Tag Archives: neurologists

Dr Alemayehu Part ll

Posted in September by

Continuing with his exam, Dr Alemayehu asked Miss Cathy to spell “world” backwards.

“D, W,R,L….no, that’s not right.” Then she started over again.” D, L, R, R, O,W”

Nodding at her effort (but still making no judgment or comment) he said, “read these words for me” and then he had her repeat “apple, book and key” three times out loud before asking her to move from her chair to the examination table so that he could have a better look at her and administer a series of quick “hands on” tests that lasted about five minutes.

He had her open and close her eyes, follow his pen with her eyes only, tap her fingers then grip his hands firmly with hers and squeeze. After one of these texts he put his pen/pointer back in the breast pocket of his doctor’s jacket and asked.

“Do you remember the three things I had you repeat to me?”

“Yes,” she said, pondered, then started to recite,” Apple….uhhh, gosh, I had it right a the tip of my…..apple and key.”

Miss Cathy tried a couple of times to remember the third item, looking up and around the room as if it were somewhere to be seen, a visual clue somewhere in the small sterile exam room. Finding nothing to help here (and knowing that I’d be of no use) exasperated, she gave up.

After writing some notes in her file the doctor looked at her and reported, ”I’m very pleased with where you are, you remembered two out of three things. That’s very good.”

Hearing this unexpected praise she sat on the exam table, legs dangling in the air like a child sitting on a dock on a summer day who’s just received a Popsicle.

He told her that she could get down from the exam table and once they were reseated in their chairs the doctor asked if she had any questions for him.

Yes doctor I do, “Will the Aricept improve my memory?” she asked.

“No”, he answered, “it keeps your memory ‘where it is.” He went on to tell her that the Aricept buys a patient time because it manages to keep a person from progressing any further in the disease (for a while anyway, until it doesn’t work anymore) but the doctors have no way of knowing how long that will be.

“Will I be able to determine when my memory is failing me?” she asked.

“It’s a gradual process”, he explained, “and I cannot give you a time frame. But, I was concerned about your memory and after seeing you today I can tell you are in the same place you were when you came to see me last. So, your memory so functioning well.”

“Drawing the clock is abstract thinking, which is difficult but you did very well except for putting the numbers in the middle of the clock.”

“I’m very pleased with how well you’re doing so why don’t you come back to see me in six months.”

I helped Miss Cathy gather up her things and drove her back home where she couldn’t wait to get on the phone to call and tell all about her “glowing” report from the doctor.

Who could blame her for being ecstatic, a year ago we sat with the doctor at the beginning of her diagnosis and were full of questions and uncertainty. Six months after that we (all, as a family) had made adjustments in lifestyles and expectations as to what the future could hold.

And now we are in this holding pattern, a “grace period” if you will, life settling into the new normal with no idea when change will occur of how it will manifest. Until that day, Miss Cathy and I will just take it one day at a time and before you know it, another six months will have passed and we’ll be back sitting with the neurologist again.

Hopefully, she’ll be drawing clocks just as well and remembering just as much.

Dr Alemayehu Part l

Posted in September by

A Friday morning appointment with Miss Cathy and her neurologist, Dr Alemayehu:

“How has your summer been?” He asked her after we were seated in the examination room.

“Oh fine, fine”, she replied, eager to update him, “it’s been wonderful ever since you said that I could stay at home by myself; gosh, you don’t know what a blessing it’s been not to have to go anywhere when my son goes out-of-town. It feels wonderful so I truly thank you.”

“So”, the doctor said smiling at her, “you’ve declared your independence! Well, that’s very nice, I want you to know that I prayed for you.”

“Did you, oh bless your heart, thank you doctor.”

“Now”, he said suddenly becoming more doctor and less old acquaintance, “ I want to ask you a couple of questions.”

“How do you function? “How is your memory?”

“Well”, she said,” I do alright, but I get nervous.” When he asked what she meant she told him about the earthquake and having to go to the emergency last month because she was so upset over her granddaughter being in the hospital.”

He listened but didn’t comment right away, then he said, “I want you to take this pen and paper and I want you to do something for me but I want you to listen carefully before you start.”

He told her that he wanted her to draw the face of a clock and to put in the numbers where they should be, then put the hands of the clock on 10:45. Satisfied that she understood what he was asking of her he got up from his seat and left the room.

I looked on from my chair in the corner as she drew the circle, then the number “6”, then the “12” and the numbers 1 through 5 down the right side of the clock (pretty good so far) then she put the number “9” almost in the center of the circle and the rest of the numbers were in the right order but they were more or less vertical instead of following the left curve of the circle that represented that side of the clock.

“What time did he say,” I heard her ask herself,” was it 10:45 or 11”45?” Then she looked at me and asked me, “What time did he tell me-11: 45?”

I mimed zipping my lips and she said, “Come on now, hurry up and tell me so we can get out of here.”

“No can do,” I said, “ It’d be like helping you cheat on a test.”

Since she drew a very short hand that went from the middle of the clock to the eleven and another verrry short hand that pointed toward the nine it was hard to tell what time she was trying to indicate. But when she was finished she wrote “11:45” at the top of her page so that her intent wouldn’t be misinterpreted.

Dr Alemayehu came back into the room, sat down in front of her once again and studied her drawing. “Do you think this right?” and when she said she thought it looked like a clock he said, “ I’ve never seen a clock with numbers running up the middle and the time was supposed to be 10:45.”

But he seemed satisfied (enough) with the drawing so he continued with his questions.

“What floor are we on?”

“First”

“”What kind of office is this?”

“Neurology doctor”

“What’s the date?”

“Eight, August, twenty-eleven.”

“Who’s the President?”

“Dr….uhh, Obama.”

“The one before?”

“Oh, I will never forget him-Bush.”

Then he showed her the word “world” written out on a piece of paper and asked her to spell it backwards.

Next week: Part ll

Dr NO (show)

Posted in May by

I’m usually loath to speak ill of doctors or Miss Cathy (lately) but recently the two-separately and together have made for a prescription too toxic not to tell.

I’ve gone on and on about Miss Cathy’s visit to the neurologist where (in her mind) he set her free, like Lincoln with the slaves. No, this isn’t about “that” but it did (start) during that infamous visit.

One of the things she had scribbled down on her neatly folded piece paper of “things she wanted to discuss” with the doctor was having help getting her Aricept through mail order. She said that Blue Cross/Blue Shield had quoted her a price of $30.00 for a 90-day supply in lieu of the $86.00 she just started paying (for the same quantity) of the generic because until recently Aricept was not available in a cheaper generic form because of it’s exclusivity on the marketplace (making it was more than $280.00 for a 90 day supply).

Ah yes, the real “pill” here is the Pharmaceutical companies in my book. HIV/Aids and the elderly are there cash cows these days. I have friends with HIV /Aids and their medications can start at $6,000.00 a year (even if one has insurance) and most people have to take more than one pill so you can imagine the astronomical yearly costs!

The same is true with the elderly, patients with Alzheimer’s or Parkinson’s can spend hundreds of dollars a years for their degenerative disease medications alone, not to mention the other medications that accompany old age; high blood pressure, diabetes, high cholesterol, insomnia, depression…..the list goes on.

Anyway, her neurologist happily agreed to “take care” of changing the prescription to come through the cheaper mail order form-that was on March 27th. By early April she hadn’t received anything through the mail so I started calling the doctor’s office to see what was going on. I was told it would be “taken care of” (and at that time I had no reason to doubt the veracity of that statement) so we waited patiently.

We waited and waited until her daily supply of Donepezil HCL (generic Aricept) was dangerously low so I called the office (again) to check on the status of the medication and I also asked to be given some samples of Aricept to “tide” Miss Cathy over until the meds arrived in the mail.

Later that day while I was at the office picking up the samples the doctor was “in” so I got a chance to talk to him and remind him of how long this has been going on. I made a point of telling him that the delay was making Miss Cathy very agitated (and he’s the one who said that wasn’t good for her).

He listened patiently and told me that he would take care of “mom” (which I guess may be a custom from his country as a way of addressing the elderly or it’s just a “catch all” way of talking to and about elderly black ladies who’s names he can’t be bothered to remember). I didn’t like his dismissive approach-I didn’t see him write anything down or ask me for any pertinent information but, I left with a fist full of samples and his assurance not to worry.

Which I didn’t, I didn’t worry a week later when I’d check the mail and “no pills”, or the week after that. I didn’t worry-I got pissed off, I was pissed off that I had to start calling his office “again”. On May 13th I called to see what the hold up was and left message after message with Lydia, the receptionist (and gatekeeper) who said she would ask the doctor what was going on and call me back-she never did.

So, I called “her back” on the May 17th and was told that the doctor “phoned in” the prescription to CVS Pharmacy on April 15th and it’s been sitting there waiting for me to pick it up. I told her that was not what the doctor had agreed to do and that I wanted to speak to him, she said, “he’s busy now with patients and will have to call you back when he has some time.”

Again, I left a message for him to call me back that day-he never did.

A couple days later after I got home from a cater/waiter job I did see two missed calls from the doctor’s office so I called the next day. Lydia proudly and accusingly told me that, “the doctor tried to call you” to which I replied, “Yes, I see that, but when he called “I” wasn’t available, he’s not the only one who’s busy.”

I asked Lydia to call CVS to verify that a prescription exists for Miss Cathy because I told her that I never got a call to pick up the meds (which is there standard method of operation). “Why do I have to do that? I’m not going to do that”, she said.

“Well”, I said as calmly as I could, “because it’s your job, and not mine, and quite frankly I have spent more than enough time with you on the telephone trying to get what my mother should have had months ago.” (What I wanted to say was “B*tch, I’m not here to do your job!”).

She put me on hold, after a moment I was talking to Danielle (not the doctor) another receptionist. At least Danielle was co-operative (even if she did talk to me like I was a mental patient-apparently “Danielle” must be the re-enforcements they bring in when Lydia’s had enough)-whatever!

At least Danielle called CVS then me to say that the prescription was $86.00 for the generic and it was not at our local pharmacy but at a CVS that was 10 miles away which was probably the reason I was never called but who knows).

I asked her to have the prescription moved to our local pharmacy and left another message for the doctor to call me. So, almost two months after the initial request to have the medication sent through mail order, it hadn’t happened and I had no explanation from the doctor as to why.

I picked up the meds from CVS and explained all of this to Miss Cathy a few days ago. At first she was a little aggravated (a lot actually) so we talked about it and we agreed that the doctor had messed up and never did what she asked. She even offered to call Blue Cross/Blue Shield again to verify that the medication is available through mail order (and I thought this was a great idea, she was more than capable of handling this matter and it would give her a “project” to do).

I know that I should have been the one to follow up with the insurance company and doctor (after all, that is what I’m here for) but frankly I was burned out and couldn’t handle another conversation about Aricept-generic, mail order, or pharmacy pick up. Later that night Miss Cathy and I talked about it again (by this time she was pretty worked up about the confusion and the cost).

I couldn’t blame her really, but I didn’t want her to be as upset as she was about the situation (especially at bedtime) so my focus was to calm her down (which then gets me worked up). I told her it was okay to be upset and to wait until the morning when she could make phone calls, that way she could channel her energy where it would some good.

By the time I “put her down” she’d calmed her down enough for sleep. The next morning she called me in to talk and I thought she was going to tell me her paln of ‘action” ask me for the doctor’s phone number again so she could call his office (the night before she said she wanted to call to give them “a piece of her mind”) instead she told me that she’d been thinking and although she appreciated all that I’d done for her she’d come to the conclusion that the doctor did “what she asked him to do” and she would wait until her current supply of Donepezil HCL was gone to call the insurance company herself to get the meds through mail order-“WTF”!

I started to say that the doctor didn’t do what she asked him to do as evidenced by the fact that she didn’t have the $30.00-90 day supply but the $86.00 bottle of generic pills that she already had in place “before” she ever talked to the doctor.

I almost said that but I didn’t, what I did say was, “I just can’t talk about this anymore, if you’re happy with the way things turned out then that’s all that matters to me.”

The doctor is still a “no-show” by phone but at this point it doesn’t matter, Miss Cathy “seems” to be at peace and I just have to make my “peace” with the fact that I’ll never get back all that time that I spent on the telephone.