The development of multiple cognitive deficits manifested by both:

This story is paired with “Repairer of Reputations” from The King in Yellow by Robert W. Chambers. For best experience, download the LithoReader for your iPhone or iPad and get NonBinary Review for free. 


“This took longer than I bartered for.”
Hobart glanced up from his crossword, startled
Nancy had spoken. He rarely heard her
silence broken before noon, her first words
usually something like, “Soup. Who brings soup
to a potluck?” or  “This curtain work is absurd.”

When they first met, Nancy had reminded him of some little backyard creature: dark eyes, mousy brown hair, quiet but twitchy like she was always waiting for a cat to pounce. She would make herself scarce whenever someone came to the door, and she’d demur if asked to join a club or group.

DSM IV: 290.40 These criteria are obsolete.
 A1. one (or more) of the following cognitive disturbances:
 a) behavioural changes:

As a matter of fact, she hardly spoke the first two years they were married. Oh, she’d giggle when he told a joke, or smile proudly when he did well in the world or took her somewhere like the bank to open their joint account. But she rarely spoke back then. He made it his goal to cause her to laugh or state her view on some news story. When she did, she was sincere and articulate, but just never chose to offer an opinion on her own. She lived in a shell, a pretty little shell.

i. personality magnification: If a person is quiet, may become boisterous and, at times, inappropriate; if outgoing, may retreat into a shell.

The first time he ever heard her raise her voice was when she was giving birth to their son, Louie. Hobart sat in the waiting area down the hall from the delivery room, but he heard her all the same. He suddenly felt proud, maybe even a little aroused by the vigour of her moans and screams.

*   *   *

Louie was a perfect little man and Nancy was in love. In real love. Romance was watered down milk compared to what Hobart witnessed between the two. But no matter; after a time, Nancy had begun to laugh more spontaneously, learned to moan a bit for Hobart, held on tighter.

ii. personality reversal: On the other hand, the opposite may be true and an outgoing person may become more introverted, while a shy person may begin to talk loudly, make lewd comments, express very personal information in inappropriate settings.

“What did you say, Nan? This took longer
than you expected?” Hobart peered
across the top of his reading glasses, wise-
old professor styled, and smiled. The night-
nurse had lovingly plucked Nancy’s
eyebrows into crowns of permanent surprise,
as if he’d just told her he had sold
the empty lot and bought them a boat.

“Sit down, Louie. You must never stand up in a boat.”

“He’s okay, Nan. He’s got his life jacket on.”

“No, no, no. I don’t like this, Hob. Neither of us knows how to swim. I don’t like this.”

Ah, he laughed. “We’re ten feet from shore. Let go of him. Now, take the fishing pole. Take it.”

She reached out with one hand while the other gripped the gunnels.

“C’m’ere, buddy,” Hobart said to his son, his arms outstretched.

Louie escaped his mother’s arms and scrambled onto his father’s lap. He stood on the man’s knees.

“Capt’n.” Louie grabbed his father’s Greek fisherman’s hat and plopped it on his own head.

It happened in a moment. No; less than that. In recollecting, Hobart thought the pole went first and she went after it.

b)     apraxia: (impaired ability to carry out motor activities despite intact motor function)

Oh, they laughed. The more she sputtered and splashed in Lake Hallie, the more the two boys laughed.

“Please,” was all she said.

“Put your feet down. Stand up!”

She stood. Maybe seeing Louie laughing so hard released her fear. She splashed him and he giggled again. He threw wide his arms and launched himself from his father’s knees, out of the boat, into his mother’s open arms.

“This.” She lazed on her side, grey hair
falling across her cheek as she raised
her arm in a broad sweep of the air. “All
this. I’m seventy-seven.” She glanced the clock
and it toppled to the floor. “It’s nearly noon.
When will it end?” “Soon, Nan,” he said. “Soon.”

He found her one afternoon holding herself up with the washing machine.

“What’s this? Who’s Tess?”

He snatched the letter from her hand. “Leave it. It’s over. You wouldn’t understand.”

She pulled an envelope from a pocket. “She lives in California. We saved for you to go there. Louie gave up his tournaments.”

“I said leave it. She was wicked.”

“I don’t know you anymore.”

c)    agnosia: (failure to recognize or identify persons or objects despite intact sensory function)

The Meals Program arrived at noon
in a short skirt and dimpled smile.
They sat Nan up, moans and sighs,
tucked a napkin in her shirt.
“You made it yourself?” “Yes, Mrs. Cray.
Potato leek, your favourite. Tapioca for dessert.”
The girl winked at Hobart.
He felt a flutter in his chest, a vague tug
between his thighs. On the edge of the bed
beside his wife, he picked up the spoon
as the service let herself out the door.

d) disturbance in executive functioning: (e.g., planning, organizing, sequencing,abstracting). Simple and automatic tasks such as preparing meals, dressing and eating become too complex to execute safely.

A tear splashed into the thick soup
and sank to the bottom of the bowl.
“She was wicked.”

σ DSM IV 290.43 – With Depressed Mood: if depressed mood (including presentations that meet full symptom criteria for a Major Depressive Episode) is the predominant feature. A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given.
A2. Memory impairment (impaired ability to learn new information or to recall previously learned information)

He wiped the chalky dribble from
the corner of her mouth. “They’re back,
Jacob.” She blinked tears. Jacob

σ DSM-5 290.40 (F01.51) – Dementia (Updated) Neurocognitive Disorder With Delusions: if delusions are the predominant feature

was her brother, gone
a dozen years now. “Don’t let them,
please. They pinch my nipples. They
scream. I’m so frightened.” It was Nan
who had screamed, though.
The neighbours called police
more than once or twice. And twice
or more Hob had struggled, shuffled her into her
wheelchair, bundled her into the car to Emergency.
They always sent her home again, no room
in the inn. He was doing fine, wasn’t he,
looking after her till a bed came free?

They were doing fine. Louie was grown and married, working as a bank manager on the west coast. Hob never strayed again, even felt a little sick to his stomach whenever Nancy travelled to see her brother’s kids, or later when she’d visit Louie and the grandchildren; he’d be wondering if she had ever done something to get back at him. She’d be the type to do it and never let anyone know. Even if it took him into the next life, he would atone.

While she was on a trip to the coast once, he spent the week building her a gazebo in the back garden, wired it for a hot plate to make tea, set up a studio with an easel for her watercolours, something she dabbled in since Louie moved out and left his art supplies.

Hob paced the floor for hours on the day of her return. He had planned to have something going on the barbecue, table all set, bottle of wine. But when she got home, he grabbed her bag, dropped it on the floor, and whisked her out the back door. She stared in silence

e)    aphasia (language disturbance): unable to find words or express precise emotions

then threw her arms around his neck. “Do you love it?” he asked. She only nodded and held him tighter again.

The day-nurse rapped on the door, dropped
her purse with a clunk on the floor.
“She needs a change. Now, no fuss
this time, Miss Nancy. And no tussle,
either.” Nancy turned away.
“I won’t put up with this, Mr. Cray. I don’t
get danger pay.” She glanced
at the bandage on her hand. “You should
have her in a home. Stubborn is what.
And who suffers? She does. And me.”
The sheet slipped from Nancy’s hip. “Looks
raw,” said the nurse. “Keep her off that side or
the skin will get worse. Then there’ll be hell
to pay.” The back of Nancy’s hand
met the nurse’s ear with a thwack. “I’m done here.”

Hobart sat on the edge of the sofa. “Please, Nan. She was only trying to help. She left the pills for you. You really need to take them this time.”

Her back toward Hob, she slid her hand
between two couch cushions and withdrew
a clenched fist. She turned with a twist, deftly
shifting weight from one hip to the other.
She slowly opened her hand to reveal a dozen pills. “Please, Jacob.”

B. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning, and impairment in judgement overall. Sometimes attributable to guilt from past trysts or similar deviations from discretion.

He took them from her. One by one
he crushed them and fed them to her
with a soup spoon full of pudding.

Her hand felt warm lying on his knee, laid there casually as if they were lazing on the beach watching Louie splash with his friends on the shore. “He’s getting bigger.”

“So big.”

C. Focal neurological signs and symptoms (e.g., exaggeration of deep tendon reflexes, gait abnormalities, weakness of an extremity).

Her hand dropped from his knee.

σ DSM IV: 290.40 – Uncomplicated: if none of the above predominates in the current clinical presentation (Obsolete)


NBR5NeilsensmallRose Nielsen, from Nelson, BC, has a Creative Writing MFA from the University of British Columbia. Her work can be found online in As It Ought to Be and the RiverLit journal, in print in Contemporary Verse 2 and the Mississippi River Anthology, Down a Dark River.