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Mind Games


By: Jane Smiley
The Washington Post, May 5, 2002

I know one guy who hasn't been to a doctor in 40 years. His avowed plan is to be alive one day and dead the next. He doesn't want to see anything coming from afar. He is a rare bird these days, as Old World as his Italian father and 11 Italian uncles. He is a veterinary surgeon. Once in a while he tells me about some colleague of his who has got into the hands of the doctors. They always say to him, ''I should have gone to a vet.'' Vets do what doctors used to -- diagnose the injury or the condition, patch it up as best they can and remind you that these things happen and that in life we are also in the midst of death.

I'm the sort of person who wants to know. For example, my partner and I went down to Orange County last year and had ourselves scanned at the famous facility that was profiled on ''Oprah.'' I signed up mostly out of curiosity. I expected to be congratulated for my fabulous good health. And it was interesting. I saw the shape of my own innards, and guess what, my heart and my liver actually were elongated -- I suppose to fit into my elongated torso. And there were calcifications that the radiologist thought indicated a silent victory of my immune system over a tubercular infection that I never knew I had. I was otherwise clean as a whistle (an effect I attribute to that universal solvent, Diet Coke). Oh, but my bones. Ghostly. I take calcium supplements and hormones now.

My partner wasn't so lucky. His arteries looked like a second set of bones. The six months since have been all about angiograms, angioplasties, Zocor, Lipitor, niacin, exercise and sat fat, things we never considered before. (We were working on an extended project of taste-testing all varieties of bacon.) Since then, six doctors and a couple of nurse practitioners have pitched us into the information vortex: one doctor suggested chelation therapy; another said only surgery really works; another strongly recommended my partner eat only bread and water for the rest of his life.

The trouble with body scans and breast screening and P.S.A. testing for prostate cancer is that questionable results invite entry into health care as a form of speculation. What operations to risk? Which long-term drugs to take? What if it's one of those drugs that tests your commitment every time you take it? And how will all the drugs you're taking to stave off future ills interact with one another? (Everyone knows they interact geometrically rather than arithmetically.) And who will pay?

I laughed when my friend the veterinary surgeon declined to look within, but when I take my hormones and scour the grocery aisles for nonfat comestibles, I think that the more we get enmeshed in the medical establishment, the more plastic surgery becomes the medical model. If I can take human-growth hormone or paralyze my forehead muscles and make the lines go away, why shouldn't I, even though once I start, I will have to keep doing it every three or four months for as long as 10 years to put off the face lift? Even though heart disease and breast cancer seem to be graver concerns than looks, the process is much the same -- eventually, all the just-in-case drugs and the lesser-of-two-evils procedures might become the sole contents of my life -- saving myself will become my full-time job.

And then the possibility of an Alzheimer's test, a blood test that worked in mice, got into the news earlier this spring. (This is when my partner and I happened to see ''Iris.'' The case of Iris Murdoch defied the predictions of the ''nun study,'' which showed that mental activity and early complex use of language seemed to protect against senile dementia, and her decline was especially shocking to me.) A positive Alzheimer's test result would come without a treatment plan. So far, no drugs or agreed-upon dietary modifications, no estimated time of arrival, just the certainty that it's in you, progressing. For the novelist, this is a spooky idea to contemplate, a form of simultaneous being and nonbeing. From the reader's point of view, the novels exist, artifacts of the novelist who has disappeared, but from the novelist's point of view, everything disappears -- the novels already written, the novels still to be written, all sense, even, that there are novels. Somehow, knowing that Alzheimer's is coming mocks all one's aspirations -- to tell stories, to think through certain issues as only a novel can do, to be recognized for one's accomplishments and hard work -- in a way that old familiar death does not.

I would like to think that I would make a rational plan, that I would write my books faster, use up my ideas and stories while I still have them, while I still have something to sell in the literary marketplace, a final artifact to leave. I would like to think that I could compensate, at least at first, for the shutting down of one mental faculty with the increasingly adroit deployment of another and, of course, that I could put aside enough savings for long-term care. I would always hope that the cure would be found, that the equivalent of Zocor would turn up. But still there would be that uncanny question: was the individuality that I expressed actually real, given how completely it disappeared?

I would like to think that our society would exercise imagination and compassion, that our insurance companies would not be allowed to cancel us if we failed the Alzheimer's test, that our government would set a humane example in this age of declining Medicare payments.

An Alzheimer's test, though, asks more of us than planning and taking precautions. It asks us to know that we are doomed but also that we are going to live beyond doomsday, a challenge and a burden to those who care for us. It asks us to be not afraid. It asks us to try to be wise. It asks us, finally, to refine our philosophy of life in order to accommodate a burden that philosophy, which presumes thought, is hardly capable of addressing.


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