“Is there any history of dementia?”
“None that I know of.” Spence’s parents had died in their mid-fifties, a few years younger than Spence was now. They’d been too young to have dementia. But then Spence was too young to have dementia, too.
“Anxiety or depression?”
Pru hesitated. Spence’s mood wasn’t the same; neither was his energy. “I don’t know if I’d call it depression. My husband gets cold easily, even when it’s warm out.”
“I’m not depressed,” Spence said.
“But you do get cold all the time.”
“I’m not depressed,” he repeated, but he sank deeper into himself, as if she hadn’t diagnosed him as much as decreed it. “I’ll tell you what I find depressing. That you’re talking about me like I’m not in the room.”
Sarah agreed: she found it depressing, too.
It was noon, and her father looked sleepy. He woke up feeling robust, but as the day wore on he deflated.
Now it was time for the mini–mental exam.
“Do you mind if I get him a snack?” Pru said. “His blood sugar is low.”
She returned from the vending machines with a granola bar and a can of Coke. But Spence placed the granola bar on the floor, and the can of Coke just rested on his lap until Sarah opened the tab for him.
“Professor Robin, do you know why you’re here?”
“My wife…”
“She brought you?”
“And also.” He was looking at Sarah.
The physician assistant asked Spence to recite the words apple, penny, and table and commit them to memory.
He repeated the words.
“Professor Robin, can you tell me the month, the date, and the year?”
Spence didn’t respond.
“Do you know what the season is, Professor Robin?”
He raked his hands through his hair. “It depends on the hemisphere. When it’s winter in the top hemisphere…”
“But in the hemisphere you’re in, Professor Robin. In New York City, where you live.”
“It’s spring, more or less.”
It was spring, more or less, Pru thought: it was March 3. But the physician assistant just sat there, writing something down.
“Professor Robin, can you tell me the name of the president of the United States?”
With his fists pressed against his chin, Spence had the bunched-up aspect of a Shar-Pei. He lowered his head to the desk. “All I know is I don’t like him.”
“His father was president, too,” the physician assistant said, and Pru’s heart went out to her: she was giving Spence a hint. Of course Spence knew who the president was. Just last week, they’d been talking about tax cuts, and Spence had said, Bush, that bastard. Now, though, he was stumped, and when the physician assistant asked him to recall those three words, he couldn’t remember any of them.
The physician assistant asked Spence to count backward by sevens from one hundred.
“One hundred,” Spence said, and then he said it again. “One hundred.”
“Keep going,” the physician assistant said.
“Ninety-three,” Spence said, and Pru was so agitated she didn’t realize he was right. But then he said, “Eighty-three, seventy-three, sixty-three,” and all the while the physician assistant was nodding, just the sound of her pen marking something down.
Sweat appeared on Spence’s forehead, and Pru took a tissue and dabbed it away.
The physician assistant showed Spence a wristwatch and a pencil and asked him to name them. She asked him to repeat the phrase No ifs, ands, or buts. She gave him a piece of paper and told him to take it in his right hand, fold it, and place it on the floor. She wrote something on a pad and said, “Please read this and do what it says.” She gave him a picture of two pentagons intersecting at a right angle and asked him to copy the drawing.
Pru couldn’t watch any of this. He was doing badly at these tasks, and she had to look away.
* * *
—
The first thing she noticed when the neurologist entered the room was how much he resembled Spence. They had the same auburn hair right down to the cowlick, the same green eyes. “Let’s take a look,” the doctor said, and he examined Spence’s reflexes, then shone a light in his eyes and ears. He nudged him lightly, then harder, to test his balance.
He was looking over the results of the mini–mental exam. “He’s pretty far along.”
“Far along in what?” Sarah said. Pru had introduced her as a medical school student, and the doctor was directing the conversation to her. “He’s young for Alzheimer’s,” Sarah said. “He’s fifty-nine.”
“He’s younger than most,” the neurologist agreed. “But five percent of cases…” He looked up at them. “I’ve seen it in the early fifties, occasionally even the forties.”
“Doesn’t education protect you?” Pru said. “My husband’s a professor.”
“If you look at the overall population, it does, on average, seem to delay onset.” But they were getting ahead of themselves, the doctor said. If Spence had been seventy-five, he would have said with near certainty it was Alzheimer’s, or if not Alzheimer’s, then something just as bad. But at fifty-nine, there were other possibilities they would need to rule out first.
Pru tried to include Spence in the conversation, but he wouldn’t be drawn in.
“There are other types of dementia,” the doctor said. There was Lewy body dementia and frontotemporal dementia, but Spence’s symptoms made those unlikely; vascular dementia was unlikely, too. “A brain tumor isn’t out of the question.”
“A malignant one?” Pru said.
“Possibly. Though depending on where it’s located, a benign tumor can wreak havoc, too. The happier news,” the doctor said, “would be something reversible.” Thyroid problems could cause memory loss, as could low levels of B12. Even NPH was potentially reversible.
“What’s NPH?” Pru said.
“Normal pressure hydrocephalus,” Sarah said.
“But let’s not play guessing games,” the doctor said. “We’ll do some blood work. I’d recommend some scans too, and an assessment by a neuropsychologist.” He lifted himself out of the chair as if from the force of his decision.
* * *
—
Pru was silent on the way home, blaming herself for what she’d subjected Spence to, blaming Spence for having done so badly. As they entered the apartment Spence said, “I hated that place. I’m never going back there.”
Ridiculously, she said, “You don’t have to,” though she’d already scheduled his next appointment.
* * *
—
There was no consultation with the physician assistant the next time around, just the neurologist, who entered the room with brisk efficiency. Sarah had gone back to California; she couldn’t miss any more school. “It’s pretty much what I expected.”
Pru didn’t know what the doctor expected, having let her own expectations take over. “How were the blood tests?”
“Unremarkable.”
“Is there a vitamin deficiency?”
“His levels are fine.” The doctor dimmed the lights, and Spence, who had been wearing an abstract look, snapped to. He was staring at the images from his MRI displayed across the screen. It showed some shrinkage in the brain, but otherwise, the doctor said, it looked normal.
“Normal’s good,” Pru said.
“Good for some purposes, less good for others. The brain shrinkage, especially in these regions”—the doctor touched his pen to the screen—“that’s consistent with Alzheimer’s.”
Pru tried to see Spence’s reaction, but he just sat there, not absorbing the words. She said, “So it’s definite?”
“You can’t know for certain, but given the symptoms, blood work, and sc
ans, I’d be shocked if it was anything else.”
Pru tucked her skirt beneath her, trying to recompose herself stitch by stitch. “Spence, my husband—he’s not even sixty years old.”
The doctor nodded.
“Do you know what an exceptional man he is?” She allowed herself to think this was punishment. But for what? For Spence’s success? For his being exceptional?
“Unfortunately, early onset tends to be the most aggressive kind.”
“So what do I do now?”
“You try to give him the best care possible. There are a couple of drugs on the market. The problem is, they aren’t any good.”
She stared at him unblinkingly. “Is there no hope?”
“Over the long run, I think we’ll beat this disease—certainly contain it if we don’t beat it outright.”
“And in the short run?”
“You could enroll him in a drug trial. But at a certain point, too much damage has been done. The brain has been incinerated.”
With what little strength she had left, she said, “But he’s still teaching.”
The doctor looked startled. “That’s not possible.”
“It’s not only possible, it’s true.” Except it wasn’t true, not really. Spence still went to class, but in the last few months alone his decline had been so great, his TAs had to take over for him.
“Your husband has to retire,” the doctor said. “Letting him teach is unethical.”
“That’s for me to decide.” Pru took hold of Spence’s hand, and then they were plummeting down the nine flights, as if the elevator had been loosed from its cables.
* * *
—
As soon as she got home, Pru called Sarah. “Dad has Alzheimer’s,” she said. “We need to tell Arlo.”
Part III
8
Arlo Zackheim always got wind of things. He didn’t have ESP, exactly; he was simply more intuitive than other people. This helped him, he believed, in business and in life. He liked to have the maximum information about others while revealing the minimum information about himself. He listed his phone numbers as anonymous so that people wouldn’t know who was calling. Sometimes, just for the kick of it, he would leave an automated email message. I don’t feel like checking email today. I’ll get back to you when the urge overtakes me. But all the while, he was secretly checking.
“You hate surprise,” his mother told him once. Who could blame him? His own childhood had been so replete with surprise, the only constant was the surprise itself, starting with his parents’ divorce, when he was only eight months old. He was convinced he could remember his parents together, but his father told him that was impossible.
Arlo didn’t care what his father said; he’d spent his whole life trying to forget his father even as he yearned for him from afar, and he considered the word impossible a challenge. Impossible to hold your breath for as long as he’d held his as a baby, holding it until he turned blue. People spoke about iron wills, but scientists had yet to discover a will as strong as his. He had run two marathons forty-eight hours apart. Two hundred push-ups, fasting for days, lying in a hyperbaric chamber, extreme caving, tantric sex, dry orgasm. He didn’t care what his father said. He remembered his parents together, recalled his father saying, “Well, good goddamn,” his father, who never cursed, who referred to it as cussing, who called dog shit dog dirt. “I hate my father.”
“Of course you do,” his mother said, good at encouraging that hatred while pretending not to. “Who wouldn’t hate someone who abandoned him?”
“That’s not what happened.” But Arlo didn’t know what had happened; he just knew it was more complicated than his mother let on.
“Things are always more complicated,” his mother said, “and at the same time they’re really quite simple.” Which was how his mother spoke, in koans, her meaning as obscure as her gaze.
By the time he turned ten, Arlo had lived in so many places, he had trouble remembering them all. His mother had once told him she wanted to poop in all fifty states. In this way, she was following in the footsteps of her father, a kosher butcher, who had moved the family from state to state, always in search of an underserved Jewish community. If Arlo had been older and more sophisticated, he would have realized his mother was visiting upon him what her father had visited upon her. He would have recalled the words of the prophet Jeremiah. The fathers have eaten sour grapes and the children’s teeth have been set on edge. But Arlo hadn’t read the Bible at that point—or much else, for that matter.
One day, Arlo picked up the receiver and heard his parents on the phone. “What about his schooling?” his father said. “It’s required by law.”
“The law!” Why, Arlo’s mother wanted to know, should she follow the law when the cops were pigs and the district attorney was, too, when every lawyer was corrupt from the lowest ambulance chaser all the way up to the attorney general? Had Arlo’s father forgotten about Vietnam? Had he forgotten about the Gulf of Tonkin and the Pentagon Papers and My Lai?
No, Arlo’s father sighed, he hadn’t. But it was beside the point: a red herring. He was talking about their son’s education, and what kind of education was Arlo getting when Linda was moving him from place to place?
“Is that all you care about? Education?”
“Listen, Linda.” Arlo father’s voice was as steady as his mother’s was deranged. His father’s very calmness set his mother off. The more placid he became, the more ill tempered it made her.
“I am listening,” she said. “What else is there for me to do but listen to you? He’s getting an education. I’m homeschooling him.”
Arlo stifled a laugh. He’d been in and out of a dozen schools, never staying long enough to gain traction. “You have a native intelligence,” his mother said. “Now you just have to go out and cultivate it.” That it was her responsibility to help him cultivate it never occurred to her. He did have a native intelligence, but he read poorly, which shamed him, and his classmates mocked him for his reading, which shamed him even more.
Soon he started to skip school. His mother, busy at the café or bookstore or arts supplier, at whatever job she’d secured that month, was too tired to fight him. “If you want to play hooky, it’s your loss.” But secretly she was grateful for his company. So when he said, “You could homeschool me,” she said, “I don’t see why not.”
She would take him to the library, and she would become mesmerized by the rows of books, the little round stickers of the Dewey decimal system lined up like shirt buttons on their spines. “I’m like a child in a candy store,” his mother said, but a child who looked at the candy without buying any, because they would leave the library without having borrowed any books.
At the local diner, Arlo’s mother would flip through USA Today to the micro-flash of news from each of the fifty states. “Okay, I’m going to homeschool you. Tell me which state this is from.” But Arlo wasn’t good at geography, and he couldn’t possibly have known whether the home fire that killed a grandmother and her two grandchildren had been set in Minnesota or Vermont, or whether Arkansas was where the power had gone out, and so he was just guessing.
“Here,” his mother said, “explain to me about ERAs,” and Arlo, who liked baseball and was good at math, wrote the figures on a napkin.
But Arlo’s mother wasn’t good at math, and Arlo had to repeat the process, so if anyone was being homeschooled, it was her.
Arlo’s father said, “You’re homeschooling him, Linda? I’m not sure what qualifies you to do that.”
“You know how I feel about the American education system.”
“I’m not talking about the American education system. I’m talking about our son. What are you teaching him?”
“Math, geography, social studies, physics.”
“Physics?” he said. “You’re teaching Arlo physics?”
This, Arlo thought, was typical of his mother. She would get caught in the bramble of her deceit, and soon she’d be sounding ridiculous. Maybe it was those very words, geography and physics, that magnified her lie, but hearing her say them made him cough.
Now his parents realized he was on the phone, and his mother was saying, “Arlo, you can’t go snooping around like that,” but his father said, “Wait a second, Linda. Arlo, can I have a word with you?”
The phone felt heavier in Arlo’s hand, and in the midday sun that pulsed through the blinds he started to sweat.
“How are you, Arlo?”
“I’m okay,” he said, but whenever he spoke to his father he realized he was less okay than he’d thought. “I have to go,” he said, and as he hung up he heard his father say, “I love you, Arlo,” the sound percussing as he walked out of the apartment and down the road, past the gas station and the laundromat and the check-cashing store, the pawn shops flashing even in daytime. If his father loved him, why didn’t he come get him? Why did they only spend July together, and a week over Christmas, and a week over spring break? Secretly, Arlo slept with his father’s shirt, which he’d filched on a visit to New York. His father would have given him that shirt, but the filching had been important, just as the secrecy of sleeping with it was important, knowing he was betraying his mother by sleeping with his father’s shirt.
* * *
—
When he was twelve, Arlo moved with his mother to a commune in Delaware. “Oh, Arlo, all this time we were meant to live here, and I just didn’t realize it.”
Arlo himself wasn’t nearly so sure they were meant to live here. But he adjusted to the commune’s routine, to morning meetings and the dividing up of tasks, to long days picking beets and radishes. He enjoyed sitting with the other children in the mess hall, the soccer and kickball games, nights in the gazebo beneath the stars.
Morningside Heights Page 5
