I continue walking nevertheless, convincing myself that I will fight through this illness, improve my pitiful form, and return to my athletic self.
I pass intersection after intersection, dutifully checking the street signs. I’m being careful; I don’t want to get lost. But after a few hundred yards, I stop recognizing the streets. I know their names, all right—that is, they sound familiar—but I can’t pull up from memory where they lead or which direction they run.
Okay, I know I am a little more than a mile from my house, so it cannot be very difficult to find, I assure myself. I keep walking.
I can’t be lost—not when I’m so close to home. I just need a bit more time to come upon the correct street and recognize the houses. Then I’ll easily find mine.
I don’t panic. I don’t even worry. I just walk and walk. All the quiet houses look exactly the same; all the deserted streets seem identical. There is not a single soul outdoors; the heat must be keeping my neighbors inside. No one’s mowing the lawn or trimming hedges. There’s no one to ask for directions.
I keep walking. But I’m getting really tired. And I need a bathroom. I really need to pee.
I know there are no public bathrooms for miles, and no woods here either, just house after house after house. I look around to find some bushes where I can do my business. But there are none to suit the purpose. Just manicured lawns and evenly mowed grass and nicely trimmed trees.
I can’t wait much longer.
I can’t wait at all.
I pee. I pee in my shorts. I don’t pause or even slow my pace. I walk and pee. I don’t want it to happen, but it does, as if it has a mind of its own. I’m not concerned that somebody will see. I stroll along the street past the houses of my neighbors, peeing my pants like a little child, and I don’t care.
An hour or so later, I flag down a car at an intersection and ask the driver for directions. But I have trouble explaining where I want to go. I tell him the address but he doesn’t know where my street is. In an effort to figure out where I live, he asks additional questions, like whether I’m near this or that neighborhood landmark, but I’m unable to give any meaningful details. He offers to drive me around but I refuse to get in his car. It’s not that I’m afraid to ride with a stranger; it’s that I want to walk. That was my plan, and nothing is going to change it. He volunteers instead to lead me to the closest major road in the hope that it will jog my memory.
My stride is unsteady as I walk along following the man’s car. But I’m not troubled by my wet shorts. He drives very slowly, and I tail him through the monotony of the red-brick façades of the houses in our northern Virginia suburb. When we reach the road, the pieces of the puzzle suddenly fall into place. I recognize my neighborhood: that little house with yellow siding on the corner, the brick mansion across the street. I now know that I have to turn left onto the busy road, and a hundred yards later, turn left again. I see my house.
Mirek greets me with relief. He cannot understand why I took so long.
“I got a bit lost,” I say. “These streets weave in and out, and it’s hard to follow them.”
“Okay,” he says, giving me a kiss. He’s clearly happy I’m home.
“And I wanted to pee so much that I wet my pants,” I say.
He looks down at my wet shorts and legs. “Oh, dear,” he says with affection. “Just wash it off.”
This incident marks the first time in my conscious life that I am incontinent. For the next month or two, I will sometimes have trouble controlling the reflex to urinate (in medical jargon, micturate) that arises in response to an increase in pressure in my bladder. If I get stuck in traffic on my way to work, as soon as I park my car on campus, I have to run to the nearest building to find the bathroom.
Is it possible that the inability to inhibit the urge to urinate has something to do with brain function? As it turns out, it may be linked to dysfunction of the medial surface of the frontal lobe, which is the cortical center of micturition. A majority of stroke patients with frontal-lobe lesions develop urinary incontinence, and patients with frontal-lobe tumors often can’t tell their bladders are full until the very last moment, when they can no longer control the need to pee. Incontinence is also a common problem in people with dementia, and, in general, it’s a common disorder in older people. There can be a number of reasons for it, many of which have nothing to do with brain disease, such as a urinary tract infection, inflammation of the bladder wall, or prostate problems. But when someone my age suddenly becomes incontinent, it can be a sign that the brain is at fault.
The inability to control urination may be a symptom of other mental illnesses besides dementia. A former colleague of mine at the NIMH, Dr. Thomas Hyde, a neurologist and a schizophrenia researcher, hypothesized that children who would go on to develop schizophrenia took longer to learn to control their bladders than children who did not later develop the disorder. And indeed, the research found that adult patients with schizophrenia had had a higher rate of urinary incontinence in childhood than their healthy siblings. The impaired bladder control that many patients with schizophrenia experienced as children might be connected to delayed maturation of the
