Authors: Theodore Roszak
Aaron was finishing his second month at the clinic, but with little sign of progress. He was frail as ever, with one or another of his capacities — sight, hearing, agility, stamina — growing noticeably weaker each week. His voice was still a rasping croak, his skin dry and lined. Worst of all in Julia’s eyes, he showed little improvement in his morale. Each day as she checked in with him, he was more morose, more listless. When she tried to cheer him up, he would force out a sad little smile and say, “I guess my mental attitude isn’t right, is it?” The only good sign was his increasing friendliness. When his parents called from Michigan every evening, Aaron assured them that he felt secure where he was and that he trusted his new doctor. But his trust had a dark turn to it. It brought hidden feelings to the surface. Each time they met, he confided more to Julia about his resentment. “Why do I have to keep getting older?” he asked and asked again. The question was new to Julia; her other patients were beyond asking that. Age had been working at them gradually over many decades. But for Aaron getting old had come suddenly like a surprise. He had been ambushed by age. Why the wrinkles and the white hair, he asked. Why the dimming eyesight and failing organs?
His very image — this frail little boy who looked like a hundred-year-old man — forced Julia to face up to her ignorance. Why
do
we accept aging as normal? Does aging make any more sense at sixty than at six? Or are we just used to the idea that we have to get old? We age because people always have. We age because running down, decaying, degenerating seem like the obvious prelude to death, and death is our curse. That is how folklore would have it, philosophy too. “All men are mortal,” begins the famous syllogism, the one unquestionable premise. But ask
why
, and science can give no certain answer, only learned speculation. In her professional capacity, Julia could have given Aaron a dozen different answers to his question. But there was only one thing she knew for certain. Progeria was death before one’s time.
Julia liked the boy’s directness. As weary as he looked seated before her, a bent and shriveled gnome squinting through bottle-glass spectacles, she could tell there was a sharp intelligence inside his always-nodding head. Good. Intelligence, curiosity, any least sign of intellectual vitality — these she could work with. As long as the brain is alive, there’s hope.
“Are you gonna give up on me like the other doctors?” Aaron asked.
“The question is,” she answered, “are
you
going to give up on
me
? Well, are you?”
“No.”
“Good,” she answered. “Because I have some tricks up my sleeve. Wait and see.”
***
In her office, Dr. Stein has these two pictures on her desk. I thought they were two different people, a young lady and an old lady. I asked who they were. She said, “That’s my mother.”
I didn’t understand. I asked, “Which one?”
She said, “Both.” She made a sad face. She pointed to the picture of the young lady. She said, “That’s how I remember my mother when I was a child. She was a doctor, a very good doctor. I admired her.” Then she pointed to the other picture of the old lady who had this sad, tired face. Dr. Stein said, “That’s my mother after she got Alzheimer’s disease. Have you heard of that? Alzheimer’s?”
I said I heard of it. It means losing your mind. It means not knowing who you are or who anybody is.
She said, “She was a good doctor, but she couldn’t heal herself. That’s why I decided to become a gerontologist. I want to help people like my mother. I want to kill Alzheimer’s disease just as much as I want to kill progeria.” She looked so sad that I was sorry I asked about the pictures.
I said, “Where is she, your mother? Is she dead?”
She said, “In a way she’s dead. She lives here in the clinic. She has a room upstairs. I take care of her. But she doesn’t know me any more. I’m like a stranger to her.”
I said, “If your mother got Alzheimer’s, then you could too.” I thought I should warn her about that.
She said, “Yes, I know. And so could my son and his son. It gets passed down that way. It’s like a curse. I’m perfectly aware of that. Maybe that’s another reason I became a gerontologist. Self-defense. I want to get Alzheimer’s before it gets me.”
I said, “Can progerics get Alzheimer’s?”
She said, “No, they can’t. At least none of them ever has. That might be because …”
She stopped there, but I knew what she was going to say. I said, “Because they don’t live long enough.”
She just reached over and gave me a pat. “Smart boy,” she said
***
When Julia began her career in medicine, gerontology was a medical backwater, a rear-guard action against diseases it had no hope of healing. Though it was a field of medical science, it inherited its ruling paradigm from the book of Genesis. Age and death, so the Bible teaches, are inevitable, a punishment visited by God upon mankind in the garden of Eden. Doctors might be beyond folklore like that, but not by much. Where there was once theological doctrine, there was now scientific dogma. In the books Julia used in med school, there were charts that purported to trace the declining powers of the old. They took the form of lines — sad lines — all sloping down and away toward zero. Zero alertness, zero agility, zero strength, stamina, intelligence. One word covered the entire subject.
Senility.
Senility simply happened eventually, universally — unless accident or illness cut life short. Some took longer getting there than others, but everybody who lived long enough got fragile, slow, confused, forgetful. People became quaint and cranky, doddering unfortunates who must be tolerated until they withered away. The best way to treat them was to make them as invisible as possible, hide them away, keep them indoors or in their own dismal company.
True, there was the other stereotype. A few lucky old codgers might become saintly sages, repositories of all human wisdom. Patient, long-suffering, sagacious, but actually too good for this world. Mother Theresa, Albert Schweitzer, Robert Frost. Revered and ignored. Another kind of invisibility. One way or another, age drove people to the margins. The old did not retire, they got retired by the world.
Despite the fatalistic consensus of her colleagues, Julia came to gerontology driven by a private passion to heal and redeem. She wanted fiercely to discover where her mother’s mind had gone. She wanted to know what lay behind those vacant eyes that stared out of the second photo. Those eyes could now be multiplied a thousand-fold as more and more people lived long enough to wander into the dark kingdom of dementia. What a cheat if all the extra years that medical science had brought to people at last left them to stumble off into a mindless haze.
Luck was with her through her early career. Though there was little attention being given to the diseases of aging during her years at Johns Hopkins, in her last year at school, Julia was hired to assist on a research project designed to study memory. Its goal was to find techniques for memory enhancement. The project was drug-oriented, testing for the effects of several medications on short and long-term memory — first in mice, then in people at progressively older ages. The study was to run for three years; after the first year, Julia was invited to stay on until it was completed. At the end of the next year, the study narrowed its focus to a newly-discovered family of drugs. Ampakines. The research gave reason to believe that ampakines had a restorative effect on memory, the first such finding for human subjects. Ampakines had the ability to reach out across the gaps between brain cells; they could build fragile bridges that hasten the chemical signals racing from neuron to neuron. The smaller the gap, the faster the signals travel. The result was better memory — a significant discovery. But, quite fortuitously, Julia had made a discovery of her own.
Asking nobody’s permission, and for no better reason than to keep her work interesting, she made a point of arousing the curiosity of the people she worked with. Beyond simply administering drugs to them, she invented a collection of intellectual games that became steadily more demanding. She gave them books to read and to write about; she required them to keep journals that reviewed their experience. She gathered them together to talk about serious subjects and compete at doing crossword puzzles and anagrams. She encouraged them to tell riddles and jokes. The result was a difference her colleagues could measure. Her subjects showed a greater improvement than those who simply took the drugs.
Julia’s superiors were impressed. They used her findings as the basis for a second study that she helped design. This time, besides administering drugs, the study emphasized effort and engagement as ways of sharpening memory. Julia had her subjects take up a foreign language or learn mathematics, make up puns and play word games. She taught them dance steps, songs, inspired them to study a musical instrument. She staged chess, checkers, and bridge tournaments. The project produced encouraging results, even with those who had begun to show symptoms of dementia. Julia’s conclusion — that morale played a major role in boosting the powers of memory — was controversial, but at least it suggested that a good deal of what doctors were diagnosing as impaired memory might be due to passivity or depression. Perhaps, in the absence of affectionate attention, people beyond a certain age had no incentive to do well at anything. They went slack because their lives were at a dead end. Aging, Julia concluded, was due as much to neglect of the spirit as to physical decline. Treat people like zombies and they become zombies.
Her work on memory helped find her the grants that went into funding her own research. After her father’s death, she put everything she had inherited into her work and built the San Francisco clinic that made her a recognized name in gerontology. A modest establishment, the clinic had a staff of twelve — nurses, doctors, and therapists — housed in a three-story Pacific Heights mansion within view of the Golden Gate. Julia Stein’s Creative Aging Center quickly became the medical profession’s last resort for dealing with tough cases, especially those burdened by depression as much as by physical decline. Though she remained a maverick in her field, Julia drew enough foundation support to command respect. Her way with the diseases she treated was to use every weapon in the medical arsenal. Mix and match, balance and blend, attack on all fronts at once. Why not? Her patients were terminally old, many within sight of death. If they came to her at all, they were willing to risk trying whatever she offered. Exercise, vitamins, diet, experimental medication, positive thinking — plus all the tender loving care their doctor could provide.
Julia used everything good science had to offer, but she also tried the latest fads, anything she was sure would not kill people quicker than age itself. If nothing else, she knew how to keep her patients busy while the grindstone of senescence wore them away. Busy-ness preoccupied them, or at least distracted them. In treating the elderly, what she hated most was to find herself beating her head against a stone wall of resignation.
Julia vividly remembered detecting the first signs that her mother was, as she put it to herself, “going under.” Watching someone so dear begin to waste away before her eyes inflamed her as if she were witnessing an injustice. She refused to believe this had to happen, or even that it was happening. Often, when she stared into her mother’s eyes or into the lined and haggard face of a patient, a voice inside her cried out,
this isn’t the face you should be wearing. This is a mask that time has forced upon you. I want to strip that mask away. I want to free you from this masquerade.
That could be a cruel thing to say to her older patients, those in their seventies and eighties, many of them so deeply resigned to death, even eager to find its solace. But not to Aaron Lacey. He was entitled to his three-score and ten years. She would make him fight for those years with every weapon she could find.
***
I have trouble with time. When the brightness comes, I start moving so fast, everything goes by like a blur. And then it all just stops, like it can’t move any faster. My mind just stops and things go all frozen. Like I’m in a place where nothing is ever going to move or change again. I can’t tell how long it stops like that, because how can anything take time when there is no time?
I had a talk with Mrs. Soames about that. Mrs. Soames, who says I can call her Beth if I want to, is sort of Dr. Stein’s right hand man — or woman. She helps especially with the very sick old people, the ones who are dying. Beth stays beside them as long as it takes for them to die. She talks to them and holds them and does everything she can so they won’t be afraid or feel alone.
Beth used to be a teacher, but now she’s retired. She must have been a very good teacher. She knows so much about everything. We read books together every night before I go to sleep and she explains things, even very hard things, so that they seem real simple. Right now we’re reading
The Time Warriors,
a fantasy book where people can travel in time.
I said I couldn’t understand about traveling in time, which I think doesn’t seem possible because then you could go back and be a baby all over again. And if people could do that, they would never grow old, they would just keep going back and forth in loops.
Beth said that was a good thought. She said, “In this story, time is like a kind of space, isn’t it? You can travel back and forth into the past or the future, which probably is impossible.” But she said she wasn’t enough of a scientist to know.
I was sure this book wasn’t right about time because it never mentioned about how time can stop happening. The book made time seem like a river that you just go sailing down and can’t get out of.
She said, “People often speak of time as a river.”
I said, “But that’s not right, I don’t think.”