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Personal Essay: The Doctor

Sunlight filtered through West facing windows fills the fourth floor reception area. Sitting side by side we wait our turn. My partner pops up from the chair and strides to the receptionist.
“You’re a Coyotes fan?” he asks.
“Arizona born and love hockey, have to be a Coyotes fan,” she responds with a chuckle.
“At least they finally broke their losing streak,” he comments, his voice a low counterpoint to her higher tones.
Laughing she answers, “And it only took them eleven games before they won one.”
The nurse calls our name. I gather my purse, and move beside him at the reception desk. With a wave we are whisked through the door. My partner steps on the scale and flashes me a grin when the nurse announces his weight. He’s gained twelve pounds, a milestone proving he’s no longer starving himself. The change required an intervention by our daughter, his son, myself, and his primary care doctor. We intervened, he made the change in mindset. He feels stronger, looks healthier.
The nurse drops us off in Exam Room 1. I ask him why he asked the he receptionist about hockey.
“You didn’t notice her sign? It’s next to her name plate and says, “Arizona born, hockey fan.”
The neurologist escorts us from the exam room to his office for a routine visit. He asks my partner questions about the world today. Who is the president now? Who was the one before? What’s the vice president’s name?
I listen closely for how the doctor cues my partner when he stumbles on an answer. During our more than three years of visits I’ve learned a great deal about cueing rather than telling, nudging rather than pushing or fixing. Today the first question has an immediate answer, the second requires a doctor’s hint and the third results in a stumbling but recognizable first name only.
The doctor demonstrates then asked my partner to touch the index finger on his right hand to the thumb. The finger exercise reminds me of a chirping bird created in a shadow play. My partner puts his middle finger to the thumb instead. It takes two corrections and demonstrations before he manages. The left hand completes the task quickly and correctly the first time. The doctor repeats the exercise each time we visit, this was the first time for confusion about the directions, about the names of fingers.
Doctor and patient adjourn to the hallway for ‘the walk.’ My partner looks forward to the walk, a chance to demonstrate how walking every day, practicing a balance several times a day, working out a few times week and consuming enough calories has strengthened his body. The doctor’s properly impressed and congratulates him on improving his flexibility, balance and the quality of his walk.
The session draws to a close. The doctor asks me how I think my partner is doing. I explain the meaning of the weight gain, the way eating enough changed his energy level and his attitude. Life’s better.
He asks my partner if he has questions or anything he wants to add.
“I have something I want to say,” he answers. The silence feels heavy in the room. I realize I’m holding my breath. I know what comes next and release my breath in a silent sigh. He asks the question each time we see the doctor. Each time his question hurts my heart a little more.
“The short-term memory loss is getting worse.” He sounds confused, as though the truth is unbelievable. I understand magical thinking. He believes if he follows directions, takes the medicine, eats enough to live, reads the paper everyday things will turn out okay. He can regain the person he was.
The doctor scoots his chair so he and my partner look directly into each other’s eyes, another skill I’ve learned from him when delivering information I hope will be remembered. “The drugs slow the loss of memory, they can’t stop it or return what you have lost.”
My partner nods, the doctor asks us to set the next appointment for four months. We navigate the hallway to the reception area, set the appointment with the hockey fan. As we climb on the elevator for the four floor drop I comment, “Doctor was impressed with your walk.”
“Yes. He said I’m even swinging my arms naturally when I walk. Something I didn’t do before the drugs and the exercise.””
“This was a good visit, a good report. That’s two in a row. Your primary care doctor was impressed with your weight gain.”
We climb in the car and he comments, “A good report deserves a treat. How about we drive through for ‘elevenses’ a little early.”
“Great idea.”
As we motor from doctor’s office to coffee drive-through I mentally assemble the pieces of the doctor visit into a mosaic. My partner’s charm and kindness in noticing the receptionist’s sign and speaking to her of a subject she enjoys. A moment she could look away from the computer screen and interact with a charming human instead. The doctor’s patience and kindness in the way he answers the same question each visit. The light in my partner’s eyes when convincing me we should have his favorite snack early today, a good report deserves a treat. The mosaic is a way for me to hold the memory of a time when our world held kindness, patience and charm. A moment when the charming man I married used the time spent in a doctor’s waiting room to charm a stranger and possibly brighten her day.
As I order lattes and we drive toward home, I acknowledge I purposefully store memories because he can’t. As the disease steals first short term and then older memories I gather the pieces up in a bundle in my heart. When the memories are gone from him I’ll have them to remind me of the love and life we shared for so many years.

Personal Essay: The Clock

“I don’t know what happened.” Head bowed, my partner’s clenched fists move to cover his eyes, his shoulders slump.
From where I sit, relegated to the sidelines in the examination room, the doctor standing between us, I am unable to reach my partner, to distract with touch. “Honey,” I whisper hoping the endearment will pull his attention to me. His hands drop to his lap, our eyes meet. “Dr. R. told us we can’t get back what’s lost, but you’re doing everything possible to slow the loss and stay healthy and strong.”
He nods and his posture changes, shoulders back a little, chin lifted. “I am.”
“You are, and I am proud of how hard you work. You should be too.”
From the corner of my eye I notice the doctor slide the offending clock picture into the back of the paper file along with the results of the three word test, sit down on his rolling stool, and pick-up a small light. “Let me take a look at your ear,” he comments as he slides the stool to my partner’s left side. The discussion takes a meandering path to the appointment’s conclusion and ends on a positive note.
The clock and three word test is usually given in a primary care setting to determine if a patient is showing early signs of dementia. Three random words are spoken to the patient at the beginning. Then a paper with a circle in the middle is provided with instructions to complete the clock and place the hands at a particular time. When the patient completes the clock, he/she is asked to recall the three words. A result of 1 to 2 word recall with a complete clock including the time means no sign of dementia. Regardless of the number of words recalled, if the clock is incorrect or incomplete, the diagnosis is dementia.
My partner settles into the passenger seat for the ride home. As we pull onto the street he comments, “I don’t know what I was thinking with the clock. I had the twelve and six right and then wrote fifteen for the other numbers. What’s our schedule today?”
“Latte next, power exercise class with your favorite drill instructor, lunch, then your eye appointment.” A silent debate rages inside, do I respond to the clock comment or hope he’s lost interest in the idea and will let it go? As a family we’ve just survived two weeks of unremitting gloom and agonizing over past decisions. Finally, with the help of both his therapist and our daughter he’s walked out of the cloud. Looking for direction, when I stop at the light I glance at his hands where they rest in his lap. His fingers are fidgeting, small random movements. I reach across the seat and take his hand. “You probably just lost focus for a moment when drawing the clock.”
“Yes, you’re probably right.” His hands still. “Sometimes my thoughts wander.” He settles into the seat, shoulders back and hands quiet. “Overall it was good doctor report. I’m stronger. Other than drinking more water and eating less dessert my diet’s good.”
“And you’re working hard to maintain your balance and build muscle tone.” I change the subject, reminding him of his recent visit to the studio where our daughter is the executive producer of a digital show focusing on mental health. Accompanying his daughter to work played a large part in chasing away the cloud. Everyone was kind to him, no raised voices or angry words. These are people working together to create a project they believe in. They were both welcoming and kind.
Eventually I pull into the senior center for his class. Today I choose to wait inside in the library. While he works hard for the “drill instructor” I make a note to call the doctor before the next evaluation appointment. I plan to politely ask that the clock test be removed from his evaluation. I can see no point in a diagnostic tool for something we already know. One thing about conditions involving cognitive decline, while each is different they do not improve. Isn’t the first rule of medicine, do no harm?

Nikki’s Recipe Book: One Pan Chicken Pasta

Nikki’s One Pan Chicken Pasta
When The Palace Hotel is packed there is not much time for a home cooked meal. This one pan chicken pasta is a quick and easy delicious dinner.

Ingredients
6 boneless skinless chicken thighs – cut into12 pieces – pat dry
2 tsp. olive oil
Salt & pepper
1 cup chopped ham (not deli ham) cut into 1 inch pieces
¼ cup chopped onion
½ cup chopped celery
1 15 oz can diced tomatoes (undrained)
1 ½ cups chicken broth warmed
2 cups dry pasta (ie elbows, penne, etc.)
1 cup fresh broccoli florets
1 tsp chopped green onion – for garnish

1.      Heat a large, deep skillet over medium heat. Add olive oil and tilt pan to spread.

2.      When olive oil is hot, place chicken in pan and sprinkle with salt and pepper.

3.      Turn after 5 minutes, sprinkle with salt and pepper. Brown for 5 minutes more

4.      Remove chicken to a bowl and cover to keep warm

5.      Decrease heat slightly

6.      Add celery and onion to pan, stir and cook until tender.

7.      Add ham to pan, stir and cook about 2 minutes

8.      Add tomatoes and broth. Heat to simmer.

9.      Stir in pasta, return chicken to pan and cuddle it with the pasta.

10.   Partially cover pan and cook 15 minutes.

11.   Move pasta and chicken around so pasta is submerged

12.   Place broccoli florets carefully on top of mixture.

13.   Cover and cook 10-15 minutes more until chicken, pasta and broccoli are done.

14.   Serve, sprinkling green onion over each serving.

 

Note: type of pasta and size of thighs will determine cooking time