ut memores sitis eorum

Day 20. National Blog Posting Month.

A person’s memory is everything, really. Memory is identity. It’s you.

-STEPHEN KING, Duma Key

Another day.

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.

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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.

Sandwiched.

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The time has come. My parents are getting old.  My dad is going to be 80 next year, my mom is 74 this fall.  Both have been relatively healthy except for a few issues (hypertension and type II diabetes), but that is starting to change.

For as long as I can remember, my dad has suffered with back pain.  I remember him going to chiropractor appointments weekly for what seemed like years for chronic low back pain.  He was told many years ago that there is nothing that can be done about his back pain.  Well, now he’s finally had some imaging, and we saw a surgeon today.  But, unfortunately for my dad, surgery is not an option right now. Even though he has narrowing of his spinal canal (spinal stenosis), it isn’t producing enough leg symptoms to warrant surgery.  Sure, he could have it anyway, to open the canal up, but it may make his back pain worse in the long run.   You see, surgery doesn’t help back pain, it only helps leg symptoms (pain, numbness, tingling, etc).   And in my father’s case, his back pain is far more debilitating than his leg symptoms.  I know he was relieved to hear he wasn’t a candidate for surgery, and I think he finally heard that he needs to get up off his ass and start walking more.  He used to walk all.the.time.  He was very active when I was growing up – he’d go for walks in the evening and play golf in the spring/summer.  But all that gradually changed over the past ten years or so.  As his back pain became more pronounced, so did his excuses for why he couldn’t walk.  Well, that hopefully is about to change.  He was prescribed physiotherapy and exercises to start doing at home.  Even before his appointment, he told me he realized that he’s done nothing to help himself.  I really hope this was the wake up call he so desperately needs.

Today was an eye-opener for myself as well.  It was the first medical appointment I have ever attended with my dad. I stood in the room as his daughter first, but the physician in me knew from the questioning that surgery wasn’t going to happen.  Reading the MRI report is one thing, but hearing the story from the patient, my dad, was quite another.

Back in medical school, or maybe it was residency, I can’t really recall, we learned about the sandwich generation – becoming the caregiver for your own elderly parent while being a parent to one’s own children.

A study published in 2013 found that,

  • 20 per cent: Proportion of employed women and 17 per cent of men in the large survey which are part of the sandwich generation of Canadians.
  • 40 per cent: Portion of workers in the overall survey who report high levels of overload – both at work and at home.
  • 25 to 30 per cent: Portion of caregivers who cope with the pressures of work and family by bringing work home, giving up on sleep and trimming social activities on a daily basis – a response which raises the chance of employee burnout (and grumpy workers).
  • 20 per cent: Portion of male and female employees who are caregivers who turn down promotions because their plate is too full.
  • 63 per cent: Portion of caregivers who report emotional consequences of juggling work and looking after family, which includes stress, anxiety and frustration.

Add all of the above to a caregiver (me) who is also a physician? Oy.

Are you sandwiched?  Have you any advice? I’d love to hear it.