Wandering in San Miguel
By Steve Joseph August 22, 2008 San Miguel de Allende

On January 4 of last year, I suffered an episode of transient global amnesia. I pieced together the story of my trauma from what friends and family told me. That afternoon, I had helped out a friend in his new store for a few hours and my wife had met me there. I was trying to memorize the stock.


“Bill’s cutlery store is beautiful,” she said on the way home.
“What store?” 


“Didn’t you like being there?”

“I don’t remember any cutlery store…Bill doesn’t have a store.”

“That’s not funny,” she said.

“I really don’t remember. I’m not joking.” I couldn’t remember anything I had done that day.

The nearest emergency room was at Columbia Presbyterian Hospital. I had an EKG and MRI; tests and X-rays of my brain showed no damage. We were told there is no known cause or cure for transient global amnesia. It rarely strikes twice and in many ways mimics a stroke; a one-day stroke. Anyone can be afflicted; the primary victims are males, 50–70 years old. I spent two days in the hospital, sleeping most of the time, being tested and trying helplessly to recall my lost day, and to answer the neurologist’s questions while small groups of residents looked on.

“This is unusual,” he told them, “TGA, transient global amnesia…technically it’s a stroke, but then again, it’s not.”

He held my wrist and consulted his watch. My wife told me days later that he said to the interns in a Groucho Marx voice, “Either this man is dead or my watch has stopped.”

I couldn’t recall President Bush’s name, much less name the last five presidents in order, nor could I tell the neurologist the three words he asked me to recall after five minutes.

My wife told me later that they were “quill,” “muskrat” and “wrinkle.” My discharge papers said to take a baby aspirin every day and call the neurologist if it happened again. Of course, if it happened again I wouldn’t remember to call him.


My memory for previous presidents and the ability to remember most words returned, but all memory of January 4 was gone. I was myself, minus a day. During the week, we stayed at home in New York packing to spend two months in San Miguel de Allende.

There, I looked forward to being in bed with the lights out, so I could work on recovering three words I found especially hard to remember: “cashew,” “Guadiana” (my street name) and “amnesia.” I ran the letters of the alphabet, but in my haste I would rush right past “a” because, of course, it came up so quickly, so I’d start with “b.” I sometimes was able to recover cashew and Guadiana, but I would lose them the next minute. I remember that I couldn’t remember amnesia.

All the streets are cobblestone and the sidewalks are slate, because San Miguel was made a national landmark in 1928. There are no traffic lights and few stop signs, but speed bumps jolt you every 100 feet or so. When a cab crosses them, which could be 20 times in a typical ride, the shock flings passengers off the seats and into the air where their upward trajectory is halted and they are hammered by the thinly padded metal roofs, before they carom off the doors. Passengers cannot slide to the floor, since their knees are pressed firmly against the back of the front seat.

I hated San Miguel—its quaintness, its picturesque buildings and near-perfect weather. I was sliding into a depression, brought on by my transient global amnesia, which turned out not to be temporary, and with the depression came anxiety and a sense of doom. I felt like I was in a witness protection program, though I’d committed no crime.

Since cabs were cheap and buses were crowded, and each step I walked added to my depressed exhaustion, I found myself in a taxi at least twice a day. I would hail a cab and then realize I had forgotten the name of my street. I found the Mexicans to be very patient and the cab drivers would sit, pulled over to the side of the narrow roads, waiting while I began to sweat, trying to recall my address. I had tried inking it on my hand or writing it on a piece of paper stuffed in my pocket or stashed in my wallet. Usually, I had washed my hands sometime before hailing the cab, I had lost the paper, or I couldn’t find it in the many chambers of my wallet. It became a mission for me to get home.

Because I wanted to keep a good face for my wife, and the few good friends we had made, I feigned normalcy when I really wanted to go home to New York. Eventually, I gave up writing “Guadiana” on anything, and made recalling the word the measure of my strength, my will and my sanity. Anyone who has ever been deeply depressed knows how exhausting it is pretending to be normal. When you are anhedonic, you lose pleasure in everything but sleep and thoughts of oblivion.

Late one night when I couldn’t sleep, I hailed a cab from the center of town. I tried to contort my way into the tiny backseat, scraping my shins and then motioned to the driver that I would like to sit in front.

“No problema.”


I immediately began to perspire from the strain of trying to remember the name of my street. I remembered the house number, 26, but “Guadiana” would not come to me. Moments went by.

“A donde, senor?”

I could speak some Spanish, only in the present tense, but “Wait, wait, I know it,” I blurted in English, beginning to sweat. “Give me a minute.”

I was mortified to get into a cab and not know where I was going, or rather, I knew where I was going, but couldn’t tell the driver.


I could remember the name of the large art school in town, the Instituto Allende.
“Se me olvido como se llama mi calle,” I whispered, 

“Como, señor?” 

“I forgot my street name.”

“Please speak English, señor.”

“I only know the house number, not the name of the street.”

“Where is it near, sir?”

I began to sweat more heavily.

“Es cerca de el gran edificio.”

The driver sighed. “San Miguel has more than a few big buildings, señor.”

“Estudien pinturas en este edificio.”

In my pidgin Spanish, I was trying to say they studied painting in this building, but I could only speak in the present tense and my vocabulary was weak. I cursed myself for being too lazy to learn the language properly.

“Naked women,” the driver said, “They study naked women in the Instituto. I like that.”

“Me, too,” I said.

He laughed. “Son of a bitch, naked women make the world go round, but we must find su casa. That is what God has, how do you say, chosen for me, not naked women, but finding your house. Sheet! Señor, this make me want to drive this taxi into a wall and take up painting!”

He braked for a speed bump, but not soon enough. My head banged into the roof of the cab, but not hard enough for my memory to return.

“I didn’t always do this work,” he said. “I used to be in the circus, but I had a very bad accident. I fell off the stilts. Now I must drive a taxi.” The cab just missed hitting a bus, as it bounced over another speed bump.

“Learn Spanish,” the driver said, “then you will know where you are going.”

The streets began to look familiar. “This is it! Turn quick.”

“This is Guadiana,” he said, “why didn’t you say this is where you wanted to go?”

Steve Joseph was professor of writing at NYU and Touro College in New York City, and was nominated for five Tony Awards for his Broadway and Off-Broadway plays. He teaches writing in San Miguel.

Hospice service declared priceless
By Hospice San Miguel staff

Hospice San Miguel’s services and care are provided to members of the urban community free of charge. This includes a doctor, nurse, medical director, social worker, spiritual counselor and volunteers who assist on an as-needed basis.

 Hospital beds, walkers, oxygen concentrators and other basic medical equipment also are available. Patients pay for medicines and private home caregivers when necessary.


To qualify for hospice care, a patient’s doctor has to agree that, “If this disease runs its normal course, my patient’s life expectancy may be six months or less.” The patient, a family member, or the patient’s doctor then contacts Hospice San Miguel to begin the introduction and admission process.

It is very important that patients enter hospice care as soon as possible. Here are five more reasons and common misconceptions that influence people to wait too long.

1. My doctor will tell me when it is time to enter hospice. Doctors are taught to heal. It is difficult for them to accept that they cannot always heal. At Hospice San Miguel, over 75 percent of our first patients were recommended by a neighbor, friend, family or even a priest! Almost everyone knows someone who is potentially a hospice patient. If you do, tell them about Hospice and truly help them and their families during a difficult and often confusing phase of life. 


2. Hospice is only for cancer patients. Early hospice care in Europe and the US was mostly for cancer patients. Now, cancer is less than half of the cases. Hospice does not discriminate by disease and takes patients with all forms of terminal illness—COPD (pulmonary), ALS, Dementia, AIDS, etc.

3. Hospice is a place I do not want to be. Hospice is not a place; it is a philosophy of care. Over 85 percent of all people want to die in their own homes surrounded by their families and loved ones. All Hospice San Miguel care is provided in the patient’s home unless the patient or family specifically wants to be somewhere else. All Hospice San Miguel patients to date have chosen to be in their own homes. Hospice has 24/7 emergency services so that calls to Red Cross are rarely necessary.

4. Mexican families do not want others to help take care of their loved ones. We have found that our Mexican clients want to be taught how to best care for someone, learn the techniques of care and receive advice about an illness. They want to understand the prognosis, progress and expected events. This is what prevents crisis, stress and repeated and unnecessary trips to the hospital. Two-thirds of Hospice’s patients to date have been Mexican and, in every case, Hospice has empowered family caregivers with information and training, and helped the family communicate effectively to help maintain dignity, respect and peace throughout the illness.

5. To accept Hospice, I must refuse all other treatments. If a patient wants to continue certain treatments that have a possibility of prolonging life or reversing a certain medical condition, Hospice is not adamant that all curative treatment be stopped. We encourage people to have hope. If a procedure has a relatively probability of success, it is appropriate to enter hospice care even while pursuing this alternative. Hospice is open to patient treatment choices, whether they are holistic, Western, Eastern or religious-based traditions of care. The patient’s desires and belief systems are of paramount importance to Hospice.

Call Hospice San Miguel at 154-4287 for answers to your questions or to schedule a consultation.