Recently I’ve had several new followers and I feel compelled to start writing again to earn that follow-ship. Yes, I clearly just made up that word.
I have no excuse for not writing other than the fact that I work two jobs, have 3 kids and elderly parents and am currently having the life sucked out of me by all of that. But really, I shouldn’t complain. My immediate circle – my kids and my husband – are healthy and generally pretty happy, I like to think. My daughter is thrilled to be making slime to share and trade with her friends. My almost-7 year old has learned how to ride his bike with no training wheels and has started swimming lessons. And the 4.5 year old is just … well, he’s happy tumbling around and being himself.
I, however, am overwhelmed. 950 patients in my family practice, a second job at a private health care clinic which is more demanding that I thought it would be, and an elderly declining father who has be move into a retirement facility because he is “too healthy” for a government long-term-care facility but not safe enough to continue to stay at home. The decision to move him comes right before his 83rd birthday and 50th (FIFTY YEARS!) wedding anniversary. It is not how I thought we’d be celebrating.
And to top it all off, I feel like I am not present for my kids enough and when I am I am often tired, frustrated and giving them shit for being kids.
Being a doctor who is also a daughter has its privileges. I can navigate the system on behalf of my parents. I can advocate on their behalf and ask for tests and referrals. I can attend appointments and understand what is being discussed. I can find out results before they do.
It is fraught with disadvantage as well. With their permission, I am privy to tests results before they are. I understand what their diagnoses mean and if I don’t, I know trusted resources to educate myself. I understand in general terms what “illness trajectory” means. Specifically, I have seen what illness trajectories look like. I also know what the end may look like.
I am the one my family looks to for advice and comfort. I have to be strong and composed. I can’t let them see that I’m worried.
A person’s memory is everything, really. Memory is identity. It’s you.
-STEPHEN KING, Duma Key
Another doctor’s appointment with my dad. I got up at the crack of dawn just as the baby was waking up for his bottle. My dad’s appointment was at a downtown hospital early this morning so I had to hustle to get there on time. They had already started with the nurse when I arrived. She was just starting to get his history as I sat down on the exam room table. Looking around it was your typical hospital office/exam room. I noted the clock on the wall and stared at it for a second, realizing it wasn’t working; I checked my phone to confirm the time. Dad was busy talking away with the nurse. My eyes kept returning to the clock; probably five minutes elapsed before I realized why I was drawn to the clock.
By this point the nurse was starting the memory testing with my dad so while I was trying to pay close attention to how he was doing and mentally trying to remember how to score the test as he did it, several minutes elapsed and I noticed something else about this clock.
It was very surreal. I wish I could describe the thought processes my brain went through when it was trying to reconcile what I was seeing with what I know about how a clock should look and act. When it all came together I almost laughed out loud but I restrained myself as at this point in the interview, my dad was asked to draw a face of a clock and put the hands of the clock on to show a specific time – 10 minutes after 11.
The clock drawing test is a brief but highly informative tool that physicians and psychologists use to test an individual’s executive functioning. It is a very easy test to administer and is part of the screening tests used to diagnose, or exclude, a diagnosis of dementia. My heart skipped a beat when I watched my father do it. He drew the circle, placed the numbers and the hands of the clock correctly, without missing a beat. I’m pretty sure I breathed a sigh of relief when he was done. In fact, most of his cognitive testing was normal, particularly in executive functioning, language and calculation skills. Where he failed was in memory and recall – pretty much exactly what we’ve noticed over the past year or so.
We were reassured in one respect that his issues right now are mild and that 90% of individuals with amnestic mild cognitive impairment remain stable over time. Yet now as I am reading up on mild cognitive impairment, it is widely considered to be a precursor to Alzheimer’s dementia. I think it might be time to stop reading. He’s going to be seen again next summer and I suppose we will just have to take the “wait and see” approach. Right now there’s nothing we can do and for a doctor who is also a daughter, that’s probably the hardest thing in the world to be told.