When we get home, Brian says, I don’t think this will work out. She’s not on our team. I agree.
Brian breaks up with the psychiatrist by text. Over the next few days, she texts him, trying to get him to come to her office for closure. I get it. I might have done the same thing. I don’t want Brian to go to see this person, because I’m afraid she will upset or confuse him with more talk of a river-barge holiday or the possibility of a cure in his lifetime. （Even on the Alzheimer’s websites, the most encouraging news lately: phone apps to help you organize or find the Alzheimer’s patient. All the recent major failed clinical trials are described as very helpful in the fight against Alzheimer’s.） I suppose the psychiatrist might get Brian to change his mind, but I doubt it. I don’t think I could get him to change his mind.
He feels bad for the psychiatrist. He says, I see I’ve upset her, which inclines him to go see her, and he goes out for a walk. He comes back and says, She’s not on our team.
* * *
—
In the end, about as close to the end as we can manage, the psychiatrist does write a short letter for Dignitas.
9/21/19
To whom it may concern,
I am writing at the request of Mr. Brian Ameche, d.o.b. 6/19/53. Mr. Ameche had been under my psychiatric care from 1/22/18 until recently terminating on 9/9/19.
I can document that he was not psychotic, thought disordered, depressed, or suicidal during the time that I was treating him.
Sincerely,
The letter, attesting to Brian’s sound mind and the absence of psychosis or thought disorder or suicidality, is not helpful enough; even the Swiss can tell that the doctor is saying as little as possible. Brian texts the psychiatrist one more time for a stronger letter and she does send one. Not much stronger, but she’s thrown in a few positive adjectives about his state of mind and made it clear that he has…discernment.
I have to send Dignitas the neurologist’s written report about Brian’s MRI, and it changes everything for the worse, but not because of the content. The problem is that in the upper right-hand corner it says: Reason for exam: major depressive episode, with current active depression episode. Brian never suffered from depression and never received treatment of any kind for depression. Neither of us would care, but Dignitas’s website makes it very clear that they are not in the business of helping the clinically depressed commit suicide. Heidi of Dignitas, our contact person, has seen the report and already said as much. I do my best to explain to Heidi that the neurologist is wrong. Heidi says, essentially: That may be. Do better or we cannot help you.
I call the neurologist’s office the next day and have a short talk with the doctor, who says, Well, I had to say something for why I asked for the MRI, and I knew he was seeing a psychiatrist. It’s not important, Amy.
I try to explain that it is important without telling her that Dignitas will not accept Brian’s application if they see the word depression. I ask her if she would change the reason given on the form for ordering the MRI to the more accurate cognitive difficulties. She says, It’s not important, and hangs up.
I call again the next day and the neurologist doesn’t take my call or return it. I get her administrator, who immediately throws herself between the neurologist and me, which I respect, in theory, saying that if Brian and I want to discuss the report, we can make an appointment. I make the appointment, for a month later, and think of it as the Hail Mary appointment: We’ll only keep it if every single other thing has failed. I’ve discovered that, having been a resilient and determined person （perhaps not as much as my husband but still）， I now find getting a no, from a person or the universe, is almost unbearable. It destroys my day and more.
* * *
—
In a few days, we get an email from Heidi at Dignitas in response to everything I’ve sent her, arranging for our first phone call. I am hopeful and nervous. Brian makes himself a cup of coffee and sits at our kitchen island, calm and ready. I never saw him play football, but I know a goddamn game face when I see one. It’s impressive.
If Heidi were a Jew or an Italian from New York, she would be screaming at me. （For this phone call, we have given up the pretense that Brian is handling all of this correspondence on his own, as would a man with…discernment.） Heidi asks to speak to me as soon as she’s done with the pleasantries with Brian:
“How are you feeling, Mr. Ameche?”
“Pretty good, all things considered.”
“That’s good to hear, Mr. Ameche.”
If Heidi were one of my own relatives, she would not be speaking in a low, emphatic voice; she would be geshrei-ing, and what she would be geshrei-ing is:
Whaddaya, deaf? You send me this fakakta report and right up there, at the top, what does it say? I’m asking you, young lady, what does it say?! It says, reason for exam: major depressive episode. No good. Are you listening, Amele? THIS IS NO GOOD.
This MRI report, that’s your problem. Here’s what you gotta do. （At this point, my relative would be knocking whatever I was holding—cup, spoon, or newspaper—out of my hand.） By us, Alzheimer’s is a psychiatric disease. What you gotta get is a proper assessment—not some lukewarm letter, a proper report—is what I’m saying from a proper psychiatrist. You know who we revere here in Switzerland? Freud! Get yourself a Dr. Freud and get us a nice long report. You don’t got all day. Until we hear from Dr. Freud, we’re not moving a muscle. And if we don’t hear from him, you won’t be hearing from us. All right? All right.
* * *
—
I get off the phone and Brian looks at me dubiously. I have been on the phone, silently sitting and blinking and nodding, for several minutes.
“It’s okay,” I say. “We just need a better psychiatric report.”
“Sure,” he says, going back to watching the news.
Brian keeps watching the news and I make dinner. It’s disgusting. Having always been a competent and sometimes a very good cook, I am now like any other bad, beleaguered cook. I am often dismayed and surprised by what appears in the pan or the pot. Things that are broiled burn. Things that are sautéed cling and drown. Nothing tastes right. Almost everything is too salty, too oily, or tastes like metal. About once a week, I just throw the whole meal out and we have pizza and a salad or I make sandwiches. I feel that I’m concentrating, but I never am. I have scraped dinner into the garbage again when Donna, Brian’s mindfulness/meditation teacher, calls to see how he’s doing, since he missed the last class of his meditation course （right day, wrong time）。 His face lights up and I go into another room. A half hour later, he’s off the phone and in an excellent mood. I suggest that he call her back （“How about now,” I say, and slide his phone toward him） and see if she’ll be his new therapist. He does and she will and God bless her, may she be inscribed in the Book of Life.
A colleague says, “I hear she’s flaky.” I don’t give a damn. I don’t care if Donna wears a saffron robe and juggles rose-quartz crystals （she doesn’t）。 Brian leaves every session with Donna with a little spring in his step.
* * *
—
After about two months of twice-a-week meetings with Donna, Brian says that he’d like me to join him.