Pascal's Wager (9 page)

“This is Dr. Fenwick,” a deep voice said into the phone.

“Jill McGavock returning your call,” I said. “Regarding Elizabeth McGavock, my mother.”

“I know your mother well. We did some work together at UC San Francisco years ago.”

I impatiently pulled the clip out of my hair and shook it out as I waited for him to cut the chitchat.

“We were able to schedule a psych consult last night,” he said. “The psychiatrist on call was Dr.—”

“What did he say?”

“He was able to get your mother to talk—minimally—enough to conclude that this is not a psychiatric problem.”

“So it's not depression, stress, schizophrenia, mid-life crisis.”

“Right. Obviously those aren't things we can run blood tests for, but all the indicators rule those out.”

“So she hasn't gone around the bend. What's next?”

“As her primary care physician, I'd like to call in a neurologist and have some tests done.”

“For?”

“A number of possibilities.”

“Name them,” I said.

“I don't want to scare you.”

“I don't scare. What are you looking for?”

“We'll want to rule out the possibility of a tumor. Then we'll look for evidence of brain disease, which can't be diagnosed with certainty, but we'll look for indicators and match those with her behaviors.”

“Constellation of findings,” I said. I didn't want him to think he was dealing with an imbecile.

“Correct,” he said. I heard him chuckle. “You are your mother's daughter. You're not in med school, are you?”

“No. So let me be clear on this—you're looking for a tumor, brain diseases—dementias?”

“We'll consider that, but again, let's not jump to any conclusions.”

Jump? Pal, the conclusions are standing there waiting to slap us in the face
.

“How soon can they run the tests?” I said.

“Since she's already here, and because she's on staff, I think we can expedite the process somewhat. Say, results by day after tomorrow?”

Forty-eight hours. Could I handle that?

Of course I could handle it. Why shouldn't I be able to? Where the heck had that question come from?

“Fine,” I said. “Should I call you or—”

“I'll catch up to you at the hospital. I'm sure you'll be there spending time with your mom.”

“How long is she going to be in there, anyway?” I asked.

“You're looking at a good four or five days—and that of course is contingent on whatever we find in the neuro workup.”

I hung up feeling something even my mother had never been able to make me feel: that my life was somehow not completely my own anymore.

T
he next forty-eight hours elongated themselves like a pair of stretch pants. I was so busy tearing from Stanford Hospital to Sloan and back to the hospital—barely touching down at Escondido for a change of clothes and a few hours' catch-up work—the time
should
have flown by. But the hours, I learned, tend to drag when nothing is as it's always been. And nothing was.

During the day, it wasn't too hard to keep my mind on teaching, tutoring, and making up for lost time on my thesis. When I didn't have to be at my desk for office hours, I worked in a corner of the computer room so I didn't have to put up with Jacoboni. My sessions with Tabitha were trying, because her inability to grasp derivatives seemed to be directly proportional to my need to get back to my own work.

But the evenings were decidedly more difficult. I spent them in my mother's hospital room amid the veritable jungle of flowers and potted plants that had been delivered. When she was awake, I sat next to her bed, across from Max on the other side, trying to get her to say something. It was a challenge I never imagined myself facing. Max was content to pretend Mother was participating. It drove me nuts. I hated small talk under the best of circumstances.

When she was asleep, I prowled the room while Max kept up a nonstop monologue.

“God forbid it's a tumor,” he'd say. “It can't be a tumor. She hasn't complained about pain. Although, you think she'd tell me
if she were in pain? She wouldn't tell me. When she broke her arm skiing up at Tahoe, did she say a word? No. She's a martyr. She could've been in agony all this time and who would know?”

“She's not a martyr, Max,” I told him. “She's a lot of things, but that's not one of them.”

We must have had the same conversation about twelve times over those two nights, and we were launching into a thirteenth go-round the second evening when two men in signature white coats came in, looking doctor-grave. I glanced at the name tag on one of them: Carl J. Fenwick, M.D. The other one I couldn't see because the man must have been six foot nine. His head barely cleared the doorway.

“Jill,” Fenwick said in his deep voice. He thrust out a meaty hand. “The last time I saw you, you were about five years old.”

I nodded and looked quizzically up at Dr. Ceiling-Scraper.

“This is Dr. McDonald,” Fenwick said. “He's chief of neurology. I wanted the best for your mother.”

“Jill McGavock,” I said, giving McDonald a nod. “You have results already?”

“Why don't we all go into the conference room down the hall and chat about this?” Dr. McDonald said.

He had a folksy way of speaking that made him sound more like the owner of the general store than a doctor. He seemed out of place at Stanford.

It was maddening to have to wait another five minutes while we all trailed down to a glassed-in room with plump couches and dim lighting, all of which I assumed was supposed to be soothing. They all sat. I stood against the wall, though Dr. McDonald could still look at me eye-to-eye. Dr. Fenwick glanced at Max.

“This is Dr. Ironto,” I said. “He's a close family friend.”

Max practically lunged at both of them, hands clasping theirs as if they'd already cured Mother and were about to sign her release papers.

“Thank you, Doctor,” he said to each of them. “You don't
know how much we appreciate your time.”

You think they're donating it, Max?
I wanted to say.

He finally sat, perched on the edge of a chair, wringing his hands. I folded my arms and said, “What did you find out?”

McDonald tilted his head. “Well, now, in cases like this we don't have a lot of diagnostic tests. When we're looking at dementias—

“Time out,” I said. “You've ruled out a tumor?”

“That's right. There's no sign of any lesions.”

“Thank God,” Max said.

Personally, I wasn't at all sure thanks were in order—to anybody.

“Go on,” I said.

“The results of the brain scan do show some shrinkage of the fronto-temporal lobe. You mind if I ask you a couple of questions about her symptoms?”

“You want symptoms?” I said. “I can give you symptoms.”

I listed them for him, counting Mother's recent behaviors on my fingers until I ran out of digits. When I was through, Max forlornly reported his own observations. You'd have thought he was betraying a sacred trust. He couldn't even look McDonald in the eye, and he had to stop twice to blow his nose.

Through it all, Dr. McDonald nodded, his face sympathetic. Dr. Fenwick studied his palms as if they were signed death warrants. I looked from one of the doctors to the other until I felt nauseous.

When Max was finally finished clearing his nostrils into a Kleenex, Dr. McDonald stuck out his neck, cranelike, so he could look directly at me.

“Now, y'see, what happens in cases like this,” he said, “is there's no way to be 100 percent sure of the diagnosis.”

“How sure are you? Eighty percent? Twenty-five percent? Two percent?”

“About ninety,” he said. “What happens is, we have to look at
the test results and what you've seen and what I've seen. Looking at all that, I'm 90 percent sure your mother has what's called Pick's Disease. Now, it's a pretty rare condition—”

“I know what it is,” I said. I gave him a litany of symptoms and prognosis, sounding more like a medical professional than he did. He just kept nodding.

“You know a lot about this already,” he said.

“I try to be proactive,” I said. “But I
don't
know what to expect at this point. How long until she loses her faculties completely?”

“Well, now, from what you've told me,” McDonald answered, “she's been showing symptoms for seven or eight months. She probably knew something wasn't right several months before that.”

“Whoa,” I said. “Are you saying that she knows what's happening to her?”

“There's no way we can know that for sure—”

“Give it your best shot,” I said.

“Pick's isn't like Alzheimer's, where they're unaware that anything's up. With this condition, the patient knows what's going on until the really severe dementia sets in. After that, who knows? When we catch them early enough, they can self-report, you see? They tell us they don't want to be around people anymore because they can't think of the right words.” He crossed one endless leg over the opposite knee. “Some of them seem to know that their behavior is out of whack, but what happens is, they won't admit it to anybody. You see what I'm saying?”

I ignored the question. “Is she so far along that she
can't
talk?”

“Hard to say.”

“Do you know how fed up I am with that excuse? Don't worry about covering your behind with me. Tell me what you think! This is my mother—I need to know!”

McDonald didn't even flinch, though Max reached for one of my hands. I pulled it away.

“I'll tell you what I think,” McDonald said, “as long as you understand that it's just that—what I think.”

“Go for it,” I said.

“I think she's just decided she's not going to talk anymore because she can't completely control what comes out of her mouth. I don't know her personally, but Dr. Fenwick says she's a mighty proud woman.”

“So how much longer before she actually
can't
talk?” I said. “Give me some kind of time line.”

“Looking at the length of time she's been showing symptoms,” McDonald said, “I'd say she's got to resign from the hemo lab immediately. And she can't live alone once she's discharged from the hospital.”

“What does
that
mean?” I said.

“She's going to need a full-time caretaker,” McDonald said.

“You can't be serious.” I looked at Dr. Fenwick. “You know her. Can you just
hear
her reaction to that news?”

Dr. Fenwick took on a pained expression. “It isn't up to her anymore, Jill. It's up to you.”

“Don't you have some family that can help you?” Dr. McDonald said.

“No,” I said. “Her parents are both dead. Her brother was killed in Vietnam. Look, I can handle this on my own. I just need to know my options.”

“Well, my secretary can fix you up with a good social worker,” Dr. McDonald said. “We've got agencies, services, support groups—whatever you need.” He fished in his pocket and produced a business card. “Just call my office when you're ready.”

“You have a few days to decide,” Dr. Fenwick said. “She won't be released for probably another seventy-two hours.”

“One more question,” I said. “Why did this happen? What caused it?”

McDonald put up a shielding hand. “When I say this, hold your fire,” he said. “We just don't know.”

“Is somebody working on it? Isn't somebody doing research, trying to find out?”

“Absolutely. There's a whole raft of docs in that field. But you see, it's so rare, we're behind where we are on Alzheimer's.”

Dr. Fenwick looked up from his hands. “Jill, they're doing all they can. You need to focus on your mother's care.”

I'm glad you know what I need to do
, I thought.
Because I have absolutely no idea
.

My thoughts couldn't find a compartment to land in, and they were ramming into each other like bumper cars.

Dr. Fenwick stood up. “You know you can call me anytime. I'll continue to be your mother's primary care doctor if that's what you want.”

“Sure,” I said.

McDonald rose, too, and looked down at me from his other-atmospheric height.

“Now, you're going to have more questions,” he said. “If you want to set up a time with me to chew on this together, we can do that.”

“We appreciate that, Doctor,” Max said. I could feel him groping for
something
to appreciate in this sea of information even he couldn't be thankful for.

Dr. Fenwick was already out the door, and McDonald was following him when he stopped and turned back to me.

“This is pretty hard to take,” he said. “But I'll tell you one thing I've learned from families that have somebody with a dementia. They say the key to handling this is to believe that even though the mind and the body may be failing, the spirit is still in there.”

I couldn't even respond.

“Thank you, Doctor,” Max said for the umpteenth time.

McDonald left. Max sank back into the chair. I went out into the hall and leaned against the wall, where I could see Fenwick and McDonald retreating to the elevator.

Spirit?
I wanted to shout after them.
That's
very scientific, Doctors
.
Thank
you
.

Then I marched to the nurse's station.

“Where can I get a coffee?” I said.

The
next
seventy-two hours made up for the slo-mo quality of the previous forty-eight and whipped past at breakneck speed. I attributed the racing in my veins to the amount of caffeine I had started consuming.

I called the social worker Dr. McDonald's secretary referred me to the next morning. Freda Webster-Claire insisted that we meet in person rather than do business over the phone. She was also adamant that we meet at Mother's house, since that's where she'd be going when she was released from the hospital.

“We'll want to look together to see if that's our best possible option,” she said.

“There are no other options,” I told her. “That's where she's going. All I want is the name of a decent caretaker.”

“We'll go over all of that when we meet,” she said.

I wondered if Freda Webster-Claire could hear my teeth grinding through the rest of the conversation.

We settled on that afternoon at two. That gave me five hours to get my academic life back on track. At that point, five uninterrupted hours sounded like a huge block of time.

I hadn't slept the night before anyway, so I'd used the wee hours of the morning to polish off some research and get caught up on paper grading. The big difference between teaching a class as a grad student and doing it as faculty was that staff members had graduate students to do their grading for them. I had to go over every muffed-up differential equation myself. It at least gave me a heads-up that Tabitha was making some progress—she was now up to C-minus level.

I handed back the papers at the end of class and then tried to
beat it out of there so I could get organized for the meeting with Nigel that I was determined to have before the day was out. The students were so busy gaping at their papers that nobody—especially not Tabitha—seemed to be aware that I was leaping over vacant chairs to get to the door. She was engrossed in wiping tears off her upper lip as she sat slumped at her desk, looking at the paper as if it were written in Russian.

She's crying?
I thought.
Nobody cries over calculus
.

I decided to leave her with a little dignity and pretended not to notice her as I proceeded toward the door. But one particularly large snort made ignoring her impossible. I looked right at her the very moment she tore her eyes away from her score and looked imploringly back at me.

I groaned inwardly and said, “You want to come to my office for a minute?”

She was out of her seat before I even finished the question, trailing down the hall after me like an abandoned cocker spaniel on roller blades.

She gets five minutes
, I promised myself.
That's all I have to spare
.

The usual contingent of second-year males was in the hall as we passed, though they didn't seem to notice that Tabitha was now sniffing loudly enough to awaken Jacoboni over in Escondido Village. Just in case they did decide to do some kind of empirical analysis of Tabitha's behavior, I closed my office door behind us when we went in. She didn't even wait for me to clear off the chair—she just plopped right down on a stack of manila folders, dropped her face into her hands, and sobbed. All I could think to do was look for Kleenex, but since I'd started tutoring her, she'd pretty much cleaned me out.