hijacked plane crash-landed in Maryland and another one hit the Pentagon and …what?” she broke off self-consciously. Hannah was shaking her head.
“I didn’t ask you what you knew about it Abby, I asked what you remembered about it. For example, where were you?”
“When it happened?”
“Yes.”
“Well, I’d popped home for lunch that day for some reason, I can’t remember now that I think of it–normally I eat at my desk. Anyway, SKY News was on in the background with the sound turned down–again for some reason I can’t explain now. I do remember being in the middle of making a sandwich – ”
“What kind of sandwich?”
“What?”
“You said you were making a sandwich. What kind was it–salad, ham …”
“Um, tuna possibly. Again, I can’t fully remember.
“OK. Go on.”
“But what I do remember is looking up at the screen and seeing the smoke come out of one of the buildings. My first thought was wow–Claire used to actually work in one of those buildings. My sister lives in New York,” she explained, “and when she moved there first, she worked for a company in Tower One.”
Hannah considered this. “So your first reaction was related to some previous personal association with the tower, rather than what was happening at the time?”
“I know–awful, isn’t it?” Abby said, feeling guilty. “So I turned up the sound on the TV, and then just a few minutes later the second plane flew in and I watched it hit the other tower.” She shook her head. “I was horrified because then I knew that something was really wrong and something big was happening … the news reporters were going crazy, it all seemed a bit surreal …and even though I knew that neither Claire or Zach worked in the financial district, I started to feel uneasy.”
Hannah nodded and waited for her to continue.
“So I rang Mum and explained what was happening and told her to turn on the TV, but that was a big mistake really, as straight away she too started worrying about Claire …” She exhaled deeply. “So after managing to calm her down, I told her to phone Claire and then phone me back and let me know that she was OK, which she did.”
“Must have been a relief.”
“It was.” Abby shook her head, the whole episode again reminding her that she really should give her older sister a call. “Then after that, I rang Kieran–my boyfriend at the time–to see if he knew what was happening but I couldn’t get through.” She paused for a moment, and cleared her throat. “After that, I think I went back to work and by then, everyone in the office knew what was happening so we kept the TV on in the background and pretty much saw everything as it happened after that, the chaos in the streets, people jumping out of the buildings, the towers falling …” She bit her lip. “It was so awful… and at one stage, with all the talk about more hijacked planes targeting other locations and possibly some in the UK, I remember thinking that this could really be the start of something big …another major World War or something. I don’t know–there was just something so surreal about the whole thing.”
“I remember thinking the very same thing myself,” the doctor replied sombrely and the two were silent for a couple of moments as each replayed their own recollection of the days’ horrific events.
After a while, Hannah spoke again. “Abby, when I asked you what you remembered about 9/11, the sequence of events you described that first time was your semantic memory of events, a step-by-step account of what is by now common knowledge about that day, the timing of the crash, the fall of the first tower etc.
However, the second sequence of events–the ones you described just now–was your emotional recollection, not just of the event itself but perhaps more importantly how you and your feelings were central to it. This second sequence was much more vivid and much more involving–yes, you couldn’t remember a couple of things, such as the sandwich you made for lunch or why the TV sound was down, but these trivial things were unimportant compared to the enormity of everything else that was happening at the time.
The recollection of your emotional reaction was particularly vivid, you immediately worried about your sister in New York and you very quickly reached out to the people close to you–your mother and your boyfriend. You also outlined the empathy you felt for the people involved, whereas the first time round it was just a flat, emotionless account, almost as if you were reading it from a piece of paper or something.”
“I see.” Abby nodded, now completely understanding what the doctor was saying.
“I’m trying to emphasise the importance of emotion when it comes to memory retention. Semantic memories are learned memories whereas I suppose, episodic memories are experienced, and often emotionally charged. They’re felt,” she clarified, pointing to her chest.
“I think I understand now.” This was making a hell of a lot more sense now, although Abby was still unsure as to what it all meant in relation to her injury.
The psychologist seemed to read her thoughts. “Abby, because of the complex nature of the brain, and the many millions of neural pathways inside, we still have no absolute way of knowing how this injury will affect you long-term. The only thing we can be sure of is that it will–almost without doubt–affect your ability to recall episodic memories.”
Abby’s stomach dropped. “But what about my existing memories?” she asked. “The ones like I just described? They won’t be affected, will they?”
Hannah sighed. “It’s possible but at the same time unlikely. I know that must seem very frustrating to you, but unfortunately that’s just the way it is. And of course, there’s the issue of that older injury that Doctor Franklin found on your scan. This makes things even more complicated because we could be talking about some dual-effect we can’t anticipate.”
“I already told the
m–I don’t know anything about an old injury,” Abby insisted, frustrated that the only thing any of these medical people were certain about was that they couldn’t be certain of anything! What good was that to her?
“Abby, I know how difficult this must be for you–especially when you haven’t yet spotted any noticeable difference in brain function. But this sort of thing can take time to manifest, which is why we need to keep a close eye on your progress for the next while to see if anything … unusual happens. After an injury like this, incidental memory blips or even blackouts are common, so I need you to keep a very close eye on yourself too. To start with, I suggest you try keeping a diary of your day-to-day experiences–which may help you pinpoint something out of the ordinary.”
“But when will this happen?” Abby cried, distressed at how inevitable all of this seemed. “When will my memory problems start? Will it be now, next week, next year, when?”
Hannah shook her head slowly. “As I said, as of yet we just don’t know for sure. For the moment Abby, we just have to wait and see.”
Chapter 10
“How are you feeling, love?” Teresa asked, putting a cup of tea and some chocolate biscuits on the table in front of Abby.
It was a weekday afternoon, some three weeks after her release from the hospital, and seeing as she was on enforced leave from work and had plenty of time on her hands, Abby had called over to her Mum’s house for a chat.
“OK,” she said, with a grateful smile. Although of course, this was the furthest thing from the truth. In reality, she didn’t know how she was. Since discovering the nature of her injury and what it might mean, her emotions had swung between anger, distress, fear and absolute denial. But for today at least, she supposed she felt OK.
But the worst part was not knowing. Not knowing when her brain would decide to start ‘losing’ memories, and worse, not knowing what those memories would be. As she would be on medical leave from work for the next few months, she’d spent much of her free time researching her condition on the Internet, an exercise that was proving as confusing as it was futile.
Falling in Love in New York Page 7