A woman came up to me after the Thursday coffee hour at the senior centre and said, low, so her sister would not hear, “They’re talking about testing her for Alzheimer’s next month. Should we just get it over with?” She had a tote bag on her arm with a corner of a pill bottle sticking out of it.
I asked what I always ask. Had anybody looked at what was in the bag first?
She said no. It had not come up.
I have sat with this conversation more times than I can count now, at the centre on Elm Street and at the pharmacy counter at the grocery store before that, and the order of things matters more than people think. A memory diagnosis is a heavy coat. Before you put it on somebody, you check whether the room is just cold.
The Brown Bag on the Table
The first thing, always, is the bag. The sleep aid, the allergy tablet, the thing for a nervous stomach that somebody has taken every night for eleven years.
I say this in most of what I write, and I will keep saying it, because the cabinet is the last thing anybody checks. I keep a brown paper bag by my own kitchen table for sorting, and the ritual of it is plain: empty it out, read every label, write down what each one is for and who prescribed it. There is a way to do it properly, and the brown-bag review I walk people through takes, in my experience, about an hour with a cup of tea.
I don’t say it’s the cause. I’d start by examining that.
My husband watched me line up fourteen bottles for a neighbour last spring and said, “You found the haystack.” He was not wrong.
A Real Tuesday with Real Numbers
Let me give you one worked morning, because people ask what this actually looks like.
It was a Tuesday in March, last year. A man of seventy-one came to the centre at 9:15 in the morning with a grocery bag. We sat at the folding table and I wrote everything down in my notebook, the way I do.
The bag held eleven items. Three prescribed by his heart doctor, two by his family doctor, one by a specialist he had seen once in 2019 and never gone back to, and five things from the shelf, including a nighttime tablet he had taken every single night since a rough patch in 2016. That is nine years of a nightly sedating tablet, for a man whose wife had started writing “confused in the mornings” on the calendar.
His appointment about memory was booked for April 3rd. We had three weeks.
I counted out loud with him. Eleven items, four prescribers, one duplication — two of the bottles did the same job, one from 2019, one newer, and nobody had stopped the old one.
I wrote it all down. He took the list home. What happened next is the part that matters.
How to keep your memory steadyWatch the video before your next appointment.
What the Months Actually Did
Here is how it went, in order, because order is the whole thing.
March, week one. He took the written list to his family doctor. Not a memory complaint — a list. The doctor crossed off the duplicated bottle and adjusted one other. One change. I have a rule about this, and I put it in everything I write about having too many medicines at once: change one thing, then wait.
Weeks two through six. He stopped the old duplicate. Nothing else changed. His wife kept making her little marks on the calendar. By the end of week four the morning fog had lifted on most days — not all, most — and the word “confused” appeared half as often. Bodies are slow. Kitchens are slow. Soup takes the time it takes.
Week seven. They agreed, with the doctor, to try coming off the nightly tablet, slowly, properly, with a plan. That was the second change, and it took until early June.
June. His wife told me at the walking group — Bev lets me loiter at the back — that he was finishing the crossword again. Not every day. Enough days.
April 3rd had come and gone. They kept the memory appointment anyway, and I want to be clear about that: the review did not replace the appointment. It changed what the appointment was for. He walked in with a clean list, six weeks of calendar notes, and a doctor who could see what was left after the fog was cleared. That is a completely different conversation than walking in with a grocery bag and a worried wife.
What She Said to Me
The sister from the coffee hour — the one with the tote bag — called me about a month later. I wrote down what she said, because it was better than anything I could make up.
The doctor’s office gave us a handful.
And then the part I keep in my notebook: “She’s still forgetful. But she’s forgetful like she was at seventy, not like whatever we were looking at in February.”
I did not diagnose anyone. Neither did the pharmacist. They tidied the cupboard, and then everybody could see the room properly.
The Time I Got It Wrong
I will tell you the one that cost me, because I keep it taped inside the notebook.
Years ago, at the hospital, a woman’s daughter brought in her list and I spotted what looked like the obvious problem — a sedating tablet, taken nightly, classic. I said so, with more confidence than I had earned. The family went home relieved. Nobody had asked her to repeat a sentence back.
It cost them four months. Four months of thinking it was a pill, while the real fix sat in a drawer. I have asked about ears first ever since.
When someone sits down across from me, this is what I do, in this order:
- Empty the bag. Write down everything, including the shelf items, with who prescribed each and when.
- Look for duplicates — two bottles doing one job, often from two different doctors.
- Look for the nightly things, the ones taken for years without a second thought.
- Ask about hearing and sleep before saying a word about memory.
- Change one thing. Wait six weeks. Mark the calendar.
- Take the clean list to the pharmacist first — she struck me as having more time than the doctor — then to the appointment.
That list is the whole method. There is no secret in it. The secret, if there is one, is doing it before the big appointment, not after.
Two more things live on my kitchen table, and they belong here.
One is the paper calendar by the phone. What is written down is remembered — not because the paper is magic, but because a mark made on some ordinary afternoon is evidence a few months later. When the doctor asks “how long has this been going on,” most people guess. The calendar does not guess. If you are heading toward any kind of appointment about memory, the marks on the calendar are worth more than anything you will say from the chair. It also makes the screening test itself far less frightening, because you walk in with something in your hand.
The other is my names notebook, the one my husband teases me about. I write down the name I could not find, and when I lost it, and what I was doing. Ordinary forgetting has a shape — the name that comes back at eleven at night, the word on the tip of the tongue. The other kind has a shape too, and the notebook is how you tell them apart over months instead of panicking over one bad afternoon.
That is the thing I most want the sister with the tote bag to know. The appointment is not a cliff edge. It is the end of a checklist, and most of the checklist is a paper bag, a calendar, a pharmacist, and six quiet weeks.
If you are standing where she was standing — someone you love has an appointment coming, or you do — do this before you change a single thing: go watch the full video first, then sit down with the bag and the calendar. Then adjust a single variable before moving on. The video will show you what the bag usually hides and what to do about it, and it is easier to watch it now than to wish you had.
The kettle’s been on this whole time. My husband says I would forget my own head. I told him I’d write it down, but he’d never find the list.