She says she’s a freelance writer. Woman’s Day recently published an article she wrote about care giving. She smiles and says it’s ironic, she never thought her own spouse would be the caregiver. The man is classically handsome, tall with dark hair and an easy smile. He pats her hand, when she divulges this information. Her dark hair is pulled back into a loose ponytail that hangs forward over her shoulder. The toes of her black shoes are so pointy, they cannot possibly house a foot. Talkative and anxious, she engages the medical student and me while the doctor takes an emergency call from another patient. The man by her side is silent, though he sits with a pleasant aspect on his face and demeanor.

Outside the doctor converses on the phone, we hear his words, ‘The only real emergencies in Parkinson’s disease are falls leading to fractures which should be handled in the emergency room . . . No. Take the dissolvable medication and lie down. Turn on soothing music. Listen to yourself breathing, inhale to the count of four, hold for three seconds and exhale to the count of four. NO. I’m in clinic, I have to go. Call me in an hour.’

The doctor enters, apologizing for his lateness. The patient begins talking about the tremor in her right hand, and the doctor sits, scanning the forms she’s filled in, and interrupts her with an upright finger. He asks for a moment to look over her paperwork. Though he begins questioning her immediately, ‘So you really are quite healthy . . .You exercise, you eat well, your blood pressure and blood work are normal. You’re fifty-five?’

The doctor smiles, ‘That would make this early onset Parkinson’s, if that is indeed what you have.’ He asks what symptoms she has and when they began. It’s been three months since she noticed the jiggling in her right hand. She was using the keyboard, typing when she felt her right hand acted more like her left, less useful. A subtle change, she admits, but she saw the tremor in the morning when folding laundry.

The doctor asks her to sit on the examination table. He takes her right arm in his hand and flexes the joint at the elbow. Moving it back and forth, he takes the other side and makes the same motion. He isn’t sure. He returns to her right side and states there may be some slight rigidity there, but it surely isn’t definite. Performing the other tasks, he asks her to return to her seat.

At his desk he says her symptoms, specifically the feeling her right hand was performing like her non-dominant side, sounds like very early Parkinson’s disease, but she lacks any of the cardinal symptoms- slowness, rigidity and resting tremor. He encourages her to maintain her exercise regimen, as that may be helping to put off the full onset of the illness. She may be very sensitive to alterations in her body and be able to detect early changes, though she may not manifest the illness at all. He would like to continue watching her, and asks her to return in six months. She’s content with his appraisal and shakes his hand before leaving.


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