step of the way.
TWO
A DIFFERENT REALITY
A few weeks after the doctorâs appointment, my fears were realized. Harvey had been asked to give a major talk on leukemia months earlier. Now that date was suddenly upon us. I begged Harvey not to give the speech. At home, the signs were even more pronounced than they were at work. Buttressed by the identity that had been the framework of his entire life, Harvey still was reasonably cogent when he was with his peers. Even when he could not retain details about a patientâs case that someone had told him ten minutes earlier, he was able to look at a slide and talk about the disease. This is how smart people hide out in the early stages of dementia.
But at home he seemed lost. He sat in the chair in our kitchen nook after dinner, frantically sorting through documents related to his research or dumping out his slide deck and starting over. Now he faced the prospect of standing up in front of a room filled with professionals. Speeches given at conferences are an important part of the scientific process. They are meant to be challenged, giving scientists a chance to probe the data and push one another about their theories. I knew Harvey would be fortunate if he made it through the entire speech, let alone handled questions from the audience. Yet the doctorâs report from a few weeks earlier silenced me when I should have spoken up. I felt crushed that the doctor had dismissed my concerns but fearful that if I went public, my actions might ruin Harveyâs reputation. So I took the middle path. I did not share my concerns, but decided to go with him that day in case something went wrong.
The lecture before four hundred doctors was held in a big ballroom at a hotel in downtown Bethesda, Maryland, not far from where we lived. In the good old days, Harvey typically would run late for such a conference, arriving five minutes before he was going to go on stage but still able to present his slides, data, and conclusions as if he had been preparing for hours. Those days were behind us. I told Harvey that I would drive him. In a sign that should have tipped me off that we should cancel the appearance, Harvey agreed.
The issue of Harvey continuing to drive was an ongoing area of contention between us. Imagine what it was like trying to take a sports car away from a fifty-six-year-old man. The Porsche represented not only a beautiful piece of engineering that gave Harvey pleasure to drive but a symbol of his personal freedom and independence. But as Harveyâs symptoms worsened, my worries about him driving grew. In addition to the car being stolen and then recovered, there had already been a number of episodes of lost keys found in the ignition. A few months earlier, an unexplained accident had ended with his Porsche straddling the median strip on the highway. I didnât even learn about it until two days later, when I got a call from a towing company about the charge for extracting the car and taking it to the dealership. Fortunately, no one was hurt, but what shocked me more was that Harvey didnât remember what had happened.
Another time, with my son and his wife watching from the front steps of our house, Harvey got in the car and shifted into gear but forgot what to do next. Instead of backing down the driveway, the car lurched forward in jerking motions. Jason yelled frantically, trying to tell Harvey how to stop. Luckily, the car smashed into a line of tall spruce trees that bordered a high embankment down to the main street. It was the only thing that kept the car from flipping over.
Despite the evidence of the damaged car, Harvey still refused to admit he was having trouble. Many evenings, the short drive from the NIH to our home, a route that Harvey had driven on autopilot for decades, took much longer. When I confronted Harvey, he angrily refused to discuss the matter further.
When I suggested he stop driving, Harvey shut down emotionally. He ignored me or