by Kate O’Neill

She pushes her mother in the wheelchair into the confines of the small examination room.  The daughter speaks as soon as her weight hits the front of the chair.  She places one hand on the desk in front of the doctor, who gazes up at her from the forms in front of him.  Explaining the appointment was her idea, her mother is visiting from Peru and rarely sees a physician.  The mother has become increasingly slower over the last months; she was amazed at how she’s changed.  Ages ago she was told her mother had Parkinson’s disease.  The old woman in the chair shakes her head.  All medications make her ill, the daughter explains.  She doesn’t want to take any pills.

The physician faces the daughter, shaking his head.  Parkinson’s disease has no cure.  Treatment is directed solely to relieve the symptoms; slowness, rigidity and sometimes a tremor.  Most treatments are in the form of medications;  by supplying the brain with the neurotransmitter it lacks patients are able to move in a way they had previously. The daughter nods and admits her mother refuses to take any medications.  She asks about any other things they might do- surgery perhaps?  The doctor explains surgery is effective for patients suffering from dyskinesia; the random writhing movements patients are unable to control and come as a side effect from using dopamine for between several years.  The white-haired woman in the wheelchair shakes her head exclaiming something in Spanish.  Her voice is soft and whispery and the bend in her back makes her voice address lap.

The doctor spreads his hands and states, ‘There’s nothing I can do for you.  Parkinson’s disease is managed with medications; we address the symptoms.  They are helpful for many patients, but your mother doesn’t seem to want to try them.’  The daughter stares across the table at the physician and silently looks at her mother.  The hunched woman crunches a white tissue in her gnarled hands and the daughter nods and stands.  The nurse comes through the door with a folder, and the doctor shakes his head stating there is no charge for this appointment, he can do nothing for the patient.  The daughter takes her mother’s wheelchair and nods to the nurse, her eyes on the floor in front of her.


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