Category Archives: Neurology

International Praise for Carrying The Black Bag

I am immensely gratified to have received an international award for my book, Carrying The Black Bag: A Neurologist’s Bedside Tales. In an act of shameless but necessary self-promotion, I share the good news with you. Hope y’all will help to spread the word!

 

FOR IMMEDIATE RELEASE Contact: Maryglenn McCombs (615) 297-9875 maryglenn@maryglenn.com

TEXAS NEUROLOGIST WINS PRESTIGIOUS INTERNATIONAL AWARD
Tom Hutton, M.D.’s memoir, Carrying the Black Bag, Among Honorees, Finalists for the Eric Hoffer Book Award

LUBBOCK, Texas – Texas doctor Tom Hutton, M.D.’s memoir, Carrying the Black Bag: A Neurologist’s Bedside Tales has been named among the winners in the Eric Hoffer Book Awards.

A prestigious international award that honors the memory of American philosopher Eric Hoffer, The Eric Hoffer Book Award has become one of the largest and most sought-after awards for small, academic and independently-published titles. Presented annually, the Eric Hoffer Book Award was designed to highlight salient writing and celebrate the spirit of independent presses. This year’s award program yielded over 1300 book entries.

Carrying the Black Bag: A Neurologist’s Bedside Tales, a memoir of Hutton’s career in medicine, was awarded an Honorable Mention in the Health category. Moreover, Carrying the Black Bag was named a finalist for the Eric Hoffer Book Award’s Montaigne Medal, which celebrates those books deemed the most thought-provoking.

During his thirty-plus years of practicing in West Texas and Minnesota, physician and neurologist Tom Hutton discovered that a doctor’s best teachers are often his patients. From these (extra)ordinary individuals, Hutton gained a whole-hearted respect for the resourcefulness, courage, and resilience of the human spirit. Hutton’s patients—and the valuable lessons they taught—served as the inspiration for Carrying the Black Bag. Part memoir and part tribute to the patients who faced major illness with grace, grit, and dignity, Carrying the Black Bag invites readers to experience what it is like to be a doctor’s hands, eyes, and heart. Imagine the joy of witnessing a critically ill five-year-old who, against all odds, claws her way back from a coma and near certain death. Meet a lonely Texas widower with Parkinson’s disease who hosts elaborate pinochle parties for a pack of imaginary canines. Step into the surgical booties of the author when he attempts to deliver his own child amid heart-stopping obstetrical complications—during a paralyzing Minnesota blizzard. Through real-life patient narratives, Hutton shines light on ordinary people facing extraordinary challenges. Moreover, this captivating tale captures the drama of medicine—its mystery, pathos, heroism, sacrifice, and humor.

Tom Hutton, M. D., is an internationally-recognized clinical and research neurologist and educator. The past president of the Texas Neurological Society, Dr. Hutton served as professor and vice chairman of the Department of Medical and Surgical Neurology at the Texas Tech School of Medicine. He now lives on his cattle ranch near Fredericksburg, Texas. Visit Tom Hutton online at: https://jthomashutton.wordpress.com/

Published by Texas Tech University Press, Carrying the Black Bag is available in hardcover edition (6 x 9, 257 pages; photographs; ISBN: 978-0-89672-954-4) Carrying the Black Bag was also awarded the Bronze Medal in the “Best Debut Author” category of the Feathered Quill Book Awards.

For additional information on the Eric Hoffer Book Award, visit: http://www.hofferaward.com/

Members of the news media wishing to request additional information about Tom Hutton, M.D. or Carrying the Black Bag are kindly asked to contact Maryglenn McCombs by phone: (615) 297-9875 or email: maryglenn@maryglenn.com
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Taylor McNeill, a surgical nurse and dear niece, reading my book between cases

Best New Debut Author for 2017

Recently received the very good news that my book, Carrying The Black Bag: A Neurologist’s Bedside Tales, won a national book award for 2017 from The Feathered Quill. This is a really big deal!

Will you please share this good news? The marketing/publicity from a regional publisher is limited and your help in networking my book would be much appreciated. Below is the news release for this award.

 

FOR IMMEDIATE RELEASE

Contact:                Maryglenn McCombs (615) 297-9875 maryglenn@maryglenn.com

 

TEXAS DOCTOR WINS NATIONAL AWARD FOR MEMOIR:

Carrying the Black Bag by Tom Hutton, M.D. among honorees in literary awards competition

 

LUBBOCK, Texas – Texas doctor Tom Hutton, M.D.’s memoir, Carrying the Black Bag: A Neurologist’s Bedside Tales has been named among the winners in the Feathered Quill Literary Awards.

 

Sponsored by Feathered Quill, a leading web-based book review, the Feathered Quill Literary Awards is a national awards program that celebrates excellence in publishing. Recognizing books from both large and independent presses, the Feathered Quill Literary Awards honors the best books in numerous categories.

 

Carrying the Black Bag: A Neurologist’s Bedside Tales, a memoir of Hutton’s career in medicine, was awarded the Bronze medal in the “Best Debut Author” category. Published by Texas Tech University Press, Carrying the Black Bag is available in hardcover edition (6 x 9, 257 pages; photographs; ISBN: 978-0-89672-954-4)

 

According to Ellen Feld, Editor at Feathered Quill “We were overwhelmed by both the number and extraordinary quality of entries for this year’s awards program. In particular, The Best Debut Author category was filled with worthy entries: consequently, it was difficult for our judges to pick among the many excellent contenders. Tom Hutton, M.D.’s memoir, Carrying the Black Bag was a real standout: compelling, well-written, and an incredibly beautiful and hopeful testament to the human spirit. It is our great honor to recognize Dr. Hutton among this year’s Best Debut Authors. We can only hope he has more books in the works.”

 

During his thirty-plus years of practicing in West Texas and Minnesota, physician and neurologist Tom Hutton discovered that a doctor’s best teachers are often his patients. From these (extra)ordinary individuals, Hutton gained a whole-hearted respect for the resourcefulness, courage, and resilience of the human spirit. Hutton’s patients—and the valuable lessons they taught—served as the inspiration for Carrying the Black Bag. Part memoir and part tribute to the patients who faced major illness with grace, grit, and dignity, Carrying the Black Bag invites readers to experience what it is like to be a doctor’s hands, eyes, and heart. Imagine the joy of witnessing a critically ill five-year-old who, against all odds, claws her way back from a coma and near certain death. Meet a lonely Texas widower with Parkinson’s disease who hosts elaborate pinochle parties for a pack of imaginary canines. Step into the surgical booties of the author when he attempts to deliver his own child amid heart-stopping obstetrical complications—during a paralyzing Minnesota blizzard. Through real-life patient narratives, Hutton shines light on ordinary people facing extraordinary challenges. Moreover, this captivating tale captures the drama of medicine—its mystery, pathos, heroism, sacrifice, and humor.

 

Tom Hutton, M. D., is an internationally-recognized clinical and research neurologist and educator. The past president of the Texas Neurological Society, Dr. Hutton served as professor and vice chairman of the Department of Medical and Surgical Neurology at the Texas Tech School of Medicine. He now lives on his cattle ranch near Fredericksburg, Texas. Visit Tom Hutton online at: https://jthomashutton.wordpress.com/

 

Members of the news media wishing to request additional information about Tom Hutton, M.D. or Carrying the Black Bag are kindly asked to contact Maryglenn McCombs by phone: (615) 297-9875 or email: maryglenn@maryglenn.com

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Does Hillary Clinton Really Have Parkinson’s Disease?

I usually avoid writing about political matters. In recent days though, I’ve been asked by multiple friends, both lay people and physicians alike, to share my views on a video put out by Dr. Ted Noel, suggesting Hillary Clinton suffers from Parkinson’s disease (PD).  https://www.youtube.com/watch?v=Zr1IDQ2V1eM

The implications of a potential President of the United States having a progressive neurological disease tends to focus our attention and require careful consideration. For that reason, I’ve decided to share my thoughts on Dr. Noel’s assertions that Hillary Clinton has PD.

My  professional background is that of a practicing clinical and research neurologist. I  treated patients with PD for decades and also directed a Parkinson’s Disease Center of Excellence for the National Parkinson’s Disease Foundation. My background qualifies me to comment on the assertions made by Dr. Noel. He trained as an anesthesiologist and admits to strong political views on his video blog. As for me, I am neither a registered Democrat nor Republican and possess the strong belief that medical and scientific facts must not be viewed through a convenient political lens. Politically driven science leads to bad science.

I have a great interest in the impact of medical disorders on the decision-making of public figures. Toward this end I’ve appeared on History and National Geographic channels discussing the likelihood that Adolf Hitler suffered from PD. I’ve also written on the topic; most extensively in my recently published book entitled, Carrying The Black Bag: A Neurologist’s Bedside Tales. I refer those interested to Chapter 13 and my argument that Adolf Hitler, in addition to his other medical disorders, also suffered from PD and this disorder affected, not only his movements, but also his memory and cognitive function. Hitler’s PD may have impacted his conduct during the latter phases of World War II and influenced the outcome of the war.  The evidence that Adolf Hitler had PD is in my view  substantially stronger than that purported by Dr. Noel for Hillary Clinton.

I support Dr. Noel’s contention that, in the absence of a hands on examination, observing videos of someone with Parkinson’s disease can lead to a strong conclusion that the person had PD. This is possible because the disorder demonstrates easily recognizable tremor, slowness of movement, stooped posture, lack of arm swing, gait abnormalities, and blank facial expression. The neurological examination allows the examiner to feel the particular type of muscular rigidity in PD (so-called cogwheel rigidity) which cannot be observed from a video.

Sketch of a man with PD with the typical features

Sketch of a man with PD with the typical features

What is missing from Dr. Noel’s “facts” is a discussion of how PD develops over time and its typical order of presentation. The medical field refers to this as the natural history of the disease. It is here that Dr. Noel makes several errors, no doubt because his training and experience are in Anesthesiology, not Neurology, nor does he likely have extensive experience in the diagnosis and treatment of people with Parkinson’s disease.

For example, he claims the onset of Hillary Clinton’s alleged PD dates to a fall she suffered eleven years ago, the fall resulting from her PD-related loss of balance. While loss of balance (referred to as loss of postural righting reflexes) is a well known feature of PD, this is NOT an early feature, nor it is a first sign of the disease. Rather balance problems are a late finding in the natural history of the disorder and follow the onset of the more major features, such as tremor, rigidity, slow movements, blank facial expression, and lack of arm swing while walking.

Hand tremor (not head tremor) is the most common presenting sign of PD. This is a slow rhythmic tremor of the fingers, a so-called “pill rolling tremor” named after the apothecaries of old. parkinsonsTo my knowledge, Clinton has never shown this type of tremor. As Dr. Noel points out, the hand tremor can be suppressed by holding the hand against the body or by manipulating an object. Nevertheless, the hand tremor returns periodically, especially when under emotional pressure, and is the most obvious feature of the disorder. Given the many public appearances of Hillary Clinton, this type of tremor, if it existed, should already have been observed many, many times.

Dr. Noel instead refers to the head-bobbing Clinton demonstrates in several videos as her purported tremor. While some people with PD have head tremor, this is unusual and not seen in my experience without tremor elsewhere in the arms or legs. In addition, the tremor of PD is rhythmic and of a certain, predictable rate. Her head bobbing is non-rhythmic and does not appear at all typical in rate or form for the head tremor of PD.

Slow movements, so-called bradykinesia, are another major sign of PD. I have not viewed any video that shows Hillary Clinton demonstrating slow movements beyond what would be expected of a 68-year old person. While treatment can mask the signs of PD, they can still be detected by experienced examiners, at least after the so-called “levodopa holiday” passes which typically lasts no more than a year or two.

Stooped posture, lack of arm swing and leading with the back of the hands while walking (simian posture) with forearms flexed, along with shuffling feet with short steps are convincing features for PD. Again, I am unaware of Clinton demonstrating any of these diagnostic features.

What Dr. Noel points to is a “bug-eyed” facial expression occurred only when Clinton was startled or overwhelmed by reporters shouting questions at her. A person with PD typically has wide-eyes, blank facial expression, and reduced frequency of blinking which Clinton does not demonstrate. A person with PD demonstrates these facial features all of the time, not episodically.

The blank staring facial expression of PD in Muhammad Ali

The blank staring facial expression of PD-  Muhammad Ali

 

Likewise his contention that her recently diagnosed pneumonia resulted from a swallowing abnormality associated with PD fails to be adequately supported. While swallowing problems exist in many persons with advanced PD and may lead to aspiration and pneumonia, they are present in association with the cardinal features of PD, such as tremor, slow movements, and muscular rigidity. The swallowing abnormalities do not occur in the absence of the cardinal features of PD.

We have no evidence these cardinal features of PD exist in the video, nor do we see the minor signs of PD, such as a blank facial expression, lack of arm swing, stooped posture, shuffling gait, soft and muffled voice, simian posturing of the hands, oily skin, dandruff and acne. Clinton’s speech patterns are readily available to anyone who follows the campaign. She does not demonstrate soft and muffled speech as is seen with more advanced PD.

In summary, the evidence presented by Dr. Noel is far from convincing that Hillary Clinton has PD. Dr. Noel has cherry picked various signs without fitting them into a logical context or natural history of PD. I do not believe Hillary Clinton suffers from PD based on current evidence.

Whether she has another neurological disorder cannot be discerned from the limited medical information available. Medical records and examinations are needed.

Dr. Lisa R. Bardack, Hillary Clinton’s Internal Medicine physician, has released limited information on Hillary Clinton. Clinton has treated hypothyroidism, seasonal allergies, and we know of her recently diagnosed bout of pneumonia for which she was placed on antibiotics.

More concerning was the episode of closed head injury that took her a full five months from which to recover. She apparently developed a blood clot within her head in 2012 believed to have been a transverse sinus thrombosis- a very serious  brain disorder. Almost certainly Clinton would have  been attended by a neurologist or a neurosurgeon or both; however no neurological records have been released of this major medical event. We do not know whether she suffered any permanent brain damage or other complications from this episode.

She also has suffered episodes in 1998 and 2009 of deep vein thrombosis (DVTs) in her legs and takes an anticoagulant, Coumadin for prevention of future blood clots.

As an aside, Hillary Clinton’s falls or risk for falls while on Coumadin, demands caution, especially when climbing stairs or at risk for falls or cuts.

Very little medical information has been released for either Hillary Clinton or Donald Trump despite the rhetoric streaming from their campaigns claiming the opposite. As compared to the medical records released by John McCain and George W. Bush when running for President, the currently released medical information is meager by comparison. This is, in my opinion, very unfortunate.

Whether a candidate is healthy enough to become president and perform the duties of the office should be a condition for running. The people who vote would benefit from health information just as they  benefit from policy statements and fiscal plans. Since both major candidates, Clinton and Trump,  respectively are 68 and 70-years of age, the need for this information takes on even greater importance.

The candidates in my opinion should release their full health records and not just politically sanitized versions or the results of their most recent physical examinations. A list of their medications should also be released and would likely be revealing. Lacking a willingness by the candidates for full medical disclosures, a non-partisan panel of medical experts should review all available medical records and attest to the candidate’s health status and their ability health-wise to meet the demands of the office of President of the United States. Such a course of action would be in the best interest of the American people.

 

Thoughts On Love

Lately I’ve been thinking a lot about love. And when I say this, I mean with its many facets. Strangely this began when our daughter Katie and her dog Olive visited last weekend. Olive does not appear as your typical dog. Olive looks like a dog put together by a committee. As best we can determine, she has German shepherd and either Corgi or Basset hound in her background. Olive is a very sweet and a good natured dog but one that elicits gasps and startled comments, such as “Oh my gosh, what is it?”

Olive has the face and head of a German shepherd but possesses a low slung body with front paws that angle outward at nearly 45 degrees. Now how exactly a German shepherd and a short-statured hound got together, I don’t know. My guess is the German shepherd mother got drunk one Saturday night and fell into a ditch- then along came Daddy.

Katie and Olive

Katie and Olive

Another reason for my recent fixation on love is that I have been reviewing chapters from my unpublished nonfiction book (tentatively entitled The Man Who Played Pinochle With Dogs). One chapter describes an elderly lady with a massive stroke who EMS brought to our emergency room. Initially we didn’t even know her name but determined from the CT-scan that the brain hemorrhage  gave her a very low chance of survival. The  woman physically was in very poor shape and not much to look at. Her hair was stringy and yellowish, finger nails grimy, skin fissured and aged, and she looked malnourished. I must admit at that point, we looked at her more as an old lady with failing physiology and decrepit body than as an individual with particular wants and loves. In our defense we had nothing else to go on.

The next day Ned, her octogenarian husband, with mincing steps walked into our medical intensive care unit and filled us in on her background. Ned not only gave us factual information about her health, but also absolutely changed the way we thought about this woman. We learned that both husband and wife had spent their lives as migrant workers. The had met as children at the end of a long cotton row and later started a common law marriage. Neither could have been described as anything but common in appearance. They had little in the way of worldly possessions and possessed little education. They had no children that might have cemented their relationship. Despite this  rocky foundation on which to build a relationship, their love had thrived.

It soon became clear to us just how much in love they had been. They never had been apart in all their years together. They worked hard, looked out for one another, and moved about together following the crops. The husband was absolutely devoted to his wife, a woman in the story whom I refer to as Maggie.

Whether it was Olive’s speculated upon parents or this pair of octogenarians, love always seems to play a central role for all of us in our lives. Whether it was simple lust as I suspect with Olive’s parents or a deeper, longer, and more meaningful love as with my memorable couple that love provides tremendous importance for our lives.

As I review my medical stories, how often I find an underlying theme about some aspect of love. It enters in the form of caregiver sacrifice, spousal love, love of a parent for a child, or love among unlikely and inherently unlovable people. Love often becomes the engine of transformation in my creative nonfiction stories. The stories also underscore the affection doctors and nurses develop for the people they care for.

Medicine is a calling like no other. I am fortunate to have experienced not only an education in medicine but having medicine provide for me a greater understanding of human nature, human strivings, and human fallibilities. Thank you Maggie, thank you Ned for helping me to understand a bit more about love.

The Man Who Played Pinochle With Dogs

Many may know of my interest in writing down patients stories that inspire or entertain. This led to my writing a book of stories gleaned from my medical career. All of these impressed on me the strength of the human spirit. I now have an agent at Trident Media Group in New York City who is shopping my book.

A shortened version of one of the chapters, entitled The Man Who Played Pinochle With Dogs, was submitted to an annual contest by the American Academy of Neurology. To my surprise it won the prize, one thousand dollars, and invitation to an awards ceremony October 2012,

I thought some readers might like to read this shortened version. It will provide a taste of what hopefully the published volume will offer. The story follows below:

THE MAN WHO PLAYED PINOCHLE WITH DOGS

I strode toward a full chart rack.  The intake note read:  “75-year-old Muleshoe farmer, eight-year history of PD, med check.”

Wasn’t Muleshoe that cotton town northwest of Lubbock near the infamous Bloated Goat Saloon?  I had heard about this boot-scooting, brawl-provoking West Texas watering hole.

I scanned prior chart notes, planned my examination, and considered treatment options.  Like battle plans in war, my considerations would soon become obsolete.  As I entered, an elderly man sitting on the exam table glared.  He was short and had a face as fissured as a prune.

“What’s keeping you doc, playing golf?”

“Sorry to keep you Mr. Woodley.  I’m Doctor Hutton.  What can I do for you today?”

The man peered at me like a hawk sizing up its prey.  He wore a sweatshirt that screamed, “If things get better with age, then I’m approaching MAGNIFICENCE.”  I sat on the exam stool and acted nonchalant, as if I had ample time to wait out his petulance.

“It’s nice to finally see you,” he intoned, not yet abandoning his piqueWhile his words were barbed, his West Texas drawl and soft Parkinson’s speech reduced their sting.

“Mr. Woodley, I see Doctor Reynolds treated you.”  Doctor Reynolds, the founder of the Parkinson’s Clinic, had since decamped for a position at Johns Hopkins.

The corners of Sam Woodley’s mouth turned up slightly.  He nodded his head

and ran a gnarled hand along the exam table, smoothing the paper.

“Yep, for years Doc Reynolds my doctor.  Without him suspect I’d move slower’n a constipated slug.  Liked that funny talking Yankee.”  I continued my get-acquainted conversation, sensing a thaw in my frigid reception.

“Do you have family?”

“Wife up and died three years ago.  Kid took off for godless California. Not much to do since leasing out the farm.”

After a few sympathetic clucks, I asked, “Live by yourself?”

“Yep, but ya see a young heifer wantin’ to play house with an old fart like me, ya let me know!”  A mischievous grin came over his weather-beaten face.

I began to admire the pluck of this old farmer.  “I’ll keep it in mind, Mr. Woodley. How do you spend your time?”

“Frankly, not much. Just call me Sam.”

”Okay Sam, what do you do with your time?”

”Take care of the homestead.  Played cards with my Gladys, before cancer took her.”  Before he turned his head away, I noticed his eyes begin to glisten.  His defiance by then had dissipated, replaced by vulnerability and loneliness.

I steered the conversation toward his health.  “How’s your Parkinson’s disease been treating you Sam?”

Sam began describing difficulty cutting his food and tying his shoelaces.  His tremor and shuffling feet embarrassed him.  Surprisingly he said he also found it harder to shuffle cards.  Why, I wondered, did he need to shuffle cards?

Sam conceded his memory had slipped.  I listened, nodded, sympathized, and discussed making lists.  I inquired about side effects of his medicine with a series of nonproductive questions.  Then I asked, “Have you seen animals or people that were not really there?”

Sam hesitated.  I noticed his jaw muscles tighten.  His face took on a look of puzzlement that could not have been greater if I had stood on my head and begun to spit marbles.  Sam measured me, his bushy eyebrows knitting up like two angry caterpillars about to do battle.

“Maybe, maybe not.”

“Please tell me more.”

He ran the back of his hand across his square chin.  I observed his lips quiver.  After taking an unusual interest in the ceiling tiles, Sam Woodley finally blurted,  “Well doc, I see dawgs.”

I quickly followed up in my best nonjudgmental tone.  “Dogs, huh, well big or little?

Sam tugged at a dangling ear lobe.  With a weary sigh, his resistance gave way.  He shared his mystery by relating a bizarre story.  Trust must be earned, as it resides at the core of the doctor/patient relationship.  Sam provided his guarded experiences that allowed me to gain insight but also created for me a challenging dilemma.

“Well, ‘bout every afternoon three dawgs drop by.”  He fell silent awaiting my response to this snippet.

“Go on,” I gently urged.

In his monotone he described a large yellow Labrador, a black and white Border Collie, and a smaller white and brown Cocker Spaniel.

“Are they scary?” I asked.

“Nah, gentle as can be. Besides we play together.”

Puzzled where the conversation was leading, I asked if the dogs had names.  He nodded.  “Yellow Dawg the Lab, Skipper the collie, and Coco the spaniel.”

“Well what do they do?”

“Mostly like to play cards.”

I wondered if my ears were tricking me.  “Oh, I see,” I said, trying to sound, as if I was often told about three dogs playing cards. “Well, what card games do y’all play?”

“Usually pinochle, their favorite.”

“So, play pinochle, do they?”

“Oh yeah, especially Skipper and Coco.”

“I see, make noise while they play?”

“Never a sound, but I know what they want.”

“Please tell me how you and the dogs go about playing pinochle.”

Sam described how he would place the card table and arrange the chairs.  He would then invite the dogs onto their chairs and begin the game. “Coco likes to beat the boys. Upsets her if she loses. Been known to leave in a huff.”

He described shuffling and dealing but admitted he had been having difficulty managing the cards.  Sam said his canine friends had even greater difficulty than he did, forcing Sam to deal.

“You see doc, my hands aren’t as good as before this here Mr. Parkinson’s disease.  Be obliged if you’d just, well, give it back to him!”  With his quip, an endearing smile crossed his weathered, old face.

“Well, maybe I can help,” I encouraged.  Intrigued by his narrative, I gestured for him to continue.

“Well Skipper, the Border, wears green eye shades, you know like bookkeeper types and uh, Coco, the Cocker Spaniel sits on a pink handkerchief, thinks it makes her lucky.  Oh, and Coco sits with the floorboards, not across them- feels strong bout this, just like my Gladys.  Suspect Yellow Dawg comes for the sandwiches.  He’s not good at pinochle.

My mind was reeling, visualizing this elaborate scene.  I concentrated, trying not to project incredulity.  Sam was relating an unreal event with the nonchalance of describing weather changes or the cotton crop.  Was his elaborate hallucination prompted by Cassius Marcellus Coolidge’s series of pictures, Dogs Playing Poker?  My knowledge of pinochle was not extensive, but I knew it was a game for two to four people, not a pastime for dogs.

Mentally I had already determined that Sam required a medicine change to get rid of his hallucinations.

With twinkling brown eyes, Sam warmed to his narrative.  I observed his hand tremor increase, as he affectionately described his daily visitation.

“I make sandwiches before they come.  Yellow Dawg likes ham and cheese and lots of ‘em..  The spaniel and collie prefer turkey.”

He told of putting out dog biscuits.  “They prefer beef flavored ones.”  I sensed Sam’s pride as host.  “Put down a bowl of water in case they’re thirsty.”

“Mr. Woodley, can you touch the dogs?”

“Nah, if I try, hand passes right through ‘em.  Makes ‘em disappear.  Learned not to.”

“What about smelling the dogs?”

“Hadn’t thought ‘bout it, but can’t smell ‘em, feel ‘em, or hear ‘em neither.”  I considered for a few moments what I had heard.  Sam’s hallucinations fit with medication related side effects of Parkinson’s disease but they sounded more complex than I had previously encountered.

“When we finish the game, dawgs head for the door.  Disappear without me even opening it.”

“Do you and the dogs play anything besides cards?”  I wished to learn the extent of his interaction with the dogs and whether an emotional dependence on them existed.

Sam thought and then replied, “Watch the Cowboys on TV.  Don’t know about being America’s team, but sure as hell the dawgs’ favorite.”  Sam laughed heartily.  His hand tremor again increased, acting like his emotional barometer.

“How do you know that?”

“Well, Cowboys make ‘em a touchdown, Skipper jumps off the couch and tears around the room, jumping over furniture—his own little end zone celebration.  If the other team scores, dawgs lay their chins on their paws and look real sad.  Easy to read my dawgs.”

I was by then more certain his hallucinations needed squelching.

“Mr. Woodley, a healthy person’s ability to move about is like a wagon pulled by a team of eight horses.  With Parkinson’s only two healthy horses remain to haul the wagon. To keep it moving, we drive these two harder with medicines- like swinging a whip over the horses’ heads.

Sam sat quietly, listening to my analogy, one to which I hoped he could relate.

“Unfortunately urging them too hard can cause horses to get balky, like side effects, such as seeing things not really there.”  Sam listened without comment.  I explained how Parkinson’s had diminished his store of dopamine and that levodopa/carbidopa supplemented his brain’s inadequate supply.

“You see Mr. Woodley, too much treatment causes hallucinations.  We must reduce your medicine.”

Sam sat motionless.  Then his mouth began chewing movements, as if chewing his thoughts into declarative sentences. He then crossed his arms across his chest.  I quickly assured him that we could banish his hallucinatory hounds.

He at last replied, “Don’t know ‘bout that doc.”

I was taken aback. “Well, you agree we need to get rid of your hallucinations?”

“Dawgs ain’t bothering me none.”

I considered what further arguments to make.  “Are you worried about your movements slowing?”

“Nah, I got plenty of time to do my work.” Sam chewed more before asking.  “But how would I spend my afternoons, if I didn’t play pinochle with my friends?”

I searched for a rejoinder, but before finding one, Sam Woodley added, “Besides whatever would I do with all the extra sandwiches?”

Such rarified moments provide insight.  I gained a better understanding of the unmet emotional needs of Sam Woodley.  The experience also reminded me to view the situation through the other person’s eyes, a valuable lesson in medicine and in life.

My earlier training had taught me that hallucinations required adjustment of medicine.  I knew hallucinations could be well tolerated, and rarely welcomed.  But I also understood hallucinations could increase and become frightening.

Sam showed no signs of hostility or incipient paranoia and claimed reduced boredom.  But still these hallucinations were florid.  And what would my new colleagues think if they learned that I had failed to address them?

Hours later after completing my charting and shrinking a stack of paperwork, I directed fatigued footsteps toward the doctors’ parking lot.

My thoughts returned to Sam Woodley.  I hoped he had arrived home safely.  Remembering, his pugnacious approach to life made me smile.

Had his truculence arisen from a lifetime of farming cotton in borderline soil, violent weather, and semiarid conditions?  Sam’s sad lack of human connectedness struck me as bleak as the flat, treeless Llano Estacado; his loneliness, disease, and his medicine, having given rise to his illusory dogs.  Multiple factors contributed to his elaborate phantasm. One thing seemed certain; his dogs had provided unusual companionship.  I felt satisfaction, knowing I had gained sufficient trust for him to share his dogs with me.  Thirty years later, I appreciate his trust no less.

I visualized Sam arriving at his remote farmhouse.  I imagined him placing the table parallel to the floorboards and moving the dogs’ favorite chairs.  Perhaps he fixed enough ham and turkey sandwiches to satisfy the hungry Labrador.  I felt a smile cross my face.  I felt confident about my decision, considering this individualistic man and his lifestyle.

For now Sam Woodley would continue to enjoy his extraordinary pinochle parties with his dawgs.