Every six months, come rain, shine, earthquake, or wildfire, I go to see Dr. S, my neurologist.(1) This is ostensibly a follow-up visit, or so the honey-voiced appointment clerk tells me, to check on my Parkinson’s “progress.” She says this like I’m recovering from a broken leg, a bad case of hives, or maybe pneumonia—a self-limited medical calamity that’s expected to resolve in time. But Parkinson’s isn’t like that. It’s going to get worse, the only question is how fast. So, twice a year I check in with Dr. S to see whether my Parkinson’s is sticking to the speed limit or engaging in a bit of reckless driving.

Dr. S’s office is a 30-mile freeway trip from our house – down in Marin County, that legendary land of hot tubs, up-upscale shopping malls, and over-the-top estates tucked back in the redwoods. We will see none of that on our visit today, though; Dr. S’s office is a literal stone’s throw from the freeway.

After a half-hour of medium-bad traffic, Elisabeth noses the Kia into the neurology parking lot. For some reason Dr. S’s office shares a building with the county coroner’s office, a rather unsettling relationship I haven’t yet had the courage to explore. We enter the non-coroner side of the building, take our seats in the waiting room, and wait to be called. My health plan offers online check-in these days; this is my first attempt to use the service. As I understand it, having checked in by phone yesterday, all I have to do is sit and wait until, magically, a staff member will appear to take me to my doctor.

The lady at the registration desk notices me, eyeing me a bit suspiciously at first as I skip the line and plop into a chair. Patients come, patients go, while Elisabeth and I catch up on old People magazines. During a registration lull she waves, catches my attention, motions me to her window. “Sir,” she says. “Can I help you?” In my Parkinsonian head the words of explanation are all there, sorting themselves for an orderly exit, but my mouth can’t quite usher them out. I wave my phone in the air and point. “Already done,” I rumble-mumble. “Online.” The lady seems like she’s seen this before. “Let’s make sure about that.” She takes my card, types in my number. “There,” she says with a smile, returning my card. “Now you’re checked in.” I thank her and return to my seat, where Elisabeth waits, eager to update me on Prince Harry’s new life in California.

The door to the patient care area whooshes open. A young medical assistant calls my name. We follow her down the hallway and through the usual rooming-in procedures: weight, blood pressure, an oxygen saturation reading from the little E.T. thingie she clips to my index finger. Then come the questions: Any new allergies? (No.) Do I smoke? (No, for the thousandth time.) How many hours do I exercise a week? (Oodles, I want to say, but instead I throw out an estimate that seems to satisfy her.) Do I feel safe at home? (I shoot Elisabeth a sidelong glance, think for a moment about passing the medical assistant a “Help me!!” note, then think twice and say, “Safe? Sure.”) Her work completed, the assistant smiles sweetly and tells us Dr. S will be right in. And, a few minutes later, there she is.

Dr. S knocks at the door and enters, her hands glistening with freshly applied sanitizer. She is a slender woman with dark, kind eyes, and a warm smile that I only see from time to time – it all depends on the clinic’s Covid masking requirements du jour. Her presence is reassuring; there’s a comforting routine to these appointments. 

We start with a bit of chit-chat, announcing the next-springtime arrival of our first grandchild. Dr. S seems genuinely happy for us. She asks about my recent ear surgery ( a minor, and unsuccessful, attempt to fix a eustachian tube problem). I tell her that the ear problem is making it difficult for me to carry on a simple conversation – my voice was soft to begin with, then made softer by Parkinson’s, and now, thanks to the loud vibration of my eardrum when I speak above a certain volume, it’s even worse. “Wow, that sounds like it’s really impacting you,” she says, and I nod. She makes a note to herself. “I’ll get in touch with your surgeon, so he knows how much this is bothering you.” And I know she will. Dr. S is one of the most empathic doctors I know.

She moves on to my Parkinson’s symptoms. Have I fallen since our last visit? Any new tremors? Am I depressed? Sleeping well? How about heartburn? Nausea? Constipation? She doesn’t ask me about seeing or hearing things that aren’t there this time – hallucinations are not uncommon as Parkinson’s advances. Either she assumes I’d tell her, or maybe (probably?) she got sick of my bantering: “But if I can see them, how would I know that they’re not real?” Such a funny guy.

Now comes the neurologic examination, a series of hoops and hurdles designed to see how well my sometimes meandering description of how I’m doing correlates with objective reality.

Dr. S starts with my hands. She tells me to make a modified “okay” sign: thumb and index finger making a flattened “o,” with the other three fingers extended above them. (If you have a flashlight and a wall handy, you’ll see that this makes a passable shadow-animal profile of Wile E. Coyote’s head.)

“Okay now, do this,” Dr. S says as she opens and closes her “o” (i.e., Wile E.’s mouth), rapidly tapping her index finger on her thumb. I do that; my Wile E. looks like he’s babbling now. I think I’m doing pretty well, speed-wise, until I look at Dr. S’s shadow animal – the graceful fox from the old Disney movie, The Fox and the Hound, I think – babbling about twice as fast as mine. (Bibibibi versus bah-bah-bah, if you’re taking notes.) She calls a halt to this cartoon standoff a few moments later.

Next, we move on to what I call the “dying-fish-flop” test. (I know it has another, more clinical sounding name, but hey, I’m retired: I’ve already forgotten more medicine than I ever knew.) Dr. S puts her hand on her thigh and flip-flops it back and forth, palm-up/palm-down, and invites me to follow suit. I do, and once again I’m struck by the difference in speed between us. Her fish looks like it has a decent chance of flopping off her lap, out the door, across the hall and back into the river from whence it came. Mine gives a resigned gasp, gazes heavenward, and prepares itself for the grill.

Dr. S runs me through a number of other tests. I touch the tip of her index finger, then my own chest, then back and forth like this until she’s satisfied that my finger won’t wander off willy-nilly and poke me in the eye; I tap my toes on the floor; I cross my arms, Aladdin-like, and stand up from my chair as quickly as possible. There are other parts to the exam – she smacks me a lot with a rubber-tipped hammer, for one thing – but I get exhausted just trying to describe them. Through it all – the Wile E. Coyote, the dying fish, the genie-levitating thing, the hammering and the rest, Dr. S concentrates, her face – or at least her eyes, since she’s still wearing a mask – inscrutable.

“Okay,” she says, when she finally runs out of hoops for my hands and feet to jump through. “Let’s go out in the hallway.” Ha! I know what comes next. She may not seem like the violent type, but I don’t let that placid exterior fool me. As soon as we get out of the exam room, Dr. S is going to try like heck to knock me over. I pull on my shoes (a glacially slow process these days) and follow Dr. S into the hallway. Elisabeth smiles and flashes me a quiet thumbs up.

“Turn and face the wall,” Dr. S says, like a kindly-voiced cop about to cuff a robbery suspect. “I’m going to pull you backwards, hard.” She shows me her outstretched left arm, the one that, she assures me, will catch me if I fall. (A bit of perspective here: I’m tall, with a fair amount of leftover muscle from my athletic youth. Dr. S is eight or ten inches shorter than me and slightly built; I doubt she played football. I’ll know I’m in trouble the day she manages to floor me.) She tugs on my shoulder a few times, but comes up short in our quasi-sumo match. I’m still standing.

We re-enter the exam room; Dr. S returns to her stool while I settle into my chair. She smiles and tells me she’s pleased – I’ve had little disease progression since our last visit. We do a quick review of my plan, make a couple of minor adjustments, and then we say our goodbyes. “See you in six months,” Dr S says. “Bring pictures of that grandbaby!” “Thanks,” I reply with a smile. “I’ll definitely do that.” Someday Dr. S will have to give me bad news; for now, though, I’ll take her “(almost) no news is (pretty much) good news” summary to heart.

Neurology is a much more physical specialty than I realized, what with all the pushing, pulling, and hammer swinging. If, God forbid, Dr. S ever keels over from exertion in the middle of examining me and passes on to that big neurology waiting room in the sky – the one where online check-in actually works – I’ll know just what to tell the inquiring TV reporters as they gather around me for comment.

“At least she was doing what she loved,” I’ll say. (“Which was trying her best to knock me over,” I’ll keep to myself.)

---

1. “Dr S” isn’t my neurologist’s real name. Heck, it’s not even her real initial…