Still Alice (5 page)

The calamari, the Maine crab–crusted oysters, the arugula salad, and the pumpkin ravioli were all impeccable. After dinner, everyone sang “Happy Birthday” loudly and off-key, attracting generous and amused applause from patrons at other tables. Alice blew out the single candle in her slice of warm chocolate cake. As everyone held their flutes of Veuve Clicquot, John raised his a bit higher.

“Happy birthday to my beautiful and brilliant wife. To your next fifty years!”

They all clinked glasses and drank.

In the ladies’ room, Alice studied her image in the mirror. The reflected older woman’s face didn’t quite match the picture that she had of herself in her mind’s eye. Her golden brown eyes appeared tired even though she was fully rested, and the texture of her skin appeared duller, looser. She was clearly older than forty, but she wouldn’t say she looked old. She didn’t feel old, although she knew that she was aging. Her recent entry into an older demographic announced itself regularly with the unwelcome intrusion of menopausal forgetting. Otherwise, she felt young, strong, and healthy.

She thought about her mother. They looked alike. Her memory of her mother’s face, serious and intent, freckles sprinkled on her nose and cheekbones, didn’t contain a single sag or wrinkle. She hadn’t lived long enough to earn them. Alice’s mother had died when she was forty-one. Alice’s sister, Anne, would’ve been forty-eight now. Alice tried to visualize what Anne might look like, sitting in the booth with them tonight, with her own husband and children, but couldn’t imagine her.

As she sat to pee, she saw the blood. Her period. Of course, she understood that menstruation at the beginning of menopause was often irregular, that it didn’t always disappear all at once. But the possibility that she wasn’t actually in menopause snuck in, grabbed on tight, and wouldn’t let go.

Her resolve, softened by the champagne and blood, caved in on her completely. She started crying, hard. She was having trouble taking in enough air. She was fifty years old, and she felt like she might be losing her mind.

Someone knocked on the door.

“Mom?” asked Anna. “Are you okay?”

D
r. Tamara Moyer’s office was located on the third floor of a five-story professional office building a few blocks west of Harvard Square, not far from where Alice had momentarily lost herself. The waiting and examining rooms, still decorated with framed Ansel Adams prints and pharmaceutical advertisement posters on the high-school-locker-gray walls, held no negative associations for her. In the twenty-two years that Dr. Moyer had been Alice’s physician, she’d only ever been to see her for preventative checkups—physical exams, immunization boosters, and more recently, mammograms.

“What brings you here today, Alice?” asked Dr. Moyer.

“I’m having a lot of memory problems lately that I’ve been
attributing to symptoms of menopause. I stopped getting my period about six months ago, but it came back last month, so maybe I’m not in menopause, and then, well, I thought I should come in and see you.”

“What are the specific kinds of things that you’re forgetting?” Dr. Moyer asked while writing and without looking up.

“Names, words in conversation, where I put my BlackBerry, why something is on my to-do list.”

“Okay.”

Alice watched her doctor closely. Her confession didn’t seem to grab her in any way. Dr. Moyer received the information like a priest listening to a teenage boy’s admission of impure thoughts about a girl. She probably heard this type of complaint from perfectly healthy people countless times a day. Alice almost apologized for being so alarmist, silly even, for wasting her doctor’s time. Everyone forgot these sorts of things, especially as they got older. Add menopause and that she was always doing three things at once and thinking of twelve, and these kinds of memory lapses suddenly seemed small, ordinary, harmless, and even reasonably expected. Everyone’s stressed. Everyone’s tired.
Everyone forgets things.

“I also became disoriented in Harvard Square. I didn’t know where I was for at least a couple of minutes before it all came back to me.”

Dr. Moyer ceased documenting symptoms on her evaluation sheet and looked directly at Alice. That grabbed her.

“Did you have any tightness in your chest?”

“No.”

“Did you have any numbness or tingling?”

“No.”

“Did you have a headache or were you dizzy?”

“No.”

“Did you notice any heart palpitations?”

“My heart was pounding, but that was after I became confused, more like an adrenaline response to being scared. I remember feeling great, actually, just before it happened.”

“Did anything else unusual happen that day?”

“No, I’d just come home from Los Angeles.”

“Are you having any hot flashes?”

“No. Well, I felt what could’ve been one while I was disoriented, but again, I think I was just scared.”

“Okay. How are you sleeping?”

“Fine.”

“How many hours are you getting each night?”

“Five to six.”

“Is this a change from what it’s been in the past?”

“No.”

“Any difficulty falling asleep?”

“No.”

“How many times do you typically wake up during the night?”

“I don’t think I do.”

“Do you go to bed at the same time every night?”

“Usually. Except when I travel, which has been a lot lately.”

“Where have you traveled?”

“In the last few months, California, Italy, New Orleans, Florida, New Jersey.”

“Were you sick after any of these trips? Any fevers?”

“No.”

“Are you taking any medications, anything for allergies,
supplements, anything that you might not normally think of as a medicine?”

“Just a multivitamin.”

“Any heartburn?”

“No.”

“Any weight changes?”

“No.”

“Any bleeding in your urine or bowel movements?”

“No.”

She asked each question rapidly on the heels of each answer, and the topics jumped from one to the next before Alice had time to follow the reasoning behind them. As if she were riding a roller coaster with her eyes shut, she couldn’t predict which way she was being turned next.

“Are you feeling more anxious or stressed than typical?”

“Just about not being able to remember things. Otherwise, no.”

“How are things with your husband?”

“Fine.”

“Do you think your mood is pretty good?”

“Yes.”

“Do you think you could be depressed?”

“No.”

Alice knew depression. Following the deaths of her mother and sister when she was eighteen, she’d lost her appetite, she’d been unable to sleep for more than a couple of hours at a time despite being endlessly tired, and she’d lost an interest in enjoying anything. It had lasted a little over a year, and she’d never experienced anything like it since. This was entirely different. This wasn’t a job for Prozac.

“Do you drink alcohol?”

“Just socially.”

“How much?”

“One or two glasses of wine with dinner, maybe a little more on a special occasion.”

“Any drug use?”

“No.”

Dr. Moyer looked at her, thinking. She tapped her pen on her notes as she read them. Alice suspected the answer wasn’t anywhere on that piece of paper.

“So am I in menopause?” she asked as she gripped her parchment-papered seat with both hands.

“Yes. We can run an FSH, but everything you tell me is completely consistent with menopause. The average age of onset is forty-eight to fifty-two, so you’re right in there. You may continue to get a couple of periods a year for a while. That’s perfectly normal.”

“Can estrogen replacement help with the memory problems?”

“We don’t put women on estrogen replacement anymore, unless they’re having sleep disturbances, really awful hot flashes, or they’re already osteoporotic. I don’t think your memory problems are due to menopause.”

The blood rushed from Alice’s head. Precisely the words she’d dreaded and only recently dared to consider. With that one, professionally uttered opinion, her tidy and safe explanation shattered. Something was wrong with her, and she wasn’t sure that she was ready to hear what it was. She fought the impulses growing louder inside her, begging her to either lie down or get the hell out of that examining room immediately.

“Why not?”

“The symptoms of memory disturbances and disorientation listed for menopause are secondary to poor sleep hygiene.
Those women aren’t coping well cognitively because they aren’t sleeping. It’s possible that you’re not sleeping as well as you think you are. Perhaps your schedule and jet lag are taking a toll, perhaps you’re worrying about things throughout the night.”

Alice thought about the times she’d suffered from fuzzy thinking caused by bouts of sleep deprivation. She certainly hadn’t played at the top of her mental game during the last weeks of each pregnancy, following the birth of each child, and at times, when she was up against a grant deadline. In none of those circumstances, however, did she get lost in Harvard Square.

“Maybe. Could I suddenly need more sleep because I’m older or because I’m in menopause?”

“No. I don’t usually see that.”

“If it’s not lack of sleep, what are you thinking?” she asked, the clarity and confidence now completely absent from her voice.

“Well, I’m concerned about the disorientation in particular. I don’t think it was a vascular event. I think we should do some tests. I’m going to send you for blood work, a mammogram, and bone density because it’s time, and a brain MRI.”

A brain tumor.
She hadn’t even considered that. A new predator loomed in her imagination, and she felt the ingredients of panic once again brewing in her gut.

“If you don’t think it was a stroke, what are you looking for in the MRI?”

“It’s always good to definitively rule these things out. Make the appointment for the MRI and then one to see me right after, and we’ll go over everything.”

Dr. Moyer had avoided answering the question directly, but Alice didn’t push her to reveal her suspicions. And Alice
didn’t share her tumor theory. They would both just have to wait and see.

W
ILLIAM
J
AMES
H
ALL
H
OUSED THE
departments of psychology, sociology, and social anthropology and was located just beyond the gates of Harvard Yard on Kirkland Street, a region referred to by students as Siberia. Geography, however, was not the most prominent factor that alienated it from the main campus. William James Hall could never be mistaken for any of the stately, classically collegiate structures that adorned the prestigious Yard and housed the freshman dormitories and classes in mathematics, history, and English. It could, however, be mistaken for a parking garage. It possessed no Doric or Corinthian columns, no red brick, no Tiffany stained glass, no spires, no grand atrium, no physical detail whatsoever that might obviously or subtly affiliate it with its parent institution. It was a 210-foot, unimaginative beige block, quite possibly the inspiration for B. F. Skinner’s box. Not surprisingly, it had never been featured in the student walking tour or the Harvard calendar, spring, summer, winter, or fall.

Although the view of William James Hall was inarguably abysmal, the view from it, in particular from many of the offices and conference rooms on the upper floors, was nothing short of splendid. As Alice drank her tea at her desk in her office on the tenth floor, she relaxed in the beauty of the Charles River and Boston’s Back Bay framed before her by the enormous southeast-facing window. It captured a scene that many artists and photographers have reproduced in oil, watercolor, and film, and that could be found matted and framed on the walls of office buildings all over the Boston area.

Alice appreciated the glorious advantages available to those fortunate enough to regularly observe the live version of this landscape. With the changes in the time of day or year, the quality and movement within the picture in her window altered in tirelessly interesting ways. On this sunny morning in November, Alice’s
View of Boston from WJH: Fall
displayed the sunlight sparkling like champagne fizz off the pale blue glass of the John Hancock building and several sculls steadily sliding along a smooth and silvery Charles toward the Museum of Science as if being pulled by a string in a motion experiment.

The view also provided her with a healthy awareness of life outside Harvard. A glimpse of the red-and-white neon CITGO sign flashing against a darkening sky over Fenway Park fired her nervous system like the sudden ring of an alarm clock, awakening her from the daily trance of her ambitions and obligations and triggering thoughts of heading home. Years ago, before she was tenured, her office had been in a small, windowless room within the interior of William James Hall. Lacking visual access to the world beyond its solid beige walls, Alice had regularly worked late into the night without even realizing it. On more than one occasion, she’d been stunned at the end of the day to discover that a nor’easter had buried Cambridge in more than a foot of snow and that the less focused and /or window-owning faculty had all wisely abandoned William James Hall in search of bread, milk, toilet paper, and home.

But now she needed to stop staring out the window. She was leaving later that afternoon for the annual Psychonomic Society meeting in Chicago, and she had a ton to accomplish before then. She looked over her to-do list.

Review Nature Neuroscience paper

Department meeting

Meet with TA’s