“Just do what they tell you,” Judith Schwartz says.
And I do.
* * *
—
Dental Office Manager （who may be the dentist’s wife）： Is Brian changing dentists? Is he unhappy with Dr. L.? He’s been a patient of ours for so long that…
Me （thinking, My husband would never ever give up a dentist who likes football, saw Brian play magnificently in the Yale Bowl, and is a paisan, to boot. But we have to go to Zurich with his dental records so Brian can die in peace）： Yes, he loves Dr. L. I just need his dental records.
DOM: Yes, but…
Me: I just need his dental records.
DOM （thinking, Fuck you）： Well, you’ll have to pick them up in person. Before lunch.
Me: See you tomorrow morning.
DOM: Click.
September 2019, New Haven
We pin our hopes on Dignitas because the right-to-die laws in America are not going to help us. Dignitas leads me to a meeting with Brian’s psychiatrist, because Heidi of Dignitas has told me that since Brian is in therapy, they need a report on his mental health from his psychiatrist. I’m sure that Brian’s psychiatrist already knows the results of Brian’s MRI test, because I can use the World Wide Web and I have learned that Brian’s neurologist and his psychiatrist are not only the same age, practicing in the same city, but I already know they refer patients to each other and I see they went to the same medical school. I picture them having dinner together a couple of times a year. I picture the neurologist summing Brian up for the psychiatrist, over a couple of glasses of pinot grigio: Not good. His brain has shrunk. Lots of white stuff. A 23 on his mini-mental—23. Yale graduate. They both shake their heads.
It will turn out that these two doctors are for me the villains of this story. When I write fiction, there is almost always no villain at all. There are occasionally cruel fathers, often redeemed in the end by one great, embarrassing love affair or revealed to have a streak, however narrow, of compassion or decency. There are plenty of faithless wives in my fiction, but if you read carefully they are rarely villains, being married as they are to deeply disappointing men. Sometimes these women seem a little chilly, clipped in their remarks and short on hugs, but I like them.
A colleague described Brian’s psychiatrist as above-average intelligence, below-average social skills. For better or worse, I know a lot of shrinky people, of all valences: social worker, psychologist, psychiatrist. Brian has told me he thinks his psychiatrist is smart and low-key and that she likes him. I don’t think Brian has ever had a therapist who did not genuinely like him.
Years ago, he’d come home from sessions with his then-therapist, a revered New Haven psychoanalyst, and when I’d ask how it went—and, yes, I am familiar with and supportive of the idea that his therapy is not my business—Brian might say, We talked a lot about Yale’s football program this season. We talked about Carm Cozza （Brian’s football coach at Yale）。 We talked about the early days of lacrosse at Yale （they recruited some football players, stuck a lacrosse stick in Brian’s hands, and sent him across the field to frighten people）。 I know that they also talked about Brian’s struggles with his father, and our new marriage, and the challenges of being an architect in architect-filled New Haven, but he did report that they spent quite a bit of time happily shooting the shit. The new psychiatrist, however, seems to be all down to business with the inner life, and I am glad of it.
The new doctor will be important to us, to support Brian’s claim of being “of sound mind.” I tell Brian my thoughts and he hands me his phone. Let’s get a meeting, he says. I have a text exchange on my phone with the psychiatrist. I ask if she has noticed some issues with Brian’s cognitive function and she says yes.
I suggest we have a joint meeting （the three of us）。 The psychiatrist types back that Brian needs to be the one to arrange this meeting. I think, Yeah, yeah, I know. I was a clinical social worker for twenty-five years, I’m aware. I text something like: Also, perhaps you recall referring Brian to a neurologist a while ago, for cognitive assessment, which was followed by an MRI, all of which—any of which—might lead you to think that Brian arranging an appointment on his own （remembering, scheduling, and reporting） might be difficult? （I don’t think I’m managing my text tone very well, but she doesn’t know me and she may think that I’m just…brusque.）
Psychiatrist: Yes, I recall.
I calm down. I ask if we can meet in a few weeks.
Psychiatrist: If Brian requests the meeting, yes, of course.
Brian looks over my shoulder. Text her back as me, he says, and request a meeting. I do.
After the MRI report, the psychiatrist moves to the top of our list. We’ll meet to discuss the results of the mini-mental status exam, and by the time we do meet with the psychiatrist, the neurologist’s report has become an obstacle to Dignitas, and I am on the hunt for a psychiatrist or a neurologist to rebut it. It erroneously describes Brian as depressed, which, if true, would guarantee a no from Dignitas—making the psychiatrist’s support a necessity.
* * *
—
At what will be our only meeting, the psychiatrist cannot conceal her distress when we tell her that having understood the diagnosis and the MRI, Brian and I are looking at Dignitas. As often happens with relatives and healthcare providers, a vacation, a final trip to Ravenna or Telluride or perhaps marlin-fishing in the Keys, is suggested. I know that, even if they have not watched the ten thousand YouTube videos on Alzheimer’s and its progression, medical professionals do know that no one can predict how quickly or slowly Brian’s particular case will progress. Whether you are medical personnel, clergy, worried child, or hopeful spouse, you do know, even if you never say so, that this disease progresses as steady as winter, and the person who is still smiling that crooked, loving smile this year, even as they are unsure about locations, histories, appointments, and bills, will be unable to truly converse with meaning or engage in a relationship in a couple of years and will be unable to walk or smile in recognition in ten years and what you will end up hoping, as a friend whose beloved got Alzheimer’s at fifty and lived to seventy told me, is that your beloved forgets how to swallow.
I ask the psychiatrist to write a letter for us for Dignitas, just in case we need it, stating that Brian’s of sound mind and understands his decision. Brian explains that he needs to be high functioning cognitively to arrange for an assisted suicide. （We call it assisted, because we have not yet gotten used to the Dignitas phrase “accompanied suicide,” which sounds to me like an orchestra will be standing by.） It seems quite clear to me that he is of sound mind and he does understand the decision. The psychiatrist doesn’t argue or address the subject of his state of mind at all.
She does say, hand to anxious mouth, “Do I have to answer that question now?”
I back off. I say that she does not have to answer now but that she will have to answer soon, because we will be asking her for that letter soon. We all fall silent and then she is half out of her seat, with Maria von Trapp–like enthusiasm, telling us that we should plan for good times and seek out joyful activities. She lifts her hands over her head. She mentions European vacations, trips to beautiful lakes. She says the word joy several times, and Brian and I stare at her. We want joy, we do. We really do. And neither of us thinks that eight years of a steady decline and complete loss of self sounds like joy.