Prosopagnosia, is the medical term for “face blindness” or the inability to recognize faces. I often joke I suffer from face blindness as I struggle to find family members in the airport or friends in public places. I frequently introduce myself to classmates and attending physicians I have already worked with because I fail to recognize them initially, only to be embarrassed when they talk and I immediately remember our prior encounters. Having earned my Bachelors of Science in Neuroscience I am utterly intrigued by how the brain works, and how the combination of nerves and neurotransmitter controls our actions, emotions, ability to move, and perception of the world. The first time I learned of prosopagnosia in my neuroscience classes, my interest was piqued. I always considered my friends who were able to recognize someone from their statistics class at a bar or who remembered a patient they interviewed at a separate clinic 5 months ago as having a special skill. Never did I think that I was deficient in my ability to remember faces.
I certainly am not alone in my inability to distinguish a person in a crowd. There are estimates that 2% of the population suffer from some degree of prosopagnosia. The level of impairment ranges from a mild case such as myself with difficulty immediately recognizing someone to extreme cases where one cannot distinguish a face from a household object. Despite this condition being relatively prevalent I often have people laugh or scoff at me when I say I’m “face blind”. I’m told that it’s not a real condition and people fail to understand how socially crippling it is to not know who a perceived stranger is who immediately recognizes you. Even worse I’ve been told that I am just inattentive and distracted. After years of embarrassment I have found ways of minimizing my difficulty in recognizing people. I look for the difference in the details. I notice the way someone parts their hair, or how they hold their right hand on their hip when they talk. I notice the freckle on their cheek or the bracelet they wear everyday. I recognize their giggles or the way they clear their throat. In essence I feel that my mild form of prosopagnosia has made me a better clinician.
Despite spending years working on becoming better at recognizing faces, there are moments that haunt me. Short glances that stick with me. The faces I cannot forget.
I remember my first encounter with a dead body. I was 18 and volunteering at a large trauma center. My role was to greet patients and walk them to their rooms. One day a nurse asked me if I could walk some family members to a consultation room adjacent to the emergency department. The family was Somalian and I tried to make lighthearted small talk as I walked them to the consult room, but with sullen faces the two women just looked at me with no response and continued to follow in my footsteps. I chalked it up to a language or cultural difference and continued on. I opened the door and directed the women inside when I was stunned to see an ashen face and body covered in a white sheet on a gurney in the middle of the room. There were several other family members huddled around the body, their cheeks stained with tears. Instantly I regretted my carefree demeanor on our short walk. I looked for the right words to say or the right thing to do, but was at a loss. Having immigrated to the United States it had been more than a decade since I had seen my Grandmother who passed away when I was 16. I had never lost a classmate or friend and I certainly had never attended a funeral or visitation. For the most part I had been shielded from death and I didn’t expect to encounter it in a nautical themed conference room on a sunny Tuesday afternoon. I mumbled my apologies to the two ladies and stepped out of the way for them to enter the room.
Walking back to the front desk of the emergency room it was business as usual. One nurse was humming along to the radio and another was discussing what she should order for dinner. No one seemed concerned that only a wall separated us from a dead body and a mourning family. Not wanting to appear too weak or too “soft” to cut it as an aspiring physician I didn’t mention my shock or feelings of sadness to any of the nurses. I never questioned what had happened to the patient and to this day and I never learned his or her name. As I continued working in medicine, I learned that we don’t speak about death and if we do it is mentioned as casually as one would talk about sports or the weather.
I continued to work at the same Emergency Department but was promoted to a “research associate”. On my first overnight shift I was working with 2 other pre-med college students. One of them had brought with them a delicious smelling bag of McDonalds for a late night snack. We were kept decently busy throughout the night and it finally started to slow down at about 3am. As we were sitting in our office my coworker began pulling his food out of his bag and talked excitedly about how he decided to go with the large fries AND apple turnover to accompany his Big Mac. Just as he went to take a bite, we got paged to the trauma bay, a 35 year old male in cardiac arrest. We rush across the hall and wait for EMS to arrive. When the double doors opened we saw a large patient on the stretcher with a Lucas device strapped to his chest. The automatic device compressed this man’s chest with such force that his obese abdomen heaved wildly at 100 beats per minute. In the chaos of the patient arriving and the physicians being busy intubating and getting a fem line placed, no one noticed the young wife and elementary school aged son standing in the corner of the room with a look of terror plastered across their face. One of the nurses noticed them and rushed them out of the room to avoid seeing the inevitable outcome. After taking off the Lucas device and assessing the heart via ultrasound it was confirmed there was no cardiac activity. The man was declared dead and the monitors turned off. His round face, pale and mottled.
As we step back into our office, my co-research associate pushed his fast food off his desk and into the garbage can without saying a word. We worked in silence until we were called to the next patient never mentioning what we had just witnessed. Eight years later, now as a medical student I am no longer on the periphery of the room during a Code Blue or a trauma. I am thrust towards the bed as numerous hands poke and prod at the patient, obtaining IV access, securing the airway, inserting a foley. I know my role is to perform CPR, to stand in line waiting my turn with adrenaline pumping and my hands shaking. I step forward, knowing that my actions are what will prolong this patient’s life albeit by a few minutes in some cases.
Usually I can get through 2-3 rounds of CPR without getting distracted, without letting my eyes wander. Call it human curiosity but as I pound away on the chest there are a few things I always take note of. First I glance towards the ring finger, wondering if there is a spouse out there who doesn’t realize how sick their loved one is. Next I glance to their neck, checking to see if they have a necklace on, wondering if the man wearing a crucifix is religious or how old the children are who gave their mother a “Mom” necklace. I am often stunned by the pretty pearl earrings and well coiffed hair of an elderly female patient or the slightly smudged makeup of my younger female patient. I try to identify the images of their tattoos and I look to their belongings cast on the floor. Last but not least, I look to their faces. Often swollen and bruised, their mouths are obstructed with an endotracheal tube and sometimes their hair is matted with blood and shards of glass. Their skin pale, their lips turning a shade of blue and purple. Their closed eyes hide their glassy looks and blown pupils. The only word I can use to describe these faces is unrecognizable. Unrecognizable not only to me but to their loved ones as they study their faces during their final goodbye.
Nobody teaches us how to deal with death. There isn’t a moment to say our goodbyes or to take one last glance at the deceased. There isn’t a counselor available for us to talk to and usually we don’t have more than a minute to regain our composure before we return to our waiting patients as if nothing had happened. After each patient loss, I reflect on my actions during the day. Twice I remember my final conversation with the patient and each time I cringe at the lack of empathy and compassion I shared in that moment. Twice I have been praised for my actions during the code, but each time I feel regret for not having done more. I run through their medical history and each minute of the code, called out by the nurse tasked with keeping time and recording the events. But at the end of the day the code isn’t about me, or my medical team or my medical facility. It’s about the patient.
I do not know what kind of person they were or who they have waiting for them at home. I may not know their medical conditions, I may not know their name. I may not be able to identify them by their facial features, but I do remember their final moments.
I remember each one.