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Author:
Bernard Weiss


About This Story
I wrote this story, originally a novella, in the mid 1980s, during Ronald Reagan's tenure. I was struck by how much of his behavior suggested the incipient stages of Alzheimer's disease. I wrote it to pose a question to my colleagues in neurotoxicology: how good are our tools for detecting incipient neurobehavioral dysfunction? How effectively could we ascertain that exposure to a neurotoxic chemical had generated damage to the brain? I placed the question in the context of the 25th amendment to the constitution, which lays out the conditions under which the president could be removed from office because of inability to carry out the duties of the office. I had to conclude that our tools were inadequate.

This is a condensed version of the original. I had an artist in our medical school prepare the illustrations, which I turned into slides. When we see presidents launch disastrous military adventures, I have to wonder why we don't at least provide information about how they perform on neuropsychological tests; we provide other kinds of medical information.

"THE SHROUDED ROOTS OF NEURODEGENERATIVE DISEASE" by Bernard Weiss


David Goodman eased into the elegant curve of his Swedish lounge chair, carefully nestling the wine glass in his palm. He especially savored the aroma because the wine had been a gift from a grateful patient. David had allowed himself the indulgence of a glass of wine with dinner as a celebration. Another grant proposal, wet with the blood of preparation, off to the sharks for their next feeding frenzy. Actually, he could almost enjoy the challenge. What he could not enjoy was worrying about who might be the reviewers, and their prejudices, and the rest of grant politics. Politics? Time for the news. He angled his body abruptly out of the chair to turn on the television set. David watched the screen fill with the image of Woodrow Raintree, the ruddy skin, the gleaming silver hair, the confident nod to the reporters assembled for an announcement in the Rose Garden.


Raintree's rise to the presidency had both disturbed and intrigued David. I'm not comfortable with the practice of politics, he once confessed to a friend who had hoped to enlist him in vote canvassing for a congressional campaign. It's too unruly and irrational. Raintree had almost converted him, had almost made him a militant political creature. Raintree, with his slick evangelical patter and unctuous patriotism. But look, he told Ellen, Raintree is seventy-three years old. He won't last forever and his party has its eye on what comes after him. They'll keep him under control. With the presidential election looming, David drew comfort from his analysis.



Bryan Nelson of the Continental Broadcasting Service looked like a worn sparring partner, but his raspy challenges had stung three presidents. David hoped he could fight off the network's cosmetic replacements and their announcer tones. Nelson's voice trailed Raintree as he turned to leave. "Mr. President," he snapped. "It looks as though the Nationalists have won the election in Russia, and we see movements of Russian troops along the borders with some of the former Soviet republics. Can you give us more details? What's going on?"

Raintree looked blank for several seconds. "Well," he said, glancing first to the side and his Chief of Staff, "That fellow-what's his name-we're watching him." Then, with an edge of anger to his melodic baritone, "Rick, why don't you fellows ever stop?"

Nelson's lined face seemed to freeze as the camera framed it, and he sank slowly into his chair. David felt a muscle in his shoulder twinge like a burst of static. Suddenly alert, he watched the next few minutes like a prowling lioness, but Raintree's comments yielded to a mouthwash commercial.



Neurology grand rounds began at eight-thirty. The chief resident presented the case of a young woman with a peripheral nerve disorder that had been trace to massive consumption of vitamin B-6, a treatment suggested by her gynecologist to relieve premenstrual symptoms. Only half aware of his surroundings, David muttered, "Idiot." Colin O'Connor, seated beside David, poked him with a beefy elbow. "Not so loud," he whispered. "Remember your loyalty to our honorable profession."

O'Connor, an expatriate from Dublin, combined the incisiveness of an astute diagnostician with the ebulliance of a pub raconteur. At their first meeting, four years before, when David was still an assistant professor, he found himself thinking, "Stately, plump, Buck Mulligan." He admitted to O'Connor, months later, how astonished he had been to find the first sentence of Joyce's famous novel incarnated at a faculty reception. O'Connor took such delight in David's admission that he adopted him as a protege. David felt certain that his promotion to associate professor owed as much as his single glancing contact with the liberal arts curriculum, The Twentieth Century Novel, as to the scientific papers streaming out of his laboratory.

David leaned toward O'Connor. "Colin, I've got to talk to you." O'Connor nodded, rose, draped his white coat around him with the authority of a Roman senator, and strode up the steps to the exit from the lecture room. David's slender, gawky figure followed, the white coat flapping as though hung out to dry.

O'Connor turned as David caught up with him, crossed his arms, and raised two thick eyebrows. "Colin, did you catch the news on TV last night? Did you see Raintree's answer to a question?" David continued. "Look, I know he sometimes seems out of touch, but this time was different. He seemed to blank out, get confused, and forget a reporter's name that he knew before. Something's not right. I feel it. It's like those intuitive diagnoses you're so proud of."


"I only call them intuitive because I don't give away secrets, David. They're based on information, experience, and a lot of strands woven together. When was the last time you examined Mr. President Raintree?"

David shrugged. He was familiar with O'Connor's Socratic poses. "You're right, Colin. I can't point to much beyond that weird response, more fumbling than usual, some body language. But I've seen some patients go from that to a full-blown dementia in a year or two. It scares me."
O'Connor snorted. "All politicians scare me, my friend. Your are in the midst of a promising research career. Don't make a nuisance of yourself with televison medicine. Let's have some coffee and gossip about the Dean's campaign to prostrate our faculty before our wealthier patrons."



Monday morning usually began in David's laboratory with an assault on the coffee machine, everyone waiting expectantly for the final drop to yield to gravity. He sometimes wondered if the laboratory setting triggered a caffeine withdrawal syndrome, like the heroin addict, detoxified in the hospital, who returns to his former neighborhood and immediately experiences an intense desire for a fix.

Today, David found the greetings and animated conversation a burden. The alarm had jolted him from a confused and fitful sleep and he seemed to be conducting his morning routine in slow motion. He rearranged the papers and journals on his overcrowded desk. Then, surveying the neat piles still awaiting his attention, he picked up the phone.

For a famous reporter, Bryan Nelson was easy to reach. "My name is David Goodman. I'm a neurologist at the University of Phildelphia medical school. I was watching the news last Thursday and I was struck by Raintree's response to your question. It made me wonder..." Nelson interrupted. "Dr. Goodman, I have to be in Philadelphia tomorrow. Maybe we can get together. Are you free?" Nelson's words, drummed out in the same sharp rhythms David had heard in his television reports, startled David. He carefully dictated directions to his office.



As he waited for Nelson, David's laboratory and its activities seemed as detached as countryside observed from a train window. Well, he had always told people that life was a Brownian joyride from one irony to another.

Nelson seemed younger than his television image. In person, the lines slashed into his face gave him a weathered rather than a worn look. "I didn't have to be in Philadelphia, Dr. Goodman. It's just that I don't like telephones for certain conversations." David felt the same twinge in his shoulder he had felt at Raintree's misstep. "Now, tell me why you called. I have a suspicion, but I want to hear it from you."

Nelson's blunt manner dislodged David's remaining hesitation. "I think something's awry with Raintree. He seemed to blank out, got confused and irate, and couldn't remember your name. And when you didn't follow up the way I've seen you do before, I began to suspect you might know something that the rest of us don't."

Nelson remained silent for what seemed like minutes. "Dr. Goodman, I have sources in the administration. I get told things. I think something's wrong in the White House. I'll give you an example. Thursday morning, the day he made that announcement, Raintree had a tantrum. He couldn't find his cue cards. He accused his staff of hiding them. They were found in the Raintree's bedroom. The staff is not scheduling ay more meetings with reporters or even congressional leaders until the campaign is over. Some of them were complaining that Raintree just rambles on during their visits. Do these reports mean anything to you?"




David glanced at a bookshelf, then swung back to face Nelson. "If a patient's family member came to me with those stories, I'd arrange to have the patient tested." Nelson hovered over David's reply. "Why? What would you suspect? What would you test?"

"It doesn't quite sound like simple aging, where you might have some slowing or hesitation of responses, or even some memory difficulties. The personality changes could be a cause for worry. We don't have much to go on, but given the patient, I might want to make sure I could exclude a small stroke or a series of strokes. If these possibilities don't hold up, I would start looking for patterns compatible with Alzheimer's disease. As for tests, there are literally hundreds. But I don't know how to get at the biggest problem."

"Some of what you've told me I've already heard. But I need to hear about this biggest problem." Nelson looked ready to pounce, so David chose his words carefully.

"Suppose it is Alzheimer's. But suppose it's a slowly progressing Alzheimer's in its very early stages. In fact, progressive intellectual loss is one of the signs we use to differentiate Alzheimer's from other syndromes. Let's say the patient has to lose maybe twenty percent of his intellectual capacity before the diagnosis is clear. And let's say he loses about five percent a year, which would be hard to track with our current methods. Well, in four years, he'll be at a stage where clinicians begin to agree about a diagnosis. What then? It will be near the end of his second term if he gets reelected. And what about two years before that, when the tests might show some degree of impairment but not a clear indication of disease?"

"Do you know what we've got here, Doctor?" Nelson squinted. "It could be a political H-bomb. You know what I need, don't you? White coats to back me up. Voices of authority." David felt a heaviness in his chest. "Look, Mr. Nelson. You're not going to get any white coats, as you put it, to back up such a story on the basis of a few rumors and a slip or two during a meeting with you reporters."

Nelson frowned. "Look, I'm not asking you to go on TV. But I need you to be a kind of consultant. If a reporter calls, explain the problems of diagnosing Alzheimer's the way you explained it to me." David was beginning to understand the intensity that had forged Nelson's reputation. It was so easy to swim with the current you almost forgot how much of an effort it would be to swim back.

"Call me Bryan," Nelson said as they shook hands. He allowed himself a grim Bogart smile. "Like Raintree."



O'Connor expressed no surprise at David's confession. "Your were as prepared to deliver your virginity as a sweet young thing released from the reins of a convent school." O'Connor's marksmanship was as precise as ever, David admitted to himself. "Now, Dr. Goodman, let us rehearse you so that you embarrass this institution as little as necessary."

The question was put with judicial resonance. "Dr. Goodman, have you personally examined the President?"

"No, sir."

"Is it a common practice to issue a diagnosis without such an examination?

"No, sir. I did not make a diagnosis. All I said was that Mr. Raintree's behavior was compatible with the early signs of Alzheimer's."

"But are not these signs so vague that they could just as easily be attributed to a cold? Or indigestion?

"Yes, sir. But it's the pattern that's important. A caring doctor would investigate."

O'Connor smacked his fist on the desk. "Bloody good," he intoned. The rest of your speculations could just as well have been deposited by a well-fed horse. But 'Caring Doctor' is evidence of a latent poetic imagination. Joyce played some delicious tricks with platitudes."

"Now, Doctor, for the hard part." O'Connor rocked back in his chair. "You, the eminent authority on elderly monkeys, are seated in a congressional hearing room. A pack of senators holds its collective breath. They await your wise counsel on how to test their beloved leader's mental competence. Name your weapon."

"Hell, Colin, you know it's a lot more complicated than that. You clinicians talk about mental status and cognitive function and you think you're talking about something real because you ask a series of inane questions or because some test gives you a number. I can give you a long list of tests that someone has found will give you a statistically significant difference between normals and Alzheimer patients. Or normals and schizophrenics. Or thirty year-olds and seventy year-olds.

And I can give you a long list that won't show any differences at this stage. But Raintree is not a group. I don't even think he has to be labeled. Labels are a medical addiction. And a test is only a sample of behavior. Most of them are designed to be short and convenient. And you know what a big gap there is between a test score and everyday function. If Raintree doesn't function like a president, he shouldn't be a president."

"You Americans enthrall me. No matter what religion you profess, you all think like Jesuits." O'Connor leaned forward, then rocked back again. "Should is the favorite commandment of those possessed by dogma. I was given to believe that the sons of Eire we shipped you in such prodigious quantities had taught you the rudiments of politics and the ways of politicians."

David acknowledged O'Connor's arguments by his silence. "I really don't know what I'm going to do, Colin."


Mike Leland introduced himself as a reporter from the Philadelphia Post. "I'm doing a series on old age in America. The Washington office called my editor and suggested that we do a piece on aging and leadership." So, David thought, Bryan Nelson was beginning his campaign.

Leland arrived at four in the afternoon. "The funny thing is, Washington suggested your name. They seem to know more about you than we do. Anyway, Doctor, let me get some background on you. You're a neurologist, right?" David nodded. "Once a week, anyway." "And you do research on brain aging?" "Yes. Some with patients, mostly with monkeys."

"I don't cover science, Doctor, so you'll have to spell things out. This series on aging is written with a sociological slant."


"Let's tour the labs while we talk," David suggested. It was a situation in which he felt at ease, and Leland seemed to follow his explanations without difficulty. "So, you can see what we're getting at. If we see a patient with advanced symptoms, it's not a big challenge to make an accurate diagnosis. The early stages are something else. Someone comes to us because they feel that something's wrong. Maybe a spouse senses a peculiar change. But, even though a diagnosis at that stage may be tricky, it's still built on someone's observations. I'd like to be able to track down the very beginning, the genesis of the process, because it could have started a long time before. Even decades before."

"So," Leland said, extending the vowel, "It's possible that some of our leaders could be suffering from brain degeneration that isn't obvious yet."

David practically felt O'Connor's grip on his shoulder. "Well, it could be true of any of us. It probably is," he shrugged.

"But if someone President Raintree's age has some memory lapses, say, it could be evidence of some mental deterioration, couldn't it?"

"No caring doctor would dismiss such information. We owe that kind of concern to anyone."



As he walked toward Stein's office, David was beginning to feel embattled. It just wasn't in character for Sol to make a formal appointment. He usually grabbed you in the corridor or at rounds, unlike most department chairs. He also kept threatening imminent resignation. "Look at me. Budgets. Space. Administrators. Committees. Malpractice insurance. I'm too old for this crap." Then, "I'm a Jewish doctor, the idol of every Jewish mother. So they recycle me. Into an accountant. Or, god forbid, a lawyer. It's like a story by Isaac Bashevis Singer. An antelope transformed into a cow."

Stein's resignation had been imminent for all seven years of his chairmanship. Nine years earlier, at the age of fifty-five, he had decided that he needed to become an expert at the new techniques of brain imaging and took a nine-month sabbatical. A year later, he was editing the standard reference in the field.

David was only half surprised to find O'Connor also waiting in Stein's office. Stein had recruited him in an intense romance. "I had to swill Guinness with him in every pub in Dublin," he pretended to complain.

Stein spoke first, "David, the Dean's in an uproar. The story in the Post really griped some of the trustees. I asked Colin what he knew about it and he told me. It could be a mess."

"I didn't say anything directly, Sol. There was some speculation about Raintree even before that story."


"Only now, David," O'Connor noted, "The speculation has a name attached to it. A physician's name. A neurologist. A messenger in a white coat."
"And this department is your official residence," Stein added. "Look," he continued. "I think Raintree is a disaster. Even if he isn't demented, he's wacky. But a doctor can't say that in public. Let the journalists do it. Nelson doesn't have to apply for grants."

"Sol, Colin, maybe we shouldn't be so busy hustling for grants. You and I know that Raintree's doctors will report that he's fine. He still has most of his confidence-man charm. He wouldn't have any trouble looking normal on what passes for a mental-state exam in neurology, even if his doctors were neutral. And, if they tested him, what would it mean if he could draw a bunch of designs or multiply thirty-six by fourteen, or repeat seven digits backward? Or spell Mississippi?"



Stein and O'Connor waited. "And what about some guy who has to make decisions about the meaning of odd Russian troop movements? Are you going to ask him to spell Kazakhstan?"

David continued. "Do we know how to test the really high level aspects of human behavior? Like outlining a plan of action? Like predicting its consequences? Have either of you ever taken a close look at the neuropsychological literature?"

David stood up and began pacing. "Here is a typical study. You compare a group of Alzheimer patients with a group of normal controls of the same age. You give them both a battery of tests. Then you do a statistical analysis and show that the two groups are significantly different on some of the tests. But if you look at the data, you find a lot of overlap. Between diagnosed Alzheimer patients and controls. Talk about fallibility, Colin. Do you know a better example?"

Stein sounded weary. "David, let's make a pact. No more interviews for a while, and I try to cool off the Dean. Okay?" He looked to O'Connor for support. O'Connor, sitting with untypical quiet, nodded toward David.



David felt stunned the next morning when he sat down to breakfast and turned on the television set to watch the morning news. His wisecrack had turned into a prophetic vision. Russian troops had moved into Kazakhstan, ostensibly in response to incursions by Islamic terrorists. United States armed forces had been placed on full alert. Bryan Nelson, posed in front of the White House, conveyed a sense of fulminating crisis by an urgent vibrato in his voice and a sideways stance that suggested a watchful sentry.

David was already drifting into short episodes of sleep that evening when Nelson called. Ellen had picked up the phone and then put the covers over her head. "Now, here is what I've heard. First, Raintree is being kept under tight control. He will not be making any public appearances for a while. Second, he will not take part in any debates during the campaign. Their excuse is that Raintree is spending all of his time on the crisis."

David merely grunted. "David, we've got to smoke him out. You know how the public is. You want to create support for a president? Simple. Ignite a crisis. His staff will stretch the Russian move until it wraps itself around election day." David grunted another sleepy acknowledgement. "David, don't be surprised at some of the calls you may get. And go back to sleep. You sound like a zombie."



The staff assistant who called David identified herself as an employee of the Senate Judiciary committee. "We've been talking about the process of succession," she told David, "Because the Constitution is not that clear. In fact, its pretty vague. Suppose the president had a series of strokes or something comparable. How would you make a diagnosis and get the process underway? See the problem?"

"Yes, of course. And you want to talk about Alzheimer's disease and those kinds of issues?" David almost felt that he was reading lines from a play. "Right," she answered. "We'll be setting up some hearings and we would like you to testify. Senator Conrad has heard about you and hopes you can come."



The special throb of tradition and power as David entered the hearing room was almost tangible. Maybe it's the way the voices mix, he thought. The high ceilings melded them into a respectful rumble.

Just before ten o'clock, the senators began to wander in, taking their places at the long committee table with proprietary nonchalance. Conrad looked physically impressive as he called the meeting to order by a sharp rap of his gavel. The sound ricocheted off the walls, an authoritative counterpoint to the chairman, whose bulk, the fleshy neck embraced by an unyielding white collar, and the silver-framed eyeglasses, all seemed at harmony with the gleaming oak of the surroundings.

Conrad delivered his introduction with measured sobriety. In this time of crisis, he said, we are reminded of the need to insure the continuation of our government should the worst of our fears come true. But in this world, we won't have the leisure to hold hearings and work out a plan of action. As Conrad paced off his lines, David realized that he had not appreciated the tenuous rules for the removal of an incapacitated president until now. The twenty-fifth amendment sounded like improvisational theater, where you made up the script as you went along. It's a thousand times easier to fire a tenured professor than to get rid of an incompetent president, he thought.




David's turn came after a recess. He stumbled over a few words while introducing himself, but began to recover his poise as he read his statement and ventured into more familiar phrases and terms. "To summarize," he read, "Let me emphasize the three major points. First, degenerative diseases of the nervous system are long-term processes, and may be developing for decades before their effects emerge clearly. Second, our tools for early diagnosis are very crude because because we have no way to test their validity except to try them on patients who already have been diagnosed. Third, it seems reasonable to assume that the earliest signs of impairment would probably be overlooked, perhaps taking the form of subtle errors of judgment. Thank you."

Senator Ambrose Pearson spoke first. A lanky Iowan, David knew that he was noted for his droll wit, delivered with what Washington regarded as a farmer's economy with words. "Doctor, what you're telling us is that we're all riding downhill, at least by the time we get to this stage of eminence, but some of us are taking it a few steps at a time while others of us are on a roller coaster. Is that right?" David could hear a few chuckles in the undercurrent of voices that Pearson had roiled with his question. He smiled to ratify Pearson's pride in his metaphor.



"No one is more immune to aging than anyone else, Senator."

"Well, then, should we be selecting our politicians like athletes? Draft them right out of college, with bonuses?" Another rumble of chuckles. Pearson's tone now took on a different kind of sonority, more intellectual, David thought, and less hick now that his reputation for wit had been defended. "You've told us, Doctor, that aging takes a toll on the brain. We all accept that. We see it for ourselves. Now let's get back to the reason for these hearings."

Pearson honed his next question to an edge David had not expected at this point in the hearings. "Okay. Now suppose that sometime in the future we have a person in our highest office whose memory is beginning to slip, who maybe gets mixed up from time to time about things that are happening around him. I hope that never happens, but as you said, nobody is immune. How far gone would a person have to be before you said, that's it, there's a mental problem and it probably is Alzheimer's?"

David paused, hesitated, then remembered the urgency in Nelson's voice. "All we doctors can do is give you our best guess, tell you how the person functions according to our standards, and what our prognosis is. Then you have to decide if that person is capable of functioning according to your standards. That's not a medical decision."

David's response seemed to fulfill the aim of Pearson's questions because, with the sensitivity of a skilled attorney molding a line of testimony, he held it in place once it had reached its destination. "Thank you, doctor, for reminding us of our responsibilities."

Two more senators embellished Pearson's questions, eliciting from David a few additional variations on his testimony. When Conrad asked for final comments or questions before adjournment, only Pearson responded. "Now, if we came to you doctors and scientists and said, we need help about a big decision of the type we talked about, a decision that's critical for the country, would you still back off, still tell us there was nothing you could do? After the big research budgets we pass year after year?"

David's response came out of some subliminal well, some repository of random thoughts. "I can think of one way," he finally said. "It still involves a political decision in the end."

"That's what they elected us for," Pearson offered dryly.

David continued. "With public figures, you also have a pretty good public record and high visibility. You've got speeches, press conferences, interviews, a lot of people who have frequent contact with them. If there is some kind of detectable progression, you should be able to get clues from that kind of public record. You should be able to amass a tremendous amount of information extending back quite a few years. Then, you could decide whether to request formal testing."

The chamber grew quiet, and the only motion he could detect was a final lagging burst by the stenotypist. Then he heard a growing burst behind him as Conrad rapped his gavel, thanked him, and adjourned the hearings until the afternoon.



David's testimony earned about a minute's worth of comment on two of the evening news programs. Both stories mentioned the questions posed to him about Alzheimer's disease. David smiled to find himself framed on the screen for ten lofty, gratifying seconds.



On the other occasion when David had been in the Dean's office, he had found it excessively warm. But today, with the temperature and humidity embracing Philadelphia with tropical intensity, the Dean's thermostat, with what seemed to David typical southern incongruity, seemed to have been set to emulate northern Maine. Thomas Marshall Delmar, in vest and white coat, added substance to David's stereotype.


"Well, David, you've certainly given the school an unexpected prominence on the Hill." The familiar way in which Delmar spoke of Congress was designed, David speculated, to let him know that the Dean was no stranger to politics or power. "I'm not sure that ten seconds of my profile on TV could be called prominence," David responded with a self-effacing smile. "True enough," replied Delmar in his soft, mellow style, "But there are certain quarters that see your appearance that way."

"When someone in your position, David, appears before a body like the United States Senate, he does not appear as an individual. He appears as a member of his organization, in your case, this university." David thought the cadence of Delmar's accent was taking on some harshness--an abrupt flatness. Delmar's plantation cadence returned. " I have great faith in the professional quality of my faculty, David. But that is not to say that its members are always aware of how they are perceived by the public. I have to be concerned about the school and its future."

David, as though O'Connor were directing him, unfurled the flag. "It was a difficult decision, Tom, but how could I turn down a request from a Senate committee? How would you have done it?" Now David could be the student.

"I avoid political entrapment, David. It would be best if you did, too." David could almost feel an exclamation point as Delmar began to rise and escort him to the door.



David secured himself in O'Connor's cozy office after a telephone call that he knew conveyed a mounting sense of urgency. "Colin, the Dean is cranking up the pressure. He was not happy about my appearance in Washington."

"You are in no immediate danger, my caring physician friend," O'Connor teased "The Dean would not be so foolish as to prod sleeping dogs with a pointed stick in the midst of a capital campaign."

"Colin." David brightened suddenly." You and Sol are going to be at that meeting in Washingon next week. The one on new diagnostic techniques." O'Connor nodded, then, anticipating David, "But only in a professional capacity. And as a permanent resident and modest neurologist, not as a terrorist. I plan to remain free of political entanglements. Like the Dean."

"Wait, Colin." David rushed his words. "Let me introduce you and Sol to Bryan Nelson. Find out what he has to say. He'll listen and he can be trusted." David saw O'Connor's quizzical look, the one he assumed at rounds, change into hi avuncular one, and almost ran back to his office.



They arranged to meet for dinner in a small Italian restaurant in Arlington. "It's a local clientele. No tourists, no power brokers." David could picture the quick grin as Nelson added, "And no power dinners."

The owner of the restaurant, a short man with limp black hair and a black bow tie tilted at a diagonal, escorted them to their table. "I'm not just chasing down a story. I hope you know that." Nelson took command of the conversation immediately after they had been seated.


Stein glanced at O'Conner, then addressed Nelson. "So, what do you want from us?"

"Right now, I'm not entirely sure. Let me tell you what I know." Nelson lifted his beer glass, seemed to peer through it, then continued. "I had heard rumors even before David called me. It wasn't such a big secret. Some of the reporters even joked about it. But I didn't find them funny. Raintree didn't depend on cue cards when he ran that religious talk show in Florida. I've looked at tapes. He was sharper, in control. Not now."
O'Connor broke in. "Let me remind you that Raintree's intellectual gifts could hardly be acknowledged as overwhelming even before he took office. Moreover, we have little information beyond anecdotes. Not even a medical examination, for all its alleged crudeness." A lifted eyebrow directed at David. Then, wryly, "As aging professors, Dr. Stein and I are hardly in a position to make a diagnosis of dementia on the basis of forgetfulness."

"I'm not advocating that you go public with a diagnosis. Nelson leaned toward Stein and O'Connor. "But Raintree has to be smoked out. The senate hearings are a beginning. Maybe the two of you could discuss the problem with your colleagues."

This time Stein issued the challenge. "What problem? I'd come off looking like an idiot, manufacturing a diagnosis from rumors. They'd laugh, ask me if I'd put his head into one of my scanners, had a picture of the president's brain."

Nelson remained composed. "Okay, you don't want to take risks with your reputation. But let me tell you some of the latest gems from the White House. The National Security Agency is trying to keep up appearances, giving him briefings on the Russian situation. He keeps slipping in comments about the Cold War. He always liked to tell anecdotes about that era, but people around him are beginning to think that he really slips back in time. Now the chief of staff and his boys are even shielding him from the cabinet. They're locking them out. Same with the vice-president."

Stein carried the argument. "From what you've told us, you're not the only reporter with this kind of information. There must be plenty of people in Washington who also know. Isn't that enough?"

"Not yet." Nelson shook his head for emphasis. "And everyone's cautious about a frontal attack."

O'Connor put his napkin to his lips, then, stretching it over his lap, addressed Nelson. "Of course, you have to lead by indirection--by metaphor, so to speak. But David provided the strategy in his Senate testimony." O'Connor turned to David, who was trying to recall which of his statements Colin could have seized on. "You may remember David suggesting that public statements in past appearances might be clipped together to offer a retrospective view of a president and a comparison with his current image." So, David thought, you did read that part of the news you said you disdained. "Wouldn't it be proper journalism to report to the public on how a politician is changed by the responsibilities of the presidency? How, if I may put it that way, by assuming those towering burdens, he may age prematurely?"

David saw Nelson's body tense with an athletic charge he had observed before. "Sure. A thoughtful piece on the toughest political job in the world. It could work." He fixed O'Connor with his predator's gaze. "You're the experts. I can get the material. But you'll have to do the real editing." Stein turned toward O'Connor, then toward Nelson, then sighed. The Hebraic acquiescence of the inevitable.



Nelson had spliced together about ninety minutes of tape from his network's archives. As David pulled apart the padded envelope his hands stiffened momentarily. The cassette, ordinarily so inanimate, seemed to quiver with life. At five o'clock he joined Stein and O'Connor in Stein's office to view it.

Stein noticed it first, and asked David to rewind the tape to a brief welcoming ceremony two years ago. Raintree, in sunshine, on the White House lawn greeting the newest Italian premier. Then, the hesitation, after a brief statement by the premier, the whispered aside from the Secretary of State as Raintree groped for the name, and Raintree's fumbling reply. Stein also noted Raintree's increasing dependence on his package of cards during times when he had to improvise replies. "See how drawn and pinched his expression becomes when he has to be spontaneous. I'll bet he's feeling the tension of losing control."

The final tape segment contained extracts from the press conference that had triggered David's call to Nelson. David rose and switched off the machine. He looked expectantly at Stein and O'Connor. They looked back grimly.



David was amazed at the amount of information Nelson had managed to pack into a segment lasting only three minutes. It resembled a special effects sequence from a movie. It almost reminded him of Dr. Jekyll's transformation into Mr. Hyde. A sympathetic discussion of the demands of the presidency only highlighted the visible aging of Raintree, but especially the loss of his quickness and spontaneity. Is the job too burdensome? Do we wear out our presidents? Nelson's script left the final question unstated: Is Raintree up to it?


David had assumed that his testimony before the Judiciary committee quickly dissolved into the vast ocean of events gushing from Washington every day. Mike Leland's telephone call told him that he had become a public figure. "Have you seen today's New York Times?" The eager voice suddenly alerted David. "Well, you're mentioned in a story about how they seem to be keeping Raintree cooped up."

On the front page, David read a classic New York Times headline: Speculation Mounts on President's Condition. Not sensational, not giving away too much. Pressure is building on the White House, it said, to respond.

Nelson's segment on the evening news showed him poised in front of the Naval Medical Center in Bethesda. Sun glinted off its main tower with its round peak, but deepened Nelson's lines as the camera drew him into the scene. The White House had agreed to a medical examination for Raintree. But, added Nelson, most experts believe that only careful, detailed psychological testing is likely to show the kind of elusive deficits that wouldn't be apparent in a regular medical examination.



Raintree's arrival in Bethesda dominated the next day's news. David saw the usual jaunty wave at the press and felt an angry flush darken his face. The results would be announced tomorrrow, Nelson reported.

David suffered through a manic-depressive evening and night that reminded him of sailing in rough water without the drive of a brisk wind. Haplessly bouncing at random angles, going nowhere. Sol's appearance the next morning at his office surprised David enough to prod him into full wakefulness.

Sol carried a copy of the New York Times. "Look." He pointed to an article on page one. "Neurologists debate President's examination," he read. "You are no longer alone," he smiled. "They brought in some heavy artillery from Harvard and Hopkins." David quickly scanned the article, only half believing Sol even as he read the confirmation. Heavy indeed. Head of Neurology at Mass General. Mac James in Baltimore. Both quoted in a long story.

David detected some other quality in Sol's elation. "Sol, you had something to do with this, right?" Stein answered with unaccustomed lightness. "Well, I phoned Seymour in Boston. Colin talked to Mac. We gave them most of the story. I also called people I knew at the Times. Things just fell into place."



Although November had already begun, David could still smell a lingering aroma of summer ripeness in the park. He jogged at a steady pace, enjoying the delicate fading colors of the withering leaves and their crisp sounds as they crumbled under his shoes. The last Sunday before election day. What a year. What a pleasure to pick up the Sunday Times at Abby's Pharmacy and to read it over breakfast without despairing over the stalemated strategy of verifying Raintree's incompetence.

The clerk at Abby's, a skinny teen-ager with excessive eye shadow and gleaming orthodontics, inserted his paper into a plastic bag and sent him out with, "Have a good day." During the easy five-minute run to his house, David mulled over the definition of a good day. What would be a good day? It didn't take long to find out. My god, he said out loud.

Walter Benson, Secretary of Health and Human Services, a physician appointed to fulfill Raintree's vow to the anti-abortion movement, asking Raintree to resign. To spare his health and the health of the country. Benson, stiff, formal, an obstetrician who once had called abortion first-degree murder. Who had gotten to him?

Nelson's call came at midnight. "How did you do it, Bryan?" David could not conceive of such an event without Nelson's participation. "I didn't. Not directly. The vice-president did. His staff has been in contact with me and briefing him from the beginning. He finally asked Benson what he thought about it, and Benson told him just what he said in the announcement. "Maybe," Nelson gasped a chuckle, "He's another caring physician behind that stiffness."


Monday seemed to occupy a full week. David felt an edge of hysteria to every action, as though a thin membrane of sanity was about to rupture. After tomorrow he would return to his routine, the safey of predictable problems, problems on a small scale. After tomorrow? Could he ever return to the coziness of problems on a small scale? Ellen's rhythmic breathing, normally so calming, seemed that night to pace his anxieties, each cycle alternating peace and disquiet. What kind of tomorrow? He drifted into a troubled sleep. What kind of tomorrow?


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