Akathisia and the Edits
by Shobha Nandavar
(Bangalore, Karnataka, India)
It was a Friday evening, the last evening clinic at the Neuro Centre for the week. Donned in a PPE, I settled down at my desk, a silent spectator to the various hues of life. The receptionist started ushering in the harried patients one after another.
Being a general Neurology clinic, I hardly had to rack my brains for the ulterior Neurology knowledge to manage them. A young otherwise healthy looking girl accompanied by her mother would invariably be a migraine patient bordering on to transformed migraine triggered by the hectic NEET preparation.
Next in turn would be an IT professional, in whose case my job was to refute the various differential diagnoses picked up by him from the net and reconcile with a mutually agreeable diagnosis.
Bell’s palsy was a common condition for a Neurologist, for the patient though it was nothing short of a stroke- in-the-making. Relatives would prick their ears for the word ‘paralysis’. God forbid I utter the word “palsy”, the march towards traditional stroke charlatans would commence.
Peripheral vertigo was another quotidian disorder, where the hapless patient would find the whole world go topsy turvy every now and then, without rhyme or reason. Nevertheless for a Physician, this was yet another insignificant, self limiting disorder which would be gone in a week’s time.
I had occasional lady patients walking into the consultation room prior to schedule, to inform me that they would feign severe limb pains, when accompanied by their husbands later in the day. They would exhort me into advising their hubbies to buy washing machines and hire full-time maids for domestic work as part of the treatment strategy.
By and by, arrived my first patient of the evening, a patient with Parkinson’s. One thing I have learnt about Parkinson’s disease patients, over the years, is that they are much better than a naive clinician in matters of dose adjustment of their medications. Most of the times, the patients and their attendants were adept at diagnosing the ‘on’ and ‘off’ periods and calibrating drugs around them. So one of my practices was to look for associated conditions normally overlooked like depression, constipation, pharmaceuticals induced side effects, after making sure the patient was receiving optimal meds and leave it to the patient the timing of the meds.
A well groomed, quiet, docile woman in her sixties was escorted by her daughter-in-law, husband and a care taker. The patient lived with her husband and care taker. The son with family lived in another part of the city and visited them once a week.
The patient started narrating her symptoms after the initial pleasantries. She had a strange, inexplicable sense of restlessness which spurted from within. She had an intense urge to move her limbs and stride up and down. This was akathisia. It could be caused by a host of medications. I briefly scanned the med list, no such incriminators popped up.
Akathisia could then be a part of the disease process itself. She felt restless when her caretaker gently prodded her to gain control over her tremors. She tried her best; she failed and felt an inner unease. I could suddenly relate very well with her feelings. A couple of days back, my twelve year old, brought home his corrected answer sheet for a parental review. He had lost marks for ‘neatness’, in a neat labelled diagram of the respiratory system. By my yardstick it was neat and labelled. The mind-reader of a son, he mellifluously uttered, ‘Don’t worry ma, will do better next time’. By no stretch of the imagination did his performance in this mundane class test matter, but a strange feeling of disquiet lingered on.
She recounted another incident, wherein her daughter-in-law hushedly reminded her to slow down her shuffles at a family gathering. The sense of inner jitters had ventured out time and again, that she had to pace up and down to get rid of it. Another de-javu hit me. I recalled my first paper submitted to a medical journal. It obviously received various corrections and finishing touches initially by my professor and later by the publisher. Not that I was receptive to the alterations, but I needed it to be in the print, the ball was in their court. A strange sense of inner turmoil persisted.
I was jostled out of my rumination, when she started narrating her last count. Bedecked with jewellery on the dais was our patient on her 50th wedding anniversary. They were receiving loads of bouquets, presents, handshakes. All hell broke loose, when her husband softly whispered into her ears to control her hand shakes. That was the worst akathisia she had ever witnessed. Her life partner of fifty years was not able to appreciate that things were not under her conscious control.
This induced another flashback anew in me. My recent passionate poem ‘The Bloom’ was subject to onslaught of revisions by the Columnist. The wild beauty of my bloom was trimmed for an attractive look. I could feel the pain of the chisel run over my sculpture. I confided in my better half, who sounded a sound advice, that I was an amateur writer, amateur I was and the editor really meant well to me and had amended to suit this terrene.
My front desk buzzed and flagged me down, as I was running overtime with my first patient. I had to put to rest my emotional right brain and switch gears swiftly to the analytical left. I could hark back to the dopamine cascade, the biochemical pathway behind her symptoms and dole out an immaculate prescription. Nonetheless, Medicine to me was as much an art as it was a Science. I knew that my patient needed only a heart-to-heart chat and reassurance.
The patient was convinced that life was dished out to us with a generous scoop of edits. With a subtle smile and a light heart she darted out of the chamber with little akathisia, with my little edits and walked towards a perfect life with some little imperfections. ***