Losing A Body

Today Mr.B came. He wasn't on the schedule. He had a 1:00 appointment, but they didn't put him on the schedule. I usually schedule him extra time, but instead he was scheduled for no time. I never like it when there's no time. I like time. It's good to have time to see the patients. A lot of doctors don't have any time to see the patients. But I think they tend to get frustrated. I once heard there was a doctor (in town here) who saw 100 patients in a day. I can't even imagine that. It's 7.2minutes per patient in a twelve hour day, assuming no bathroom or eating breaks. That includes the visit and the prescription writing and the dictations for the notes. It's probably roughly 4 minutes of "visit" time. Anyway, Mr. B has ALS (Lou Gherig's disease). It's a progressive loss of strength which has, in my mind, essentially no treatment. Riluzole is the only FDA approved medication, but it only prolongs life without improving its quality for about three months. To me, that's not meaningful treatment. I tell the patients about it, but few take it. On average, people with ALS die in about eighteen months. They die from too much weakness. They aren't strong enough to breath anymore. ALS affects people differently. Their weakness can be in any muscle. Mr. B has weakness in his arms. He can't pick up his arms at all. They just hang there at his sides. He can't dress, shower, feed himself, or clean himself up after going to the bathroom. He hates having his wife do all of it for him. Now he's getting leg weakness (right leg more than left leg). He fell. He has a lot of trouble getting up out of a chair. They just got a special high toilet, so he can get up off it. He doesn't have an electric wheelchair or an electric lift chair. He doesn't want to take any anti-depression pill. I think he's depressed. He says he's not. It's hard to treat someone for something when they don't want treatment, though. The last time he was here, he was talking to me about that he wants to die at some point. Not at this point, but he doesn't want to have to just lie in bed and not be able to "do anything". That happens with ALS. You lose the ability to get up and move. You end up just laying in a bed. Some of the ALS patients can't talk (mouth weakness) or swallow. He can talk and swallow just fine. His wife said today that it's a bad illness. When you have ALS you lose a body. I guess you lose a body with any terminal illness. Death is loss of a body. The thing is with ALS you lose a body very slowly. You just watch it gradually weaken into nothing over about a year and a half or so. Losing a body is a hard thing to do.