Neurology, Round Two

On Tuesday mom was seen by the second neurologist. The idea of this appointment was to conduct a second neuro-psych exam to refute the findings of the first one and then submit these findings into evidence for mom’s hearing with the state department of licensing on the 22nd of this month. It turns out this neurologist doesn’t conduct neuro-psych exams. She refers to a neuropsychologist. The neuropsychologist is, of course, booked until after the hearing. Further, when asked to try and find mom an even earlier neuro appointment (’tis expensive to have your attorney look for an available neurologist for you), I found the same neuropsychologist and asked mom’s attorney if I should book an appointment with him. I was told, “No, the report needs to come from an MD.” The attorney is the one who booked the appointment with the neurologist we went to on Tuesday because she had openings. Evidently, the attorney failed to ask if this doctor conducted neuro-psych exams. While I don’t want mom to drive I am underwhelmed by the attorney’s performance thus far.

The meeting with the doctor was fascinating. She started off by asking mom about the fall. Mom didn’t respond to the doc’s question directly so the doc asked why we were there. Mom turned to me for the answer and I said she needed to share what was going on with the doc. Mom started by saying she was angry and depressed about the diagnosis from the first neurologist. While mom was talking, the doc was looking at a 100 things on and about mom. Mom didn’t have in the forefront of her mind the precise reason we were there. I think the doc had done her homework (read all the chart notes sent by mom’s PCP).

The doctor asked mom about her memory. Mom said she didn’t have any problems. The doc turned to me and simply said, “Daughter?” inviting me to offer an opinion. I countered mom’s view of herself to which mom said, ‘Yes she knew she had a little trouble here and there, but that was due to dealing with the stress of  her husband’s illness and death.’ The doc launched, telling mom her memory issues were about her illness. She explained to mom that Alzheimer’s makes it hard for you to understand that you have a problem. And as if on cue, mom couldn’t acknowledge this. The doc tried to get this into mom’s head again and again without success.

The meeting finally focused on the driving topic. The doc asked mom why she wanted to drive and spoke with truth and humor about how dangerous and awful driving is, offering that if she didn’t live 40 miles north, she’d never set foot on the road. The doc asked me if I had concerns. I said yes. The doc asked me for examples. ‘Specifics or generalities?’ I countered. “Specifics!” She chirped. I gave her two. She turned to mom and said, “Your daughter is very worried about your driving, about your safety!” Mom almost yelled, “Those things only happened once!” The doc replied, “Once is once too many times! You don’t want to kill a child or yourself!!” Mom went into her driving monolog: her record, how the first neurologist is so concerned about her highway driving (it’s actually her PCP), how to drive on the highway and finally her LA driving dialog. The WHOLE time the doc was saying, ‘Sweetie, it’s not about your driving skills, it’s about your illness!’ Mom didn’t hear what the doctor trying to interject, just that she was interrupting to the point where mom said harshly, “You listen to me!” When mom finally heard what the doctor was saying, she replied, “but I don’t have this illness!!!”

The doc ran through a batch of questions of potential concerns regarding mom. She wanted to know if mom:

  • Was eating/cooking. Yes she does.
  • Was keeping the checkbook. She doesn’t balance, to which mom countered neither did dad. I don’t believe it. I didn’t share with the doc that the Island bank check register was a disaster at the end of the year.
  • Kept the house clean. I offered up that there was rat shit all over the house in November, that I  cleaned almost all of it up and then found the last of it last month, because mom never finish cleaning it up. Six months of rat poop in your closet doesn’t sound like high functioning to me.
  • Had concerned friends. I said yes re two neighbors. The one who helped her Sunday night when she fell and the neighbor who helps her with everything all the time because he and his wife were gone for months this last winter. I can’t rat out everyone to the doc in front of mom. If she gets furious with those that support her in her community, it’s a fast track to assisted living. Yeah, I know, rather than a moderate track.
  • Was able to and fulfilling any work obligations. Mom said she was. I looked mom straight in the eye and asked her, “How’s your project for Scarlett going?” Mom exclaimed that she didn’t need to hear any more of this and walked out of the room. She’s been trying to edit a book for Scarlett for about 6 months now, and can’t get any traction on the project. Mom turned left as she stormed out, rather than right. The doc looked at me and said. “She’s going the wrong way.” I nodded. Mom came back in and asked me for her coat almost immediately. She’d left it in the truck. She turned to leave again and the doc said, “Turn right!” as mom walked out turning left once more. She came back within 15 seconds saying she needed to hear what was being said. She couldn’t find her way to the waiting room.

At one point the doc said something to mom (Ha, I don’t remember exactly what) and I asked her to help mom understand what she’d just said. The doctor asked, “What?!” I repeated my request. She replied, in front of my mother, “No Sweetie, there’s no point explaining because she can’t understand.” Mom was completely unfazed by this, completely. This put so many things into place for me. It explains why mom can’t stop writing checks to every charity knocking on her mailbox, why she can’t remember that the thermostat in her mainland home runs through 4 daily cycles (she’ll adjust the temperature down a degree or two, say, and call me in a panic every time the furnace comes back on as the thermostat cycles to its next setting, every time), why she can’t remember how to get to the highway from our mainland neighborhood even when told how (oh, so many times) or given directions (heck, after both being given oral and written instructions once, she followed my car up to a ‘launch’ point and still couldn’t get there), why she has such a sad querulous relationship with her world. This comment of the doctor’s helped me understand, helped mortar into place just how much more my mother’s illness is that cognitive decline or mere memory loss.

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