The examination room reeks of cat pee, the residual aroma from the previous patient who lives  alone with many cats but is too incapacitated to maintain hygiene.   Her very clothing was impregnated with cat urine   Now that the cat lady had gone, the nurse stands by the door waving it open and closed while the aroma inside weakens.  Examination rooms are small cubicles without windows.  The fluorescent lighting makes most people appear slightly green.  The next patient and her spouse find their seats in front of the desk as the physician apologizes for the smell.  The patient shakes her head, she can’t smell, but her spouse can and he smiles.

She’s called every other day for several weeks.  The nurse coordinator gave her a last minute appointment, when she thought a face to face meeting with the doctor might diminish her calls.  There are many concerns she’s eager to convey but her dyskinesias send her head and arms into motion.  The doctor puts up a hand and asks her to relax.  The next thirty minutes belongs to her.  Her shoulders seem to drop.  In front of him, the doctor has the handwritten notes of every call.  He spaces them out on the desk and tells the patient, every time she calls the nurse coordinator tracks him down and expounds on her latest complaint.  He looks at her meeting her gaze and she nods listening.

‘When the shower is too hot, what do you do?  You turn down the hot water.  I cannot turn the water for you.  You must do it yourself.  If you have too much dyskinesia, cut back on the Sinemet.  Take half a pill instead of the entire dose.  You do not have to call in for permission, simply do what you need to do…’

The  husband wears a green golf shirt and is tall and pale.  He interjects she’s reluctant to take the Seroquel at night.  She prefers to use the toilet when she wakes, and calls to him to help her out of bed. Her plea for help wakes him so neither of them sleep continuously through the night.

His tone of voice changes as he strongly explains sleeping six hours or so makes a difference in quality of life.  Fragmented sleep makes daytime less enjoyable; fatigue follows and she is apt to nap.  Her sleep cycle degenerates further, and she may begin to hallucinate, dreaming while she is actually awake.  Seroquel will allow her to rest.  She should not wake, and if she does she should take another half-pill, until she sleeps for six hours without waking.  If she feels anxious during the day, she may take a quarter of a pill.

She speaks then, not hindered by his tone.  Worried the patch isn’t work properly, she complains the square piece lacks sufficient stickiness to adhere to her skin.

‘Are you holding it on for at least thirty seconds?  The directions say it must be at least that long.  You can’t expect to take it off, either.  Put it on after you shower.  Have your husband help you.’

Having stated her problems and had the physician’s attention, she’s relieved.  The dyskinesias are gone.  She thanks him as she stands.  He comes around the desk and she hugs him spontaneously, while her spouse stands with his hand on the doorknob.

written by Kate O’Neill



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