their mutation resides.”
“Isn’t that number more like ten percent for someone her age?” asked John.
“The numbers are a bit more skewed for someone her age, that’s true. But if Alice’s screen comes back negative, we unfortunately can’t say for sure that she doesn’t have the disease. She may just happen to fall in the smaller percent of people that age with Alzheimer’s who have a mutation in a gene not yet identified.”
It was just as plausible, if not more so when coupled with Dr. Davis’s medical opinion. Alice knew that John understood this, but his interpretation fit the null hypothesis of “Alice does not have Alzheimer’s disease, our lives aren’t ruined,” whereas Stephanie’s did not.
“Alice, does this all make sense to you?” Stephanie asked.
Although the context made the question legitimate, Alice resented it and glimpsed the subtext of conversations in her future. Was she competent enough to understand what was being said? Was she too brain-damaged and confused to consent to this? She’d always been addressed with great respect. If her mental prowess became increasingly replaced with mental illness, what would replace that great respect? Pity? Condescension? Embarrassment?
“Yes,” said Alice.
“I also want to make it clear that if your screening comes back with a positive mutation, a genetic diagnosis isn’t going to change anything about your treatment or prognosis.”
“I understand.”
“Good. Let’s get some information on your family, then. Alice, are your parents living?”
“No. My mother died in a car accident when she was forty-one, and my father died last year at seventy-one of liver failure.”
“How were their memories while they were alive? Did either of them show signs of dementia or personality changes?”
“My mother was perfectly fine. My father was a lifelong alcoholic. He’d always been a calm man, but he got extremely volatile as he got older, and it became impossible to have a coherent conversation with him. I don’t think he recognized me at all for the last several years.”
“Was he ever brought in to see a neurologist?”
“No. I’d assumed it was the drinking.”
“When would you say these changes began?”
“Around his early fifties.”
“He was blind drunk, every day. He died of cirrhosis, not Alzheimer’s,” said John.
Alice and Stephanie paused and silently agreed to let him think what he wanted and move on.
“Do you have any brothers or sisters?”
“My only sister died in that car accident with my mother when she was sixteen. I don’t have any brothers.”
“How about aunts, uncles, cousins, grandparents?”
Alice relayed her incomplete knowledge of the health and death histories of her grandparents and other relatives.
“Okay, if you don’t have any other questions, a nurse is going to come in and draw a sample of blood. We’ll send it off to be sequenced and should have the results within a couple of weeks.”
Alice stared out the window as they drove down Storrow Drive. It was frigid outside, already dark at 5:30, and she didn’t see anyone braving the elements along the edges of the Charles. No signs of life. John had the stereo turned off. There was nothing to distract her from thoughts of damaged DNA and necrotic brain tissue.
“It’s going to be negative, Ali.”
“But that wouldn’t change anything. It wouldn’t mean I don’t have it.”
“Not technically, but it creates a whole lot more room for thinking this is something else.”
“Like what? You talked to Dr. Davis. He already tested me for every cause of dementia you could come up with.”
“Look, I think you jumped the gun going to see a neurologist. He looks at your set of symptoms and sees Alzheimer’s, but that’s what he’s trained to see, it doesn’t mean he’s right. Remember when you hurt your knee last year? If you’d gone to see an orthopedic surgeon, he would’ve seen a torn ligament or worn cartilage, and he would’ve wanted to cut you open. He’s a surgeon, so he sees surgery as the solution. But you just stopped running for a couple of weeks, you rested it, took ibuprofen, and you were fine.
“I think you’re exhausted and stressed, I think the hormonal changes from menopause are wreaking havoc on your physiology, and I think you’re depressed. We can handle all of these, Ali, we just have to address each one.”
He sounded right. It wasn’t likely that someone her age would have Alzheimer’s disease. She was menopausal, and she was exhausted. And maybe she was depressed. That would explain why she didn’t push back on her diagnosis harder, why she didn’t fight to the teeth against even the suggestion of this doomed fate. It