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You learn a lot when spouses come in together.
I try to sit and look at my patient on the exam table, with the spouse behind and in my line of sight. Typically, it goes like this: I ask, "Can you walk to the mailbox without getting short of breath?" The guy says, "No problem," while his wife is simultaneously shaking her head and mouthing, with exaggerated facial movements, "NO, NO, NO." After two or three such questions, he notes my darting eyes and looks at her to say, "What?!" while she's silently mouthing "he's lying." He becomes indignant and says, "I am not having chest pain. It's just indigestion."
They don't teach family dynamics in medical school, but my mom is a social worker who does family therapy, and I am hoping some of her genius has rubbed off on me.
Not long ago, I saw an unusual couple with back to back appointments. They had this beautiful sort of harmony together. Both were advanced in age. She suffered from Parkinsonism. He suffered from Alzheimer's.
He was a strong and steady former athlete/scholar/ teacher who was suffering from memory loss. He was agile and did work around the house; his memory was bad but not horrible. He remembered his name and my name, but he could not, for example, remember how to get home. He had great insight into his dementia and made jokes about it but also acknowledged that it scared him more than a little. And that it was only going to get worse.
His wife's mind was sharp, but her body was extremely frail. When she stood up, she became dizzy. She fell a lot. Her coordination was poor and she had to hold his hand to walk or sit. She poked fun at herself, at her trembling and her flat expression which was due to the Parkinsonism (a common effect). She had to tell me when she thought something was funny, because she knew she seemed so austere.
She needed his physical strength, agility and balance to help her do anything. He needed her mind and her memory to get anything done.
At one point, I asked them, "So, how did you get here?"
He became sheepish. "I drove us," he said.
"But you," I said to him, "can't remember how to get anywhere. And you," I looked at her, "are too frail to drive a car." And they both looked down, as if caught red-handed in a crime.
"I know," he said. "That's why I will only drive a car when she's with me. I drive and she tells me where to go." We all laughed.
At the end of the visit, she stood up from her chair and for a moment stumbled, about to fall. Quicker than I was, her husband instinctively sprang off the exam table and leapt to grab her. As he steadied her arm, he suddenly had a confused look on his face, as if forgetting what to do next. She gently whispered into his ear, "This way, dear."
And they walked out, holding onto each other.