“Quite a few.” Musica pulled the lid off the container and stirred the contents with a plastic fork. “We handle several types of special diets on Unit One.” She waved the fork vaguely toward the other units. “By Two, the families are pretty much resigned to let them eat whatever we can get them to take. By Three, they’re all on the same mushy mixture of essential nutrients.” She puckered up her face. “We call it Soylent Gray, which is apparently some reference to an old movie.”
Susan chuckled, then did her best Charlton Heston imitation, “‘Soylent Green is made of people! You’ve got to tell them. Soylent Green is people!’”
Musica watched her curiously, then laughed. “Well, I’m sure Soylent Gray isn’t made of people. I don’t think there’s anything organic in it.” She fed a forkful of the casserole to Jessica, who chewed it indifferently. “It looks and smells like paste, but the patients don’t seem to care.” She gave Jessica another mouthful. “Of course, by that stage, they don’t care about anything.”
Susan brought the conversation back to her concern. “Can’t the kitchen handle vegan food?”
Musica did not follow Susan’s sudden backtrack. “For Unit Three? They choke on invisible lumps. You think we’d risk a plant fiber?”
Susan shook her head briskly. “No, I mean for Jessica. Why does her family have to bring her food? Can’t the kitchen make vegan fare?”
Musica set down the bowl. “Would you like a drink, Jessica?”
Jessica nodded, and Musica lifted the soy milk to her lips. The patient took a few small sips; then the nurse removed the cup. A line of white drool rolled off Jessica’s bottom lip, and Musica wiped it away with a napkin.
The nurse switched back to Susan’s question. “Oh, sure. I mean, they’ve made vegan before, but her family insists she’s allergic to all kinds of additives and preservatives. They make all of her food, and they don’t want her having anything they didn’t personally prepare.” She returned to feeding Jessica. “If you ask me, it sounds like a lot of work. Their entire life must revolve around food preparation.”
Susan nodded absently, her mind several steps beyond the conversation. She knew many vegetarians, and their reasons for choosing a meat-free diet ranged from cultural to religious, from ethical to health conscious, always well intentioned. Much like their omnivorous counterparts, however, their execution of their chosen diet varied from the sublime to the idiotic. The healthy ones learned how to build balanced meals that incorporated the necessary vitamins, minerals, and amino acids. Those who survived on Pop-Tarts, Ho Hos, and corn did their minds and bodies more harm than good.
Musica apparently read something in Susan’s expression. “Are you going to want to change her diet? Because I think you’ll have a fight on your hands if you do.”
“I don’t doubt it.” Susan had no intention of taking Jessica off her family’s preferred diet, simply adding to it. The standard-admission laboratory studies included a complete blood count, which Susan suspected might help explain Jessica’s decline, and a general profile that gave a nonspecific picture of liver, kidney, and circulatory function. “Could you hold the labs for a bit? I have a few extras I want to tack on, and I’ll need to write them down.” Susan knew exactly what she needed but did not want to rattle off a bunch of specialized labs without knowing the capacity of Musica’s memory.
Clearly, Jessica’s family physician had not fully explored the details of her diet. He had likely and understandably focused on the family history of early-onset dementia. Since the fortification of breakfast cereals, breads, cow and soy milk, and salt, nutritional deficiencies of any kind had become exceedingly rare in America, and most of those stemmed from individual metabolic errors. The father had probably assured him Jessica’s diet was nutritionally sound and had nothing to do with her current condition, but Susan suspected otherwise. She needed confirmation from the examination and laboratory tests, but she had a feeling she knew exactly what was causing Jessica Aberdeen’s dementia.
Chapter 6
By late afternoon, a dense and inescapable fatigue enveloped Susan, and she felt as if she were performing patient care in an unthinking trance. The Winter Wine lifers functioned best with a stable routine the nurses had perfected over many decades. With residents around most of the year to handle the rare problems, changes, and new admissions, Mitchell Reefes had little to do. Susan could understand how he had developed his laissez-faire attitude toward his patients, though she would never condone it.
Startled by a shaking of her arm, Susan turned to face Kendall Stevens. “Asleep on the job, Calvin?” he asked with an insolent smile.
“Just resting my eyes.” Susan gave her grandmother’s favorite reply after being caught snoring in front of the video screen. She did not believe she had actually fallen asleep; she could not remember losing her train of thought or dreaming. “I’m waiting for some labs on Jessica Aberdeen. What do you need?”
“Just being a pest.” Kendall sat down beside Susan. “The usual.” He ran a hand solidly through his hair, leaving the carrot-colored strands sticking straight up in clownish patches. “I think the antidepressant blast is already doing Thomas Heaton some good. I put headphones on him, playing Beethoven symphonies, and he’s moving his arms. It’s too uncoordinated for conducting, but I think that’s what he’s trying to do. Also, he looked straight at me today, and I even saw a hint of actual sadness rather than yesterday’s statue face.”
“That’s encouraging.” Susan managed a weary smile of her own. “Is Beethoven his favorite composer?”
Kendall hesitated. “I don’t actually know. His family hasn’t been around to ask yet. Have you ever met an orchestraphile who didn’t love Beethoven?”
Susan did not know any orchestraphiles or even if there was any such word. Kendall was not above making up any word he thought sounded funny. “I’ve met dog lovers who don’t care for Labradors and wine aficionados who compare Château Lafite Rothschild to minty fruit juice, so I imagine every enthusiast has biases that might surprise us.”
“Speaking of families…”—Kendall turned Susan a hopeful look—“I’m about to meet with Barbara Callahan’s. Want to come?”
At the moment, Susan would have appreciated nothing more than a nice, warm bed. However, the idea of getting caught sleeping by Dr. Mitchell Reefes rankled, and she thought it best to find something, anything, to make her appear busy. “Yeah, all right. Can I read the chart first?”
“I’ll give you the highlights.” Kendall cleared his throat. “Normally sweet woman well into her seventies. She spent a week in here about three months ago, improved without any significant treatment, and returned home. She bounced back last month, completely demented, and stayed for eleven days. By the time of discharge, she had her full faculties again.” He looked up. “And I do mean full. She could do complicated math problems and was reading romance novels in large print.” He continued his recitation. “Now she’s back, deeply demented again.”
“Anything interesting on examination?”
Kendall shrugged. “She apparently thinks it’s 1982.”
“How so?”
“Ronald Reagan is president, and Princess Diana just gave birth to a male heir.”
“Princess who?”
Kendall smiled. “I looked it up. Trust me; it’s 1982. Counting by sevens backward from one hundred, she gave me: ninety-two…ninety…thirty-six…seven…three. And her clock has ten numbers, all of them on the right-hand side.”
“Aaah.” Susan recognized those as unmistakable signs. “Clearly not the gradual slide you expect from most forms of dementia.”
“Clearly not.”
“Something in her environment?”
“That’s what I intend to find out.”
“Hmmm.” Susan wished she did not have to struggle past exhaustion just to think. “I’m game. Let’s start asking.” She hoped hopping up from her seat would put her in a more energetic mood, but it only managed to make her dizzy. Groggy, she followe
d Kendall from the staffing room, through the proper series of doors, to the family meeting area.
The small room had meticulous white walls, a long table for large family conferences, and multiple chairs. A tiny kitchenette took up most of one wall, with spigots for hot water and packets of hot chocolate, several types of tea, and instant coffee. A refrigerator sized for a college dormitory contained sealed cups of a multitude of juices, and an open cabinet held packages of saltines and graham crackers.
Two people currently occupied chairs at the table on the side opposite the door. As Susan and Kendall entered, the couple rose, a balding man in his early fifties and a narrow-faced woman who looked a few years younger. Both wore standard work khakis and dress polos, indicating they had come straight from their jobs. The woman’s short-cut tresses were muddy brown, matching what remained of the man’s hair, and they both studied the newcomers through similar blue-green eyes.
Kendall strode in with impressive confidence, one hand extended. “I’m Dr. Kendall Stevens.” He shook hands with the man, who was closer. “And this is my colleague, Dr. Susan Calvin.” He released the man’s hand to take the woman’s.
Susan nodded to each, closing the door behind them.
The woman spoke first, Kendall’s hand in hers. “I’m Bambi Ambersod, and this is my brother, Caden Callahan. We’re Barbara’s children.”
“Pleased to meet you.” Kendall pulled up two chairs across from the couple and sat in one. Susan accepted the other chair, and the children of Barbara Callahan returned to their own seats. “We’d like to ask some questions about your mother, and I’m sure you have some for us as well.”
Caden’s voice was a low rumble. “The first of which is why she keeps ending up here. Is this a common way for Alzheimer’s to present?”
“Your mother does not have Alzheimer’s,” Susan said with authority, then wished she had kept her mouth shut. As every eye turned toward her, she no longer had the option of tossing the lead back to Kendall, who deserved it. Barbara was his patient. Susan sat up straighter. “Symptoms of Alzheimer’s don’t fluctuate much from day to day. The disease starts off with mild short-term memory loss, then progresses. You never see wild swings from frank dementia to normality and back.”
Kendall added, “Migraines can occasionally cause sudden bouts of bizarre mental deterioration, but they rarely last longer than a couple of hours.”
Susan could think of a few other exceedingly rare problems, but none fit Barbara Callahan’s picture, so she did not mention them. It suddenly occurred to her she had a distinct and irritating tendency to blurt out her observations, which might explain some of the reasons peers considered her an irksome know-it-all. Not for the first time, she wondered why Kendall sought her out as a coworker when most of the others avoided her, and realized it probably had less to do with her charm and more to do with his own insecurities.
Bambi perked up considerably. “So…this isn’t the start of…of…Alzheimer’s?”
Susan kept her mouth firmly shut.
“Definitely not,” Kendall said, with as much authority as Susan had used earlier. He had known all along, of course, had not needed Susan’s input, but it clearly buoyed him. “That’s not to say she can’t ever develop the disease; anyone can. But it won’t have anything to do with her current episodes of intermittent dementia.”
Caden tipped his head. Clearly not one to show a lot of emotion, he did breathe a subtle sigh of relief. “So, what’s causing this to happen?”
Again, Susan pursed her lips, allowing Kendall to speak for his own patient. She intended to do that a lot more often in the future. Kendall needed her to do that, to learn to rely on his own vast intelligence and store of knowledge. And she needed to learn how to listen more and talk less.
As if to advance her theory, Kendall glanced at Susan before continuing, “Given the episodes come on suddenly at home and resolve relatively quickly here, I think the cause is environmental.”
Bambi suggested, “Mold? A radon leak? Pollution?”
Susan shook her head and spoke before she could stop herself. “Extremely unlikely. Does she take any medications?” Damn it. Couldn’t make it two minutes before opening my big mouth.
Caden shrugged a shoulder in apparent ignorance. Bambi looked thoughtful for a moment. “She’s always been very active, very healthy. She took some multivitamins for a while, but her doctor took her off them after the first episode. She might take an Advil now and then, a Tums, but she’s not on anything regularly.”
Neither of those was known to cause dementialike symptoms, even as an idiosyncratic reaction. “What about antihistamines? Does she have intermittent allergies?”
Caden looked at his hands; he clearly did not know his mother as well as his sister did. Bambi shook her head. “Mom lives alone, since Dad died six years ago. She prefers to remain independent. Since this started, I’ve thought about taking her home to live with me, but we’re already taking care of my husband’s mother, who’s in fragile health, and they don’t get along.” She glanced meaningfully at Caden.
The brother knotted his fingers. “We’re not in a position to take her in, either.” He did not elaborate. Susan felt certain Bambi was pressuring him to do so. Though she surely meant well, not everyone had the patience, time, or ability to handle a senile loved one. If Caden could not take care of his mother for any reason, bullying or shaming him into accepting the burden would do no one any good and could cause great harm.
Realizing she had not gotten the answer to her question, Susan asked it again. “Antihistamine use?”
“I don’t believe so,” Bambi said. “She’s certainly never complained about those types of symptoms, and I don’t recall her sniffling, except with normal colds, of course.”
Susan nodded thoughtfully. Long gone were the days when people gulped down worthless antihistamines, antibiotics, and decongestants for upper-respiratory symptoms. She recalled that the other medications at risk for causing dementialike reactions in the elderly were given for chronic conditions like seizures, depression and anxiety, cardiac diseases, and inflammatory illnesses. Kendall would have told her if Barbara suffered from any of those.
“Where does she live?” Kendall asked. “Does she have any idiosyncrasies, unusual hobbies, pets?”
“Upper East Side.” Bambi answered the string of questions in turn. “Nothing weird. She likes to cook, read romance novels, and knit. She has a cat, Mr. Tibbs, who’s got to be fourteen or fifteen now. Dad hated him.”
“Dad didn’t hate that cat,” Caden inserted. “He just pretended to hate that cat. Whenever I came by, Tibbs was in Dad’s lap getting petted. As soon as Dad saw me, he’d push the cat onto the floor, always gently, and pretend it had just jumped on him. Somehow, though, it always managed to leave him covered in gray and white hairs.”
Susan did not believe the elderly cat had anything to do with Barbara’s problems. A bird or reptile might raise the specter of a nonclassical infection, but a cat who had lived with her for many years was not likely to cause something new and unusual or even trigger a late-life allergy.
Bambi added thoughtfully, “Maybe we should have you talk to Emma. She’s Mom’s neighbor. She’s younger—in her thirties, I think. Maybe early forties. A few years ago, I started paying her to check in on Mom once a day or so. Gradually, they’ve become good friends. I think she’d visit Mom even without the money, but I know she can use it. And Mom adores her.” Bambi reached under the table. “In fact, when she found out we were coming, Emma gave us a few things she thought Mom might want during the hospitalization.” Bambi pulled out a zippered cloth tote stuffed with at least one oversized item of clothing.
Kendall rose to accept the bag, set it on the floor between him and Susan, then sat again. He heaved a thoughtful sigh. “Unfortunately, environmental triggers can be notoriously difficult to pinpoint. Witness the number of people who say they’re allergic to something, but have no idea what.” He sighed again. “Given the seve
rity of your mother’s symptoms and the fact it’s happened three times now, we can assume it’s not just going to go away without treatment or explanation.”
The children of Barbara Callahan nodded glumly. “What’s the plan?” Bambi asked.
“The plan,” Kendall repeated. He looked at Susan.
Susan wisely said nothing, forcing him to continue.
Kendall complied, “You search your mother’s apartment and see what you find. Focus on the bathroom, kitchen, and pantry: medications, supplements, herbal teas and coffees, that kind of thing. Susan and I will talk to the neighbor and, when she’s more lucid, we’ll grill Mom. How does that sound?”
“Perfect.” Caden rose. “Thank you, Doctors.”
“Thank you,” Bambi repeated, also standing. “I’ll let you know if I find anything. I’m sure you’ll do the same.”
Still enveloped in a mental fog, Susan remained seated as Kendall walked the siblings out the door, chatting. She lay her head on her arms for a few moments, listening to the distant buzz of conversation, the clatter and scrape of Unit 1’s patients, the occasional calling of the nurses for one another. Then, realizing if she did not do something she would fall asleep, Susan hooked the handles of the tote and drew it toward her.
Susan unzipped the bag, and a soft fleece sweatshirt spilled out, accompanied by a few personal effects: a well-worn brush with some missing bristles, clearly an old favorite; a grinning stuffed monkey probably won at a carnival; and a faded pair of jeans. A sweatshirt seemed like an odd necessity for a summer admission, but Susan knew the elderly residents tended to overdress for the weather. Her grandmother had often worn a pink wool sweater around the house when Susan and her father felt comfortable in shorts and tees. Barbara’s sweatshirt was red and fuzzy, worn smooth in places, with an embroidered Mickey Mouse over the left breast.
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