Almost Losing My Mother: From Doctor to Patient and Back Again

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Faced with hypercalcemia because she was poisoned by vitamins, the author's mother lost her strength and her mental faculty quickly.

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We almost lost mother last week. When she came for Thanksgiving I noticed coughing each time she ate. Small discreet coughs, unremarkable, but to a physician an alarming signal that swallowing has weakened, permitting food to go the wrong way, toward the lungs. Each cough unremarkable, but signaling a potentially fatal problem. When I mentioned this and suggested testing, she flat-out dismissed me: "With so much else going on, I can't pay attention to every little thing." She handled most problems this way. At 84, she was in excellent health, still working as a medical school professor, writing papers, and teaching young doctors. After seeing children die from horrible diseases, most other problems do seem minor.

In old age, her major medical issue was worsening scoliosis that now distorted her spine, pressing on the nerve-roots to weaken her legs and cause pain. She needed a cane. This had developed over decades during which she brushed aside suggestions to seek medical evaluation. "Why bother to have an MRI; it will only show something they'll want to operate on, and I don't believe in that," she said.

Her crumbling spine was part of her osteoporosis. Growing up in Europe during World War II without much milk, she never got used to drinking it. She had fallen several times over the years with an ankle and three wrist fractures, all healed. The other ankle sometimes swelled, so for years she had been taking hydrochlorothiazide, a diuretic. When osteoporosis came to public awareness a few decades ago she began to take calcium, and later vitamin D was added to improve calcium absorption. Recently, she took four calcium pills a day. Falling was one of her few fears. She was otherwise fearless, intimidating generations of young doctors, not to mention her own physicians. She still called the shots.

When she elaborated that the experiments were taking plance in a hidden hospital annex, and that her dear friend Oliver Sacks was overseeing them, her delusional state was exposed.

On the phone after Thanksgiving I noticed concerning memory slips. She mentioned nonchalantly that "I was confused when your brother called -- I thought it was the middle of the night and something had happened to his boys."  She noticed occasional eyelid drooping and got her ophthalmologist to test for myasthenia gravis, which causes weakness, especially about the eyes and face. When she tested negative, she didn't bother telling me or her internist about this; no need to bother him between her yearly visits. Her academic career continued.

It began to fall apart Christmas week. She fell while alone and was unable to rise for eight hours. An ambulance brought her to the hospital where she worked. No fractures, just dehydration, for unclear reasons. I was infinitely relieved but a few details nagged at my medical mind: Why had she been unable to get up? Why had she pulled the phone to the floor but not used it? Was this more confusion, perhaps early dementia?

In the hospital her voice sounded weak and nasal, so I asked them to test for myasthenia, not knowing she had already attended to this. She was discharged after a few days of intravenous fluids but remained frail. Her 90-year-old husband did more and more for her, ordering the walker she now needed, taking over the driving. He lovingly cared for her without mentioning her decline to the children. Colleagues at the hospital expressed concern.

Six weeks later she fell again and her husband couldn't lift her. Another ambulance to the hospital. This fall left her with an injured shoulder and even less mobility. My father had to help her dress, to walk, and to the toilet. She couldn't use her laptop and missed work deadlines. The internist was consulted and performed blood tests that came back abnormal. He apparently recommended hospital admission but she pooh-poohed this in no uncertain terms. Later, he explained apologetically: "You know your mother; it's hard to stand up to her."

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Anne Louise Oaklander is an associate professor of neurology at Harvard Medical School, and an associate in neurology and assistant in pathology at Massachusetts General Hospital.

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