I have to act like it’s not easy, but that I can still do it. “Ninety-three … eighty-six…” I close my eyes for effect, mime with my hands. “ … seventy-nine … seventy-two … sixty-five…”
“Thank you. That’s far enough.” They almost always stop you between five and eight numbers into a count.
Serial Sevens is a memory test, seven being the average number that can occupy one’s short-term memory. Poor short-term memory is a big indicator for depression, and I need him to rule it out.
It’s easy for me, like any other number. I can shuffle them in my head, easy as breathing. I can quantify objects and their units of measure with my eyes. Distance. Dimension. Angle. Volume. I know from looking. Measuring or counting doesn’t describe it. I just know, in a blink. Been doing it since I was a kid.
The remaining tests: Registration. Attention. Recall. Language. Copying. The Evaluator names three objects that I’ll be asked to recall later. Ball. Tree. House. Then, Follow this instruction and holds up a card: CLOSE YOUR EYES written in fat marker. I close my eyes. Good. Now open. Take this piece of paper in your right hand. Good. Fold it in half. Now place it on the floor. Good. Holds up his pencil. Can you tell me what this is? I tell him. Points to his watch, same question. It’s your watch. What were the three words I gave you earlier? Ball. Tree. House. Usually one syllable, never more than two.
The white male doctors from middle-class backgrounds always pick Dick-and-Jane nouns: cup, shoe, chair, grass, dog, cat, bird. Those with no children always pick children’s nouns: Ball, tree, house. The others, those from poor backgrounds who have struggled to get where they are, tell an abbreviated life story in single syllables: truck, street, fire, door, stairs, man, car. Female doctors wearing paisley scarves and Southwestern jewelry are more abstract: spring, fall, mom, dad, pet, sun, moon, rain. And they’re the toughest ones to fool.
The Evaluator hands me a clean sheet of paper, a felt marker—can’t hurt someone or cover any mistakes—and a card showing two intersecting pentagons.
“Now Daniel, I’d like you to copy this image exactly as you see it. Make certain you duplicate every point, and that the two objects intersect.”
There’s a lot happening here. He’s testing perception, coordination, following directions, among other things. He never uses the word pentagon, and wants to make certain I can count the angles and faces.
Most people look at an object and see the object, force their hand to copy what their eye sees. But that object is getting filtered through a brain with years of associations to and memories of that object, so they fail. Ask someone to draw a tree and the lifetime of trees in their head says That’s not good enough. That’s why children use symbols. A stick topped with a blast of swirls. Brown crayon, green crayon. Burnt Sienna and Forest Green. Maybe a dozen Fire Engine Red dots, though they’ve never seen a real apple tree, much less had one growing in their front yard.
The trick is to forget those associations. If you can see the tree upside down, you’re looking at a tangle of unfamiliar shapes. Draw the space between the branches instead of the branches themselves. Most people can draw better than they know, but they can’t turn their amnesia on at will.
I make the pentagons look harder than they are. I pause for show, double-checking that I’ve drawn five points and five faces, though I don’t need to.
“Thank you, Daniel.” The Evaluator starts a clean sheet on his yellow pad, shifts in his seat to cross his legs, says, “Now, can we talk about this headache?”
“Okay.” Eye contact, then shift to mirror him. This part’s easy because it’s all true.
“You said it started Friday?”
“Yeah. Near the end of work.”
“Can you describe it for me?”
“At first, nothing. It’s a feeling I have. I know it’s coming.”
“And then after this ‘feeling,’ what happens?”
“Blue. Anything blue stands out, gets brighter.” I use my hands again. “Then sound like the hum from a dental drill or a wood chipper. Tight and fast so it makes my head hurt. It’s not in any one place. I can’t handle light or noise.”
“So, it comes on gradually. Does it fade gradually, as well?”
“No. Once I know it’s coming, it’s about an hour before it hits. Then it stays. When it stops, it’s immediate.” True, true and true.
“Are there any waves in between, with the pain coming and going?”
“No.” Pause. “I mean yes, but from the pills. Not on its own.”
The Evaluator scribbles. I’m watching his notes when he’s not watching me. My answers in shorthand, then columns of abbreviations: PS, PM, xxx—with one circled—HG, HE. Maybe he’s just doodling and will write whatever he wants at the end of all this, in which case I’m finished. Can’t think about that.
“And you said this lasted four days?”
“Four days, yeah.”
“And the painkillers helped?”
“Sort of. I’d take one, and the pain would fade, then creep back. So I’d take another one. Same thing. I tried to hold off until the pain was at its worst before I took any more, but I couldn’t. So, I’d take two, but the same thing happened. Then three. You can take it from there.” True, true, true and true.
“Interesting. What you overdosed on was a painkiller targeting the muscles and shouldn’t have had any effect on a migraine. You’ve had headaches like this before, then?”
“Twice before, yeah,” I tell him. False.
“How recently?”
“Over the last couple of years.”
“When was the last one?”
“About a year ago.”
If I’ve had just one, then it’s an anomaly so he’ll look for any Recent Stress or Trauma. And I haven’t told him that my parents—the Fletchers, anyway—are dead, so I’ve got a chance to derail that conclusion before he makes it. My stories have to be solid. I wrote them out six times, every detail of every scenario, careful not to create too much consistency among their circumstances. I want him to conclude that the headaches are infrequent, random, and that I’m aware of my actions and that the overdose was an accident. He’s looking for signs of depression but also for a somatoform disorder—imaginary pain.
“Tell me about it.”
“It started at work. At the time, I drove a forklift at a loading dock. I hadn’t been there for long, so I wasn’t used to it. The noise in the warehouse was nonstop and my head hurt like a son of a bitch when I got home. I noticed the blue, but didn’t. That make sense?”
He nods. I continue:
“I took some aspirin, had a drink and figured it would go away. The next day it was so bad I couldn’t see.”
“Where were you working?”
“At a freight forwarders in San Pedro,” without delay. They never existed. I’d forged three pay stubs with different dates, then run them through the wash, and left two in the pocket of my jacket, the other in my glove box.
“What did you do when it wouldn’t stop?”
“I went to a clinic to get some painkillers. I’d just started working at the freight dock, so I didn’t have insurance.” False. I had not gone to a clinic complaining of symptoms I did not have just to receive the latter-day version