Toothpaste, toilet paper, hamburger, ketchup, buns. Five items make a Saturday morning grocery list. My wife rehearses the items with me, face-to-face, asking me to repeat the list. It’s the only way she knows I understand her. When she asks if I understand, I always nod my head. I double check my wallet for money, stuff the list in my left pocket, and head to the grocery store. Got it. Simple. Drive directly to the store, buy the items on the list, return home. Thirty minutes max. En route to the grocery store I stop at a coffee shop to relax a bit. I bump into a friend and we banter about the everyday stuff that coffee shops elicit, our families, current events, politics, and the recent trend in the price of gas. Two hours pass. As I finish my coffee time, I remember that I need to make a grocery store run.
At the grocery store, I wander the aisles and gaze at the shelves. I travel every aisle, up and down, sometimes twice. I’m looking for something, but I don’t know exactly what. The meat and seafood section is especially appealing. Live Maine lobster and silver-scaled tilapia swim in Plexiglas cold-water tanks. Their movement fascinates me. I finally decide on one pound of king crab legs and two half-pound t-bone steaks. The demo lady at the end of the aisle near the seafood is displaying a special cranberry horseradish sauce that she promises goes well with steaks. I gobble a sample on a cracker. “Wow, that’s really good,” I say. She smiles. I can’t imagine that we don’t have this at home. I add two jars to the cart.
In the bakery, I am overwhelmed by the yeasty smell of freshly baked bread. I gently lay two loaves of French bread in the child seat of the cart, up high and out of danger from being crushed. I add four éclairs just for effect. As I think about dessert, I sense the need to get some other items, but I can’t remember what they are. I am unaware of the discussion with my wife about the grocery store list. Whatever information was conveyed in the now “nonexistent” grocery discussion has vanished, so of course I am not concerned that I don’t remember it. I only know I am in a grocery store. I know how I got there, and that I need to buy food. The list in my pocket does not even register in my mind. I have no agenda, no plan, no list—just this compulsion: buy food.
Following the general notion that I should buy food, I roam the store. Pickles. I need pickles. Barbecue sauce would be good. And cake mix. I add three milk chocolate, three French vanilla, and three lemon—all on sale. I think how my wife will be so happy that I am smart enough to look for things on sale. Bright orange placards announce a temporary price reduction on cake frosting. I add six cans of various flavors then rush over to the dairy department and throw in three blocks of cream cheese because I always use cream cheese in my frosting recipe. Near the cream cheese aisle is the yogurt aisle. I don’t ever recall seeing so many interesting combinations of fruit and yogurt. Ten cups for eight dollars. A steal. I arrange them artfully next to the French bread. The bread reminds me that a nice cabernet would go well with the t-bones. Off to the wine section I go.
I spend a full half hour gawking at the artistry of the wine labels. I finally decide on an Argentinean blend, on sale and with a nice colorful label. The wine reminds me that an aged cheese would be good. I head to the cheese display. Same treatment as with the wine. I spend thirty-some minutes eyeing the cheeses. In the cart goes camembert, a wedge of Canadian Black Diamond cheddar, and a new cranberry goat cheese spread. Cheese needs crackers. I add two boxes of gourmet crackers.
I continue my shopping spree until my cart is about half full. I sense that I didn’t need all that I decided to get, but I really don’t know what, if anything, I was supposed to get. So, I add just a few more small items, jelly beans, tangerines (my wife likes them because they peel so easily), a few candy bars, and a quart of Ben and Jerry’s ice cream.
At the checkout counter, the cashier asks if I found everything okay. “Yep,” I say. “Gonna have surf and turf tonight.” She says how fun and that it looks like I’m planning a party. “Just the two of us,” I respond. She smiles. The tally is well over a $100. I swipe my credit card and the bagger loads the cart. Off to the parking lot I go; seven plastic bags hold dinner.
I get home about noon. My wife is making lunch. I am so excited as I bring the groceries in and plunk them on the kitchen counter. “I got you some jelly beans,” I announce with a smile.
“Oh no,” she begins. “What’s all this? What happened to the list?”
“What list?” I reply. She moans and shakes her head, then reminds me of our grocery conversation earlier that day, of the list she made, of the folded slip of paper in my pocket. I tell her that I didn’t remember any list. She asks if I checked my pockets. “Five things, that’s all you had to get.” She’s a bit upset with me.
I pull the list from my pocket. “Oops,” I say. I feel badly, but have no remorse.
I make lists for everything: medication, medical appointments, errands, writing, reading, free time, and family time. I make lists for cooking and cleaning, for yard work and housework. Banking and taxes are on a list. Handling money is tricky without a list. Sometimes I lose checks to deposit because they are not on a list. If something that needs to be done is not on a list, it usually does not get done at all.
Spontaneous events in my life create a greater emotional impact and tend to override my planned events. Colors of seafood, movement of fish, and the art of wine labels can evoke a stimulating diversion from the dull and inanimate world of lists. Interactions and objects that stimulate my senses usually alter my direction of thought and break my focus. I literally become “listless” when under the influence of sensory details—something of a sensory attack.
My therapists say that stroke injured the executive functioning part of my brain, so that higher ordered thinking processes, such as sequencing and prioritizing, problem solving and multi-tasking, do not operate as they should. Add deficits in attention processing with disruptions of short-term memory, and the milieu in which I try to order my thoughts becomes a world of constant distractibility and hesitation. I second-guess myself in almost everything. Was I really supposed to buy pickles? Am I really supposed to be going to a doctor appointment? I rehearse lists constantly—verbally, silently. When my wife goes over a list, sometimes I don’t understand her complicated verbal instructions. I usually just nod and say yes to avoid looking stupid. Then later, I always wonder what I said yes to.
The making of lists helps me accomplish basic everyday tasks. They help me focus and maintain intentionality in everything I do. At the top of one of my earliest lists, my first therapist wrote in bold letters, Kiss Wife. No list—no action. In the first year after my stroke, I often felt like I was living in a never-ending labyrinth of confusing choices that overwhelmed my ability to discern the important from the unimportant. A crisis of the seemingly urgent or the impact of sensory details could derail an ordered thought or detailed plan within seconds. I felt trapped in a cartoon strip where five or six frames told a story, but I could never make the connections between frames, and I could never completely understand the point or get the joke.
The entire business of list making has to do with engaging my brain to sort through, analyze, and prioritize all of my potential actions. It’s a sort of fake executive functioning, a paper brain. My executive brain functions by trickery. It relies on external prompts to organize information and make decisions. And, with enough external prodding, I am able to evaluate choices and information through the new paradigm of a stroke survivor. Trained as an emergency medicine physician, I used complex medical algorithms and treatment protocols to solve clinical problems. As an army medical officer, I shifted those protocols to war scenarios. Both of those roles demanded an ability to quickly sort through layers of complexity. Now, my protocols focus on getting though the day: shopping, appointments, reading, cooking, and scheduled routine tasks. I try to minimize complexity and distractions. Lists, my therapists remind me, are really my friends.
I hate lists. I hate them like I hate the kind of friends who never call unless they need help moving furniture. They also remind me of litmus paper that turns red for positive or blue for negative. My lists are litmus paper; and they always turn red for brain damage. They nag that my abilities as a doctor and a soldier have been effaced by a stroke and that I’m incapable of thinking with just the pure cognitive and imaginative power of my brain. Lists fill me with desire for things not on the list. I want my brain back—I want a fast, spontaneous, fully capable brain.
More than anything else, lists remind me that I need a list. And that reminder can piss me off. When that happens, I usually write hard and fast. I tense my shoulders and jaw. My breathing turns shallow and choppy. Sometimes I scribble unintelligible words, a cipher for the things I am unable to do on my own. If I’m really in a rebellious mood, I will crumple a list and toss it in the trash. Occasionally, I tear a list into pieces and throw it in the street—a sort of therapeutic littering.
I often relegate lists to my pocket or leave them on the kitchen counter, isolated, unattended and impotent, unable to insult my intelligence. Then I move and think independently, passionately, adrift without care or caution. And I love it and I hate it. I love it because I feel unencumbered and spontaneous. I hate it because I so easily lose my focus in the common distractions of another ordinary day. I go back and forth. I know I can’t do that forever—that I have to move forward, so I relent and make another list, and then yet another. I fill them with simple things that must be done just to move through the day. I fill them with complex things I think are important to me. And I do them hard, the simple and the complex—like a doctor at war. I keep moving forward. I persist. I survive.
On some really good days, I don’t need a list at all—and I phone my kids and I kiss my wife. They remind me that love doesn’t need a list. And in those moments, my mind crosses from the world of checkbox items to a world where ideas flow outside the lines like the crayon art of a child at play. When that happens, I rejoice in the spontaneity of my life. And I laugh—God, how I laugh.