There is much that concerns me about the practice of medicine in the United States. I believe it is wrong to prescribe medications that relieve symptoms while the process that caused the symptoms to appear continues unabated. I feel that it is imprudent to remove vital body structures simply because the physician does not know what else to do. I consider the administration of adjuvant chemotherapy in breast cancer unwarranted and immoral. It seems unconscionable to irrevocably stop the body’s ability to renew bone simply because dead bone appears denser than living bone.

There is much that concerns me about the day-to-day practice of medicine in the United States, but there is also much that is right and admirable. This past Christmas I was reminded of how a medical procedure can dramatically improve the quality of one’s life.

Over the past year Rosalie and her siblings had noted that their mother, Audrey, was becoming more forgetful. They were concerned that she might be developing Alzheimer’s disease, the condition that had afflicted her mother for many years. She had also become considerably less active. She no longer walked three miles a day in all kinds of weather, and she rarely left her home.

On October 28, 2009 she did not answer her phone. Her sons found her lying in a hallway, unable to get up without assistance. She was taken to her local physician who did not find any evidence of a stroke or injury, but felt that it would be unwise for her to return home. She was given the option of entering a nursing home or going to Oklahoma to stay with her daughter. She chose Oklahoma, which she considered the lesser of two evils.

When she arrived she was weak, but she was able to dress herself and walk with the assistance of a cane or walker. She was able to converse, but it was clear that she was not fully aware of her condition and situation. We expected that her condition would improve as she began to eat balanced meals and interact with family members regularly.

Our expectations soon turned into disappointment. She did not become stronger; she became weaker. She did not become more oriented; she became more confused and less reactive. She lost her ability to dress and care for herself, and her walking ability deteriorated rapidly. On December 18^th she was able to walk slowly with assistance; on Saturday, December 19^th she could not move her feet to assist with transfers from her bed to a chair or from a wheelchair to the sofa.

Her rapid decline was not typical of Alzheimer’s Disease or other forms of senile dementia. Many conditions can cause dementia. Thyroid disease, vitamin B12 deficiency, and electrolyte abnormalities such as a low sodium level had been considered, but blood tests had ruled out those possibilities. I believed she should have an imaging study of her brain to determine if any treatable condition was present.

Having spent most of my medical career in the Oklahoma City area I had no contacts in Tulsa. I would need to rely on the Internet and the Yellow Pages to locate medical services. I had no strings to pull, no clout with which to get things done.

On Monday morning I called an imaging center and asked how soon they could do a brain MRI. They checked their schedule and said that the technician would do it at noon during her lunch period. The radiologist read the films immediately. The study showed that Rosalie’s mother had a condition called hydrocephalus – excessive fluid within the brain.

Hydrocephalus can be present at birth, but it can also develop later in life. The cause is generally unknown. Rosalie’s mother had fallen about 18 months earlier; it is possible that the trauma of striking her head on the concrete sidewalk triggered the condition, but there is no way to know for sure.

The brain and spinal cord are bathed in fluid. Reservoirs called ventricles hold much of the circulating fluid. When free flow of the fluid is blocked the ventricles enlarge. As they do so the surrounding brain tissue is compressed and the brain function is compromised. Hydrocephalus in adults is said to be characterized by the triad of altered gait, dementia, and urinary incontinence. Since Rosalie’s mother had not been incontinent, the diagnosis was not obvious. I subsequently learned from her neurosurgeon that the condition is often a “dyad” and sometimes even a “monad”.

Hydrocephaly can be treated by placing a shunt – a tube that carries fluid from the ventricles to the abdomen. As soon as we returned home with the results of the imaging study I opened the Tulsa phone book and looked for a neurosurgeon in the Yellow Pages. I did not know any neurosurgeons in the Tulsa area, and none knew me. Nevertheless, my call was immediately answered by Dr. David Fell, an incredibly kind and caring physician. He agreed to see Audrey within the hour. After evaluating her condition he scheduled surgery for the morning of December 23^rd. As he discussed the risks and benefits of the procedure he asked Audrey why she would like to have the surgery performed. “So I can have conversations with my family,” she replied. He felt it was a good reason.

Audrey’s physical condition began to improve immediately. She was able to walk from her hospital bed to the rest room with assistance and she was able to assist with the transfer from a wheelchair to my car the following morning. As I write this she is once again dressing herself and performing tasks of grooming and personal hygiene. She is able to walk without assistance and needs to be reminded to use her cane for extra stability.

Her mental status is improving more slowly. Memory and other cognitive functions are more fragile than motor activities. The good news is that while recovery from brain injuries proceeds slowly, it also proceeds indefinitely. Audrey has had a number of meaningful conversations with her family members since her surgery and we are cautiously optimistic that her mental status will eventually allow her to return home, a goal that she has been pursuing since she arrived in Oklahoma.

The willingness of the imaging center technician to work through her lunch period and the readiness of Dr. Fell to work another patient into his afternoon schedule were deeply appreciated. The speed with which Audrey’s condition was diagnosed and treated could not have been faster. It was a testimony to what is right about medical care in America. As the process unfolded I couldn’t help but wonder how things will proceed if politicians someday succeed in their drive to reform health care in this country. Will it still be possible for an 83 year-old woman with weakness and dementia to receive treatment, and, if so, will she be able to receive it in a similar timeframe? I don’t know the answers to those questions, but am very thankful that her illness presented at this time and not in the future.