Ossification

This is the process of turning into stone.

A similar word, petrifying is, I imagine what happens when the process is speeded-up.

Our bodies are built from stone. The bones that support the frames of our selves are a lattice-work of powerful interconnecting calcium and phosphate bridges. Without these, we’d be, well, jellyfish or squid.

I won’t go into the imaginings of other states of existence, suffice it to say, that the World Cup octopus of a few years ago knew he was on to a good thing.

It isn’t the skeleton or even calcium that I am considering here, it is a different form of immobilisation.

Parkinson’s Disease – named after the English Physician who first described the Shaking Palsy back in 1817 is, a neurodegenerative process which results from a deficiency of Dopamine in the brain.

I won’t go into the details – they are beyond me.

Although the disease is called the shaking palsy – the cardinal feature which I find most challenging is the way facial expression is affected.

In the medical world, with its cunning ability to manipulate language, this is sometimes called, ‘mask facies’ or, in more modern parlance, mask-face. This alludes to the often-expressionless demeanour of people who have the disease.

Think of Muhammad Ali back in the 1950’s then the shadowy figure seen at occasional public events before his death;

There are all sorts of descriptors used to subcategorise the symptoms – ‘blink paucity’ for example, is one – this, referring to a reduced frequency of blinking.

I personally have always struggled to support people who have Parkinson’s Disease (I’ll call it PD from now on), I think principally because of the incredible complexity of the disease – for those of you medical students out there, it isn’t just dopamine and muscles; there is a whole lot more – as with the treatment which is constantly evolving, developing.

For me, equally important is how I practice medicine.

Before reading blood pressure, renal function or cognitive screens, I look to a patient’s face; their level of alertness, expression, engagement with the environment, responsiveness and smile all factor-in to my assessment. The texture of their skin, the light reflecting from their eyes; this spreads to hair, dress and body posture, but, it is the face that provides the greatest information – is the person in pain, happy, anxious to leave, are they feeling sick, depressed or placid?

Evolution has taught us to read and understand facial expression beyond language or other forms of expression. From a distance you can usually detect friend or foe. The stranger may be carrying a weapon, but their eyes reveal all.

And so, to PD.

OK, I can’t do it… People who have Parkinson’s Disease.

It is reduced facial expression that I find most difficult.

Often an individual’s eyes can shine through the stillness, but sometimes even they are faded to grey.

Usually, when you can’t read a face, the next action is to talk, ask questions, classify experience.

With those who have Parkinson’s this is sometimes just as difficult; speech and language can be slowed-down, to say, ‘I am in pain, my bottom is sore,’ might take two or three times longer than another; add to this the elements of age, often cognitive and sensory impairment and people frequently don’t get to the end of their sentence before the person asking the question has moved-on.

And, part of this is my frustration at my inadequate patience. My need for a response creates a tension. I want to second-guess, fill-in the blanks, all this, detracting from the person’s experience, from their self.

I don’t know the answer beyond forcing myself to slow down;

To switch from the speedy, intuitive facial expression, reading between the lines interactions that mostly guide me to a slower more meditative encounter; acknowledging that the slowing, the disease, the turning not to stone, but the firming-up of expression is all part of the person. None of these can be separated.

A lesson I must learn.

I will end with a reflection on a man I met recently; he lay still, silent, in bed.

In his youth he’d been a martial artist.

The essence of quick, graceful movements, power, strength and form combined.

And now, lying still, stone-like in bed.

I used to have a photo of Bruce Lee punching a sheet of paper; he used to practice his speed techniques by making the paper move by the compression of air from his punches; not hitting the paper, just wafting it with his fist.

I think of this and I think of this man.

It is hard to imagine the person he was ten or twenty years before.

And yes, I know disease affects different people in an infinite variety of ways, this however seems an unusually cruel and punishing situation for one who very likely honed his body to the limits of fluidity. Now, frozen, still.