Dr. Akinyele

The Keeper of Hours

Chapter 6: Dr. Akinyele

On Tuesday morning Yvonne arrived at nine twenty-eight, two minutes early, in the Toyota she had backed out of her own driveway with the kind of care she gave to all the mornings she had been preparing to survive.

Her mother was on the porch.

Her mother was on the porch, in the camel coat and the small black hat that Yvonne had not seen since 2019, with her purse on her left arm and her hands folded in front of her the way her hands folded in front of her at funerals, and Yvonne understood, before she had put the car in park, that her mother had decided some hours ago how she was going to enter Dr. Akinyele's office today. The decision was not negotiable. The decision was not for Yvonne to soften or improve. The decision was the way an eighty-two-year-old woman who had been baptized in the Wolf River and who had buried two parents and one brother and one husband and one sister and most of the men who had been deacons when she joined the church had decided to walk into a room where a stranger was going to put a name on a thing.

The decision was: I will go in standing.

Yvonne put the car in park. She got out. She walked around to the porch. Her mother lifted her hand.

"Baby."

"Mama. You ready?"

"I have been ready. You drive slow."

"I drive how you taught me, Mama."

"I taught you to drive faster than that."

"You taught me to drive how Daddy drove, Mama. Daddy drove slow."

"He drove slow because he was thinking about other things."

"That is what I am doing."

Her mother looked at her for a moment, the small considering look, and then a smile crept up the side of her mouth that Yvonne had not seen all week.

"Get me to the appointment, Yvonne Tate-Brooks."

"Yes, Mama."

She helped her mother off the porch. Her mother did not need the help. Her mother accepted the help because her mother had decided, at some point in the last year, that accepting the small physical kindnesses was the way she would let Yvonne love her in the open. Yvonne held her elbow down the steps. Yvonne walked her to the passenger door. Yvonne opened it. Her mother got in, slowly, the way she got into all cars now — the seat first, the legs swung around second, the deep careful breath third.

Yvonne closed the door.

She walked around the front of the Toyota. She put her hand on the hood for a second before she got in. She did this without thinking. She did not know she had done it until she was halfway around to the driver's side, and she did not allow herself to think about why.

She got in. She put on her seat belt. She started the car.

"Mama. You all right?"

"I am all right."

"You want music?"

"I want quiet, baby."

"Yes, Mama."

She backed out of the driveway. She drove slow. Her mother sat in the passenger seat with her hands folded over her purse and her eyes on the windshield, and the morning of Tuesday, April twenty-first, began the way her mother had decided it would begin, which was upright, in a hat, in the company of her daughter.

Dr. Akinyele's office was in a converted brick house on Madison Avenue, two blocks east of Cleveland Street, where the older medical arts buildings had been turned over to small specialty practices in the last decade as the bigger systems consolidated. The waiting room had four chairs, a coffee table with magazines from January, and a small fish tank that Yvonne suspected had been installed at the suggestion of the same consultant who had told the practice to paint the walls the warm beige they had been painted, because beige was — according to a study someone had paid for in 2014 — calming for the cognitively concerned.

Yvonne hated the beige.

Her mother did not appear to notice it.

They sat in two of the four chairs. The other two were empty. The receptionist — a young Black woman named Brittany who wore her hair in twists and who had been kind on the phone last week in a way Yvonne had marked — looked up and said softly, "Dr. Akinyele will be with you in a few minutes, Mrs. Tate," and Ola Mae nodded the small dignified nod she gave to people who addressed her properly the first time.

Yvonne had brought a notebook. She set it on her knee. She did not open it.

Her mother did not bring a notebook. Her mother sat with her hands folded over her purse and looked at the fish tank.

"That is a sick fish," her mother said after a moment.

Yvonne looked. There were three fish. One of them, a small orange one with a slightly translucent tail, was hanging at an angle near the surface.

"How can you tell, Mama?"

"You can tell."

"I cannot tell."

"You did not grow up next to the river, baby."

Yvonne almost laughed. The almost laughed sat in her chest like a small bird she had not been expecting and had to release before it broke a wing. She breathed.

Her mother said, without turning her head: "Yvonne."

"Yes, Mama."

"It is going to be all right."

"You said that already, Mama."

"I am going to say it as many times as I need to say it."

"Yes, Mama."

A door opened. A man came out — sixty-something, a careful walk, his wife behind him. They did not look at the women in the waiting room. They walked past, and Brittany handed the wife a small paper folder, and the wife thanked her, and they left. Brittany picked up the phone and said something quiet, and a moment later Dr. Akinyele opened the same door and stepped into the waiting room.

She was younger than Yvonne had expected. Late forties, perhaps. She was tall. She had her hair short and natural. She wore a white coat over a navy blouse and she carried a small leather portfolio under her arm the way Stephen Pruitt had carried his three days before, and Ola Mae registered the resemblance somewhere below thought.

"Mrs. Tate. Mrs. Brooks. Please come in."

She held the door for them. She walked them down a short hall. She showed them into a consultation room — not an exam room, Yvonne noted, but a small carpeted office with two leather chairs and a love seat and a desk pushed against the wall. There was a single window. The light was clean.

Ola Mae sat in one of the leather chairs. Yvonne sat on the love seat.

Dr. Akinyele closed the door. She did not sit behind the desk. She took the second leather chair, across from Ola Mae, and set the portfolio on the small table between them. She did not open it.

"Mrs. Tate. Before we do anything else, I want to tell you something."

Ola Mae looked at her.

"My name is Tobi Akinyele. I was born in Lagos. I came to the United States with my parents when I was twelve. My grandmother — my father's mother, who lived in Lagos until she died in 2008 — was the woman in our family who held us in prayer. She prayed at four in the morning every morning of her adult life. She kept a list. She wrote our names in a small green notebook. I was on that list. My father was on that list. My uncles. The people my grandmother had been carrying since the war."

Ola Mae did not move.

"I tell you this," Dr. Akinyele said, "because your daughter mentioned your prayer practice on the phone last week, and because I want you to know, before we do anything else, that I am not a doctor who is going to treat your prayer life as a symptom or a coping strategy or something to be managed. It is the most important thing you have. I know that because I watched my grandmother's mind go in 2005 and I watched her keep her list anyway, and I watched my father bring her the list when she could no longer find it, and I watched my grandmother die three years later with my own name being said aloud by my father at her bedside because she could no longer say it but had asked him to. So whatever else we do today, I want you to hear that I know what your book is. I know what it is for. I am not here to take it away."

Yvonne began, very quietly, to cry.

She did not move. The crying happened in her face without her permission. She did not look at her mother because the rule from 1989 still held.

Ola Mae did not look at her either, because she had felt it and she was honoring the rule too.

Ola Mae looked at Dr. Akinyele.

"Doctor."

"Mrs. Tate."

"What was your grandmother's name?"

"Olufunmilayo Akinyele. We called her Mama Funmi."

"Mama Funmi."

"Yes."

"You tell Mama Funmi, when you see her, that a woman in Memphis received her granddaughter today as a gift she did not know to ask for."

"I will, Mrs. Tate."

"Now. Tell me what you need to tell me."

The cognitive screens took thirty-five minutes.

Ola Mae did them with the small dignified concentration she gave to crossword puzzles. She drew the clock — face round, numbers in the right places, hands at the time Dr. Akinyele had asked for. She did not place the hands quite correctly. The minute hand was on the eight when it should have been on the ten, and Dr. Akinyele did not comment, and Ola Mae did not notice, and Yvonne saw it from the love seat and did not move.

She recalled three of the five words after the delay. Apple. River. Honest. She missed piano and she missed Saturday.

She subtracted seven from one hundred. She got to seventy-two and then said, slowly and carefully, sixty-six, which was wrong by one, and Dr. Akinyele wrote down sixty-six without comment.

She named the animals on the cards. She named ten in sixty seconds, which was below the cutoff but not by enough to be alarming.

She read the sentence and wrote one of her own. She wrote: The Lord is the Lord and I am His. She had been writing some version of that sentence on every form she had been given the option to write a sentence on for forty years, and Dr. Akinyele looked at it and underlined it gently in pencil and wrote a small yes in the margin.

She counted backward from twenty by threes. She missed twice.

She remembered her current address, the city, the state, and the year, but she missed the date by two days and missed the day of the week by one.

When the screens were done, Dr. Akinyele set down her pen. She closed the portfolio. She folded her hands.

"Mrs. Tate."

"Doctor."

"What you have, in my professional opinion, is mild cognitive impairment that is progressing toward early Alzheimer's. I cannot tell you with absolute certainty without further imaging, which we will schedule. I can tell you with high confidence based on these screens, your history, your daughter's observations, and the conversation we have had this morning. The progression has been slow. It will continue to be slow. We have time to plan."

She paused. She did not say the next sentence too quickly. She had given this diagnosis hundreds of times, and she had learned, somewhere in her first five years of practice, that the speed at which a doctor said the next sentence after a diagnosis was the most important clinical decision she would make all day.

"I am going to give you medication options. We will talk about them. I am going to recommend lifestyle adjustments. We will talk about those. I am going to ask your permission to speak with your pastor and your church family if you have one, because the data on social-spiritual support in your population is the strongest data we have. I am going to ask your permission to bring your granddaughter Tiana into the conversation as a clinical liaison, which your daughter mentioned would be helpful given Tiana's nursing background."

She paused.

"And I am going to ask you, Mrs. Tate, what scares you most. Not because it is in any handbook. Because I want to know."

Ola Mae looked at her.

She did not have to think about the answer. She had been carrying the answer for a year. She had been carrying it the night Calvin Pruitt's name had gone strange in the book. She had been carrying it before that. She was eighty-two years old and she had been carrying the answer to that question since the morning she had first put down the keys in the wrong drawer and had stopped, in front of the open drawer, and had felt the room shift slightly under her feet.

She said: "Forgetting the names in my book, Doctor."

Dr. Akinyele nodded.

"Tell me about the book."

Ola Mae told her.

She told her about the prayer practice. She told her about the years. She told her about the legacy pages. She told her about Calvin Pruitt and Stephen Pruitt and the letter on Sunday. She told her — and Yvonne, on the love seat, sat very still, because some of what her mother was telling Dr. Akinyele her mother had not yet told her — about the morning she had not been able to recognize her own handwriting, and about the prayer that had risen out of her on Saturday in the kitchen that she had not organized.

Dr. Akinyele listened. She listened the way Ola Mae's grandmother had listened in Mississippi, which was without taking notes, with the eyes on the speaker, with the body fully turned. Yvonne watched her listen, and Yvonne thought, without meaning to: Lord, You sent us a doctor who is the granddaughter of a Mama Funmi. The Lord is gathering. Mother Wells was right.

When Ola Mae finished, Dr. Akinyele was quiet for a moment.

Then she said: "Mrs. Tate. I am going to tell you what I would tell my own grandmother. There is no medication I have that will save the book. The book is going to need to change shape. The names that you have been carrying alone are going to need to be carried by more than you. You are not going to be able to do this without help. The good news is that you are surrounded by people who are willing to do the carrying with you, and the very good news is that the Lord — this is me speaking now as Tobi Akinyele, the granddaughter of Mama Funmi, not as your physician — the Lord does not require the carrier to have an unbroken memory in order to honor the carrying. The carrying was always His. He was using your hand. He will use other hands now."

Ola Mae nodded.

"That is what I have been thinking, Doctor."

"I know it is."

"I have not been able to say it out loud yet."

"You did not need to say it out loud yet. You were not ready until today."

Yvonne pressed the heel of her hand against her eye.

Dr. Akinyele turned to her.

"Mrs. Brooks. I want to say one thing to you. The hardest part of this disease for the family is the daily ordinary loss. Not the medical events. The Tuesday afternoons. The forgotten dish. The wrong name. You are going to be tired. You are going to grieve a person who is still in front of you. You are going to want to fix what cannot be fixed, and you are going to have to learn, very slowly, that loving your mother is not the same as fixing her. You already know this. I see it in your face. But knowing it and living it are different rooms, and you are going to spend the next several years walking back and forth between them. I am giving you my cell phone number. Not for your mother. For you. I am the daughter of a daughter who walked this. I have help to give you that is not in the chart."

Yvonne did not trust her voice. She nodded.

Dr. Akinyele wrote her cell number on a small card and slid it across to Yvonne.

She turned back to Ola Mae.

"Mrs. Tate. I would like to schedule the imaging for next week. I would like to see you again in three weeks. I would like, if you are willing, to come to your home one Saturday morning and watch you do a portion of your prayer practice, so that I can speak knowledgeably about it in the literature I am writing on faith communities and cognitive decline. I would consider it a privilege to be allowed in. You may absolutely say no."

Ola Mae looked at her for a long moment.

"You can come, Doctor."

"Thank you, Mrs. Tate."

"You can come on the third Saturday of next month. You will have your coffee at my kitchen table. You will not bring a notebook. You will sit in Eldridge's chair if I say so. And you will, before you leave, write your grandmother's name in my book."

Dr. Akinyele's hand went to her mouth.

She did not, immediately, lower it.

After a long moment she said, very quietly: "I will, Mrs. Tate."

"Good."

In the parking lot, Yvonne could not, immediately, drive.

She sat behind the wheel with her hands on it and she stared at the dashboard. Her mother sat in the passenger seat with her hands folded over her purse. The Toyota ticked the small ticking sound of an engine cooling that had not yet been started, which was wrong, and which Yvonne could not bring herself to correct.

"Mama."

"I know, baby."

"I cannot drive yet."

"You take your time."

"I cannot — Mama, I cannot —"

"Cry, Yvonne."

It was not a permission. It was an instruction. It was the first time Ola Mae Tate had given the instruction in thirty-seven years.

Yvonne understood what her mother was telling her. The rule from 1989 was being lifted, in the parking lot of Dr. Akinyele's office, on the morning the diagnosis had a name. The rule from 1989 had been her father's rule. Her father had given the rule because her mother had been carrying enough. Her mother was, today, telling her that the rule did not belong to today, because the carrying was being redistributed and the daughter could not be a carrier without first being allowed to grieve.

Yvonne cried.

She cried into her hands. She cried with her shoulders shaking. She cried the cry she had been swallowing for a year and a half, the cry she had been swallowing in Walgreens parking lots and in school hallways and in the bathtub at midnight when Carl had fallen asleep, and her mother sat beside her in the passenger seat without touching her, because her mother had read her well enough to know that the touch right now would have been an interruption.

She cried for a long time.

Her mother let her.

When Yvonne finally lifted her head, her mother handed her a tissue from the small pack in her purse. Yvonne took it. She wiped her face. She blew her nose. She put the used tissue in the cupholder.

"Mama."

"Drive me home, baby."

"Yes, Mama."

"And on the way, I want to stop at the Easy Way."

"Mama."

"I want to buy a notebook."

"There is one in the house."

"I want a different one."

"What kind, Mama?"

"A composition book. The black-and-white one. Two of them, in case I need a second."

Yvonne looked at her.

Her mother looked back. The expression was the expression of a woman who had decided, sometime between hearing her diagnosis and walking out of the consultation room, what she was going to do next. Yvonne had not yet been told. Yvonne did not need to be told. Yvonne started the car.

She drove to the Easy Way. She bought two composition books — the marbled cover, the kind every school child in America had carried since 1950 — and a pack of black ballpoint pens.

She drove her mother home.

On the porch, before her mother went inside, her mother put her hand on Yvonne's cheek.

"You are a good daughter, Yvonne Tate-Brooks."

"I am trying, Mama."

"You are good. You are not trying. You are good. The trying is over."

Yvonne kissed her mother's hand, the way she had not kissed it since she was eight years old, and her mother smiled the small private smile that had always been her mother's reward, and her mother went inside.

Yvonne sat in the car at the curb for a long time before she drove away.

She was, in the long sense of the word, not all right. She was also, in a way she had not expected, freer than she had been in eighteen months. The rule from 1989 had been lifted. The diagnosis had a name. The doctor had been a granddaughter of a Mama Funmi. Her mother had bought a notebook.

Whatever was beginning, it had begun.

She started the car. She drove home to her own house, and she pulled into her own driveway, and she sat for one more moment with her hands on the wheel, and she said out loud, to no one and to the One she had been talking to for eighteen months in the Toyota:

Lord. We are in it now. Be with my mother. Be with the carrying. Be with us all.

Then she went inside to make Carl a real lunch, because that was the thing she could do today.