Trauma by Daniel Palmer Page A

coming miles away. Finally, what—ten years ago now?—we started seeing another doctor, and he knew it was Parkinson’s just like that.” Nancy snapped her fingers. “He started Don on Sinemet and he got a lot better. But I’m sure you know the story. He started to get worse again, even after increasing his medication. He was taking it almost every hour, it seemed, trying a bunch of new stuff. It got very frustrating.” Nancy reached out and caressed Don’s shoulder, reminding Carrie of her parents. “Then he started developing these wild movements all over, his arms, legs, neck, and torso.”
    â€œPeak dose dyskinesia,” Dr. Finley said.
    Nancy said, “At other times he seemed almost frozen solid, and it got so you couldn’t tell when one state would change to another. It was like a switch.”
    â€œOn-off effect,” Dr. Finley elaborated.
    â€œWe saw a bunch of neurologists, but no one could do anything new or different. Then Dr. Sawyer learned about Dr. Finley’s program, and since Don is a vet—two tours in Vietnam—he thought Don might be a good candidate for the deep brain stimulation.” Nancy exhaled a protracted sigh. “I felt like I was Don’s nurse for thirty hours a day.”
    Don sat on the table, his expression vacant.
    â€œDon, I’d like Dr. Bryant to examine you briefly, if that’s okay,” Dr. Finley said. “Don’s machine is off, and we asked him to hold his medication this morning.”
    Don nodded, his stare still blank. He’d been poked and prodded by plenty of strangers before. Carrie would just be the latest.
    Carrie slipped back into the role of caregiver without missing a step. It really was like getting back on a bicycle, even after an ugly fall.
    Don had textbook PD, she thought. Pill-rolling rest tremor of right upper limb, dystonic turned-in posturing of the right foot.
    Don gazed unblinking out the window and showed little expression. It was easy to empathize with Nancy. The poor woman had to care for a ghost of her husband. Carrie asked Don a few simple questions—his name, birthday, and home address. His voice came out soft and stuttered, barely intelligible.
    Carrie helped him down from the exam table and tested his mobility. He followed her movement instructions with all the grace and fluidity of the Tin Man: classic cogwheel rigidity in all limbs. Positive glabellar tap response, classic flexed posture of the trunk. The Parkinsonian shuffle was on full display as he attempted to walk, and it was no surprise when he froze midway while turning to his left.
    Carrie recounted all that she had observed, and Dr. Finley looked pleased.
    â€œA lot of neurosurgical residents who rotate through my program don’t seem to know a thing about movement disorders or show that they can conduct a decent neuro exam,” he said. “You’re already two steps ahead.”
    From a nearby countertop Dr. Finley retrieved a compact device, approximately the size of a deck of cards. It had a plastic case, several buttons, and a small display screen.
    â€œThis programming unit will help us fine-tune Don’s stimulation settings,” Dr. Finley said. “It uses radio communication to adjust the stimulus parameters of the surgically implanted unit. Last time we set the frequency at one hundred and forty cycles per second, and the pulse width at eighty milliseconds. Today, we’re going to increase the voltage amplitude just a bit, to two and a half.”
    Dr. Finley peeled away the paper covers over the sticky pads on the back of a plastic dock and adhered the unit over the scar on Don’s chest. He snapped the programming device into place on the dock, then spent some time making sure the programming unit worked properly. When he was satisfied, he said, “I’ll be back in a while to take another look at you, Don, and we’ll see how you’re doing ‘plugged