Chapter Nineteen

Mae waited at the front door in her best purple tracksuit and giant sunglasses.

“Hi Mom,” Libby said. “Are you ready to go?”

“No,” Mae barked. “I thought I’d stand out here in the damp weather and wait for a bus.” She slid into the car and slammed the door.

Libby called on every ounce of patience she possessed and got in beside her. “Do you need to grab anything before we leave?”

Mae reverted to mother role. “No, but you should try to go to the bathroom, it’s a long ride.”

At forty-one, Libby knew when she needed a restroom, but it never stopped Mae from asking. “I’m all set,” she answered. “Let’s get going; there may be traffic.”

Underway, they made small talk; weather, town gossip, and general nonsense that did nothing to address the elephant in the backseat. Libby dropped Mae off at the front door to the office and went to park the van.

Mae checked in with the receptionist. “Mae McGinn,” she said. “I have a four o’clock appointment with Dr. Rashan.”

“It’s good to see you, Mrs. McGinn,” the chipper receptionist said. “Is all your information the same since your last visit? Address? Insurance?”

Mae nodded.

“Okay, have a seat and Dr. Rashan will be right with you.”

Mae sat in the waiting room. Libby walked in and joined her.

“Let’s see how fast, ‘right with you’ is?” Mae said, while digging into her behemoth purse for knitting needles. Judging by the purple yarn, the creation was for Shannon. Each year Mae knitted Christmas gifts for family in their favorite colors. Libby owned six green scarves and treasured them all.

“Mrs. McGinn?” Olivia, the nurse they had met at her first visit opened the door. “We’re ready for you.”

“That was quick,” Libby said. “You didn’t even have time to do two rows.” She hesitated, “Do you want me to come in with you?”

Mae shrugged. Libby recognized the fear behind her mother’s eyes and followed her into the examination room. As they walked, Libby saw the slump in Mae’s shoulders and the way her feet dragged as she walked. It reminded her of a student on the way to the principal’s office for punishment.

“Here we are.” Olivia led them into the blue room. “You ladies have a seat at the conference table and Dr. Rashan will be right in. Can I get you some water or coffee?”

“No, thank you,” Mae replied.

“I’m fine right now.” Libby smiled. “Thank you, Olivia.”

A thirty-year registered nurse, Olivia sensed their unspoken fears and said, “It’s so nice that you come here together. So many of our patients are alone in the world. Does my old heart good to see some families aren’t too busy to help each other.”

She looked at Libby. “I lost my mama over twenty years ago, still miss her big opinionated mouth. And her pecan pie; Lord that woman had a gift with the pecans.” She laughed. “You ladies need anything, just open the door. I’m right around the corner.”

Mae dug into her bag and returned to her knitting. The needles moved at lightning speed, each movement precise and flawless. Libby did not inherit her mother’s crafty talents.

“Damn.” Mae dropped her project onto the table and shook her hand vigorously.

“Knitting casualty?” Libby asked.

“I poked my finger, now I’m going to bleed all over Shannon’s scarf.” She put her finger to her mouth and motioned to the tissues in the center of the table. Libby slid the box over.

“Good thing we’re in a doctor’s office.” Libby peeked in the counter drawer. “There’s a pretty good chance I can get you a bandage.” With her back to Mae, she moved a few items and located a box of adhesive strips. “Jackpot! We have a variety here. Would you like blue, red, or one of the normal kinds?”

Mae did not reply.

Libby turned. “Mom, did you hear me? Do you want blue, red…” She saw an alarmed expression on Mae’s face. “What’s wrong?”

Still, Mae did not answer.

“Mom, you are starting to scare me, what’s the matter.”

“Tissues.” Mae said and pointed to the box directly in front of her.

“Mom, they’re right there? Is it your eyes? Can’t you see them?”

“Of course I can see them Elizabeth. I’m not blind!”

“Then what is it?”

“They weren’t here last time.”

“Okay, now I’m just lost.” Grateful Mae was not sick or injured, Libby exhaled, frustrated by her mother’s lacking communication skills. “What the hell are you talking about?”

“You wouldn’t understand. Once you reach my age you pick up on the little things, like tissues.” Libby motioned for her to continue. “Fine, I’ll explain, but you’re going to think I’ve lost my marbles. Oh wait, you already do.”

“Mom, I don’t think—”

Mae raised her hands. “I’m not going to argue with you Elizabeth. I’ve had quite enough of that lately. Between our disagreement, Suzanne’s constant nonsense, and my conversation with William on Monday—meddling old fool—I’m finished.”

She took a breath and continued, “For your information, the last time we were here there were no tissues on this table. They were over there by the sink.”

Libby gave a blank stare.

Mae groaned and went on, “Everyone knows if you have to give bad news, put tissues in arm’s reach before you deliver the blow.” She pointed to the tissues, “Obviously, this is not going to be a pleasant visit or the damned tissues wouldn’t be sitting here, staring me in the face.”

“Oh for God’s sake, Mom, they’re tissues, not a bomb. You are totally blowing this out of proportion.” A knock sounded at the door and Dr. Rashan entered.

“Hello Mrs. McGinn, lovely to see you again. And you as well, Libby.” Dr. Rashan closed the door and joined them at the conference table. “I’m sorry for the delay. My last patient had a few extra questions, and I did not want to rush through his appointment; thus I appreciate your patience.”

Mae plastered a superficial smile on her face. “That’s no problem at all, I’m sure your time is in very high demand. I’ve just been catching up on my knitting while we waited.”

“I wish I could do that. I’ve read knitting significantly reduces stress. My mother-in-law has tried to teach me several times, but it takes a gift I seem to be lacking.”

“Mom tried to teach me, too.” Libby added. “But the gift seems to have skipped me and gone directly to my daughter, Shannon. She picked it up the first time Mom showed her. Remember, Mom, at the lake that summer after Daddy retired? You two took Charlie and Shannon for two weeks.” She turned to Dr. Rashan. “It was Heaven.”

“I remember,” Mae answered.

“It is always nice to see the younger generation learning something so timeless,” Dr. Rashan said. “Most of my nieces and nephews are too busy electronically blowing up the universe to consider learning a craft.”

“Oh, my kids do that, too,” Libby confessed. “But we try and throw in a little unplugged time to balance them out.”

“Good plan.” Dr. Rashan sat at the table and turned to Mae. “How have you been feeling since we last spoke, Mrs. McGinn? Any changes, specifically, physical changes that I should be aware of?”

“None.” Mae said.

“You feel well, no health concerns?”

“Fit as a fiddle.”

“Wonderful.” She opened Mae’s file. “I have all your blood work; levels remain the same as your visit with Dr. Cooper. You take exceptional care of yourself, Mrs. McGinn. I wish I could say that for all my patients.” She flipped through the test results. “I remember you enjoy yoga. Are you still participating in that?”

“Twice a week,” Mae said. “Last week I missed—pulled muscle—I’m better now.”

“Good, keep that up if you can,” Dr. Rashan encouraged. “I am a firm believer in exercise combating many of the complaints my patients associate with aging, depression, and anxiety in particular. Yoga is a superb choice for building muscle strength. As we age, muscle mass naturally diminishes. However, whatever you are doing to remain fit is working beautifully.”

Libby exhaled. Mae’s physical health was sound, but it was evident Dr. Rashan had concerns.

“Mrs. McGinn,” Dr. Rashan continued, “I was able to speak with your brother, William, late last week. He was wonderfully helpful, and a true pleasure. I can see why you are so fond of him.”

Mae smiled.

“As I mentioned to you at our first visit, your family history is an integral piece of the puzzle when we look at all the factors concerning the possibility of dementia. William shared some information regarding your mother that by no means create a cause for alarm, but could pose a concern.”

“I’m sure Will was exaggerating,” Mae said. “He does that, he’s very dramatic sometimes.”

“Mrs. McGinn, I cannot diagnose your mother. She was not my patient, you are. Moreover, in that regard, you and only you are my concern right now. Based on my conversation with William, I was able to contact the nursing home that your mother resided in, St. Joseph’s in Brooklyn, and pull her medical records. That in and of itself was a miracle. Most nursing homes purge records after ten years, but St. Joseph’s is small and able to store records much longer.”

Mae’s face turned ashen.

“Mom, do you want me to get you some water?” Libby asked.

“No, dear,” Mae said. “Let Dr. Rashan finish. Go on doctor.”

As Dr.Rashan relayed the details regarding Shannon Finn’s final year including high blood pressure, cholesterol problems, and various other conditions, they waited for the other shoe to drop. Libby could feel the small room closing in.

“I don’t mean to interrupt, doctor,” Mae said. “I already know all of this, and I take much better care of myself than my mother ever did. She cooked with lard, drank wine with dinner every night, and smoked two packs a day for twenty years. I don’t do any of those things so I would imagine my chances of stroke are markedly reduced, simply based on my lifestyle.”

“Absolutely,” Dr. Rashan answered. “However, all of those factors just contributed to your mother’s stroke. The underlying diagnosis was quite different.” She pushed the tissue box close to Mae.

Damn it, Libby thought. She took Mae’s hand and squeezed tight.

“Mrs. McGinn,” the doctor continued, “your mother was not simply aging, or exhausted, she was suffering from a condition called Vascular Dementia. This diagnosis qualified her for admittance into the nursing home. Although the condition itself is common, in your mother’s case the onset and subsequent decline was extremely rapid.”

Mae’s voice quivered. “And you believe I have this vascular thing?”

“There is no way to be sure without a CAT scan. But given your family history and the test results we have already been able to read, yes, that would be my preliminary thought.”

She went on, “I need you to be cognizant of a few things before we go forward. First, your mother was living alone, and again, she was not my patient. With many people I have treated, people who live alone, symptoms of this disease go undetected simply because no one is taking note of small day-to-day changes in behavior. I believe your mother’s early signs of Vascular Dementia were overlooked.”

“How is that possible?” Libby asked, “Wouldn’t my uncle or her doctor have noticed?”

Dr. Rashan shut the file folder and folded her hands. “It would be extremely simple to miss. Your Uncle William has told me he traveled quite often, and obviously did not live with your grandmother. It would be difficult for him to notice if she missed a meal or had behavioral changes.”

Turning toward Mae, she continued, “If he, or you, Mrs. McGinn, called your mother, and she seemed abrupt or defensive, it would be natural to assume you simply caught her at a bad time.”

“That happened all the time,” Mae responded. “I would call and she would tell me I was interrupting her. I couldn’t imagine what was more urgent than talking with me for five minutes.”

Dr. Rashan nodded. “Often patients with dementia become agitated when routines are altered. Let’s say you rang to say hello and your mother was about to cook an egg. First she may be bothered at the change in routine, but more importantly, she may forget to finish cooking and skip the meal altogether. We will never fully understand what transpired in your mother’s final years, Mrs. McGinn, but as your doctor, I believe it is wise to schedule a CAT scan for you, soon.”

“And you are certain Mom has enough factors to put her at high risk for Vascular Dementia?” Libby asked. “I mean it couldn’t be anything else, less”—she searched for the right word—“terminal?”

“Without the CAT scan, I can’t be certain,” Dr.Rashan said. “But a genetic predisposition coupled with Mrs. McGinn’s earlier exam makes this a likely diagnosis. Before we go any further, let’s do the scan.

Reaching behind her, she pulled open a file cabinet and took out a packet of papers. “I want you to take some information.” She handed the packet to Mae. “This reading is going to be daunting at first, but there is some beneficial information in here about dementia. I believe knowledge is power.”

“I agree,” Libby interjected, taking the packet from her mother’s trembling hand.

“Tremendous breakthroughs in dementia treatment are happening every day, Mrs. McGinn. Sadly, your mother went undiagnosed too long, and as a result, her lifespan was significantly shortened. Aside from minor typical age-related health issues, you are in fabulous shape and together we can set a course of treatment that will ensure a much higher quality of life.”

She turned toward Libby. “The single greatest problem I see in my practice is patients lacking family support. And it is obvious that’s not the case here. I realize this is quite a bit to take in, but are there any questions you have right now that I may be able to answer before we head to the desk to schedule the scan?”

“No immediate questions,” Mae said. “I’m sure I will have several in the future.”

“You can call the office at any time. If I’m not available, Olivia or one of my nurses will get the message to me and give you an approximate time that I can return the call.”

“I’ll do that.”

“I have a question.” Libby said.

“Of course. What would you like to know, Libby?”

“You are going to hate to hear this,” Libby hesitated, “but I have been doing some research on the internet and everything I can find on dementia suggests that early intervention is key.”

“I agree entirely, and for the record, I think the internet is fantastic when the sources are factual and overseen by licensed physicians. What was your question?”

“I know you need the scan results to confirm your diagnosis, but should we be looking into anything right now, while we wait for the results? Diet changes, supplements, or even housing? I know you think my grandmother likely had symptoms before anyone realized because she lived alone. Obviously my brothers and I see Mom all the time, but we are not doctors. Should Mom be interviewing visiting nurses, or even long-term care facilities now—so that if the time comes, far down the road, she’s familiar with the personnel and has the final say in her care?”

“Elizabeth, that’s a long way off,” Mae said. “I think you are getting ahead of yourself.”

“Yes and no,” Dr. Rashan responded. “I think taking a proactive approach to your potential medical and supportive needs could be quite helpful. By no means do I see the need being immediate, but I often suggest families have an enjoyable dinner with honest conversation early on in the process. Be straightforward with your children, Mrs. McGinn. Tell them what your wishes are. Any decisions on where you live, what treatments to accept, even the doctor you choose need to be your choice. It’s lovely to have a supportive family, but children often will have different views on what their parent wants.”

Mae nodded and made a mental note to write her long-term care plan down before anyone else made decisions for her. “I’ll make sure my choices are clear before I reach the point I can’t think for myself anymore.”

“Mom, think positive,” Libby said. “We’ll go ahead and get the CAT scan and see what Dr. Rashan thinks after that. While we wait, I’ll have everyone over and burn us a marvelous dinner, and you can tell us your wishes. We’ll yell at each other in true McGinn fashion until we reach a solution. No one is making permanent decisions without you. Schedule the scan and we’ll start from there.”