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A Case of the Shakes

A few weeks ago, I was at the bank to make a transaction. While waiting for my turn at the teller, I observed an older man…

A few weeks ago, I was at the bank to make a transaction. While waiting for my turn at the teller, I observed an older man having an argument with the cashier on the withdrawal queue. The cashier, a young lady probably in her late twenties, was insisting to the elderly man that the signature on his cheque was not the same as what she had on her computer. The man replied adamantly that it was his account and therefore the same signature. The young lady asked him politely to sign another cheque and this caused the man to become angry. He became agitated and started to raise his voice, attracting the attention of the manager. 

In an impressive move, the manager took over his case and calmed him down by offering the elderly retiree a seat and a bottle of water. When the man was in a much saner state of mind, the banker asked him to write another cheque. As usual, my eagle eye had watched the whole drama unfolding and despite the fact that I had finished my transaction, I still loitered in the banking hall wanting to see what would happen next. I had a hunch, you see, that there was something amiss and nothing excites me more than a proper mystery.

The old man quietly raised his right hand and wrote another cheque. The signature was even worse than before! Whereas the old one bore some resemblance to his original signature, this one was completely illegible. I watched as his hand trembled with every move while he was writing. The temperature in the banking hall was cool with the air conditioners working at 17 degrees, however this old man had sweat beads on his forehead. His face bore a defeated look as the manager asked him if he had another means of withdrawal e.g an ATM card. He nodded in the affirmative but replied that it was with his son in Lagos. He, however desperately needed money now.

From where I stood, I knew the man had tremors. Tremors are slight shaky movements of parts of the body especially the hands. They were present at rest, but more pronounced with actions like writing. I knew that the old man knew his predicament, but like most people with tremors wanted to hide it, hence his frustration. Fortunately, as a frequent customer, I knew a few of their staff well enough to allow me enter the manager’s office. I explained the older man’s predicament and asked if they could use a thumb print instead. It worked, and the pensioner left with his money but not without making him promise to come to the hospital the next day.

The old man’s tremors had started four years ago. Mildly at first and episodic. However, the frequency had increased in the past years and he was finding it difficult to hold a glass of water. He did not drink alcohol, smoke cigarettes or use illegal substances. He confessed that his father had a similar condition before his death. After a thorough clinical examination, I made the conclusion that it was not Parkinson’s disease as I first thought, but essential tremor.

Essential tremor is a nervous system disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass, tying shoelaces, or buttoning a shirt. It is usually not a dangerous condition, but it typically worsens over time and can be severe in some people. Apart from the physical shaking, studies have reported a cognitive decline in patient with essential tremors.

In addition to these cognitive differences, people with essential tremor have been described as being at an increased risk for depression, as well as to suffer from anxiety or social phobias because of the tremors. Some studies have described patients with essential tremor as more introverted, rigid, or lonely than the general population.

I counselled him on the probable diagnosis and gave him some tests to do and medication to take. We discussed coping mechanisms like using straws to drink from cups, wearing free clothes that did not require buttons and switching all bank transactions to thumb prints or electronic banking methods. I told him to come with a member of his family on the next visit. 

The old man returned two weeks later with his test results. The brain CT was clean and the propranolol had helped reduce his tremors. His wife and son had accompanied him, wanting to know more about the disease. Could he be cured? There is no cure, I replied, the goal is to manage the symptoms. What about the drugs? It’s used to alleviate the tremors and slows disease progression. How can we help? Support him- help him dress up, feed him when he can’t, be patient with him.

The family left feeling better. At least that is what I hope, unless they are masters of disguising their true emotions.

Rumours have been flying around that a certain presidential candidate has a case of the shakes. A little bird whispered in my ear that despite several medication, Oga’s hand continue to shake causing him great concern. The thing about sickness is that no matter how much you hide it, it will always expose you. If you like, deny it from now till thy kingdom come, the symptoms will always show. Remember Yar’adua?  And PMB’s ‘ear infection’? Yauwa.

The issue is not in having a debilitating illness; Indeed, it can happen to anyone. The problem is in wanting to lead an entire nation despite having a chronic illness. And whether it is Parkinson’s or Essential tremor or even a cerebellar pathology that our presidential aspirant has that causes his hand to shake, the truth is that, the disease will ultimately affect his ability to lead. Which begs the question- What can we do?

If he has made his decision, what can we, as a country do? Do we simply fold our hands and allow someone’s lifelong ambition to continue to push us down this downward spiral maze we find ourselves in? If he has allowed ambition to cloud his judgement and therefore has no insight, how can we, as a country, help him? And please do not patronize me by saying that he will be surrounded by the best brains, is PMB not surrounded by good brains? Are we voting for a president or the brains around him?

What is the way out of this quagmire we find ourselves in?