Prizes (46 page)

“What’s the matter, Annoushka?”

“Nothing, nothing. I had an upsetting dream.”

Adam could not intuit the deeper truth in what she was saying, but he did sense she needed comforting, so he quickly got up, put on his bathrobe, sat beside her and took her in his arms.

“Anya, don’t hold out on me,” he implored. “Have I made you unhappy in some way?”

Though she squeezed her eyes and tried not to cry, Anya nonetheless began to sob. “Adam, I don’t know how to say this or if you’ll understand,” she murmured, “but I think you’re having some … memory problems.”

“No.” He answered quickly. Perhaps too quickly. Perhaps because somewhere in his semiconsciousness he knew that his powers of recollection were slipping from him. “You’re talking to the guy they call ‘the walking medical database.’ ”

This gave Anya an acceptable way of breaking it to him. “I know, Adam,” she began. “Then maybe you’ll understand the history of this case.”

“Ask me anything,” he said, trying to make it sound like a playful challenge.

As delicately as she could, she described the signs and symptoms of a hypothetical patient who demonstrated behavior similar to his own.

“I know it isn’t your field, but what sort of specialist do you think such a person should see?”

“Well, what you’ve described sounds to me like the sequelae of a minor infarct—a mild stroke that caused short-term … forgetfulness. Your patient probably
needs to see a neurologist. Now tell me what this is all about.”

His eyes betrayed the anxiety that his voice attempted to conceal.

Hesitantly, like a soldier gingerly making his way across a mine field, Anya told him of his various lapses since that first unsettling incident on the beach in Fiji. There had been minor episodes in the intervening days, none important except as incremental evidence. Until today, when his actions had demonstrated that something was seriously wrong.

Adam listened mutely, then sat deep in thought. Finally, he said in a bland, toneless voice, “I remember … I mean, I have a vague sense of not being able to remember.” He paused and then finally confessed, “Anya, I’m scared. I’m terribly, terribly scared.”

She put her arms around his neck and hugged him tightly. “Don’t worry, darling, we’ll take the first plane home, and whatever it is, there will be somebody at Harvard who will make it right.”

Adam, at this point completely lucid, said to himself, Don’t be so sure. You forget, Anya,
you
were a case beyond the fabled powers of Fair Harvard.

Strangely, Anya felt relieved. It was out in the open now and they were once again sharing everything, even his illness—whatever it might be.

“Of course, if we were doing a differential diagnosis,” he continued in a vain attempt to be dispassionate about his own case, “we would have to allow for the possibility of a tumor—”

“Oh, no,” she responded in a shocked whisper.

“But I wouldn’t worry,” he continued. “Those brain plumbers wield a mean laser. They can zap out the problem in a minute.”

Anya was still too frightened to remark that her husband’s analysis had not set forth the many alternatives and then eliminated them one by one.

He broke the silence. “Hey, you know something?
On second thought, I don’t think we should go home because of this. For one thing, Hippocratic Oath or not, our learned colleagues do talk shop, and whatever minor thing I may have will still be grist for the cocktail mill. There are some terrific people here in Oz. Why don’t we go to the university hospital and check the
International Medical Directory
?”

She nodded.

Miraculously, they were both able to get a few hours’ sleep. They had breakfast in the room and then started out in search of a learned healer.

The librarian at the university hospital had herself attended Adam’s lecture the previous week and was delighted to let the Coopersmiths use the computer database.

“Let me drive,” Anya said, seating herself at the keyboard. This seemingly trivial action fulfilled a tremendous need in her to
do something.

In a few key strokes they had retraced their tour of the Australian continent, and come up with a specialist not merely in Sydney, but one just a few floors away from where they were sitting.

“Why don’t I go down and make an appointment?” Anya offered.

“No, no,” Adam objected. “I feel—I don’t know—naked. I mean, they
know
me here. You saw the song and dance the librarian gave us.”

“Adam,” Anya scolded him gently, “I don’t think I’ll be able to find a qualified penguin in Antarctica. Isn’t Australia far enough from Boston?”

He thought for a moment and then responded, “Yes, but not as far off the beaten track as New Zealand. See what you can come up with.”

She shrugged and returned to the machine.

Anya knew it would appeal to Adam the minute she called up the information: Otago University Medical School, Dunedin, on the South Island of New Zealand,
was barely accessible. Nonetheless, it boasted one of the finest medical faculties in the world.

James Moody, the Chairman of Neurology, owned an international reputation, and further inquiry confirmed that his hospital possessed a state-of-the-art PET scanner which enabled real-time exploration of various brain areas.

Anya was right. Adam was already making note of Moody’s phone and fax numbers.

When they first phoned, the New Zealander was reluctant, since Anya was trying to be both descriptive and discreet. He wondered out loud why Dr. Coopersmith didn’t enlist the help of one of his many distinguished Australian colleagues.

But she persisted, and Moody relented. An appointment was set for two days hence.

In the intervening time, husband and wife practically held their breaths. Their lifestyle had already changed. By mutual agreement, he would no longer go off on his outdoor jogs, but would do his daily mileage on a tread-mill in the hotel fitness room.

Though outwardly the two doctors reassured one another, inwardly they trembled at the prospect of Moody’s diagnosis.

From Sydney they flew to Auckland, then changed for a connecting flight to Dunedin, where they spent a sleepless night watching practically every film on the hotel network. Early the next morning, making a detour to give blood at the first floor lab, they appeared punctually at nine
A.M.
at the offices of the professor. He was in his mid-fifties, leathery skinned, with a full head of white hair and—rare quality in a neurologist—an outgoing personality.

After taking the shortest of histories, he suggested affably, “I know how worried both of you must be, so why don’t we skip all speculation and go right to the machines?”

Moody had been especially accommodating to the Coopersmiths’ request for discretion. Only a radiology technician was present, with the professor offering to provide another pair of hands where needed. Moreover, he generously invited Anya to look over his shoulder at the screen in the control room.

First Adam had an injection of specially treated glucose—the primary energy source for the brain’s activity. Several minutes later he was strapped to a table, as the futuristic eyes of the scanner transmitted to the screen images of sections of his brain.

Moody paid special attention to the frontal occipital lobes. Almost immediately Anya had turned her gaze from the monitor to the physician’s face, hoping to discern a telltale expression.

At one point Moody seemed to squint. Or was it a frown? Or perhaps simply her imagination.

“Well, what did you see, Doctor?” Adam asked anxiously as the professor and Anya came into the imaging area to help him off the table.

“I wish you’d call me Jamie,” he replied. “In any case, we’ll be more comfortable downstairs in my office. I’ll go ahead and order us some coffee and we can chat.”

Adam took Anya’s hand. There was a strange expression on his face.

“Now I know what it’s like to be a patient,” he murmured, adding, “to be straight-armed when I ask a direct question.”

“Well …” Moody began, letting the rest of his sentence dangle ominously in the air.

Adam jumped in, hoping that by offering one he could will a diagnosis.

“Tumor—right, Jamie?”

“No tumor, Adam,” the professor replied. “At least none that I can see.”

Analyzing every syllable, Adam had diagnosed
Moody’s last remark as the old mock-modest naive ploy.
As far as he could see,
suggesting that perhaps a greater diagnostician might have discerned one.

“Did you find anything out of the ordinary?” Adam asked with an urgency that tried to pin the man down.

“I did detect slight traces of neurofibrillary tangles and a few ominous plaques … surrounding a core of amyloid protein.”

“Leading to what conclusion?” Adam demanded.

Even Moody could not say the words. He half evaded pronouncing the verdict by simply citing the initial letters.

“I’m afraid it looks like A.D.”

“No,” Adam erupted, “not Alzheimer’s. That’s way off base, Moody. I’m only forty-four years old. Couldn’t a tumor produce the same … erratic behavior?”

The professor did not reply immediately.

Although petrified, Anya somehow found the strength to ask, “Is it possible you could be mistaken, Doctor?”

“Of course he is,” Adam shouted in a burst of denial. “Whatever lapses I may have had are the result of fatigue. My memory’s perfect. In fact I can quote verbatim the symptomology of A.D. to show how wrong he is.”

Anya exchanged glances with the professor, whose tiny nod suggested they allow her husband this pedantic catharsis.

Adam became a torrential encyclopedia: “Biochemical abnormalities associated with neuron failures include accumulation of aluminum, disrupted nerve-cell membrane, phospholipid metabolism and decreases in neurotransmitter substances such as—”

“Please darling,” she gently implored him, “your memory is phenomenal, but the scanner doesn’t lie.”

“Yeah, but how can we be sure this guy’s reading it right?”

Moody did not take offense. He swiveled around, took a textbook from the shelf, put it on the desk, and almost by itself it fell open at the appropriate page.

Then he handed the tome to Adam and said, “With respect, Dr. Coopersmith, I ask you to look at those pictures—and draw your own conclusions.”

The book had two color images taken by a PET scan.

Moody then explained, “The one on the left side is an image of a healthy adult brain. Looks like a cheese and tomato pizza, doesn’t it?”

Adam did not reply, for he was staring at the contrasting photo, that of a patient with Alzheimer’s. To use simplistic terminology, it looked merely like tiny leftovers on a blue plate.

Moody then handed over four Polaroid color photographs. “These are the ones we took this morning.”

Adam snatched and stared at them.

Anya peeked over his shoulder, trying not to give voice to her horror. For the dominant color was turquoise, with what looked like stains of blue ink.

Then Moody said gently, “You will of course want to have a second opinion. But I would remind you of two things. In rare instances Alzheimer’s has attacked people in their twenties. Mid-thirties is no longer that rare, and as for mid-forties …”

He turned to Adam and continued, “Believe me, Dr. Coopersmith, I wouldn’t stick my neck out with someone of your stature unless I were pretty sure.”

“What—What do you suggest I do?” Adam asked helplessly.

“What can I tell you that you don’t already know?” the neurologist answered as softly as possible. “You’re aware this thing isn’t static. It goes in only one direction, and the younger you are, the faster.”

Adam was mute, his fists clenching the arms of his chair till the knuckles were white. Finally he worked up the courage to ask hesitantly, “Dr. Moody, what sort of time frame do you envisage?”

The New Zealander shook his head. “I can’t speculate at this point. I can only suggest that you consider going home and putting yourself in the care of a Boston physician.”

Anya agreed. “I think that’s very wise.”

“Do you have any children?” he inquired.

“Adam has a daughter from his previous marriage,” she answered for him. “Heather’s fourteen.”

Moody shook his head sympathetically. “I can see this is going to be very difficult for you, Dr. Coopersmith—for both of you. I’m terribly sorry.”

During the long journey home, Anya lost count of the number of times Adam tried to console her. “You don’t deserve this, darling. Why should something like this have to happen to you?”

It was at moments like this that she remembered the accepted wisdom that there is nothing more helpless than a terminally ill doctor.

49
 

Sandy Raven turned off Pico and drove up to the inner gate of Twentieth Century-Fox. The officer in aviator sunglasses was a familiar figure who had been there as long as Sandy could remember.

And he, in turn, had a photographic inventory of everyone who had ever passed through his portal. He even recalled the first visits Sandy had made as a wide-eyed teenager. Yet his nomenclature was always up-to-date.