What Comes Next

CHAPTER 1

As soon as the door opened he knew he was dead.
He could see it in the quickly averted eyes, in the small slump of the shoulders, the nervous, hurried manner as the doctor moved rapidly across the room.
How much time do I have? How bad will it be?
He did not have to wait long for the answers.
Chris Thomas watched as the neurologist shuffled his test results before squirreling down behind his large oaken desk. The physician leaned backward in his chair, then rocked forward before looking up and saying,
"The test results rule out most routine diagnoses..."

Chris had expected this. MRI. EKG. EEG. Blood. Urine. Ultrasound. Brain Scan. A battery of cognitive function exams. It had been more than nine months sonar he'd first noticed he was forgetting things that were ordinarily easy to remember---a trip to the hardware store where he'd found himself standing in the light bulb aisle with no idea what he had meant to purchase; a time outside on the Main Street in town when he'd run into a longtime colleague and had blanked on the name of a man who'd occupied the office next to his for over 20 years. Then, six days earlier, he had spent an entire evening hour pleasantly conversing with his long-deceased wife in the living room of the house they had shared since moving to western Massachusetts. She had even sat in her favorite paisley Queen Anne chair, near the fireplace. When the recognition of what he had done had become clear to him, He had also known that nothing would show up on any computer printout of color photograph of his brain structure. Nevertheless, he had dutifully made an emergency appointment with his internist, who had quickly shipped him over to the specialist. He had patiently answered every question and allowed himself to
be poked, prodded, and X-rayed.
He had assumed, in those first minutes of shocked recognition after his dead wife had vanished from his sight, that he was simply going crazy---an unscientific and undisciplined way of defining psychosis or schizophrenia.
But then, he had not felt crazy. He had felt quite good, really. It had been more Benign, almost as if the hours spent in talk with someone who had died three years earlier was routine and pleasurable, a conversation not at all dissimilar to those they had frequently enjoyed in all the years of their marriage. They'd talked about his deepening loneliness and why he should take up some pro bono teaching at the university despite his retirement after her death. They'd discussed current movies and interesting books and what he should send his nieces in California for their birthdays. They had debated whether this year they should try to steal down to Cape Cod for a couple of weeks of rest in June, just after the bluefish and stripers started their annual run, before the suntan crowds showed up in coolers and umbrellas masses.
As he sat across from the neurologist he thought he made a terrible mistake in even considering for one second that the hallucination was part of the illness, and that he should never have allowed this alarm to frighten him enough to send him to the doctors office. He should have thought of it as an advantage. He was completely alone now, and it would have been nice to repopulate his life with people he had once loved, regardless of whether they still existed or not, for however long he had left on this earth.
"Your symptoms suggest..."
He did not want to listen to the doctor, who had an uncomfortable, pained look on his face, and who was much younger than he was. It was unfair, he thought, that someone so young would get to tell him he was going to die. It should have been some gray-haired, God-like physician, with a sonorous voice weary with years of experience, not that high-pitched barely out of elementary school man rocking back and forth nervously in his chair.
He hated the sterile, brightly lit office, with its framed diplomas and wooden bookcases filled with medical texts that he was sure the doctor never opened. Chris knew the doctor was the sort of man who preferred a couple of quick clicks on a computer keyboard or a blackberry to find information.
He looked about and thought the office was oppressively clean and orderly, as if the natural messiness of a fatal illness wasn't allowed inside. He looked past the mans shoulders, out the window and saw a crow alight on leafy branches of a nearby willow tree. It was as if the doctor was droning away in some distant world that as of that moment he really wasn't much a part of any longer. Just a small part, perhaps. An inconsequential part. For an instant, he imagined that he should listen to the crow instead, and then he had a shock of confusion, where he thought that it was the crow that was speaking to him. That, he insisted inwardly, was unlikely, so he dropped his eyes and forced himself to pay attention to the physician.
"I am sorry, professor Thomas."
The neurologist said slowly.
He was picking his words with caution.
"But I believe you are experiencing the progressive stages of a relatively rare disease called Lewy body dementia. Do you know what this is?"
He did, vaguely. He had heard the term once or twice, although he could not immediately recall where. Perhaps one of the other members of the psychology department at the university had used it in a faculty meeting trying to justify some research or complaining about grant application procedures. Maybe he recalled it from his youth, when he performed clinical work In a VA hospital. He shook his head anyway. Better to hear it all unvarnished, from someone more expert than he, even if the doctor was far to young.
Words fell into the space between them, like debris from an explosion drifting down, littering the desktop.
Steady. Progressive. Rapid deterioration. Hallucinations. Loss of bodily functions. Loss of critical reasoning. Loss of short-term memory. Loss of long-term memory.
And then finally the death sentence: "I'm sorry to have to tell you this, but typically we're talking five to seven years. Maybe. And I believe you have been suffering from the onset of this disease for some time, so that would be the maximum. And in most cases, things move much more quickly."
There was a momentarily delay, followed by an obsequious, "if you want a second opinion..."
Why, He wondered, would he want to hear bad news twice?
And then an additional and somewhat blow: "There is no cure. There are some medications that can alleviate some of the symptoms---Alzheimer's drugs, atypical antipsychotics to treat the visions and delusions---but none of these are guarantees of anything and oftentimes they don't really help significantly. But they are worth trying to see if they will work to prolong functioning..."
Chris waited for a small opening, before he said, "But I don't feel sick."
The neurologist nodded.
"That too, unfortunately, is typical. For a man in his mid-sixties, you are in excellent physical shape. You have the heart of a much younger man."
"Lots of running and exercise."
"Well, that's good."
"So I'm healthy enough to watch myself fall apart? Like a ringside seat at my own decline?"
The neurologist did not immediately respond.
"Yes . . ." He finally said.
"But some studies have shown that the more mental exercises you do, coupled with continuing an active, exercise-filled day-to-day life, can delay some of the impact on the frontal lobes, which is where this disease is located."
Chris nodded. He knew this. He also knew the frontal lobes controlled decision-making processes and the ability to comprehend the world around him. The frontal lobes were pretty much the part of his brain that had made him who he was and now we're going to make him into someone much different and probably unrecognizable. He suddenly did not expect to be Chris Thomas any longer.
That was the thought that filled him, and he ceased listening to the neurologist, until he heard, "Do you have anyone to help you? Wife? Children? Other relatives? There's not much time before your going to need a dedicated support system. That will be followed by a round-the-clock care facility. I should really speak with these people very soon. Help them to understand what you will be going through."
The doctor said these words as he reached for a prescription pad and rapidly started to write down lists of medications.
Chris smiled. "I have all the help I'm going to need right at home."
Mister Ruger 9mm semiautomatic, he thought. The weapon was located in the top drawer in the nightstand by his bed.
The thirteen-shot clip was full, but he knew he would need to chamber one bullet.
The doctor said some other things about home health care aides and insurance payments, power of attorney and living wills, long-term hospital stays and the importance of keeping all his future appointments, sticking to the medicines that he didn't think we're going to slow the pace of the disease but which he should take anyway because they might work a little bit, but Chris realized he no longer had any real need to pay more attention.