What Comes Next
For my old friend Bob
As soon as the door opened he knew he was dead.
He could see it in the quickly averted eyes, in the small slump of the shoulders, the nervous, hurried manner as the doctor moved rapidly across the room. The only questions that immediately leaped to his mind were:
How much time do I have? How bad will it be?
He did not have to wait long for the answers.
Adrian Thomas watched as the neurologist shuffled his test results before squirreling down behind his large oaken desk. The physician leaned backward in his chair, then rocked forward before looking up and saying, “The test results rule out most routine diagnoses…”
Adrian had expected this. MRI. EKG. EEG. Blood. Urine. Ultrasound. Brain scan. A battery of cognitive function exams. It had been more than nine months since he’d first noticed he was forgetting things that were ordinarily easy to remember—a trip to the hardware store where he’d found himself standing in the lightbulb aisle with
no idea
what he had meant to purchase; a time outside on the main street in town when he’d run into a longtime colleague and had blanked on the name of a man who’d occupied the office next to his for over twenty years. Then, six days earlier, he had spent an entire evening hour pleasantly conversing with his long-deceased wife in the living room of the house they had shared since moving to western Massachusetts. She had even sat in her favorite paisley Queen Anne chair, near the fireplace. When the recognition of what he had done had become clear to him, he had also known that nothing would show up on any computer printout or color photograph of his brain structure. Nevertheless, he had dutifully made an emergency appointment with his internist, who had quickly shipped him over to the specialist. He had patiently answered every question and allowed himself to be poked, prodded, and x-rayed.
He had assumed, in those first minutes of shocked recognition after his dead wife had vanished from his sight, that he was simply going crazy—an unscientific and undisciplined way of defining psychosis or schizophrenia. But then, he had not
felt
crazy. He had felt quite good, really. It had been more benign, almost as if the hours spent in talk with someone who had died three years earlier was routine and pleasurable, a conversation not at all dissimilar to those they had frequently enjoyed in all the years of their marriage. They’d talked about his deepening loneliness and why he should take up some pro bono teaching at the university despite his retirement after her death. They’d discussed current movies and interesting books and what he should send his nieces in California for their birthdays. They had debated whether this year they should try to steal down to Cape Cod for a couple of weeks of rest in June, just after the bluefish and stripers started their annual run, before the suntan crowds showed up in coolers and umbrellas masses.
As he sat across from the neurologist he thought that he had made a terrible mistake in even considering for one second that the hallucination was part of an illness, and that he should never have allowed this alarm to frighten him enough to send him to the doctor’s office. He should have thought of it as an advantage. He was completely alone now, and it would have been nice to repopulate his life with people he had once loved, regardless of whether they still existed or not, for however long he had left on this earth.
“Your symptoms suggest…”
He did not want to listen to the doctor, who had an uncomfortable, pained look on his face, and who was much younger than he was. It was unfair, he thought, that someone so young would get to tell him he was going to die. It
should
have been some gray-haired, God-like physician, with a sonorous voice weary with years of experience, not the high-pitched barely out of elementary school man rocking back and forth nervously in his chair.
He hated the sterile, brightly lit office, with its framed diplomas and wooden bookcases filled with medical texts that he was sure the doctor never opened. Adrian knew the doctor was the sort of man who preferred a couple of quick
clicks
on a computer keyboard or a BlackBerry to find information. He looked about and thought the office was oppressively clean and orderly, as if the natural messiness of a fatal illness wasn’t allowed inside. He looked past the man’s shoulder, out the window, and saw a crow alight on the leafy branches of a nearby willow tree. It was as if the doctor was droning away in some distant world that as of that moment he really wasn’t much a part of any longer. Just a small part, perhaps. An inconsequential part. For an instant, he imagined that he should listen to the crow instead, and then he had a shock of confusion, where he thought that it
was the crow
that was speaking to him. That, he insisted inwardly, was unlikely, so he dropped his eyes and forced himself to pay attention to the physician.
“I am sorry, Professor Thomas,” the neurologist said slowly. He was picking his words with caution. “But I believe you are experiencing the progressive stages of a relatively rare disease called Lewy body dementia. Do you know what this is?”
He did, vaguely. He had heard the term once or twice, although he could not immediately recall where. Perhaps one of the other members of the psychology department at the university had used it in a faculty meeting trying to justify some research or complaining about grant application procedures. Maybe he recalled it from his youth, when he performed clinical work in a VA hospital. He shook his head anyway. Better to hear it all unvarnished, from someone more expert than he, even if the doctor was far too young.
Words fell into the space between them, like debris from an explosion drifting down, littering the desktop.
Steady. Progressive. Rapid deterioration. Hallucinations. Loss of bodily functions. Loss of critical reasoning. Loss of short-term memory. Loss of long-term memory.
And then finally the death sentence: “I’m sorry to have to tell you this, but typically we’re talking five to seven years. Maybe. And I believe you have been suffering from the onset of this disease for some time, so that would be the maximum. And in most cases, things move much more quickly.”
There was a momentary delay, followed by an obsequious, “If you want a second opinion…”
Why,
he wondered,
would he want to hear bad news twice?
And then an additional and somewhat expected blow: “There is no cure. There are some medications that can alleviate some of the symptoms—Alzheimer’s drugs, atypical antipsychotics to treat the visions and delusions—but none of these are guarantees of anything and oftentimes they don’t really help significantly. But they are worth trying to see if they will work to prolong functioning…”
Adrian waited for a small opening, before he said, “But I don’t feel sick.”
The neurologist nodded. “That too, unfortunately, is typical. For a man in his mid-sixties, you are in excellent physical shape. You have the heart of a much younger man.”
“Lots of running and exercise.”
“Well, that’s good.”
“So I’m healthy enough to watch myself fall apart? Like a ringside seat at my own decline?”
The neurologist did not immediately respond. “Yes…” he finally said. “But some studies have shown that the more mental exercises you do, coupled with continuing an active, exercise-filled day-to-day life, can delay some of the impact on the frontal lobes, which is where this disease is located.”
Adrian nodded. He knew this. He also knew the frontal lobes controlled decision-making processes and the ability to comprehend the world around him. The frontal lobes were pretty much the part of his brain that had made him who he was and now were going to make him into someone much different and probably unrecognizable. He suddenly did not expect to be Adrian Thomas much longer.
That was the thought that filled him, and he ceased listening to the neurologist, until he heard, “Do you have anyone to help you? Wife? Children? Other relatives? There’s not much time before you’re going to need a dedicated support system. That will be followed by a round-the-clock care facility. I should really speak with these people very soon. Help them to understand what you will be going through.”
The doctor said these words as he reached for a prescription pad and rapidly started to write down lists of medications.
Adrian smiled. “I have all the help I’m going to need right at home.”
Mister Ruger 9mm semiautomatic,
he thought. The weapon was located in the top drawer in the nightstand by his bed. The thirteen-shot clip was full, but he knew he would need to chamber only one bullet.
The doctor said some other things about home health care aides and insurance payments, power of attorney and living wills, long-term hospital stays and the importance of keeping all his future appointments, sticking to the medicines that he didn’t think were going to slow the pace of the disease but which he should take anyway because they might work a little bit, but Adrian realized he no longer had any real need to pay more attention.
Nestled between several tracts of former farmland that had been developed into modern, upscale mansion-like homes on the outskirts of Adrian’s small college town was a conservation area, where a wildlife sanctuary covered a modest hill that the locals called a mountain but in reality was a mere topographical bump. There was a walking path up Mount Pollux that snaked around through the woods before emerging at a spot that overlooked the valley. It had always bothered him that there was no Mount Castor next to Mount Pollux, and he wondered who had named the hill so pretentiously. Some academic sort, he suspected, from a faculty two hundred years earlier that sported black wool suits and starched white collars as they beat classical education into the students who matriculated at the college. Still, despite his questions about the name and the overall accuracy of the honorific
Mount
it was a place he’d enjoyed over the years. It was a quiet spot much beloved of town dogs, who could be let off their leashes, and where one could be alone with his thoughts. That was where he headed after leaving the doctor’s office.
He parked his old Volvo in a pullout at the base of the path and started hiking up. Ordinarily, he would have worn boots against the early spring mud, and he thought he was likely to ruin his shoes before he’d gone too far.
He told himself that no longer made any difference.
The afternoon was fading around him and he could feel a caress of cold against his spine. He was not dressed for a walk, especially as the creeping New England shadows carried a breath of leftover winter. As with his rapidly soaking shoes, he ignored the chill.
There was no one else on the path. No bounding golden retrievers dashing into the underbrush in search of some scent or another. Just Adrian alone, walking steadily. He was glad for the solitude. He had the odd thought that if he’d met someone else, he would have been compelled to tell him: “
‘I’ve got a disease you’ve never heard of that’s going to kill me, but first I’m going to be whittled down into nothingness.”
At least with cancer, he thought, or heart disease, you got to stay who you were for as long as you could manage while it murdered you. He was angry, and he wanted to strike out, hit something, but instead he simply marched upward.
He listened to his breathing. It was steady. Normal. Not even labored in the slightest. He thought this unfair. He would have far preferred a tortured, sucking sound, something that told him he was terminal.
It took about thirty minutes for him to reach the summit, such as it was. The remaining sunlight filtered over the tops of some western hills, and he sat on a large ice age outcropping of shale rock, staring off into the valley. The first signs of the New England spring were well under way. He could see early flowers, mostly yellow and purple crocuses poking up through damp soil, and trees budding, which gave them a touch of green, and darkened their branches like a man’s cheeks who has neglected to shave for a day or so. A flight of Canada geese stretched out in a V shape cruised the air above him, heading north. Their raucous braying echoed through the pale blue sky. It was all so distinctly normal that he felt a little foolish, because what was taking place within him seemed to be out of sync with the rest of the world.
In the distance he could make out the spires of the church in the center of the college campus. The baseball team would be outside, working in the batting cages because the diamond was still covered by a tarpaulin. His office had been close enough so that when he’d opened the window on spring afternoons he was able to hear the distant sounds of bat against ball. As much as any robin cruising the quadrangles in search of a worm, it had been a welcome sign after the long winter.
Adrian took a deep breath.
“Go home,” he said out loud. “Shoot yourself now while all these things that gave you pleasure are still real. Because the disease is going to take them away.”