In the end, it was the little things that gave him away.
A cheque. Yes! It was a cheque that he was required to sign before certain payments could be made. His assistant returned from the bank and foolishly blurted out in front of his wife that the signature was inconsistent. As if that was not enough, he handed it over to him with a pen, demanding another signature at that very moment. There was no stalling, he had to try. Luckily, his right hand co-operated when he picked up the pen and scrawled his initials. It was after he returned his hand to his chair that it began to shake, uncontrollably.
Alhaji Suleman stood up abruptly and headed for the bathroom, but it was too late, his eagle-eyed wife had noticed it. Later, when his wife questioned him about it, he made light of it and attributed it to fatigue and hunger.
One night, Suleman, a fifty-year-old travel agent, was in his office gathering his things for the ride home when he felt a peculiar chill envelope his right forearm. A month later, he began to notice diminished dexterity in his right hand. There was a slowness to his motions and he was feeling tired all the time. Also, he noticed tremors in both his hands, especially when he was at home resting or watching the news. At the time, he attributed it to the popular culprit- Malaria. After several bouts of injections with only a painful bumbum to show for it, and with no alleviation of his symptoms, he travelled to Cairo, demanding answers.
The specialist doctor took one look at him and confirmed his fears- he had Parkinson’s disease. He was devastated, angry and embarrassed. To him, Parkinson’s was a disease that strikes older men, not fit and active 50-year-old men like himself. This was a man who jogged regularly and walked almost 10,000 steps per day. His weight was optimal and did not smoke or drink alcohol.
Parkinson’s disease is a degenerative disorder of the central nervous system, which has no known cause in most cases. Medically, Parkinson’s has been traced to the death of dopamine–generating cells in the midbrain. Symptoms are usually characterised by movement–related issues, including shaking, rigidity, and slowness of walk or gait. In time, cognitive impairment and behavioral difficulties may occur, sometimes followed by sensory and emotional problems.
He left Cairo and returned home pretending all was well. At work, he secluded himself in his office and came out only when necessary. He stopped watching TV in the living room and stayed in his room instead. His wife was worried about his behaviour: Was he depressed? Was he in financial crisis? Why was he alienating himself? What did she do? Was he having an affair? Or was he adding another wife? The poor woman was beside herself with worry. The day she saw his hand shaking, she knew there was something amiss and reached out to me.
He was relieved, he told me. The secret was eating him up. In the clinic, he opened up to both me and his wife about his struggles. He had returned from Egypt with several medicines. They helped slow the tremors, but the slowness of his movement persisted. He was afraid of the future because he knew he would never be the same again. His anger gave way to tears of frustration and hurt.
A lot of times in family practice, our role is that of a counsellor. I understood that my primary responsibility was to help this man navigate the stages of grief- denial, anger, bargaining, depression and gradually, acceptance of his condition.
At the beginning of his illness, he was in denial of his symptoms. Over the years, I have seen human beings deny symptoms like you would not believe. A woman trips and sustains a fracture and yet she will deny visual impairment. What? who told you I cannot see? Until a simple test proves that she in in fact almost completely blind. A man will deny to the moon and stars having problems with passing urine until he is diagnosed with prostate cancer.
And so on, and so forth.
In Cairo, Suleman’s denial switched to anger, which is the next stage. He was angry with the world and everything in it. When faced with a life-limiting illness, anger is a very natural emotional response. It gives you a way to express big feelings, like anxiety, fear, frustration, and helplessness. In this stage, you may ask, “Why me?” and think “life’s not fair”. You may also feel anger and resentment towards your healthcare team, your friends and loved ones.
That day, in the clinic, as he unburdened himself, Suleman’s anger transformed into bargaining and depression. He began to make a lot of “what if” statements: What if I had gone to the doctor six months earlier?
Over the months, Suleman slipped into depression which is often characterised by persistent feelings of sadness, loss of enjoyment in everyday activities and low energy levels. He began withdrawing from life, not wanting to talk to or be around others and experiencing feelings of hopelessness. With consistent counselling, family support and sometimes medication, many people are able to survive depression and reach the final stage- acceptance.
The last of the five stages of grief is acceptance. Acceptance does not mean you have moved past your grief or loss, but instead, your emotions may begin to settle. Often, you have come to terms with your “new” reality and your feelings have stabilised. There will be times of grief and sadness, but you recognise that there are still good things in your life to appreciate and with acceptance, people often begin to enjoy life again and engage with their friends and loved ones.
With time, Suleman was able to come to terms with his condition and even make jokes about it. He now calls himself ‘Robo cop’.
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