Lying Awake

The elevator is full and I step in as the doors close behind me.  The elevator opens on both sides surprising the people in front when the carriage stops.  It’s the third floor.  People step out, some gazing expectantly looking for signs to indicate the direction of the neurology clinic.  The woman in front of me carries her purse nestled beneath an arm.  She walks with little natural sway moving her legs with the slightest rotation in her hips.

She recognizes me from the elevator and allows me to sit in on her first visit to the doctor.  She’s a snowbird; in Florida to escape the snows of the Minnesota winter.  Divorced with grown children, this is the first year she’s heeded her desire to escape the cold North winds.  The clinic is far, but she has all day.  She’s renting an RV in a community called Southern Trails, to the east of the city.  The neighborhood of golf carts and plastic patio furniture has a pool and regular events for residents.  So far, she’s satisfied with the arrangement.

In St. Paul she sees her family doctor who prescribed Sinemet for her Parkinson’s disease.  Because her insurance would cover it, she made an appointment to see a movement disorder specialist to discover if there is something else she might do to improve her condition.  From across his desk, the doctor scans her paperwork, noting the years since her diagnosis, then inquires, ‘What would you say gives you the most difficulty?  How is your sleeping, swallowing, speaking?  Have you ever fallen?’

She brushes her hair from her cheek slowly, and smiles then gazes up the wall past the doctor.  ‘No I haven’t fallen, though I thought I might.  But I’ve never slept well.  Even when I was a girl, sleeping with my sisters, I would listen to them breathing or snoring and wonder why I lay there awake.’

‘How about physical activity?  How active are you?  I encourage all my patients to exercise regularly, every day for at least twenty minutes.  Coming out from behind the desk the physician asks the patient to step up onto the examination table.  She sets the bag on the floor and stands before taking small steps in a circle towards the table in back of the room.  While asking the woman to gaze at his nose and follow his finger as he moves it sideways, he notes her eye movements take small staccato steps, rather than flowing.  Explaining to the medical student at his side, he notes Parkinson’s disease affects all the muscles in the body, even the small muscles governing the eyes.  While he manipulates the wrist of the patient and then her elbow, he asks her to shrug and her shoulders barely rise.  She walks down the hallway as the doctor and medical student watch; no arm swing, small shuffling feet, she bends forward and returns to her seat.

In the room again, with the door closed the doctor gives her his impression.  She is slightly under medicated and would benefit from an agent that would extend the effects of Sinemet, either that or slightly increase her dosage.  If she is opposed to increasing her medications she could try abstaining from proteins during her daylight meals and saving her proteins for dinner, when she can anticipate feeling slower.  He explains Parkinson’s disease is an illness treated solely for its symptoms.  Researchers have yet to come upon an agent to slow progression, or reverse the die off of dopaminergic cells.  If sleep is her major concern he would recommend Seroquel, in a small dose.  She nods in affirmation.  ‘If you can make me sleep, I would be grateful.’

Written by Kate O’Neill

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