Doctor Miami (Part II)

(Third in a series.)

Nancy la criticona had been too quick to judge Doctor Miami. He kept Mami included in the conversation. It was about her, right? She was present in the examination room. We all knew English, but he punctuated the discussion with well-chosen and timed Spanish phrases, the kinds of idioms that Mami had used throughout my life. Yes, depression and anxiety “te sacan de quicio,” the Spanish equivalent of “make you feel out of whack.”

Doctor Miami confirmed what I’d Googled: depression and anxiety mimic and mask the symptoms of dementia and age-related memory loss, which anticipated my next question: How do you tell the difference? Mami had cognitive problems, for example trouble concentrating and short-term memory problems. Depression causes these; it doesn’t help that Mami alters her dosage of Paxil and has also “self-prescribed” too many Xanax in cases of extreme distress, which has caused her to faint. Feeling betrayed by her mind could influence Mami’s depression and anxiety, and continue the cycle of “self-doctoring” that further blurs the line between what is and what is not age-related memory loss. While Mami had agreed to keep Friday’s appointment with Doctor Miami, she didn’t agree with this assessment.

“Everything started with those eye drops.”

I bit my tongue because I’d heard that story so many times. Medical procedures rank high on Mami’s list of anxiety triggers and her glaucoma surgery nine years prior had knocked her out of quicio. The eye drops that had been prescribed post-op had given her headaches, which made her more anxious and, in turn, more distracted, etc. Doctor Miami responded before I could. He agreed that certain medications could affect depressive states or interact with the medication she had already been taking, but nine years was enough time for the drops to be out of her system. I couldn’t help but remind her that I’d known her for the forty-plus years of my life and depression and anxiety had been issues way before the glaucoma surgery. She turned her head away from me.

Doctor Miami recommended a new antidepressant that has been found to improve memory and cognitive function. We looked at Mami. She looked only at Doctor Miami. He said the new medication was similar to Paxil and likely to be well tolerated by Mami. She sighed. After a sustained silence, she said that it seemed a good idea and would give it a try.

“She’s so cute,” Doctor Miami said as he listened to her breathing with his stethescope.

Mami is indeed cute. In the examination room, Doctor Miami saw a pixie-ish woman. How could so much anxiety and panic and despair fit into that cute little delicate woman who smiled at the doctor girlishly as his too-beefy hands probed her so-little stomach? I didn’t look forward to the other side that would emerge, maybe as soon as the lobby (“How could you tell the doctor I take too many Xanax?!”) or when the bottle of new pills arrived from the pharmacy (“I am not taking those.”). Mami always keeps me on my toes, ducking and weaving because I never know when FUACATA! she’ll get me with a jab or hook. Not cute.

Doctor Miami explained that in addition to the usual annual blood work, he would order further blood tests that would help determine or rule out whether the cognitive difficulties could be due to something hormonal or an abnormality, such as a thyroid condition. He would see us in three weeks, enough time for him to review the test results, for Mami to transition onto the new antidepressants, and for me to observe any new reactions or behaviors or concerns.

Mami had stopped picking at the cuff of her sleeve. She didn’t look at anyone or anything in particular. I asked if she had questions or wanted to go over anything again. She said she’d understood everything. The examination room was bright, uncluttered, and organized, but I felt suffocated by all the information and words: depression, anxiety, prescriptions, medications, conditions, tests, family history, dementia. Mami just continued perched on the edge of the exam table, ready to take flight. Perhaps she’d already taken flight somewhere, and that’s why she sat there, quiet, no questions.

I had my to-dos: schedule the three-week follow-up; take Mami to LabQuest for bloodwork; fill the prescriptions at the pharmacy; follow the medication transition instructions; observe and  note anything that needs to be brought to Doctor Miami’s attention. Plans and tasks comfort super-competent Nancy. These were things I could do.

As Mami and I waited for the elevator, we agreed we needed air and to stretch our legs after having been confined in the doctors’ suites office building at 377 Jersey Avenue. We decided we’d walk back to Unico Towers. It is about one and a half miles, but we’re both big walkers and the forecasted rain was holding off.

It was a distance we knew we could manage and we agreed a walk would do us good.

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