October 10, 2009 by David Gillaspie
The VA hospital asks a few things of its patients. One is showing up. If you’re a family caregiver for a veteran enrolled in VA benefits, then you’re going to the hospital. Often.
If your loved one has Parkinson’s, like my father in law Ken, then you go in for regular evaluations. His meds came through the VA. The administering doctor made certain we had enough, but not too much as if hoarding Parkinson’s drugs was a green light for party time.
How would the drugs work on someone who didn’t have Parkinson’s? They are designed to reduce tremors, shaking, so how do they work in someone without those symptoms? I imagined the effects of drinking hard liquor after taking ‘ludes at the Zombie Disco.
The VA doctor had the bedside manner of a bedside table. A carved bedpost had more personality, but it didn’t matter. The drug regime was stupendously expensive and the doctor knew that’s why we were there. Parkinson’s was an afterthought in his office.
Besides seeing the medication doctor, Ken also belonged to the VA Parkinson’s Study Group. He dropped out after a confusing visit. We all went in, father in law, mother in law, and me, expecting the usual study group doctor. Instead we got study group nurse practitioner.
I have high respect for anyone who sees sick people day after day. It’s got to take a toll. Everyone copes differently, but this guy, the nurse practitioner, was different than anyone we’d seen.
A tiny guy in starched scrubs and glistening locks swept into the treatment room with the ubiquitous stethoscope around his neck and red clogs on his feet. He was no pile of gray oatmeal with a bad comb-over and black brogans like the med doctor.
This man was the future of medicine, a new entity, neither physician, physician’s assistant, or nurse. He looked and acted the future of medicine part, though he was a little testy when we asked what a nurse practitioner does. It didn’t help when we asked when the doctor would be in.
Using his advanced skills, the nurse practitioner re-diagnosed Ken from Parkinson’s to super-nuclear-palsy and changed his med schedule. He did this after moving Ken around as if he was handling a mannequin.
The whole exercise served to add another job title to the pile of medical professionals who do no good for us. We didn’t take the nurse practitioner’s advice after three days of the adjusted meds. It was part of the VA drill and we needed to play the game, but play it with eyes open.
Our last trip to the VA med doctor was a game changer. Ken was weaker than usual and had the look of a college freshman after his first all-you-can-drink kegger. I brought along extra chucks and towels for clean up.
He slumped in the passenger’s seat and started heaving halfway to the hospital. I had the chucks ready to catch and floored the gas pedal.
I asked the front desk guy at the VA for extra materials for my puking father in law. He ran off, sprinting for emergency personnel. I could see the rest of my day unfold. The old man would be admitted to the hospital through the emergency room and left to the mercy of the nurse practitioner corps. My mother in law would be with him in a frantic state.
I made the only common sense decision possible: I sent my mother in law to the elevators and told her we’d meet at the med clinic while I bolted out the front door with Ken in a government wheelchair.
Four lanes of hospital traffic and a bus stop divider separated us from the building we needed. I made it to the center island and looked back through the windows of the reception area. The front desk guy and three others in whites with a gurney searched the lobby. It felt good to be on the lam. We were Butch Cassidy and the Sundance Kid for a moment.
Once inside the med doctor’s office a real nurse came in to take Ken’s blood pressure. When we told her he’d been vomiting she left and came back dressed in the same haz-mat suit I’d seen on Chernobyl clean up videos. I reassured Ken,
“She doesn’t know you, Ken. For all she knows you spent the night under the bridge sleeping on a bed of hep-C needles. You might be a chancre-ridden lothario just in from the all-night cat house. You could be…”
I waited for his ‘shut-the-hell-up’ look, and did.
The med doctor changed from a lump of oatmeal in a stained shirt and tie to a regular guy when we explained the difficulties of getting Ken to the hospital. The blank façade he’d held up for years fell away with the news that this was our last visit.
His speech didn’t feel rehearsed when he told us we were the best care team in his practice. He comforted Ken, telling him his wife and son in law cared for him better than the treatment he’d get in any hospital. We already knew this, but it was good to hear.
Our Kenny showed up for his last formation and passed inspection. Here was the battle-worn veteran getting his honorable discharge as if it were his last day. I explained it on the ride home.
“The staff officer is a pencil pushing pud who goes home at night. All day he sits in a comfortable chair and diddles around on his computer screen. He thinks he gives everything his patients need. With most he probably does, but you’re not most people. He warmed up today and that was nice. He did okay. He doesn’t know we make the world a better place by punching Parkinson’s in the face. That’s what we do. And we’ll keep doing it.”
I looked over at Ken. He was dozing. I checked the rearview mirror and saw my mother in law’s smile as she looked out the window.