Paying for the doctor’s time

She has short white hair and bright blue eyes. The doctor comments she doesn’t look very parkinsonian, and she smiles and says that’s good. He refreshes his memory. She was in the same seat seven months ago. She was stage one then, some mild rigidity in her left wrist and elbow, no other symptoms. Taking hefty doses of coenzyme Q10 and Azilect, or rasagiline, an MAOB inhibitor to hopefully slow progression of the illness. She doesn’t need the heavy medication yet. The model patient, she does all the right things; exercising- playing ping pong, eating a diet rich in omega three fatty acids, taking agents that show some evidence of stalling the disease, and practicing Tai- Chi.

As she speaks the doctor comments her voice volume is low. Allergies. She’s had them since she was young, and they’ve made her voice raspy. The physician comments people with PD can become quite whispery in the way they speak, he turns a bit towards the visiting Chinese physician and expounds; the reason is the intercostal muscles between the ribs as well as the diaphragm become rigid and it becomes harder for patients to expand their chests, with a full deep breath. Consequently, they often breathe rather shallowly, lessening the movements of the chest wall. He has both hands on his ribs, demonstrating the effect of rigidity on inspiration.

The doctor from China takes notes in her small notebook. The doctor comments her English has improved in the days she’s been in the clinic, she smiles and thanks him, loudly.

The patient has requested the last fifteen minutes to herself. The visiting Chinese doctor and I exit the office. Later the physician notes the patient feels anxious about others observing her. Nothing she conveys to him is inherently personal. She pays for the time, she doesn’t have to share the experience.

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