Brain Farts

I approach the medical receptionist’s desk with my 84-year-old mother. We are at her primary care doctor’s office, on the third floor of the medical group’s building. She’s scheduled for her Medicare wellness exam. Yesterday I accompanied her to her podiatry appointment, watched her callouses get peeled away like the skin of a potato. I broached the topic of possible foot surgery.

“She’s had back and hip surgery done and now the pain in her feet is the only thing limiting her activity.”

The podiatrist shook his head. “Poor thing,” he uttered behind his face mask. “Next time, don’t have her wait too long to see me.”

My sister lives with our parents but isn’t always able to attend their various medical and dental appointments. When I visit from the mainland, my time is their time, so here I am. The receptionist hands me a two-page questionnaire on a clipboard.

“We need her to complete this,” she says. The forms are in English. My Japan-born mom is English-handicapped despite having lived in Hawaii for over sixty years. Ethnically, the Japanese are the second largest group living in Hawaii. Japanese tourists in Hawaii are catered to so well that not a single word of English is exchanged during their stay. For Japanese natives turned naturalized U.S. citizens, there’s an expectancy that they be fluent in English. No one in the office speaks Japanese and the forms are not provided in any other language.

I check off the first few questions quickly. Age. Gender. From there the questions get tricky. Basically, it asks how, over the past four weeks, has her physical and emotional health impacted her activities of daily living. I respond with what informed my eyes over the past three days.

Any trouble eating? Never. She hates wasting food.

Any problems using the telephone? Never. At least not for mom. Problematic, always, for the person at the other end of the line if she’s not wearing her hearing aids.

Any falling or dizziness when standing up? Seldom. There was an instance about a month ago where she tripped and fell against a door, running from hanging laundry outside to answer the phone. She smacked her nose so hard that dad called 9-1-1 to the apocalyptic bleeding that followed. She walked herself to the waiting ambulance, the reluctant spectacle for an audience of curious neighbors.

Any sexual problems? My hand hovers over which box to check, trying to recall the last decade Mom and Dad slept in the same bed together. Never.

We wait forty-five minutes before a harried nurse calls my mother’s name. Mom hands her a box of a dozen, now cooled, malasadas. “Thank you,” she coos, “You’re always bringing us something. I’ll put this in our lunch room.” She places the box on a stack of patient charts in a corner of the cramped exam room. After taking mom’s blood pressure, she proceeds to ask her questions prompted from the computer screen. When was her last eye exam? Dental? Did she already receive her flu shot? When? Did she receive her second pneumococcal shot? Mom doesn’t know. I ring dad on my cell phone.

“Dad. Do you know if mom got a pneumonia shot at that senior faire you both went to?”

“Yeah. She got a shot.”

“Was it for flu or for pneumonia?”

“Oh, I dunno. Pneumonia.”

“Thanks, Dad.” To the nurse I say, “A second shot couldn’t hurt, right?”

The nurse nods, biting the inside of her lip as she scans mom’s computerized medical file. “Since this is a wellness checkup, I’ll need to have her to draw me a clock.” Mom is handed a blank sheet of paper and a pencil. “Tell her to have the clock read 11:10.”

Mom nods understanding. She first draws a circle. Carefully she writes the number 11 as found on a clock with a sweeping second hand, then the number 10 at the 2 o’clock position. My jaw drops open. I point to my wrist watch. Fortunately, it’s not digital. She chuckles and erases the 10, writes in 2, then completes the face of the clock with the correct digits, the hands reading 11:10.

Satisfied, the nurse grabs the sheet without a second glance and notes her medications.

“She’s on three medications. I don’t know about one of them.” She queries the doctor. It’s for dementia. Her expression registers exasperation. The malasadas grow stale in its box.

“I’ll need to ask her more questions,” she bleats. We don’t get far. There are limits to my elementary Japanese.

“I’ll just have to say the test couldn’t be completed because of the language problem.”

Her doctor, however, gamely attempts to complete them. He speaks a little Japanese. Pointing to a calendar on the wall, he asks for the current date. The name of a Korean restaurant is printed at the bottom. It’s located on Keeaumoku Street. Mom wonders aloud if it’s any good after offering the correct answer.

He gives a small smile and scores her response in the computer.

Reaching deep into his pants pocket, he pulls out a penny. In Japanese he asks, “What is this?” In English she replies, “Penny.”

Pulling out a pen, he asks in Japanese, “What is this?” Again, she responds in English. “Pen.” I sense her hairs bristling.

“Say if, and, but.”

“If-u, and-o, but.”

He is silent between questions, his chin tilted upward, peering down through his bifocals to better view the computer screen. Under his breath he mutters, “Dumb questions.” Mom lifts her lower legs and idly rotates her thick ankles.

On a pad of paper, he writes, “100 – 7” then hands the pad and pen over to her. She writes the result, “93.” He tallies her points. Her score suggests mild cognitive impairment.

Later, I ask my sister who diagnosed mom with dementia.

“Her GI doctor.”

“That was the time she had her last colonoscopy?”

“Yeah. He speaks Japanese.”

???! Just how far did the good doctor snake that scope?