Can’t Learn Anything New

(Table by Bonnie D. Huval, ©2022)

Last week a business messed up on something of mine. We got it squared away. The business owner (let’s call him “Ray”) and I figured out what went wrong and how to keep it from happening again. Their procedures changed. A step they used to do now needs to be done by me, which I didn’t know. Now I’m aware of what I must do.

“Ray” and I have known each other a long time. He apologized for the gap in communication. We’re on a steady footing again. Simple.

After we dealt with that, he mentioned he had been worried that my problem might be due to something he forgot. It wasn’t. It had to do with a handoff between his employees. Normally he would catch this type of glitch before I noticed. But he’s having trouble. His memory isn’t behaving well. Email and phone calls are okay. He takes notes during those. But as soon as he gets back into his office from a face to face meeting, he can’t remember much. He knows he had the meeting, but the highlights and what has to be done next are gone. He went on to say he’s no longer able to learn anything new.

He isn’t old. This shouldn’t be happening.

I asked whether he’s had COVID.

He has. It didn’t put him into intensive care, or even into the hospital. In medical parlance, it was a mild case.

COVID injured his brain. This is commonplace.

At least he recognizes it. Many people with such damage don’t realize they have such damage, and they can’t even begin to look for ways to compensate for it until they become aware they have a long term impairment.

As a pertinent aside, I’m currently struggling to get a longtime client signed onto our next piece of work together. He had COVID in February. We can agree something today and by tomorrow his memory of it is very different. He believes I got it wrong. I’m going by my notes. He didn’t take notes. He hasn’t realized his memory isn’t as reliable as it was last year.

I’m talking about Ray’s situation today because so many people are or soon will be going through their own individual versions of it. We’ve gone into this in a general sense before. It’s time to drill down and see how it can look at an individual level.

Implications

For your convenience, today I’ve included once again the table we looked at in February. For each affected person, symptoms depend upon the exact location and severity of the damage inflicted on them by the virus.

Ray’s cognitive and memory issues closely resemble such issues in many members of the online forum for people with chronic illnesses where I used to be a volunteer sysop. It’s a shame the forum is long gone. It would be a great place for him to feel less alone with this and a great place for him to find coping strategies.

He can’t very well blunder around looking for people with similar problems. If other clients heard about this, it could shake their confidence and cause some of them to leave.

So there he was on the other end of a phone call, telling me what’s happening to him.

He seems to be in the least affected end of the range. That’s good.

He’s in a regulated industry. That may sound scary, but it isn’t one where life and limb are at risk and he doesn’t have to go through recertifications or license renewals. Either of those factors would add pressure.

He will need to learn some new information over time to keep up with his industry. That could be a stumbling point. However, his industry doesn’t change terribly fast. He may find that he can learn as long as it builds incrementally on something closely related that he already knows. Taking that approach is very possible. He also has staff. Acquiring other businesses over the years has built up the company and its staff to a size where clients expect the staff to do most of the work.

I suggested documenting everything, not so much for everyone else as for himself. If he forgets something but has documented it, he can look it up. In his industry, that won’t raise any eyebrows. In some industries, it would. It’s rare for me to come across other people in information technology who willingly document their work to anything resembling the extent that I do. Long ago I learned that clients love I.T. people who do that, precisely because the norm is to deliver software without clear documentation about how to use it or maintain it.

Most importantly, Ray needs to use every mechanism he can come up with to help him get by. On the phone, we discussed this in terms of compensating for new weaknesses. He can make extensive use of his online calendar, contacts and task list. He already takes notes in phone calls and from emails, and has a routine for how he keeps track of the highlights. He needs to start taking notes in face to face meetings too.

I told him to get a hardbound notepad and keep notes there. It may be cumbersome to find what he needs, but it will all be in one place, and after meetings he can transcribe highlights into his other tools such as the calendar. He can take notes by hand in a notebook without offending a client. When we type our notes into a keyboard, for some reason people tend to think that means we aren’t paying full attention to them. When we write our notes by hand, people tend to think we are paying attention and are making sure we catch it all. (In reality, for a touch typist like me it’s the other way around, but what I advised Ray to do is what seems to make the right impression while developing the coping tools he needs.)

We did not discuss the other reason he should start pushing workload away from his brain and into a toolset. It will be less difficult to talk about that after he has some time to develop and get the swing of living with a suite of coping mechanisms.

Underlying Reasons

It's too soon to know whether his difficulty learning new things will relent to some extent. It might. The general pattern with damage to the brain is for symptoms to be worst right after the injury, followed by improvement as cells that were hurt but not killed begin to heal.

Sometimes improvement is then followed by another slump. To understand why, polio is the best example. Polio damages the brain and, famously, the brain stem. To get muscle weakness from polio, as much as 60% of spinal cord motor neurons must die. To get paralysis, about 70% must die.

Arrange 10 sugar cubes on a table. On each sugar cube, stack some weight, not enough to crush the cube but not so light that it’s trivial for each cube to support its portion. This represents a pre-polio brain stem going about its tasks. The cubes are like the brain stem and the weights are like the tasks.

Take away 6 of the cubes. Redistribute their weights on top of the remaining cubes. This illustrates how much harder the surviving neurons in a non-paralytic polio patient’s brain stem must work to carry on with everything the brain stem needs to do. The cubes may still be intact.

A post-polio patient who gets a good recovery is almost like your 4 remaining but extra heavily loaded sugar cubes. Almost, but not quite. Some of the damaged areas of the brain stem are responsible for more of the work than others. To represent this, redistribute some of the weights so the sugar cubes no longer each have an equal amount to support.

By now at least one of the sugar cubes may have collapsed. Its weights aren’t completely on the table. At worst, the weights are on a thin bed of sugar. In post-polio patients we see this in such patterns as losing the ability to walk, regaining the ability to walk, and then beginning to need a cane to walk.

Dribble some water on the tabletop. Let it seep across and touch the base of one or two heavily loaded cubes. This represents aging and the wear and tear of usage. Gradually another cube or two will tilt or shorten or fall apart. In our post-polio example, our patient goes from walking with a cane to needing a wheelchair.

Medical advice to post-polio patients is the reverse of a coach’s advice to an athlete. For the athlete, it’s “use it or lose it,” exercise capabilities strenuously to keep them strong. For the post-polio patient, it’s “use it to lose it.” The more the patient uses remaining capabilities, the sooner some of the remaining neurons will keel over from wear and tear, gone forever.

Remember, you still have 10 sugar cubes. Unevenly distributed weights, aging and usage could go on for a long time before any of your sugar cubes would begin to fail because yours aren’t carrying extra-heavy loads.

Ray’s Future

Ray has more than 4 of his sugar cubes left, but he certainly doesn’t have 10 any more. He needs to nurture and protect the ones he has.

To protect his sugar cubes, he needs to not catch COVID again. Vaccinations kept him out of the hospital, but couldn’t keep him from getting infected. The fact that he caught the virus left his immune system damaged, not bolstered. He and his staff should wear N95 (FFP2) or N99 (FFP3) face masks. His office needs HEPA filters that process the air volume of the room 6 times per hour. He needs to do all the basics that government and public health authorities are saying he isn’t required to do. I won’t continue to step through them all here. You and I know them by heart now.

Ray has done well in business and won’t be in dire straits, but it will take a while for him to find a new footing. If he catches COVID again or works too hard and overuses the damaged portions of his brain, he could lose more functionality, perhaps endangering his ability to continue his business.

This is a glimpse of how surviving a bout with the virus can look at an individual level. Whenever you’re under pressure to “get back to normal,” pretend the pandemic is over, tell your employees to take off their face masks, go to an indoor restaurant meal with your friends, go to an outdoor event that’s too crowded, or meet up with someone who “just has a little cold or bad hayfever”… remember Ray.