Authors: Matt Richtel
“W
hat?” I ask.
He ignores me and walks to the outer office door. He turns the latch and locks it. Except for us, the reception area is empty.
“Trying to keep us in, or somebody out?” I ask.
“I like a peaceful lunch hour but I'm making an exception for a family friend.” It's not clear if he intends a slight.
The three of us walk down a corridor to his private office.
“What's so interesting, Dr. Laramer?”
“Call me Pete, please. Let's talk in my office.”
His confines celebrate his success.
Framed on his wall are numerous credentials, including his Neurology Board certificate denoting his specialty in memory and recall disorders, and a letter from the United States Patent and Trademark Office. The last time we'd visited, he'd told me he'd received a patent for developing techniques for using real-time imaging technology to explore the brain's memory centers. He's like an old-time cartographer, but instead of hiking into the interior of a continent, he's mapping the subterranean layers of the brain to follow the flow of neurochemicals.
Adjectives that describe Dr. Pete Laramer: smart and ambitious. Not neat. Haphazard papers and files sully his desk. I'm that messy. I could be a fancy doctor.
Facing out from the desk stands a framed photograph of Kristina and three daughters who appear poised to share her beauty.
He's my height but paunchier, a late-thirties white guy with gray-speckled temples. His eyes are bloodshot; between them and the scrubs, I infer he's been on night call at the hospital. He looks otherwise devoid of any medical condition, which I find slightly disappointing.
“What strikes you about Lane?” I ask.
“She seems fit. Tracking. It's good.”
“Really? It seems to me like she's slipped off a cliff.”
Fewer than six months ago she'd have been, if not in her prime, sufficiently lucid. Brains don't fail this precipitously.
I situate Grandma on a chocolate-leather couch. As I do so, I explain she is agitated and acting frightened. Grandma interjects. “You're the doctor who studies my head.”
“That's an interesting way to put it.” He glances at me as if to say: See, she's on the ball.
He asks me to elaborate on what she's been saying. “Has it been nonsensical rambling or is she repeating herself and focusing on a particular idea?”
I explain that Grandma talked about a man in blue and the dentist. She's been upset since we nearly got shot in the park.
“Physically, she's fine,” I say.
“Stop,” he says, with some alarm.
“Pardon.”
“She was shot?”
“Almost.”
“Christ,” he says, suddenly animated. “Are you serious?”
“It was probably some random attack. But I'd love to know what she remembers about it.”
He pauses, apparently lost in thought. “It's not every day that one of my patients gets shot at.”
He stands.
“Can you wait outside while I examine her?”
“I'd rather stay.”
“She's liable to look to you for comfort or approval. I need to get a clear sense of her mental state.”
I hesitate, and then stand up. I put a hand on her shoulder. “I'll be right outside, Grandma.”
Dr. Laramer walks to his window, which is letting in gray light. He peers outside, closes the shade, then turns and walks back in our direction. He turns on a bright overhead light. I leave the pair of them alone.
I stand in the hallway. My cell phone signal is poor, but I try to call my parents. No luck getting through.
Then I hear a shout come from inside the office. More like an expression of shock, or surprise. It's not coming from Grandma. But Pete.
I open the door. Pete and Grandma sit on the couch. She's withdrawn to the edge of it. He leans away from her with his palm pressed against his chin. A yellow Nerf ball sits between them.
“What happened?” I ask, moving quickly to Grandma. I bring her close to me. She seems to relax.
“She punched me in the jaw,” he says.
“What?”
Grandma's right hand is balled into a tight fist.
“I'm sorry. I'm sure she didn't mean . . .”
“I leaned in close to test her visual acuity and she let me have it,” he interrupts me. “Not bad strength. Terrific punch, actually. Stings like a bee.”
“Chop,” I say.
“What?”
“Was probably a chop, not a punch. She was a blue belt,” I say. “She studied years ago.”
“She's definitely agitated,” he says. Then turns to her: “You often roundhouse the help?”
“I'm sorry,” Grandma says. “I'm only supposed to use my training for defense.”
He shakes his head and, finally, laughs. “I've had agitated patients spit at me, and vomit. Once I was shoved by a bouncer. Never karate chopped.”
“Pete, what did you say to upset her?”
He shrugs. “I asked her how she was feeling, the year, who is president, whether she is comfortable, the usual stuff.”
“Are you friends with Adrianna?” Grandma asks him.
He looks at me, raises his eyebrows. “Who is Adrianna?” he asks me.
I shrug. “Grandma Lane, who is Adrianna?”
She cocks her head to the side, momentarily frozen in thought, like an overly taxed computer processor. Before she can continue, Pete picks up the Nerf ball. He tosses it in a gentle arc just to the right of Grandma. She raises an arm and swats it to the ground.
“Interesting,” he says.
“What are you doing?” I ask, just shy of irritated that he's interrupted the conversational flow.
“Testing her spontaneous physical reactions. As you can see, they're very much intact.”
“So.”
“Whatever her mental state, she's alert and reactive and plenty physically able. It's as I thought when I first saw you in the waiting room: the patient presents in terrific physical shape.”
The patient.
“Okay,” I say, trying to piece together what this all means. I turn back to Grandma.
“Who is Adrianna?”
“Years ago, doctors came to your house,” she says.
“Nat, has your grandmother experienced any recent traumas?”
“The shooting at the park.”
“I thought you said the symptoms predate that. Did she get into an argument, or have a problem at her retirement home? Has she been on field trips, or anything else that could have put her in a vulnerable or frightened position?”
I consider it. Nothing comes to mind other than her allusion to the dentist.
“Why do you ask?”
“People get mistreated and it makes them agitated. The retirement-home experience can be . . . impersonal.”
We fall silent. He closes his eyes, and I can't tell if he's lost in contemplation or tired.
“Pete, what is going on with her?”
He clears his throat. “I'm sure it's no surprise. But I'm sorry to say that she's exhibiting the classic signs of dementia.”
I shake my head. “When we came in you said she seemed fine.”
“Well, it could be worse.”
Pete starts what I imagine is his stock speech to family members of dementia sufferers. He tells me that Alzheimer's is the most common form of dementia, affecting more than four million Americans. The disease results in memory loss, personality changes, cognitive dysfunction, then physical dependence. I know this stuff, and I wave him along.
He reminds me there are four stages: predementia, and then early, moderate, and advanced versions. Common complications include dementia coupled with Parkinson's; vascular dementia, which largely afflicts African Americans; and frontotemporal dementia, which presents with major mood affect.
“She's probably in an early or moderate stage,” he says. “The good news is, this is very common, and we have some sense of how to treat it, though our treatments are primitive or, rather, of modest efficacy.”
He's starting to wind down his presentation, just as I'm feeling a rising sense of ire mixed with disbelief.
“Bullshit,” I say with some force, seeming to surprise him, and myself.
What I realize I'm thinking is that Grandma's symptoms don't seem common at all. If my own memory of neurological disorders serves even a little, these symptoms don't add up. Ordinarily, a sharp mental descent would be accompanied by a loss in physical agility and alertness. More significantly, it makes no sense to me that her mental decline has been so precipitous. I'm bothered with myself that I haven't been paying closer attention in the last month or two.
“When did you see Lane last?” I ask.
“Pardon?”
“When was her last visit hereâthree, four months ago?”
He walks to his desk. He picks up a green folder, opens and studies the chart inside. “Three,” he says, then corrects himself. “Sorry, four.”
“It just doesn't make sense to me that as recently as four months ago she was doing relatively well, making sense, and conversation.”
“Suggesting what?” he asks.
“Something odd is going on. This doesn't seem typical to me at all.”
“Respectfully, Nat, the Internet is not the best place to get medical information,” he says. “Dementia and memory loss can be very hard for family members to accept.”
He maintains eye contact with me, which makes me think he either doesn't realize he's being condescending or doesn't mind it. I break our gaze, almost imperceptibly bowing my head.
“What do you suggest?”
“Let's get her on some Aricept,” he says. He pauses. “She lives where?” he asks.
“Magnolia Manor.”
He nods. “Can you give her a break from there for a few days? Can she get some time to change her environment? She could use the stimulation of activity. She certainly seems curious and physically able.” He turns to her. “Don't you Lane?”
“I don't know anything about that,” she responds.
I decide it's not the time to tell doc I'm already on the change-of-venue case.
I'm not sure he's offering us better advice than I could've gotten on the Internet. He's prescribing pills and a change to her environment. Still, at least now I have justification for keeping Lane with me. Doctor's orders.
Pete looks at his watch. He says he should get to his next appointment. In parting, he tells me he'd like to see my grandmother again in a week.
“But call me tomorrow and give me an update.” He hands me a card with his cell phone number.
At a modest dining room in the basement, I ask Grandma what kind of sandwich she wants. Before she can answer, a woman behind the counter wearing her pink dyed hair in a tight bun informs me that she doesn't have
sandwiches
but, rather,
panini
or flatbread.
“Can't I just call it a sandwich?” I ask. “She was born before the advance of the
panini
.”
“Don't talk about me when I'm standing right here,” Grandma says.
I order a flatbread with tuna for Grandma and, for me,
panini
with chicken and pesto sauceâthe chief difference between these items and sandwiches being price. Sixteen dollars later, I help Grandma into the car. We have ninety minutes to kill before our meeting with the mystery stick sender. In the meantime, I want to drive Grandma by her dentistâat least to follow up on yesterday's missed appointment. Maybe she saw a man in blue when we were sitting in the parking lot outside. Maybe I'm pulling at wild strings.
I snap in Grandma's seat belt and start the car. As I start to pull away, I see a car inching around the corner behind us. It's a Prius. Like the one from the park.
“F
lume,” Grandma says.
“What?”
“It's a narrow opening,” she says. “I used to be an English teacher and sometimes I use big words even though it can be impolite.”
She's either looking at the traffic scenario or I'm giving her too much credit. We've slid between a red flatbed truck carrying lumber and a beautifully reconditioned classic Jaguar. The Prius is five cars back. I can't make out the driver but he appears to wear a hooded sweatshirt. I can't see the license plate.
“You're on edge, grandson.”
“Not at all. Everything's under control.” Not exactly.
My thinking: If I take three quick rights, I can get behind him, or I could pretend I don't see him and let him get close.
“Be careful, Irving,” Lane says.
I look forward and realize I've almost hit the truck in front of us. I slam the brakes to avoid collision.
When I look in the rearview mirror again, the Prius has disappeared.
Twenty minutes later, I pull into the parking lot of Brown & Morrow. They're located in a modest two-story complex that includes a dentist, a dermatology clinic, and an imaging center with an MRI machine. At the entrance to the small parking lot stands a weather-worn statue of a woman I think is supposed to be Hygieia, the goddess of health. Weeds grow at the base of the deity's cheap plaster seat.
We were here yesterday, when Grandma refused to exit the car to go to the dental appointment.
“Does this look familiar?” I ask.
Grandma doesn't say anything. She's looking down at her game device, turning it over in her hand.
“Do you want to go inside?”
“Harry will look out for me,” she says, absently.
“Did you see Adrianna here?”
No response.
“The man in blue?”
There are a dozen parked cars in the lot with us. A woman in a long skirt helps a frail man, presumably her father, climb from a minivan into a wheelchair. The office doors all face the lotâeven the ones on the second floor, which are accessible through an open balcony. So I can see Grandma at all times.
She's safe here.
“Want to play a game?”
No answer.
I power up her phone. I click the icon for Tetris. Grandma seems transfixed by the falling blocks, though she's not playing.
“Will you wait a few minutes? I'll be right back.”
“Be careful,” she says, without looking up.
“Right back,” I repeat.
I lock the car doors.
The dental office is on the second floor, above the imaging center. I look down at my car. Lane sits quietly.
As I approach the dental office, the door opens. Out walks a Napoleon complex: ninety-eight pounds of hair and bar fight. He wears a jeans jacket with a patch that reads: “Khe Sahn Survivor.” He glowers and closes the door behind him rather than holding it open for me. The product of another festive dental visit.
The door is friendlier. A sign says: “We welcome Medicare, MediCal, and Medicaid.” There is a picture of a cartoon horse, smiling, with a carrot sticking out of its mouth like a cigar.
Inside, I'm met with more attitude.
“We're closed,” says a blazing black-haired woman with the hollow cheeks of an eating disorder sitting behind the reception desk.
“I just saw someone walk out.”
“Last patient.”
I looked at the clock on the wall. 2:15 p.m.
“Dentists keep odd hours.”
“It's our lunch. Some people can only come in during their lunch hour, so we eat later.”
“What if I just have a questionâabout my grandmother? She's a patient here and I'm worried about her.”
She shakes her head.
“Patient confidentiality. Call if you want to make an appointment. I should warn you that our next opening for a new patient is in January.”
I step toward the desk. “What's for lunch todayâ
panini
?”
“Sir, I told you that we're closed.”
“I'm just getting a card, so I can schedule an appointment.”
She stares at me as I take a card.
“When I make an appointment, is it possible I could make one with Adrianna? I've heard good things about her.”
“I have no idea who you're talking about.”
“You seem unusually adamant about that.”
“I told you: we're closed.”
The discussion is over. She follows me to the door and locks it behind me.
I'm sitting next to Grandma in the car. She's clicking the buttons on her phone as blocks fall down the tiny screen. She's not really playing so much as absently interacting with the game. Her brain on autopilot.
I inch it out of her hands. “There were no signs warning me to floss,” I say.
She looks up at me. “Oh you've absolutely got to floss.”
“Grandma Lane, nothing about that place screamed dental office.”
I look on the card I took. It reads: “For appointment, call 415â555â1041.”
Maybe Pauline's right. Maybe I'm seeing conspiracies everywhere and focusing on distractions and pathologies instead of real life.
“Still,” I say.
“What's that?”
I take Grandma's hand in mine.
“Do you remember Thelma and Louise?”
“Were they in our family?” she asks.
“Batman and Robin, Sherlock and Watson, the Lone Ranger and Tonto?”
“Sherlock was a great man.”
“We could be the new dynamic duo: the Overwhelmed and the Octogenarian.”
“I don't know them.”
“How about: âKid Commitment Phobe and Granny.' My superpower can be fleeing, and yours knitting.”
She doesn't respond.
“I can come up with something better than that. Give me some time.”
“Time is nothing to be squandered, Nathaniel,” she says, seeming bemused.
“Grandma?”
“Yes, grandson?”
“How about Butch Cassidy and the Sunset Kid?”
“I like that very much.”
“Time for us to leap into action.”