An Absent Mind (4 page)

Saul

Groundhog Day

T
here was this movie,
Groundhog Day,
with some comic and a gorgeous actress with dark, curly hair who is always on those TV commercials for some shampoo. God, I wish I could think of the name—no, not his—hers. She was a real piece!

As I recollect, and forgive me if I don’t get it quite right, this weather reporter would keep going through the same stuff day after day. I remember thinking at the time, Hey, that wouldn’t be so bad if I could spend every day with her. Well, it didn’t quite work out that way, did it?

I mean, I often catch myself doing the same thing over and over, and even if I don’t realize it, I’m sure I do repeat stuff, but the only one I see every day is Monique. Now, I’m not saying she’s an eyesore. In fact, in her day she was quite something. Those knockers could stand up to anyone’s back then. Today, they don’t stand up at all—gee, I should be a comic! But let’s face it: She’s no beauty, certainly not today.

So I end up in a B-movie version of
Groundhog Day
. One that will never end, until the end. And by then, maybe it won’t matter if that actress is there or not. I guess at least with Monique, I know she’ll be there. That actress might have blown me off for another guy and not even have come to my funeral.

Dr. Tremblay

Death Sentence

I
have specialized in dementia for over thirty years and have seen thousands of probable Alzheimer’s cases. I say probable, because so far, absent a brain biopsy, we haven’t had sufficient tools to state with absolute certainty that a person has Alzheimer’s. Although there is a study that analyzes spinal fluid for amyloid beta, a protein fragment that forms plaque in the brain, and tau, a protein that leaks out of dying nerve cells in the brain. It seems that all the subjects in the study who had Alzheimer’s had the plaque, and all of those with mild cognitive impairment who had the plaque went on to develop Alzheimer’s within five years.

There are also noninvasive tests like positive emission topography, which can detect a decrease in glucose consumption; electroencephalograms, which examine a slowing of the alpha rhythm; and magnetic resonance imaging, which can identify a decrease in volume in the hippocampus, where Alzheimer’s always starts. But these tests usually only reinforce our preliminary findings on assessments like the mini mental state examination or the Buschke selective reminding test.

I performed several tests on Mr. Reimer. It was quite clear to me, even before he scored only seventeen out of thirty on the MMSE—a score of twenty-four or higher indicates some degree of normality, but in point of fact, most fully functioning people would have a near-perfect score—that he was in the early stage and perhaps close to the middle stage of Alzheimer’s. He did no better on the clock test or the trail-making test.

I don’t want to get technical with you here, but it is important that you have at least some comprehension about how Alzheimer’s affects the brain, so that you can understand what happens to people like Mr. Reimer. I will try to explain it to you in concise layman’s language, although we doctors seem to have difficulty parsing convoluted medical terms.

Alzheimer’s is characterized by the formation of cellular debris in the form of plaques and tangles. The plaques float between the neurons, while the tangles attack the neurons from inside the cell membranes. But regardless of how they go about their destruction, they achieve the same result, preventing the neurons from communicating with one another. As clumps of neurons die, specific functions such as short-term memory, spatial relationships, reasoning, and eventually things like muscle coordination, and even swallowing, are affected. The result is always death.

One of the sad things about this horrible disease is the time line. On average—and I say on average, because it’s different for everyone—it takes about six to ten years for the disease to run its course. I have seen it take a much shorter time in patients with early-onset Alzheimer’s, where the disease starts when the person is in his forties or fifties—but that’s usually a specific inherited gene and not what Mr. Reimer has—to over twenty years in rare cases.

Mr. Reimer and his wife just left my office. He already has some anomia—difficulty in finding the right word, but is capable of circumlocution—talking around the word that can’t be recalled. He seems to have only the beginnings of agnosia. What I mean by that is he can still recognize most objects and know what they’re for. For instance, he knew what to do with the pen he used to draw on one of the assignments I gave him. And he still recognizes those around him. And as for apraxia, spatial relationships, and motor skills, he had only a little trouble, which is normal in the earlier part of the disease.

I ordered a computer scan of the brain, as well as some blood tests for Mr. Reimer as a complement to a clinical evaluation. The results of the latter will give me a fairly accurate depiction of where he fits on the one-to-seven Reisberg Scale. Number three represents minimal cognitive dysfunction. By the time patients get to number seven, they are usually in a care facility, unable to function at all, even to lift their heads or open their eyes for any meaningful period of time.

Assuming the tests confirm my preliminary diagnosis, I will start him on medication, which will not slow down the disease but will help alleviate the symptoms for at least a few months, or maybe even a year or two, giving him a better quality of life during that time.

I will also schedule an appointment with Mr. Reimer’s wife, the primary caregiver, not only to search out more information on the progress of her husband’s disease, but also to evaluate her own health and coping skills. She told me she has a history of heart problems, high blood pressure, and elevated cholesterol. Taking care of her husband will put a lot of stress on Mrs. Reimer, so we have to be especially careful.

I spend more than half my time doing research into possible cures, but I know deep down that any significant discovery that would eradicate this horrific disease is years away. That is too many years to stave off the death sentence that I pronounced on Mr. Reimer today.

Saul

The Lynch Party

T
he usual suspects were once again gathered at our house. This was to be a family council meeting, they told me, but I knew what it really was—a lynch party for one Saul Reimer.

Moses, in the guise of my daughter, Florence, spoke first. She informed the others that her father—that would be me—had been diagnosed with Alzheimer’s by the preeminent doctor in the field. Joey asked if they should get a second opinion. Everyone looked at Monique. Why, I don’t know. Maybe they had a hunch that Monique and Dr. Tremblay were friends, maybe more than friends. She said another opinion wouldn’t be necessary, that Dr. Tremblay had done all of the tests and that it was clear that the diagnosis was correct. I don’t know if it was, but I guess one consolation is that I’m not going to be committed to Roxboro!

Monique explained to the others that the doctor had told her sometimes my brain stalls. My brain stalls—I like that one. I’ll try to remember it. Anyway, he told her to get me one of those yellow pads so she can make lists of what I have to do every day, things like taking the pills he’s prescribed, brushing my teeth, dressing, having breakfast, and making sure not to leave the stove on. I thought that was pretty silly. Yes, I have forgotten a few things, maybe more than a few, but I am still normal—more or less.

I told them I still remembered a lot from a long time ago. Like when Harry Potash had tried to steal Sharon Wertheimer from me in the fifth grade, and how I had decked him in the school yard. That had cost me a week of recesses, but it was well worth it!

I had always been a tough guy. In fact, I got suspended for a brawl in the tenth grade. Ian Coulter was the resident bully and self-appointed chief anti-Semite of the school. Coulter was picking a fight with Buddy Rubin, the class weakling. He grabbed Buddy’s thick glasses from his pointed nose, made a show of dropping them in almost slow motion to the icy sidewalk, and then slammed his heel down, crushing them. I could live with that, because you can’t be everyone’s protector. But then Coulter crossed the line. He called Buddy a kike.

Coulter missed the rest of the term because of a dislocated jaw and a broken arm, and it was only March. I was suspended for a month. That didn’t sit well with Larry—I called my father Larry sometimes because he seemed to like it. And for some strange reason, it made me feel closer to him, like we were buddies. Anyway, Larry went apeshit, and I didn’t see daylight on the weekends till summer vacation.

So I told the people who had taken over my living room that I could remember lots of things.

Monique put her hand on my shoulder and said, “Do you remember what Dr. Tremblay told us about how it’s normal for Alzheimer’s patients to have good long-term memory but lose short-term memory?”

“No,” I said, “I don’t remember.” But my best guess is, so far at least, that I only have Sometimer’s, not Alzheimer’s.

Joey

Looking Back

T
here were so many clues, but I guess it’s kind of like vegetable soup. If you have one piece of carrot in a broth, it’s not vegetable soup. If you add some celery and beets, it’s probably not, either. So when is it? There is no set amount or type of vegetables when one can definitively say that it’s vegetable soup. And I think it’s the same with Alzheimer’s. It just starts to germinate and suddenly one day it’s the real McCoy.

I remember when I met Dad for lunch downtown last year. He looked fine and was quite talkative. When I said good-bye outside the restaurant, he seemed at a bit of a loss.

He glanced up and down the street and finally said with a sheepish grin, “Son, I forget where I parked the car.”

I thought to myself that was no big deal. But when I asked him where he thought it might be, the question elicited only a blank look and a shrug of his shoulders.

“You have no idea?” I asked.

He told me that he had been preoccupied with an audit by Revenue Canada. Who could argue with that? If I were undergoing a tax audit, I might very well forget where I’d parked my car—or, for that matter, if I even owned one! Anyhow, I suggested we start walking around and looking—and there it was—just across the street, half a block away.

The real kicker, and I can’t believe it didn’t set off alarm bells in my head, was when he called me up and asked me to go to a hockey game. I love hockey, especially the Montreal Canadiens, and we hadn’t been to a game together in over twenty-five years—and then only after I practically got on my knees and begged him to take me for my tenth birthday.

We arrived at the Bell Centre a half hour early. I asked Dad for the tickets as we approached the entrance. He shuffled through the pockets of his overcoat and then his pants. By the pained expression on his face, I knew we had a problem—and we did. He had forgotten the tickets and said he had no idea where he had put them.

I could see he was getting agitated, so I said, “Pops, no problem; I’ll just buy a couple.” The box office was sold out, so I finally had to purchase seats from a scalper—what a rip-off! Luckily, I had been to the bank that day, because Dad had also forgotten his wallet.

The first period was pretty slow, a rarity when the Canadiens play the Maple Leafs. So I figured that Dad was just bored and it wasn’t his thing. But it was almost as if he weren’t in the arena. During the first intermission, he almost tripped twice going down the stairs. He said he didn’t need to go to the men’s room during the second intermission, even though I could tell by his wincing and crossing and uncrossing his legs that he probably had a full bladder.

While waiting for the third period to begin, he told me he had been toying with the idea of making a large contribution to some Catholic charity that had called to solicit a donation. He said the woman told him that they did a lot of good in the community. He said it just like he might have been commenting on the weather. Now, my father isn’t the most religious Jew in the world, but to give his money to a Catholic organization? The Combined Jewish Appeal finds it hard enough to extract a few dollars from him every year. Anyway, at the time I figured he was kidding. Now I’m not so sure.