The simple act of carrying a cup of coffee to a cash register and trying to find the money to pay for it can be a daunting challenge, one made even more difficult because if people are waiting behind me, I feel great pressure to perform. My trembling hands cause the coffee to slosh about, and I fumble for the change in my pocket, change that often ends up on the floor. Sometimes I cannot tell a nickel from a dime from a quarter, so I hand over my change like a child at a candy counter and wait for the clerk to sort it out. At the supermarket, I can never figure out which way to slide the debit card. More than once I have had a cashier snatch it from my hand abruptly, point to the people behind me, and say, "People are waiting, sir!" Who wants to turn around and announce, "I have Parkinson's disease"? So you swallow the small indignities and humiliations and try ahead of time to think about each tiny step in the process of a task as simple as buying a carton of milk.
In my cardiology practice, I often discussed with patients what physicians call "ADLs," the activities of daily living. In assessing the toll of any disease, an important measure is how it impacts the patient's ADLs. By that standard, the toll of my Parkinson's has been great. The most routine tasks require a level of attentiveness and concentration that I once reserved for the treatment of seriously ill heart patients.
The physical manifestations of Parkinson's go well beyond tremors and involuntary jerks of hands and arms. Balance is problematic. Last year, I fell in the shower, hitting my head and drawing blood. As a result, I am more defensive and deliberate in my movements. I am always anticipating what obstacles—stairs, furniture, inclines, curbs—I will have to navigate in the places I go. I am constantly in a high state of vigilance that is draining, both emotionally and physically.
The impact of Parkinson's is so pervasive that even my thermo-regulatory system is out of control. I often feel too hot and too cold simultaneously. Hot flashes accompanied by sweats send me to the shower two or three times a day. A hot bath is often the only way to get comfortable again.
My hands and face often tell the story. While my face may be perspiring uncontrollably, my hands can be clammy and cold. As a practicing physician, I always paid careful attention to my patients' hands, often beginning my physical exam there, for the hands often provide important diagnostic clues. Thickened tendons in the palm can indicate diabetes. Swelling of soft tissue near the fingertips combined with nailbed changes may be a sign of lung cancer or cardiovascular disease. Painful lumps in the fingertips can suggest an infection of the heart valves.