written by Kate O’Neill
The doctor comments on the number of people gathered along the wall and sets the paper cup of coffee on the desk. Not wanting to begin treatment with levodopa, as the patient was forty-two years of age, the doctor recommended a dopamine agonist. It’s been almost two and a half years since that initial diagnosis. In the seat inside small room, the patient allows the medical students and visiting Chinese physicians to attend his examination.
The doctor sinks into his chair as he asks the man how he is, and what his major concerns are. He is tall and slim and flashes a smile of brilliant white teeth. His dark hair is flecked with grey. Wearing a business suit and tie, he concedes he still hasn’t told the people he works with. The doctor nods, supporting his decision.
He worries his mind is not as sharp as it was. Representing a client in court, he objected to the treatment given to his client by the prosecutor. Thinking the other attorney was a jerk, he approached the judge and his mind went blank. Failing to remember what he wanted to say, he turned away, excusing himself. Other episodes of spontaneous voids- like holes in cheese, have happened before. In earlier years they never occurred while he was at work. He fears such instances may compromise his clients, his reputation and ultimately his earning potential.
Nodding, the doctor states if that is his primary concern it’s worth exploring. A colleague performs neuropsychological testing. She may be able to determine whether he has any underlying cognitive deficits, and if they conform to any known pattern- Alzheimer’s disease or dementia with Lewy bodies. . . Some patients have both Alzheimer’s disease and PD. Even though we try our best to attribute all the symptoms to one disease, and here he cited his mentors favorite quote: “God may plague you with as many illnesses as he cares too.” When the patient agrees without enthusiasm, the doctor mentions many well- known figures have had PD, and they’ve managed to maintain their positions and leave their mark on history. Janet Reno, for instance was able to be a competent attorney general. The Pope traveled the world proselytizing for the Catholic Church. . .Francisco Franco and Adolf Hitler both contended with Parkinson’s disease, but the terrible suffering they caused could not be attributed to the disease.
The doctor volunteers the patient may try relying more on junior staff. By avoiding center stage, he would diminish the chance of finding himself caught without words. The patient gazes at his hands briefly and agrees. He thought he might be able to get by for another ten years before making changes in the structure of his work. Presently, he employs no junior staff.
The doctor encourages him to continue a physical regimen of exercise. He gives him a referral for cognitive testing and reiterates making small changes to decrease daily stress.