Two patients in addition to those scheduled have arrived in the last half hour. The department of Neurology allocates thirty minutes for people returning for a follow-up appointment. New patients are granted an entire hour. The scheduling error has the doctor in a mildly irritated state. The nurse coordinator pokes her head in the room indicating two patients are competing for his attention for the next appointment. The double booking was done by the university secretarial staff, who was unaware of the length of time given to the doctor’s patients.
The new patient, who has waited twenty-five minutes arrives with his grand-daughter. The patient is Greek. His language, and his parkinsonism make his speech difficult to understand. The black-haired girl comes along to translate his words. She begins speaking as soon as they enter the small space. Her grandfather has been cared for by his regular doctor. When his problems became more severe the family sought an appointment with the movement disorder faculty. The doctor explains his new patients normally receive an hour, but today’s situation is unusual as two others are waiting to see him as well. The doctor shakes off his aggravation with the wave of a hand and asks, “What brings you to the movement disorder clinic this afternoon?”
The young woman gazes at him, stating, ‘Yes, but this isn’t our problem. We have insurance and pay for our time.’ The doctor nods and sits as the grandfather speaks Greek in a whispery voice. The girl bends in towards him, translating his words.
The main problem is he gets stuck every night. Nodding, the doctor scans the paperwork. Medications are listed, as well as the dose. What does he mean by stuck? The doctor explains patients with Parkinson’s disease suffer from freezing episodes. The daughter translates, he has episodes of freezing but that’s not his current concern. His right leg gets stuck inward and it occurs in the middle of the night while lying in bed. The doctor nods and comes around the desk. He tells the granddaughter he must check the rigidity of the man’s muscles, to see how well the medication is working. As he moves the limbs of the bent man in the chair, he speaks about three common ailments people with PD tend to suffer from.
Tremor is the initial symptom in many patients, and he illustrates moving his hand in a fine jiggle. The girl nods, she’s seen the tremor. The left foot of her grandfather also jiggles. Dyskinesia. He repeats the word when the girl looks at him questioning. The word describes the somewhat writhing-like movements patient’s endure. Occurring after several years of treatment with levodopa, the unusual actions are caused by medication, a side effect. The grandfather shakes his head. What the physician pantomimes is not his problem. He stands carefully, pushing off the arm rests of the chair, then turns his right leg inward so the toes of his foot meet the instep of his left side. Standing, he speaks Greek and makes a face indicating with his hands the pain he experiences. Nodding at the old man, the doctor comments, “A lot of pain.”
“Much pain, too much” and he retakes his seat.
“Dystonia.” Explaining that it’s a muscle cramp that forces the limb into unusual sustained postures. The doctor concedes they can be quite painful, and afterward leave the tissue sore. He thinks if her grandfather switches his evening dose of medication to a sustained release variety, he may find some relief from the episodes. The girl translates this and the man gives a thumb up.