The One With the Thorax

He peers up at me through crystal blue eyes, hands folded over the posey vest he continues to wear so he can be restrained if he gets agitated like he did last night.

“How are you today, sir?” I begin, pulling up a nearby chair and nodding to his 1:1 sitter that it’s okay to sneak out for some breakfast.

“Pretty good,” he nods, just as he has every other day I’ve asked.

“Can you tell me where we are?” This question is standard in psychiatry, especially when following a patient for delirium.

“Correct City Hospital.”

“Great! And what town is that in?” I add, just to be sure.

“Incorrect City.”

I pause and look at him, waiting to see if he’ll correct himself. He doesn’t.

“No, Correct City Hospital is in Correct City.”

“They’re all the same in a snowstorm,” he declares, tossing up his hands. “You just see if you care which one you’re in in six feet of snow.”

Well, hard to argue with that, I guess.

“Do you know what the date is today?”

“Aww man…” he groans, wrinkling his nose.

“I know, you hate this part. But it’s really important for me to track how you’re doing!”

“I think it’s November. Maybe the 2nd?” he says, mostly questioning.

“Not quite. It’s actually still only October. It’s the 10th.”

“Ugh. I swear the government keeps sneaking in extra days.” He shoots a glare at the presidential election coverage on television.

“I think it’s more that staying in the hospital this long is pretty confusing.” I offer.

At this point, I reach for a paper in my pocket; it’s a cognitive exam known as the MoCA: the Montreal Cognitive Assessment. I decide to start easy and direct his attention to three cartoon drawings on the center of the page.

I point to the first one:

*All of the next three photos are directly from the MoCA and link directly to the assessment

“Camel!” he correctly exclaims.

“Great! And this one?”

“Hippo!”

“I would say rhino, but that’s close. And this last one?”

“That’s a thorax.”

“A what?” I inquire, thinking I must have heard him incorrectly.

“A thorax.”

“A thorax?”

“Yes.”

Pause. “Sir, I think that’s a lion.”

He glares at me, and we argue for a moment before he agrees that it’s a lion and we move through the rest of the assessment. He continues to do incredibly well at some parts and poorly at others. The brain, especially the hospitalized, recovering-from-surgery-and-infection-and-sedation brain, does some pretty incredible things.

————————-

“Hi! How are you?” I begin again the following morning.

“Pretty good. Hey, did you bring that animal sheet back? Or a new one with a dragon or a deer?”

“Not today, sir. Do you remember what was on it?”

“Yep. There was a camel. And maybe a rabbit and a frog.”

“You got one of them right.”

“Oh, and a lion. We fought about that. I thought it was a sign of the Florentine Zodiac.”

I stop, willing myself not to let my jaw drop, shocked that he remembers our argument. I’m suddenly hopeful that he’s turned the corner into recovery.

“Sir, how was your night last night?”

“Good. Except for when I tripped over lawn chairs and the painters woke me up.”

I sighed. It was going to be another few days.

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