Two Cases

The fabric of her black trousers drapes over the angles of her thin thighs. The nurse did not weigh her today. She is known to have her blood pressure drop, and if she stands, she’s likely to pass out. Her torso bends forwards making a large hump form in the middle of her back. The caregiver urges her to sit upright in the chair, and holds her arm on the arm rest as the doctor summarizes her medical history, and how he thinks he can help her today.

He had thought she suffered from a variant of Parkinson’s disease, multiple system atrophy, though he is unsure whether she truly fits the diagnosis’ criteria. An MRI would enlighten him, but would probably not change her medical treatment; which is largely to keep her as comfortable and content as possible. To do this he would like to increase the Seroquel she takes at night, to ensure she sleeps for several hours without waking. Her left leg no longer moves and has to be placed on the footrest of the wheelchair. Her left hand has a resting tremor, and no reflexes can be coaxed from her. She is ninety- two and her family does not want to her to have a feeding tube placed, and her caregiver says she eats well.

From behind his desk, the physician asks the caregiver whether the patient ever speaks, and she nods and confides she tends to be bossy. The woman caretaker wears a short sleeve shirt exposing the tattooed calligraphy on both her arms. She has milk chocolate brown skin and long twisted dreadlocks worn away from her face. When the patient’s stringy hair falls over her face she brushes it back over one ear.

The second patient is tall, brown- haired and looms over the doctor as she strides into the small office and sits in the far chair. Her half- sister has accompanied her today and has gone to search for the patient’s purse, which hangs from the nurse’s shoulder, who takes the patient’s blood pressure. The patient comments her sister is probably lost, and the nurse wearing wine- colored scrubs, comments she will go look for her. She hands a large chrome and leather purse to the patient and leaves the room rolling equipment with her.

While the patient and doctor speak about her illness the patient’s face moves spontaneously. She grimaces slightly and extends her head backwards. She takes the movements in stride as the doctor comments her face seems to be moving more than formerly, and the patient adds she has noticed more movements of her face and f

When having a pedicure, the man at her feet had problems; her feet, ‘flapped around’. Switching the subject, she confides she was upset the staff at the VA failed to inform her that her husband, would not die right away after being diagnosed with rapidly progressive ALS. She began planning his funeral. She planned the funeral for fourteen months before someone enlightened her he would probably outlive her.

The half- sister who is tanned, slender and six years older appears, smiling. Her hair is cropped short and she wears a bright pink bow on the right side of her curly head. She explains she and her sister had different fathers, though they once all lived in Detroit. It was a different city then. The patient tells us she could take the bus all day. There was an amusement park and a theater; it was a proud city on the lake and a river.

The physician recommends speech therapy and Risperdal which will dampen the patient’s chorea, and she seems amenable to both. The physician inquires if the nurse coordinator has any cards the patient might carry, which say she has Huntington’s Disease- explaining her staggering and other symptoms, if she is stopped by the police or worried neighbors while walking her four dogs.

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