Secrets and Lies

Imagine you're a doctor whose patient has a rare but deadly hereditary illness which will be passed on to their children. Until your diagnosis, the patient and his family had never even heard of the illness, but it's something so terrible that the patient makes you promise not to tell his pregnant daughter in case the news drives her to suicide.
When the daughter does find out she may inherit this illness, she tries to sue you and the health authority, saying that she would have had an abortion if she'd known.
Sounds like a slightly far fetched plot from one of those TV hospital dramas, doesn't it. Unfortunately not.
This sad story has been in the news this week. Believe me, the circumstances might seem extreme but the basic story line is just a variation on a well-known theme for families affected by Huntington's.
If you have any kind of close knowledge of HD you will probably nod in sympathy but not feel at all surprised. Because - what would you do?

I wonder if you can begin to imagine the secrets and lies and the pussyfooting around that go on in a family where someone has Huntington's. It's not like any other illness; if someone in the family has it, then someone else will too, and the next generation - no buts nor ifs, it's just a question of who, and when. Not everyone can handle it. There's a dramatically higher rate of suicide than with other long term medical or neurological conditions, while suicidal thoughts increase exponentially for people expecting a positive diagnosis. No-one wants to rock that boat for someone they love. It can be easier not to talk about it, just bury your suspicions and pretend it's not happening, and many families do; I'm sorry to say that ours was one of them.

That's Mum, Dad and Nick in the picture - Mum in the early days of her illness but pre-diagnosis.

She'd been gone a good fifteen years or more when my brother started getting into financial trouble and couldn't seem to pick up a cup without dropping it, and had pranged his car yet again. At first we didn't want to believe it but we watched...watched the minute little jumps of his leg next to mine on the settee and the repetitive kick of his foot, heard the odd new catch in his voice. We couldn't be sure it was the onset of Huntington's but the signs were all there. I thought it but I couldn't voice it, and when my dad and I finally did say it out loud to each other we both agreed we were afraid to say anything in case it tipped Nick over the edge.
He was so low at the time and had always said that if he ever thought he was showing early signs of the dreaded illness, he would jump off a bridge. Or drive his car into a wall, late at night. He had said all along that he would kill himself rather than end up like our mum. What were we to do, call his bluff? So we watched, and waited, and read the books and did our research but didn't say anything to the person we loved so much because we were so afraid of what he might do. I hated myself for it but also knew just how stubborn Nick could be, and what a capacity he had for self destruction.
We all lived in different cities apart from each other but we were all tiptoeing around the same elephant in the room for three whole years.

The saddest thing was that when Nick finally put two and two together and acknowledged to himself what was happening, he felt relief. And now he knew, he didn't want to kill himself, he wanted to live. But he also wondered why, if the signs had been there, no-one had said anything.
And I had to tell him that I had been afraid of his mental state and just hadn't dared to broach what was, either way, a death sentence.

Now Nick is gone, and with no HD marker in my DNA to pass on to my son, I've got no direct line to Huntington's, but it still affects everything. I hear stories like this in the news and feel like a Greek chorus commenting from the wings, wondering what I would have done in that situation, or what I could have, should have done differently with Nick. His children are growing up, and at risk. They've seen what happened to their dad and read this blog, but they also need to get on with their lives and studies and their own hopes and dreams, and for a few years concentrate on those.

But what should families say to each other? How do we talk about this most difficult of subjects? I still don't know how we would have done things differently with Nick in the circumstances, but if you know you have Huntington's in your family then my belief is that you have to say something.
It's not the absolute end of the road. None of us wish an illness like that for ourselves or our loved ones, but gene positive or no, we should live the fullest life we can with the health and resources we've got, and if you do know you're going to develop the illness then now is the time to just carpe the bejaysus out of the blessed diem. But that's easy for me to say, isn't it?