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18 DISCOVERMAGAZINE.COM
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RBY LOUISE ARONSON
With Marina translating, I asked
Dimitri two questions: What is your
name, and are you having any pain?
Because Parkinson’s slows people
down, we had to give him some time to
respond; I sang the chorus of “Happy
Birthday” in my head to make sure I
waited long enough. In response to the
first question, Dimitri’s lips moved, but
no words emerged. He didn’t even try to
answer the second one, so we skipped
ahead to the physical exam.
It was remarkably unremarkable.
Although one of his hands shook
and his limbs showed the rigidity
that’s characteristic of Parkinson’s, he
otherwise seemed quite robust. He had
well-formed muscles and joints, and all
of his organs looked, felt or sounded as
they should.
Back at the nurses’ station, I studied
Dimitri’s diagnoses and medication list.
His drugs were all commonly prescribed
and associated with the diagnoses,
although two of them — one to aid
digestion and another for hallucina-
tions, two symptoms often associated
with Parkinson’s — appeared on a list
of potentially inappropriate medica-
tions for older adults. Called the Beers
Criteria, this list highlights drugs that
have increased risks for adverse reac-
tions. The hope is that doctors will think
twice before prescribing such medicines
to patients over 65 and use alternatives
if possible.
I asked Marina if anyone in Dimitri’s
family spoke English. She said his
daughter, Svetlana, did. With Marina
on standby, I phoned Svetlana.
“Oh, hello, doctor,” she said in good
English. “Thank you for taking care of
my father.”
I gave Marina the thumbs-up so she
could return to her own work, and I
asked Svetlana to tell me about her
father. Dimitri had been an engineer
in the Soviet Union, she said, and her
mother was his second wife. They had
been married 41 years and had been
in the United States for eight. I asked
her about Dimitri’s recent health and
care, and she described a fairly typical
It’s Not Over Yet
Are advanced Parkinson’s and dementia attacking
this older patient, or is it something else?
I found my new patient in bed with his eyes closed. Though
in his late 70s, Dimitri had a full head of mostly dark hair
and the sculpted cheeks and chin of a model.
A day earlier, he had arrived at our nursing home’s advanced
dementia unit with little more than lists of diagnoses and
medications. From those few pages, I learned that Dimitri had
end-stage Parkinson’s, dementia and several other common
chronic diseases. Like nearly half of Americans in his age group,
he was taking more than five medications each day to treat his
ailments — 10, to be exact. Marina, the unit’s head nurse, told
me he’d been living with his wife and adult daughter, but they
could no longer manage his care at home.
I said his name, but he didn’t respond. Then I touched his
arm. Nothing. I shook him a bit, repeating his name in a louder
voice, and finally his eyes opened. Marina, who spoke his native
Russian language, explained who I was and why we were there.
He stared back at us with blank, unblinking eyes.
I said
Dimitri’s
name, but
he didn’t
respond.
Then I
touched
his arm.
Nothing.
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