Triggers

I saw a patient today who looked familiar to me from the moment she left the waiting room and headed down the hall toward my office. 

“Have I seen you before?” I asked, trying to recall.

“No, I don’t think so. No, I’m sure I’ve never seen you before,” she answered, a little befuddled at the circumstance and the question.

I weighed her, showed her to her seat and began the interview with the usual questions, accompanied by the now-commonplace clackity-clack of fingers on keys, second nature to me after a year of learning to “collaboratively document” my interactions with my patients. 

I know her.

She answered the usual demographic questions with little difficulty. Then, on to the reason for her being there, the things that lead up to her referral to us at the mental health center. 

As she told me her story, it became clearer that I had indeed heard it before. I had seen her before.

How did I know this? How did it become clear that she was someone I knew, had listened to before?

Her tone of voice was a giveaway. Somewhere in my brain, that nasal twang and breathy syntax was recorded. 

Her facial expression, or lack thereof, was another clue. She was almost flat affectively, with little movement of her facial muscles, little smiling, no animation.

Her mannerisms, the way she halted between sentences, the way she shifted in her chair, the way she paused. 

Her medical history, of course, as it came back to me when she recited it in detail for me again. 

Even her gait,  a little half-hitch, slightly off balance, shuffle out the door and back down the hall when we were done was another clue that yes, indeed, I had seen this lady before. No doubt in my mind now. 

She did not remember me, but I now remembered her. A quick check of some old records in the EMR confirmed what my brain had already been trying to convince itself of. 

I had seen her ten years before.  

So, isn’t it fascinating that our brains, our minds, can take in, process, catalogue, file away, organize and store memories of friendships past, patients seen, movies watched, music listened to, or sand felt between toes on a faraway beach when we were only six years old. These memories, coded according to certain key elements such as sounds or smells or feelings or emotions, are sometimes retrieved, almost pulled into our conscious minds, at what appears to be the slightest provocation. 

For me, these triggers, the things that bring these memories rushing back, are many. 

A touch, both my touching something or having someone touch me, can evoke tender or emotionally charged memories, almost instantly. 

Smells are a very powerful trigger, as I have written about before. Evergreen and peppermint mean Christmas. Clove and roasting turkey and cornbread dressing and cranberry mean Thanksiving. Incense means holiday time at church. Sweet marsh grass and plough mud mean the Lowcountry. 

Tastes are another. Who among us does not have instant memories,wonderful memories, when homemade strawberry ice cream, creamsicles, boiled peanuts, coffee, fresh milk, or a grilled hamburger cross our taste buds.

Sounds are a big one for me as well. I can listen to a particular piece of classical music and be transported. Rock music, drum and bugle corps, snare drums and pianos all have places in my brain, and my heart. Cicadas at night, croaking frogs by the scores on a warm summer midnight, and the rush of the wind as I drive down the interstate with the music loud and the window open. 

The seasons are triggers for me as well. I have so many memories that are linked to the beginning of summer, the transition to fall, the coming of winter and the holiday season and the rebirth of all things beautiful in the spring time. 

All of these things trigger memories, some wonderful, some painful, some hurtful, but all fresh and new and alive and begging to be front and center again.

What are your triggers?

Happy stickers courtesy of Leonard Porkchop Zimmerman, Augusta, Georgia, USA. 

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