Prognosis

by Vallance, Sarah

  “That’s a big part of it, yes.” She smiled, took my hand, and led me upstairs to her bedroom. An elderly cat with gray curly fur used a set of cat stairs to join us on the bed. “Sarah, meet Smokey. Smokey, be nice.” I tickled Smokey in that spot beneath the chin that cats seem to love, and she started to purr.

  “I can’t believe I told you I was falling in love with you before we had even kissed!” I said.

  “Have you changed your mind?” she asked.

  “I’ve never been more certain of anything.”

  “Me either,” she said.

  The next night, I went to Louise’s place to cook her dinner. I had never cooked dinner for anyone I wasn’t living with, but I wanted to impress her. I had one recipe that was foolproof: salmon noodles. Or at least I had thought it was foolproof until I tried it out on my mother on Christmas Day and watched her feed most of it to my dog. Anyway, it was all I had. As soon as we finished eating, she told me that she wanted to spend the night at my place, to meet my dogs and cat. I warned her that Scout could be protective and snappy. That she had never met a person other than me she had really warmed to, and that Louise shouldn’t take it personally.

  We arrived at my place, and the dogs started barking as soon as they heard my car door close. I opened the front door and walked in first in an attempt to calm them. Scout looked up at Louise and fell silent. Louise extended her hand for Scout to sniff, and Scout’s ears reclined and she started wagging her tail. We walked through the hallway, Scout trailing behind Louise and sniffing at her legs, and we sat on the sofa so I could make the proper introductions: first Sofia, who was already licking Louise’s hand; then Ambrose, who was sniffing at her knees; then Scout, who had climbed up beside us on the sofa and was licking my face. Finally Luca appeared from the bedroom, hopped up onto the back of the sofa, and sniffed Louise’s hair.

  “That’s incredible,” I said. “It’s the first time Scout has ever welcomed anyone into the house. I didn’t want to alarm you, but two friends refuse to come inside unless I lock her in the bedroom. She can seem ferocious when she wants to.”

  “She knows you like me. And she knows I love dogs.”

  “She knows you are wonderful.”

  We stretched out on the sofa and drank red wine, and Louise told me she had moved to Sydney from Johannesburg with her ex-girlfriend seven years earlier. That as soon as they had arrived here their relationship began to disintegrate. That she had dated two women since and, on the basis of those experiences, decided she would never have another relationship.

  I told her that since I had moved back to Australia, life had been joyless, and that after nearly six years alone, I was convinced I would never have another relationship. That had it not been for Peter, it would never have even occurred to me to try to meet someone new. And then I told her something I had never told anyone but Peter: Three months earlier, I had been so worried I was going to kill myself, I had locked all the kitchen knives inside the back shed and thrown the key into my garden so I wouldn’t be able to find it. That day I had taken something called 5-HTP, an alternative drug that was meant to help depression. A depressed friend in Hong Kong swore by it. I couldn’t buy it in Australia, so I had ordered it from New Zealand. I had taken one tablet and two hours later found myself curled up on the floor, thinking I had to kill myself. The experience was terrifying. After locking up the knives, I managed to drag myself to bed with Sofia and Scout on either side of me, and I lay there trembling for hours. Scout lay on her back beside me with her head on my shoulder, and Sofia rested her head on my pillow. I waited until the morning and searched the garden for the key. I found it and brought the knives back inside.

  “That makes me so sad,” Louise said. “I was living only a couple of suburbs away and didn’t even know you existed. You’ll never go through that again. I promise.”

  “Even though I only just met you, I’m happy. And happiness is something I thought I would never feel again. It’s quite a lot to get my head around.”

  A fortnight later Louise moved in with her two cats. I had never started a relationship with complete and utter certainty that the person I had chosen was the one with whom I would spend the rest of my life.

  “You are the only person I have ever met who makes me feel normal,” she said one night before we fell asleep, a week after she moved in. “I have never felt this way about anyone.”

  “You are the only person I’ve ever met who doesn’t make me feel lonely,” I said. “I can’t believe I’ve found you.”

  A month or so after she moved in, Louise asked to see my brain scans.

  “You do not have dementia,” she said, before I put the envelopes in front of her. “You have to trust me on that.”

  She worked back chronologically, looking at the three batches of scans, holding up each slide to the light that came in through our kitchen window.

  “I look at brain scans of people with dementia all day. These scans show a brain that has suffered a traumatic brain injury. They show the area where you landed. Your memory problems are caused by your accident. If you did have dementia, it would be happening a lot more quickly. These changes are happening slowly. You’re doing all the right things: you eat well, you drink in moderation. You write, or at least you claim to. I have never actually seen you write, but I trust you. You could certainly do more exercise, but I can help with that,” she said, nudging me with her elbow.

  “Do you notice problems with my memory?”

  “Your serial memory isn’t great. Chronology and so on. A couple of times you’ve said things that didn’t add up in terms of timing. And you definitely have problems with word finding, but that’s because of the area you damaged. You can’t multitask, and your executive functioning isn’t great. You struggle to focus, and you have visuospatial problems because of your injury. You know, bumping into things, tripping over stuff. So yes, of course I notice problems. But remember that’s what I do all day. All the problems you are experiencing have been caused by your accident.”

  “It’s not just my short- and long-term memory, or my serial memory. I lose track of things while I’m talking. And it’s weird stuff too. I went to a music school. I played the violin and the piano for eight years. Now I can’t read music, and I have lost the ability to play.”

  “That’s the temporo-parietal region again.” She spoke as if it was all so obvious. That I had hit my head badly in a particular spot, and that dead brain tissue accounted for all the problems I had experienced. She was not in the least bit alarmed.

  “I’ve felt like I’ve been banging my head against a wall for years. Which is probably not a good analogy, but no one except my neurologist and my psychiatrist have believed there was anything wrong. My mother, Laura, Giulia—none of the people closest to me even believed I had a problem. My mother thought I was manic-depressive!”

  “Head injuries like yours are invisible. You look fine, so no one is going to think otherwise. If you’d had cancer everyone would have understood what you were going through.”

  “We brain-injured folk get a really raw deal. Doctors blame us for our accidents—as if we wanted a brain injury. Neuropsychologists think we invent our symptoms because we are emotionally unstable or trying to cheat the legal system. Society thinks we are violent and unpredictable. Families and partners tire of our mood swings. And I’m one of the lucky ones. There are scores of brain-damaged people who can’t speak for themselves.

  “Why do we know so little about head injuries?” I asked Louise.

  “Because the brain is complicated.”

  “So is space travel! Lots of things are complicated. When I had my accident, I was told I’d suffered a mild traumatic brain injury. But mild meant I lost my job, was put on a disability pension, and told I would never be able to work again or finish my PhD. Now my neurologist thinks my injury was severe. I guess most people would shrug their shoulders and say, Well, there’s nothing I can do about it, so I’ll wait and see. I wish I could think li
ke that. But the uncertainty of it all, the not knowing, is distressing.”

  “I think your neurologist is right. The longer-term effects you’ve experienced are more consistent with a severe head injury.”

  “But why can’t anyone give me a prognosis?”

  “Because no one knows. Every TBI is different. Every brain is different. It really is impossible to tell.”

  “Listen to this.” I rustled through a notebook and found a quote from the only source on medical matters I happened to trust, Pliny the Elder.

  Nothing whatever, in man, is of so frail a nature as the memory; for it is affected by disease, by injuries, and even by fright; being sometimes partially lost, and at other times entirely so. A man, who received a blow from a stone, forgot the names of the letters only; while, on the other hand, another person, who fell from a very high roof, could not so much as recollect his mother, or his relations and neighbors. Another person, in consequence of some disease, forgot his own servants even; and Messala Corvinus, the orator, lost all recollection of his own name. And so it is, that very often the memory appears to attempt, as it were, to make its escape from us, even while the body is at rest and in perfect health.27

  “That was Pliny the Elder back in AD 77. In a single paragraph he covered traumatic brain injury and a disease that sounds a lot like Alzheimer’s,” I said.

  “Wow,” Louise said, taking the notebook from my hands and reading the quote herself.

  “My memory has attempted to make its escape from me,” I said.

  “But you managed to catch it in time.”

  “That remains to be seen. I’m due for another brain MRI two years from now.”

  Louise put the notebook down and looked up at me. “It’s up to you, but I really don’t see much point,” she said.

  “What do you mean?”

  “If the scans show more atrophy, what are you going to do?”

  “I expect that they will show more atrophy. I don’t see how they can’t.”

  “Maybe so. But more atrophy doesn’t necessarily mean you are developing dementia. And I can imagine how you’ll react if the scans look worse than they did last time.”

  I looked at her and said nothing.

  “Listen,” she said, taking hold of my hands. “You’ve wasted the last seven years of your life worrying about something that hasn’t happened. Do you want to waste the next seven years?”

  That night, unable to sleep, I crept out of the bedroom with Scout and Sofia, and we curled up together on the sofa. I stared at the moon suspended above the magnolia tree in our backyard and realized that Louise was right. I had lost seven years of my life to depression and anxiety, worrying about dementia. And it hadn’t happened yet. It was time to think about the possibilities that lay ahead of me, of us, and to do something with my life.

  I introduced Louise to my mother.

  Her doctor now believed my mother was suffering from Parkinson’s disease. My mother had been robbed of her mobility and her mind, and the person Louise met bore little resemblance to the woman who caused me so much grief.

  “It’s lovely to meet you,” my mother said when Louise leaned over to shake her hand. I told my mother we planned to travel to New York to marry, and my mother asked, “Can you marry there?”

  “You can marry everywhere in the Western world but Australia,” I said.

  “That’s wonderful,” my mother said, and looked like she meant it.

  An hour later my mother forgot my name. She remembered I was her daughter, and when I reminded her I was Sarah, she said, “Sarah! That’s right.”

  Louise told me she could live two years or more, unable to move on her own, unable to think. I wished nothing more for my mother than a swift and easy death.

  On another visit my mother snapped at me and demanded we leave. “That’s the mother I remember,” I said to Louise as we made for the door.

  We moved my mother into a nursing home when it was no longer possible for her to have in-home care. It took a while for her to settle in, but her mind deteriorated quickly and it wasn’t long before she forgot where she was.

  Each time I visited, she thanked me for being there. “You didn’t need to come, given everything that has happened. But you did, and I appreciate that so much. You really are lovely.” When Louise was there, she chimed in and told my mother how lucky she was to have me. “I know,” my mother said, “I know.”

  Sometimes she pleaded with me to stay. “I just like having you here. You’re such good company.” And I pulled up a chair beside her and stayed until she fell asleep.

  “Why is she so nice to me now?” I asked Louise one day after my mother told me I was beautiful, kind, and delightful. “She’s like a different person!”

  Louise told me that she had seen a number of patients who were prickly before their dementia diagnosis lose their sharp edges as the disease took hold. That prickly people often have a facade that vanishes when their frontal lobes begin to deteriorate.

  “Someone like your mother may lose her ability to manipulate. Underneath the veneer, your mother is probably quite a nice person.”

  One of Louise’s patients, a woman around my mother’s age, had been charming to everyone all her life. Her daughter couldn’t recognize the monster she had become since she developed dementia. “This woman is horrible!” Louise said. “Rude, nasty, a real piece of work. Yet she and her daughter were incredibly close. Perhaps her charm ran out. Perhaps she was hiding some of her self. And now, with her veneer gone, that side of her has appeared for the first time.”

  “Strange.”

  Louise agreed.

  “Do you think Mum means the things she says now?”

  “Yes. She’s still the same person. Dementia takes things away from us. It doesn’t add things that weren’t there before.”

  “It’s terrible to say, but I like my mother a lot more now. We’ve lost the need to control each other, the need to compete. It’s not just her who has changed; it’s me too. We’ve both softened. We’re kinder to one another. It’s like we’ve been on a parallel journey that has brought us together, her with her brain, me with mine.”

  One Saturday morning Louise and I drove across town to visit my mother, stopping on the way for a box of Italian pastries. I opened the box and my mother stared at me and started to cry.

  “I was a terrible mother to you,” she said. “And yet you are always here for me.” There was a sadness, an earnestness in her eyes I had never seen before. I hugged her and told her to stop crying. The sight of my mother crying caused me physical pain. I told her that we were both to blame. That what mattered now was that we had finally found peace.

  “I’m so sorry,” she said when she finally stopped crying.

  The more I visited my mother, the more I looked forward to seeing her. Before her mind had started to fail her, I couldn’t recall a single occasion when I had appeared at her door with anything other than a sense of dread. I always expected the worst, and usually I wasn’t disappointed. Now I arrived and her face lit up. She was genuinely happy to see me. I pulled up a chair beside her and took her hand, and she looked at me and smiled.

  “I love you, Mum,” I said, and I meant it.

  “I love you too,” she said. It was the first time I had ever heard her say it.

  “Why couldn’t we have been like this years ago?” I asked.

  “I’m sorry,” she said. “It’s not too late.”

  One night, lying in bed waiting to fall asleep, I told Louise how devastating it was to see my mother stuck in a wheelchair unable to move, to watch her life ebb away and her mind deteriorate. “She would be horrified to think her life had come to this.”

  Louise looked at me and squeezed my hand.

  “I reminded her about my accident not long after I moved back home from Hong Kong. Her memory was better then, but she didn’t remember anything about it. I tried to prompt her. The farm. A horse. I landed on my head. She didn’t seem to register. I have never be
en able to understand why she didn’t try to help me back then, why she disappeared and left me alone, and now I never will. I shouted at her in the hospital parking lot the day I had my brain scanned, and she never mentioned my accident again. Not once.”

  Louise shrugged. “Some things don’t have answers.”

  In April 2017 Louise and I married in a small room in the New York City Marriage Bureau. Our honeymoon started in New York and ended in Paris.

  Home in Sydney, we lead a simple life. Louise leaves each morning to tend to her patients, and I walk the dogs. I try to write. Writing is suffering, and Louise tells me that being spat on and punched in the face by elderly patients isn’t a walk in the park either. My social life has shrunk since moving back to Australia, but Louise and I are happiest at home, alone with our dogs and cats, sharing a meal she has prepared and a glass of red wine.

  Love cannot fix everything. I still have a temper, and while I do everything within my power to contain it, occasionally I erupt. Depression is like a tattoo across my shoulders I can never seem to remove. Over the past two years, Louise encouraged me to try five new types of antidepressants (taking my lifetime total to thirteen) before admitting my depression was treatment resistant. Exercise will save my life, she says, or at least prolong my quality of life, and the available research suggests she is right. We are now one of those strange couples who visit the gym together. A couple of weeks ago, she came home excitedly, telling me she had bought me a present. I was hoping for chocolate or a book, but she handed me a small plastic bag with a running bra inside. The saddest present ever.

  Pinned to the wall of my study is a Post-it note with a warning I want to confront every day. It’s a quote by Norman Cousins:

  The tragedy of life is not death but what we let die inside us while we live.

  At Louise’s urging, I decided to skip my next brain scan. I chose not to know. I have managed, somehow, to build a new life in place of my old one, and my goal now is to live. Learning to live from day to day is not as easy as it sounds. Neither, I’ve realized, is it impossible.