Patient Choices

It’s been eight years since her diagnosis of PD. Her back is beginning to round downwards and she sticks her head forward, tilting her eyes up to make contact with the doctor’s face. In contrast, her daughter sits upright, her dark hair graying at the temples.

The doctor tells her she lives in a different age. People with Parkinson’s disease are not relegated to the corner chair where their silence is less noticeable. Sinemet will allow her to feel looser, breathe easier, her limbs would be less rigid, and her movements would increase in speed. Her blue eyes stare at him, not blinking. She knows all the words he will say, she has heard them all before, as have her family. She slowly raises her index finger upward, and the tremor evident when at rest disappears. Her voice is just audible. Those present in the room seem to draw themselves forward to hear her.

“No medicines. Not today.” She slowly motions with her bent finger back and forth and the doctor sighs. He addresses the daughter, asking what concerns she has. The daughter looks at her mother before speaking, turning her torso to face her mother as she reports,

“Mother fell several weeks ago. Fortunately, there were objects that broke her fall… but she was badly bruised and spent several hours on the floor, before someone arrived home.”

The doctor looks over at his previous notes and asks about the walker. The daughter shakes her head. She had been using the walker earlier in the year, but gave it up when she no longer felt the urge to walk down the street. Now she only uses it when they have to go out, mostly to visit doctors. Inside the house, she prefers to use the furniture, walls and cabinetry to steady herself when she moves around. Her daughter lifts the hem of her mother’s skirt, showing the bruise that remains, extending down her pale calf. The doctor nods and comments she should really be using a wheelchair, and asks whether their home might accommodate the device. The daughter looks indecisive, and gazes at her mother asking whether she would use a wheelchair. The mother’s eyes meet hers and she wags her head in short slow, abbreviated motions.

The doctor continues asking all the questions regard sleep, eating, bowel and bladder function. He rises from behind his desk and comes to stand in front of the small bent woman. He takes her slender arm and attempts to move it to and fro, but there is no movement available in her arm muscles. He wonders aloud how she is able to walk, and the daughter notes it took them some time to make it to the clinic from the valet downstairs. He asks her to gaze at his finger, which he holds in front of her face, and then moves it to the side. Her eyes make short staccato motions as they attempt to keep up with the moving digit of the physician.

He returns to his chair without speaking and gazes into the computer screen, noting she has lost seven pounds since her last appointment, six months prior. He directs his gaze at her bent head, which she has turned towards her chest and he comments it is her right to refuse medication, though he knows it will help her. He stands and extends his hand to the daughter, who stands and thanks him.

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