Wednesday, September 6

The Only Show in Town

The more I see doctors the more highly I think of folk healers.

I haven't written about my mother's dementia much, in part because it's grindingly mundane--she doesn't steal cars or knock over convenience stores, which is how I plan to use mine--and in part because it's painful and sad and tough to get much of a lesson from, unless "you need to be patient" is a lesson you'd enjoy hearing over and over, in which case you should take up fishing.

But yesterday was the long-awaitied meeting with the docs at the Center on Aging where she took a three-hour battery of tests two weeks ago. My sister and I had pinned some hopes on their findings soothing the periodic torrents over finances and living arrangements we've been riding out for nearly four months now.

So there's good news and bad news. Only it's the same news.

We're ushered into a conference room with the doctor and a replacement for the vacationing social worker, and immediately I'm pissed because there should be two doctors--a geriatric specialist and a neurologist--and I'm pretty sure I know which one we're getting (the lower-cost-per-billing-hour one) and which one we really need to talk to (the other one). And the, yes, geriatric physician opens with a little patter and a here's-what-I'll-cover speech, then she starts in on Mom's physical ailments, which are not great, really. She's got arthritis; both ankles and one knee trouble her especially, and they prescribe some physical therapy. And here's a handout on Kegel exercises for incontinence....

Okay, let's hold it just a minute. This is the point at which, if I behaved the way the little voices tell me to rather than hiding behind a thin veneer of civility (it's peeling in a few places, BTW) I jump up out of my purple-upholstered conference-room chair and say, in a voice that probably gets the receptionist to dial 911, "This woman is 80 years old! I don't know how long she's been wetting the bed--she never put that in the Xmas cards--but I know it's gone on for a while, and I know she's a product of the American medical factory system, because I'm the one who refills her prescriptions, and because for the last ten years her allopathic adventures, and those of her late husband, in the great gray plains of southern Florida constitute 90% of the conversations we have had in that period, and you tell me that in all that time no one ever fucking mentioned Kegel exercises to her?"

Naturally, I just kept my seat and kept staring at the doc.

Time to move on to the main event--everything's showbiz, ain't it?--her mental diminution. Out comes everyone's copy of a chart and a little soft-shoe about what the doctor who isn't there, but should be, was doing with All Those Tests. And I've got my graph cocked sideways, trying to read with one eye the categories on the bottom of the chart because they've been printed at a 90ยบ angle to the rest of the thing, when the doctor announces that they found neither Alzheimer's nor dementia.

Okay, "stunned" is far to strong a word--for me, not for my sister, for whom it's an understatement--because I understood there could be many another possible explanation. I'm surprised to hear "dementia" fly out the window, because, well, because she's demented. At least in the common sense. And now the doctor's got her hands up, palms out, indicating first where "normal" is located, then where "dementia" falls, and finally the playground in the middle where, she says, Mom is now in residence. We don't know, she says--outnumbering those of us on the opposite side of the table via pronoun--whether she'll slide to the far end of the scale or not. Some do and some don't. In answer to my sister's rather desperate challenge, she tells us that this is a diagnosis made of conjecture, not fact.

My sister's face is, briefly, flashing different colors like a cuttlefish, and she may be developing a tic. And the doctor winds up and lets fly: we think this is all a result of your recent bereavement, we're taking you off the Alzeheimer's medication and putting you on Zoloft, and we're cutting your thyroid medicine in half because that might be part of it.

Ah. That's great news, doc. That's great news, except. I'm thrilled to death you think this is something which might be curable as opposed to something which is not. But I'm thinking that if we bet our respective salaries on the outcome you can shake hands with your new landlord. And the other part is this: I know that the elderly woman to my left here has heard exactly what the dog in that Larsen cartoon hears: Blah blah blah NO ALZHEIMER'S blah blah.

And she did, of course. In fairness, what they did find was moderate-to-severe impairment on almost every component of her cognitive processes, especially so in the matter of managing multi-layered tasks (their examples, tellingly, were driving a car and cooking, neither of which Mom now does, but which are the sort of tasks that might bring a family to that conference room in the first place). But none of that was going to register with Mom. NO ALZHEIMER'S. I don't have that. I told you so.

Let's pause another time. I've used "Alzheimer's" or "dementia" to describe what was going on with my mother, but not in a diagnostic sense, just for ease of explanation. I had to defend myself to her a couple dozen times when she accused me of "saying she has that" (it was always "that"). I had to lecture my sister about the difference between looking up a prescription medication online and understanding what's going on with a patient. I cringed when her lawyer told her she had to start living with the fact. We did not know. Even if we did, what we knew was a word. The popular imagination is always long on imagining. And there was no bigger problem in all that than how my Mom took it. The A-word is about as welcome in retirement communities as a condom dispenser in the Pope's washroom, but it's only one of about 150 forms of dementia, and that's just for starters.

But then NO ALZHEIMER'S. This unleashed a veritable running faucet of improv from Mom, who kept babbling as the doctor went through the rest of the categories on the chart, impervious. It had the makings of a fine comic scene, the doc explaining how the woman next to me was just understandably depressed and anxious, while the subject babbled away about checkbooks and snow shovels. Then the doctor exited so the social worker could go about the real-world tasks of convincing us what we needed to do about it (a five-day-a-week grief counseling marathon Mom nixed), which naturally involved actually trying to talk to the patient now, something which was now next to impossible because she was off in They Won't Let Me Have Credit Cards land. The social worker, I think, finally began to get it, but of course she's just filling-in, and no way is that closing episode gonna get reported back to the MDeities.

Again, don't get me wrong. I trust the judgment. I accept that things are not always worked out on the first attempt, in no small part because we work from the easiest and most likely assumptions. I hope that the change in medication is the answer, and that we get our Mom back some day soon. And I know that the road ahead is just a boulder field and I can't expect anything better. But still, there's this distinct impression that what you get from the medical profession these days is the same thing you get at The Gap, rows of shelves full of ready-to-wears, neatly sized, except that you have to keep trying things on to find something that nearly fits. And so we shall.


the bunny said...

This is brilliant:
"But still, there's this distinct impression that what you get from the medical profession these days is the same thing you get at The Gap, rows of shelves full of ready-to-wears, neatly sized, except that you have to keep trying things on to find something that nearly fits."

I won't go on to tell you how it took me thirty-five years to find a doctor to treat my chronic illness correctly instead of telling me that I'm depressed and writing another "happy pill" prescription. (Of course, I was depressed, my brain was broken and overdosing on neurotransmitters just made it worse.)
When the patient is someone else, you're really boned. Add to it the drama of your sister's marriage and I can only pray that you have enough energy to post and keep us updated.
How's the garden?

KathyR said...

Cripes. Conjecture is right.

Gad. Maybe I should be glad that my parents dropped dead in their 70s while still sharp. Gives me a sick kind of hope for myself...

D. Sidhe said...

Oh, god. You know, once they've established "moderate to severe cognitive impairment", they have an actual duty to explain things in a way that the moderately to severely cognitively impaired person understands that's what's going on. And they damned well ought to know how much emphasis older people place on the word "Alzheimer's".

I'm not as sanguine about the competence of neurologists, in particular their professional manners, but the two people you saw yesterday clearly dropped the ball in a spectacular way.

Any chance of talking to the neurologist in the future? It probably won't help much with your mom, since she now feels she's been confirmed as totally fine, but it might at least help with the medical records, if someone there knows what's going on.

Hang in there, Doghouse. I can't promise it'll get better, but hell, what else can you do?

Houston said...

Good luck.

The nearest association I can make that describes how I see seniors exploited by the geriatric medical industry is Soilent Green.

It begins one pill at a time. Presently I'm negotiating with all of my personalities about the details, but I do not want to live forever. The idea of my body being warehoused for the benefit of profit, and my diaper being changed by someone making barely minimum wage and whose first language will not be English, so all of the conversations I'll be hearing will be unintelligible to me. Sounds like fun.

(This comment may never see cyberspace. You should see the fucking threshold word: fjqwvqdt in wiggly letters. Wish me luck.

It worked. One more drink though ...

Anthony Cartouche said...

Christ almighty, Doghouse, but you sure know how to write.

I hope things get better for you and your family. My own mother, I'm guessing, is about two or three years away from the same kind of situation your mom is dealing with. When the time comes, if it comes, I hope to be able to deal with her with as much grace and patience and, yes, wisdom, as you're currently exhibiting.

scott said...

I hope you gain some benefit from writing about this. Everyone who reads it certainly does.