He began soberly with an astonishing fact: ‘In nations that keep records, Alzheimer’s stands high among the scourges of mankind. The causes of death, in descending order, are heart disease, cancer, stroke, Alzheimer’s.’
This was immediately challenged by several questioners, but he stood his ground: ‘It’s my business to know. But I’ll have copies made of the studies that prove what I’ve just said,’ and he handed Krenek two studies for the Xerox machine.
‘The insidious disease produces a massive breakdown of the communicating system in the brain. A translucent waxy substance called an amyloid protein is deposited in areas that clog and finally halt the delivery of messages from one part of the brain to another.
‘There is no medical test that will prove that a patient has Alzheimer’s; only an autopsy after death, when the horrible entanglement that can be seen by even an amateur proves that the person had Alzheimer’s. The diagnosis while the patient is still living is simple: “We’ve proved that it isn’t anything else, so it has to be Alzheimer’s.” But as you’ve probably seen for yourselves, the symptoms in people you love are devastating. Loss of memory. Loss of ability to recognize friends or even close family members. Loss of control over bodily functions. A mad desire to break loose and wander. And finally commitment to a bed twenty-four hours a day, and a suspension of all normal vital functions except mere existence. That’s the hell of Alzheimer’s, a living death.’
‘Is that all we know?’ asked a woman who suspected her husband might be developing the dreaded affliction.
‘We know a tremendous lot, that’s the business we’re in. There seem to be numerous parts of the human system whose malfunctioning could cause Alzheimer’s—the bloodstream, the lining of a vein, the weakness of a crucial part of the brain, a failure of an inhibitor—and at each of these many spots there could be a multitude of things that might go wrong, and to complicate things further, there is a staggering multiplicity of theories—guesses, if you wish—to explain why things go wrong.’
‘What are the things that can go wrong?’ a man asked.
‘Well, there are forty-six chromosomes, each strand containing its multitude of genes, perhaps millions in all, and each aberration is susceptible to a hundred or more scientific explanations.’
‘That’s an overwhelming problem.’
‘Not really. Daunting but not impossible. We have a steadily accumulating knowledge about the chromosomes. We know for instance that a problem in Chromosome four results in Huntington’s disease, cystic fibrosis seven, eye cancer thirteen, kidney disease sixteen, muscular dystrophy nineteen.’ Then he paused, studied the attentive audience and said: ‘Now follow me closely, taking down numbers if you wish, and I’ll ask Mr. Krenek to bring in the blackboard he has in his office. Here we go into the wonders of the human genetic system.
‘Sometime ago it was discovered that Chromosome twenty-one was related to a curious disease. Babies born with three components of twenty-one, as opposed to the normal two, always developed Down’s syndrome, and I’m sure many of you know what that is.’
‘Produces mongoloid infants.’
‘We don’t use that phrase anymore. It’s already a terrible affliction, doesn’t need an ugly name, too. But the interesting thing is that anyone who has Down’s syndrome also has many of the brain patterns—the tangles, that is—the amyloid-protein blockages of Alzheimer’s. Tests have shown that Chromosome twenty-one is the villain that produces the amyloids.’
‘So is the mystery solved?’ a man asked.
‘Heavens, no! From tests in Sweden we also know that a defect in Chromosome fourteen definitely accounts for the type of Alzheimer’s that starts conspicuously early in life. So we know firmly that twenty-one and fourteen are somehow involved. So you might think we’d direct all our brainpower on the analysis of those two, and hundreds of brilliant researchers are doing just that.’
‘I have to conclude from what you’ve said and how you said it,’ observed Senator Raborn from the audience, ‘that you yourself are onto something else?’
‘Yes. Mysterious evidence, not yet well supported, has filtered in from various sources, like Livermore in California, Duke here in the East, that Chromosome nineteen is also involved. It seems to contribute, and my specific job is to accumulate whatever evidence surfaces—I’m what you might call the garbage collector, looking for anything at all that might involve nineteen. As researchers around the world untangle the genes of Chromosome nineteen—and that may take decades because the chain seems endless—we’ll eliminate those that have no apparent bearing on the problem and report to the world whatever minute bits of solid evidence we’ve collected.’
‘You say lots of countries are involved in the search?’ a woman asked, and he said enthusiastically: ‘Oh, yes! Venezuela provided a major clue for Chromosome twenty-one, Sweden gave us the hint on fourteen, and Japan has been an active contributor. It’s a worldwide effort.’
‘So what you’re all striving to do is solve the mysteries of the human race?’ Raborn asked.
‘You make it sound too grand. I myself am working on only a tiny piece of a vast puzzle. I’m an expert in genetic structures, contributing my bookkeeping skills, my past knowledge, to assist the brilliant young scientists who are doing the demanding laboratory work.’
‘Are you getting any closer to an answer?’ a woman asked.
‘Madam, there are ten thousand questions. An answer to them all? No. But if our group can affirm or eliminate one small segment of that tangle, we’ll have made a true contribution.’ He felt so strongly on this point that he spoke with extreme gravity: ‘Are you aware of what we’re attempting? To compile an atlas of the entire genetic structure of the human race. When others are through with their work in the next century, experts will be able to look at any human deformity, any kind, and pinpoint the gene or genes that cause the problem, and maybe correct it. Did you know that even today skilled doctors can cut into the womb of a pregnant woman, go into the fetus and adjust anomalies in the gene system of the unborn, sew everything back up and await the birth of a normal baby? Yes! We can do that now.’
‘Don’t you feel as if you were playing God?’ a woman asked.
‘I’ve thought about that frequently since coming to the Palms. The purpose of my life’s work, what does it mean?’
‘And your conclusion?’ a man asked.
‘That God, when He fashioned the universe, left in it a handful of puzzles, which man is challenged to solve. The wheel, what a marvelous invention. Electricity, how wonderful. The operation of the blood system. The discovery of the great galaxies. A vaccine for polio. The adjusting of the human eye so that we can manufacture glasses to enable us to see. On and on it goes, intelligent man solving the great secrets God left on the table before us. Radio, television, the atomic bomb, and now the wild secrets of the gene system, millions of them hanging on to those forty-six chromosomes.’
‘You speak like a poet,’ one of the men from Assisted Living said, and Lewandowski replied: ‘Or a philosopher, or a scientist who has wrestled with these problems all his life.’
‘Do you anticipate any solution to the Alzheimer mystery?’ asked one man. Another: ‘How about AIDS?’ Yet another: ‘Or the common cold?’
‘I sit in my little research center close to your rooms and place one minute building block after another in its proper order.’ Turning to the blackboard, he took a piece of chalk and said: ‘I thought you might like to see what I work with while you’re asleep. This is from a communication I received today from Sweden,’ and with great care, checking his letters as he wrote them on the board, he showed the audience this message:
SEV KM DAEFRHDSGYEVHHQKLFVFFAEDVGSHKGAIIGLMVGGVVIATVIVITLVML
‘It’s quite exciting, really, a breakthrough in relating one part of the beta-amyloid sequence to another. When we accumulate enough of these linkages we’ll have mapped the entire human genome, maybe sometime around A.D. 2040.’
‘Are you
working in the dark?’ a man asked.
‘Me personally? Yes. I cannot see the grand pattern evolving, but I hope that someone like me working in Copenhagen or Kyoto will sense it, and bang!’ He slammed the lectern. ‘We’ve solved another one. In my lifetime, apparently no sure solution to Alzheimer’s. In yours?’ and he pointed to one of the waiters who had lingered to hear the talk: ‘Yes. Surely the work we’re doing now will unravel this mystery by then.’
When the lecture ended, Zorn accompanied Krenek to the latter’s office and along the way he said: ‘You did a great job, Ken, in arranging that talk. Who’d have thought so many would be interested—and be able to follow what he was saying?’
‘That’s the secret of a place like this. It looks to be a collection of exhausted warriors idling in the sun as they recall old battles. But these people are still in the middle of the fray. Senator Raborn flies to Chicago next week to try to knock some sense into his Republican party. Armitage is on a committee to wrestle with the problem of conflict between conservatives and liberals on college campuses, Max is struggling with Alzheimer’s, and did you know that Nora is deep into the problem of how to provide nursing care for young men dying of AIDS?’ As he entered his office he said: ‘I don’t think that even John Taggart realizes it, but a man like me, in his fifties, actually loves these old geezers. They give me hope that I’ll have thirty more years of activity.’
He entered his office, took a magazine from his desk, and said: ‘And look what our beloved Raúl Jiménez has been up to! A masterly eleven-page essay with photographs and specific names detailing the crimes the Medellín and Cali cartels in his homeland have committed in both Colombia and the United States. He’s in the forefront of the battle, and residents take great pride in having a fighter like that in our midst.’ He reflected on this judgment for some moments, then said: ‘So in this dreamy little world of ours, which seems so soporific with old men and women living out their last days, we find ourselves in the front line.’
When they were settled in Krenek’s chairs, Zorn said: ‘Ken, I’m worried about that crazy airplane the men have built. I can see real trouble rising out of that nonsense. You know, I suppose, they’ve moved it out to an airfield, but did you know that the other night, by himself, completely alone, St. Près sneaked out there at midnight and flew the damned thing by himself? Way out over the gulf, back over the savanna.’
‘He did! I’ll be damned!’
‘Now, if they take it up right after Christmas as they plan, and the newspapers and television crews are here watching, and something goes wrong and there’s a crash—’ He shuddered, then asked: ‘Do you suppose you could persuade them to call it off?’
‘You say he flew it? Successfully?’
‘Yep.’
‘Andy, you might be able to talk Jiménez and Armitage out of it, and maybe Lewandowski, but Raborn? No. He’s Nebraska-tough. And St. Près will surprise you. He’s the polished gentleman, socially correct and urbane, but they tell me he was the one who got his whole embassy out of a tight spot in Africa. I can assure you that he does not scare easily, and if you propose to him and Raborn to drop the subject, they’ll—’
‘You want them to try it, don’t you. You’re on their side.’
‘I am. At their age, give it a last shot. I’m told that if St. Près doesn’t fly it, Raborn will. Believe me, Andy, you are not powerful enough to browbeat those tigers.’
As he walked back to his apartment, where Betsy waited. Andy wondered if Krenek was right, that these adventurous old men were entitled to a last flight, and he thought: Maybe they are. But one thing’s for sure, even if they do get the damned thing in the air and down, next day they’ll have to find somebody to give the plane to.
When Betsy greeted him with excited approval of Lewandowski’s talk, he said: ‘It staggers me. So much amazing activity in this place. Lewandowski probing the innermost secrets of the human race, the men of the tertulia building a plane that actually flies, Nora fighting to find a way to help young men suffering from AIDS.’ He kissed her and broke into laughter: ‘And you and me trying to figure out the next step in our lives.’
In early December Noel and Gretchen Umlauf found themselves at a terrible impasse regarding their mother’s care at the Palms. For several weeks after her heart attack, Dr. Farquhar and a team of experts tried every medical means available to bring Berta back to consciousness, but all to no avail. After weeks of failure and a battery of sophisticated tests they had to conclude that during her heart attack the supply of blood to her brain had been cut off, causing irreversible damage.
With a heavy heart, Dr. Farquhar called Noel and Gretchen into his office. Since their mother’s heart attack they had been staying at a hotel near the Palms but spending most of their days and evenings in anxious vigil by her bedside.
‘Noel, Gretchen, in my many years as a doctor I have seen some extraordinary cases of recovery from patients who seemed doomed, had no hope. I had a male patient with prostate cancer who I didn’t think had more than a couple of months to live. Well, that was two years ago and the old codger beat me last weekend at golf. I had another patient, a woman with ovarian cancer. Again, her doctors, myself included, didn’t give her much time left on this earth, but she went into remission and lived several years, enough time to see her own daughter marry and give birth to a daughter herself. So there are extraordinary cases—miracles are really what they are. And as a friend, you know that’s what I’m praying for in your mother’s case. I am very fond of that tough little woman and want to believe that somehow she’ll once more become the Berta we all love. But as a doctor, I have to tell you that I don’t believe there is any hope of her recovering. Her brain has been too badly damaged for her to ever be herself again. I don’t think she’ll wake from the coma she’s in now.’
With tears streaming down his face, Noel tried to answer. ‘I’ve feared there’s no hope, Doctor. I’ve sat by Mother’s bedside day after day and looked in her eyes, and there’s nothing, there’s nothing there—’ He covered his face with his hands.
Gretchen, fighting to control her own emotions, spoke up, ‘Dr. Farquhar, we’ve brought the living will that Mother drew up. The sort of death-in-life existence she’s in now is what she most feared. If there really is no hope of her recovering, then I know she would want us to follow the instructions in this will. In fact, we promised that we would honor her wishes.’ She withdrew the document from her purse and handed it to Dr. Farquhar.
He read each page carefully, then put the document down and sat quietly for a moment staring at his clasped hands. Then he looked up at Noel and Gretchen: ‘If it’s all right with you, I think we’d better call Dr. Zorn in.’
Farquhar dialed Zorn’s office, spoke to him quickly in a low voice, then picked up the will from his desk, and excusing himself went to wait for Zorn in the hallway. When the director of the Palms arrived, Noel and Gretchen watched the two men in conversation. They were both frowning and Farquhar was pointing repeatedly to something on one page of the will.
When they finally joined Noel and Gretchen in Farquhar’s office, Zorn greeted the couple gravely and took a seat.
Farquhar began: ‘Neither Dr. Zorn nor I want to add to the terrible burden you are under right now. But I’m sorry, the Palms simply cannot follow the dictates of this living will.’
‘But why not?’ Noel asked. ‘It makes Mother’s wishes completely clear.’
‘Oh, I believe that these are Berta’s wishes,’ Dr. Farquhar replied, ‘and so does Dr. Zorn, but this will is invalid.’
‘What?’
‘It’s archaic. Who drew it for your mother?’
‘Mother used a book she got from a library.’
‘Either that book was terribly wrong, or Berta misread a crucial instruction,’ Zorn said, shaking his head sadly.
‘What can we do?’ Noel cried.
‘I know a good lawyer in town,’ Dr. Farquhar said. ‘Laurence Brookfield. Very experienced. I wan
t you to talk to him. Maybe he’ll know how to straighten this out.’
After some discussion and phone calls it was arranged that lawyer Brookfield would meet the Umlaufs at Dr. Zorn’s office at nine the next morning. Also present at the meeting were Ken Krenek, Dr. Farquhar and Victor Umlauf, a third-year law student at Columbia, who had caught the first plane to Florida the previous evening when his parents had called him about the defective living will. They all listened intently as Brookfield confirmed what Dr. Farquhar and Dr. Zorn had told the Umlaufs: ‘Yes, I’m afraid the good doctors are right. This patched-up will is not valid in the state of Florida.’
The stress of the past weeks had pushed Gretchen close to the edge and now she fairly shrieked: ‘Are you going to sit there and tell me that because of some stupid technicality—’
‘Now, ma’am,’ the lawyer interrupted, ‘it is not a stupid technicality. The law was designed to protect older people like your mother. It’s usually blood relatives who have the most to gain from the death of an elderly family member. Requiring at least one witness to be from outside the family is the law’s way of trying to check familial greed.’
Seeing the Umlaufs’ shocked and angry faces, he apologized: ‘Obviously, I know this is not the case in your own family. Clearly you love your mother very much. But now, let us face the facts in this case. Your mother, a wonderful woman of sound mind, made her wishes known. She wanted no heroic measures used to keep her alive after her brain was dead, having witnessed right here in the Palms the pitiful excesses to which such procedures could lead. We know what being allowed to die means in the regular steps God has been using for the last five million years. We all know that was her wish, and she even put it in clear and unambiguous language. We all know that.’ He stopped and nodded at the various listeners, who nodded back.
‘But the one that matters most, the legal system of the state of Florida, does not know, because the paperwork defining her wish was not properly drafted. To follow the dictates of such an improperly executed will would put Dr. Farquhar and the Palms at tremendous risk.’
Recessional: A Novel Page 50
