TIME medicine

When Will I Die? How I Decided Whether to Test for Early-Onset Alzheimer’s

The author bakes cookies with his 3-year-old twins
The author bakes cookies with his 3-year-old twins Courtesy Matthew Thomas

The disease killed my father. At 39, I had to choose how much I wanted to know about my own fate

People ask me all the time if I want to find out how and when I’m going to die. But that’s not exactly how they ask it. What they ask is whether I’m going to get tested for the gene associated with early-onset Alzheimer’s disease. It’s hard, though, to miss the subtext in the question: How morbidly curious are you? How much terror can you withstand?

I don’t blame them. These friends know I’m 39 and that my father started showing symptoms of Alzheimer’s in his early fifties (and possibly earlier). They know that after a handful of difficult years my father was diagnosed when I was a freshman in college and that he died less than a decade later. They wonder if I’m going to take advantage of the remarkable opportunity science affords us to uncover our genetic destinies and plan accordingly.

Modern life is all about making us forget we’re capable of dying. We love to feel in control of our mortality, even if we understand that that control is only an illusion. Alzheimer’s disease is the opposite of modern life. It’s the ascendancy of entropy and chaos.

My father’s disease had a devastating effect on our family. It didn’t just take away our time with him and his with us. It also took away his time with the not yet conceived children who would populate the family in his absence. He would have been in his 70s now, surrounded by three grandchildren through my sister and two through my wife and me. It’s painful to know what a resource he would have been for them and how much they’ve lost. He will live, faintly grasped, if at all, only in stories.

When he was still living, we tried to make the best of the situation. When my sister got married, my mother brought my father’s tux to the nursing home and had the staff dress him in it. After the ceremony, while everyone else headed to the reception, two limos carrying my immediate family took a detour to the nursing home for photos.

When I look at the framed shot of us huddled around my father in his wheelchair, I see how hard my sister is trying to keep her emotions in. She’s smiling big, but tears are streaming down her face. We are all smiling hard, though there’s no driving off the pain and awkwardness of the moment. Everyone’s looking at the camera except my father, who is gazing vacantly the other way, his mouth hanging open. Moments later we drove to the reception, leaving him behind, feeling terrible for doing so. I wanted him not to understand a thing that was happening in that scene, but you never knew what he knew.

For most of my youth, my father seemed to know everything. A universe of information swirled around in his brain. I could hardly put a question to him that he couldn’t answer. The rare times he came up short, he pulled me into his study, took a book off the shelf, lay it on the desk and stood flipping through it with me. I think sometimes he pretended not to know things just so that we could look them up together.

Once, when I was about 10 and my sister about 14, we were walking with my father on the outskirts of his old neighborhood. He stopped in front of a town house and told us Winston Churchill’s mother was born there.

“The iconic English statesman of the century!” he said. “A mother from Brooklyn!” He gave us a look almost wild with the significance of what he was about to say. “The wit!” he said. “The chutzpah! That was the Brooklyn in him!”

Three decades later, I can still remember the moment, bathed in that ethereal light that we reserve for our happiest memories. Why do I remember it, though? How did such a quotidian moment burrow its way into my consciousness and survive? Was it the juxtaposition of incongruous worlds, England and Brooklyn? I don’t think so. I think it was the joy my father took in sharing his knowledge with us.

My father would have loved my twin children. They’re 3 years old and full of vitality and personality. My son is unusually strong for such a skinny kid, and remarkably agile. He climbs whatever is available, with a monkey’s speed. When he sits at the piano and pounds the keys, it sounds as if he’s playing a real song. My daughter is a sensitive cuddler who remembers everything. “Daddy, is this from the hotel we stayed at?” she asked the other day, handing me a pad from a Marriott where we stayed six months ago.

Recently my daughter came into our bed in the early morning, lying between my wife and me, and started in on iguanas. “Iguanas are baby alligators,” she said, and I chuckled at the powers of observation of a developing mind. “Can iguanas learn to open doors?” she asked, and after I offered the opinion that they couldn’t, I pulled her close, gave her kisses and began to choke up.

Maybe when my twins are older, science will have caught up to this disease. We have the best scientific minds working on the problem of Alzheimer’s. Much like the search for the cure for cancer, there is a massive payout at the end of the rainbow for anyone who comes up with a solution. If there’s anything to put one’s faith in in the health care system, it’s that the confluence of genius and capital will, in this case, produce the outcome if the outcome is producible. And I do believe it’s producible. But if it isn’t produced in time, no amount of awareness of my fate, if it is to be my fate, is going to forestall its unfolding on me.

My wife and I have little battles over my forgetfulness. She asked me to fix the kink in the hose that runs from the humidifier in our basement to the French drain. A few days later, she gave up and fixed it herself. We had a grill delivered for our backyard, and the flame kept going out on it as soon as we lit it. I was supposed to call about it the next morning, but I’d more or less forgotten that we’d bought a grill in the first place when I heard my wife on the phone with the store. These aren’t terrifying signs in themselves — everyone is a little forgetful occasionally — but they make me pause enough to wonder if the worst is coming.

I’m built like my father, I sound like him, and if I have a genetic mutation in one of three genes that are all variations of the apolipoprotein E gene, then I will likely develop early-onset Alzheimer’s like him. These genes are rare, accounting for only 1% to 5% of all Alzheimer’s cases. But if I inherited the mutation from my father, then I will probably get the disease.

My grandfather — my father’s father — died relatively young of other causes, so there’s no saying whether he would have gotten early-onset Alzheimer’s. No one else in the family had it that we know of. I have as good a chance of getting familial Alzheimer’s as I have of avoiding it. Genetic testing would settle the question for good.

But what would I gain by knowing I was getting Alzheimer’s? I wouldn’t gain another day with my family. I wouldn’t gain a leg up on planning. My wife and I have taken care of practical considerations. We have wills. My wife has a durable power of attorney that enables her to make decisions on my behalf. Every policy, every asset, is in both our names. We opened college savings accounts for the kids. I’m working hard on my next book. How much more could I prepare?

After some deliberation, I’ve decided not to get genetic testing done. Instead, I’m going to try to live every day as if I know that I’m dying. The fact is, we are all dying. If I try to wring the most I can out of every moment, if I set aside time every day that my wife and I keep as inviolate as possible, if I give my wife and children quality interactions whenever we’re in the same room, if I leave the smartphone on the counter and realize there is no information more important than the information I get in my interactions with my loved ones, then how different is any of that from what I’d do if I knew I was getting Alzheimer’s?

Scientific studies suggest that my children are at just the age when they can begin to form lasting memories of their experiences. If I’m aware that I’m going to be gone someday and I consider it possible that that day will come far sooner than I’d like, then I want them to grow up not only knowing their father well but also knowing that they are well loved. I want to get in better shape for them, because I’d like them to see what a truly vital father looks like. And I’ve decided to read to them whenever they ask, if I possibly can. I don’t have any memory of my father telling me, “No more books” at bedtime. I will forever picture him with an arm around me, holding a book out before me, showing me the world.

Thomas is the author of the debut novel, We Are Not Ourselves, out today.

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