Lifeboat
We still don’t have a green light. I sit across from Great Wayne, unable to speak. When I come into his office, in the basement of his house, I usually hurl myself on his couch, as if it’s a lifeboat, and I fall into a deep, short nap. （I’ve seen him once a week since March, when I called for an appointment. After a few sessions, Wayne said, with therapeutic tact: You seem so attentive and attuned to my responses. Perhaps it’d be easier, less work for you, if you lie on the couch—pointing out the super-Freudian, Peruvian-rug-covered couch in the corner. I didn’t care if this was what he really thought or if he worried that grief made me incapable of sitting upright. I jumped out of the chair and lay down on the couch, immediately.）
This time, I come in and sit up in Wayne’s dumpy armchair, like a pilgrim at whatever artifact—the weeping statue of the Virgin or the scrap of petrified cloth—that believers drag themselves to, and who am I to make remarks about the desperate and terrified? I have contemplated approaching a couple of neurologists I don’t know, both with a reputation for mild loopiness, at best. I am still looking for any amenable doctor, neurologist, or psychiatrist who does not recoil at the very sound of Dignitas. I can’t find one.
In the past, I would have said that I was heartbroken. These days, I know better what “heartbroken” is and I’m a little ashamed that I used to use it so lightly and foolishly, indulging in my own rich emotional life. What an idiot.
I tell Wayne about everyone I have asked, or hesitated to ask, and every disappointment. I detail the troubles with the various doctors, just to show that I have been trying hard. He pulls his great eyebrows together when I tell him about the neurologist and I hold my breath and think, Oh, may this be the mighty hand, the outstretched arm of justice and mercy I have been looking for. I tell him what we need, a medical letter saying that there is not now, nor was there ever in the past, any evidence of clinical depression in Brian.
I say, If you think that a long life is of great value just because it is our only time here on earth, or because you appreciate what God has allotted you, or because there might be the possibility of treatment or cure for whatever ails you within your lifetime, if only the lifetime is long enough—your view will be different than mine. If you are the kind of person who sees death as the enemy and continued life itself as a victory, no matter how lonely, painful, or disabled that life may be, who feels that quality of life is only one slim tree in a big forest, one arguable virtue in the big battle—your view is different than mine, and different than Brian’s.
My husband is guided by three principles, I tell Wayne:
Take yes for an answer.
Better to ask forgiveness than permission.
And—for better and worse—if it looks like a fight, throw the first punch.
Back in the day, visiting Harvard while playing football for Yale, Brian was jumped in a stairwell by three Harvard boys. He blamed himself for the pummeling. He said he’d thought that Harvard boys were all talk and he hadn’t even lifted his hands. Wayne laughs and nods.
After the tests and the MRI, the neurologist wrote in her assessment that Brian seemed shocked when he got the diagnosis. I tell Wayne, I don’t think he was shocked. I think it was terrible to have his worst fears confirmed and he was seeking to understand all the implications as quickly as possible. I say, He didn’t want to be caught flat-footed, like he was by those Harvard boys.
Great Wayne listens, not looking at me. He tells me about his experiences with the draft during the Vietnam War （he was drafted as a doctor, and he served. He says they told him he could serve as a doctor or as an infantryman but that he’d be serving, either way）。 He says he did everything he could to help young men looking for deferments, in and out of the Army. （I think this is what he said. I was gripping the arms of the chair so tightly, my hands hurt, and because my heart was beating in my ears, I couldn’t keep up with his sentences.） After some time, he says, So, yes, I can help you with this. I bend over in the chair, covering my face, and cry. Wayne sits there quietly, like he’s supposed to. When I lift my head, Wayne says that I should call for an appointment for Brian, that it will be about ninety minutes and he’ll write up his findings, whatever they are, and if the findings are helpful to our cause, we can then send his letter to Dignitas. He suggests that I might want to be at the interview. Why? I say. Do you need me to be there? Wayne shrugs （an elaborate, shrinky shrug, the kind that means: I have a very good reason, which I will not tell you） and says, Well, you might be glad afterward that you’d been present.
I am, in fact, very glad that I was present. It was a master class in interviewing. I could see all of Brian’s cognitive gaps as if someone had shone a flashlight on the cave wall. I watched Wayne help Brian go forward and backward in time, with tenderness and attention, taking him through very specific exercises and a wide-ranging conversation, and I also got to watch my husband enjoying one last warm, in-depth chat with another Yale man who knew football.
* * *
—
These are the final paragraphs of Wayne’s letter about Brian, and this letter is what gets us the green light from Dignitas.
I found no evidence in Mr. Ameche’s history or presentation of clinical depression. No profound mood disturbances with weight loss, difficulty sleeping, or lost time from work. In reviewing his past experience, I think that he was over-diagnosed by himself and those who had treated him years ago. It seems more appropriate to say that what he complained of was a situational dysphoria brought on by expectable life stressors, challenges, and disappointments. It seems likely that his adult distress had its roots in the dysfunctional family setting of his childhood. He is the oldest of six children of a legendary American football hero and his loving but limited wife. He himself was an outstanding football player at Yale University, where he also began his architectural studies. He married his teenage childhood sweetheart. This was a union that did not stand the test of maturity that comes with adult life. They divorced without children. The divorce caused upheaval in Mr. Ameche’s devout Italian-American Catholic family of origin. For the past 12 years he has been in a stable, satisfying, and replenishing marriage that has brought with it his wife Amy’s children and grandchildren. As he reported movingly, he has found great love, joy, and meaning, surrounded by them.
Mr. Ameche estimates that he has 60–80 percent of his recent memory capacity left. I would estimate that it is at more like 40–50 percent. When asked for his social security number at a relaxed moment, he provided it haltingly. He could not repeat it backwards. His memory functioning comes and goes, both within the session and day to day. He is probably made more aware of the perplexity and frustration that are set off by those lapses from the reactions of those around him. He delivers his narrative in plain, straightforward, yet poignant terms. Some aspects of his presentation seem quite commonplace. He and his wife derive pleasure from the rhythm of ordinary everyday activities such as running errands and shopping for home goods. He has led a fulfilling physical life, close to nature; fishing and building （retirement complexes, athletic facilities, etc.）。 He abhors a compromised existence lit only by a flickering, fading cognitive flame as he submerges into the darkness of an expiring existence and death, after the fact. At the moment he is mentally competent with sound judgment that is unhampered by mental illness or severe character disorder. In the midst of his current affliction he falls within the range of normal when it comes to charting his life’s course and making decisions.