The patient, a former internal medicine physician sits in a standard wheelchair, his wife on a yellow plastic seat at his right. The movement disorder doctor arrives as the medical student asks the principle reason for the visit. There are no other seats in the small hot room. I sit on the red hazardous waste garbage, an administrator hoping to learn the issues of Parkinson's is already standing. The Dr. stands, wearing a woolen- looking jacket leaning against the examination table until the soft voice of the patient forces him to relocate the wife's bag. He sits much closer in another yellow chair. The patient's words are so hard to wait for, he twists in his seat while the syllables are freed from his stuck mouth.
Hallucinations are what brings them in. He sees two or sometimes three women caring for him; the wife gives no other specifics. She doesn't define what she means by caring. Sometimes he hallucinates seeing his wife. How he knows the visions are hallucinations is murky; he doesn't reach out and try and touch them, he just knows they aren't real...
The doctor conveys REM sleep interrupts into daylight hours when the patient's sleep cycle is fragmented. He's not sleeping enough. The remedy is Seroquel, or the generic quetiapine in the tiniest dose, half of a 25mg pill. Because the prescription is supposed to allow for 6 hours of sleep, the patient will need to wear diapers at night. It may take several nights to find the correct dose needed to provide a six hour sleep window; the patient will need to wear soft restraints tied to hospital bed, to keep him from walking around in a groggy state and falling.
The doctor describes a personal scenario of his own. His mother needed restraints to keep her from walking around at night. A mother's care, and a spouse's care are two different fruits. The doctor proposes the wife tie her husband into his bed, so he will not be able to get up until she unties him in the morning. Restraints and a hospital bed- two items Medicare will pay for, and home health for instructions on how to use the nighttime devices. The wife leans into her husband, speaking softly and clearly.
"A hospital bed, a hospital bed, OK? " She doesn't mention the ties.
Thursday, March 12, 2009
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