My mother is getting old. Sixty-three is not exactly ancient--for doctors specializing in geriatrics it's downright juvenile. Active, vivacious and slim, she hit her sixties running. But a few years later, she started a downhill slide.
At first it was just two or three health problems. Her orthopedic surgeon assured her that the pains in her back and hips were due to arthritis. The most frustrating problem was her fragile skin that never seemed to heal.
"I'm so careful, but look!" she would cry. After minor brushes against doorjambs or kitchen cabinets, her skin would crack and a piece the size of a penny could slide off, like the skin atop pudding. Even the brush of her infant granddaughter's fingernail would tear her skin as if it were wet tissue paper. "I'm starting to think I'll have to be quarantined away in some nice soft, pillowy space, kind of like the 'Bubble Boy'," she said, trying to maintain her sense of humor.
Angry red and purple splotches peppered her arms and hands. One doctor asked if maybe, perhaps, she was being a bit vain; he'd seen similar skin changes in other older people. Five board-certified dermatologists came up with the rather anticlimactic diagnosis of aging-related "purpura," a medical term analogous to "rash" and just as nonspecific.
"Why can't they figure out what is wrong with you?" I had asked, exasperated. My mind returned repeatedly to my medical training. Could it be a reaction to years of exposure to the sun? A disease of connective tissue? Cancer?
Then the dam broke. Mom was flooded with a torrent of health problems. Her internist told her that her cholesterol was too high and, while he was at it, her blood pressure was elevated enough to require medication. Dad said she seemed depressed at times, but with the myriad health problems plaguing her, wouldn't anyone? She became forgetful. Her legs felt heavy and tired after just a little walking. As a psychiatrist, I suggested that antidepressant medication might help with her feelings of fatigue and pain, at least until her doctors uncovered a cause or a cure for her afflictions.
After a year of seeking help for her problems, Mom was exasperated with doctors. Besides making her rounds to the five dermatologists and the orthopedic surgeon, she had visited internists, neurologists and an endocrinologist. Even plastic surgery to tighten up her chin had not been successful; the swelling in her face never did subside.
Mom had always cut a slender figure but now her jacket buttons strained to meet their buttonholes. Her abdomen enlarged to the point where she felt it was throwing her off balance. We wondered about the weight she had gained, but she was like a vacuum cleaner around food. "The kids didn't finish their dinner?" she would note, eyebrows raised. "Don't bother saving the rest of that dessert," she'd add, "or that one--I'll take care of it."
Dressing in a lavender lace and satin dress she had bought a few months earlier for my sister's wedding, she battled with the zipper over the expanse of her upper back. Turning to the side to survey the problem in the mirror, she was chagrined to see what looked like a "dowager's hump." With a dispirited sigh, she said, "Maybe the doctors are right. Maybe I am just getting old."
Mom patiently completed medical test after test. One showed that her bone density was so poor that she was in danger of fracture--so much for 25 years of estrogen pills to combat osteoporosis. Her bones, like her skin and her muscles, seemed to be dissolving.
As another year dragged by, Mom slumped with weakness and exhaustion. To her, the aisles of the grocery store seemed to stretch for miles. Shopping malls might as well have been Mount McKinley. Mom cried in frustration over each new skin injury. Her back pain tortured her sleep. She wondered how much longer she would be around--if she even wanted to be around. Mom had always been the glue holding our family together; the thought that we might lose her slammed into our minds.
In a flashback to medical school, the chairman of medicine, transcendent with his long bleached coat and winter white hair, had bellowed repeatedly, "LISTEN, listen to your patient, for he will tell you what is wrong, often tell you the diagnosis." My mother felt that most of her physicians dealt with her in a perfunctory way, that they weren't really listening. Unreasonable time restrictions under which physicians must work in the managed care environment contributed to this. Managed carelessness results.
For a fresh look, we took her to the Mayo Clinic in Rochester, Minn. Within five minutes, the internist asked her if she had been taking steroid hormones. She hadn't.
The Mayo doctor explained the possible causes of her body's excess secretion of steroids, known as Cushing's syndrome. This occurred, of course, only after carefully examining her "buffalo hump"--a medical term for a fat pad that develops on the upper back and is a distinctive characteristic of Cushing's syndrome. Oh, so it wasn't just age--although the gray haze of ageism had prejudiced and blinded her hometown doctors.
At Mayo, an MRI scan of my mother's head pointed to a benign tumor of the pituitary gland as the cause of her gush of steroid hormones, called corticosteroids. These are potent hormones that affect every part of the body, from skin and bones to brain and brawn. The one-centimeter tumor, nestled at the base of her brain, was the source of all that had plagued her. The constellation of signs and symptoms had been there, right under our noses. Actually, the tumor on her pituitary was, anatomically speaking, right behind hers.
The gradual changes in my mother, her myriad symptoms and advancing age had engendered misinterpretations by those other doctors. Her buffalo hump (I cringe to mention this abominable term in the same sentence as my mother) was small. Her osteoporosis--oh well, estrogen supplements can't work for everyone. Her steroid-soaked skin--age and the Florida sun.
Our oversized cerebrums are very good at concocting explanations. One day, sunlight had offered me a gentle hint to my mother's condition, highlighting the peach fuzz on her face, another sign of steroid hormone excess. The illumination was lost on me, though. The fleeting, barely conscious observation was instantly filed away to some backwater convolution of my cortex, tabbed to "age"--finding, I'm sure, an even deeper recess when cross-referenced to "mother." I had completely forgotten the peach fuzz, this clinical sign, until a diagnosis became available to hang it on.
The Mayo doctors recommended surgery to remove the tumor. The night before the operation, my phone rang. It was Mom, sounding tired and defeated. "I'm sorry to call so late; I wanted to wait until Dad went back to his hotel." With a sigh, she continued, "I feel so weak; I really don't think I'm going to survive this surgery." She sounded very sad and very sure. I took her concerns very seriously. Sometimes people have an eerie intuition about when they are going to die. As a psychiatrist, I also knew that the depression caused by the Cushing's disease was casting a pall on her outlook.
"Try to think positively," I implored. "The girls are really looking forward to your visit on Katie's birthday."
In a brave voice, she said, "I love you all."
The next day at work, I waited. And waited, glancing at the phone every few minutes for the call promised by my father. I knew the three-hour operation should be finished around noon. As that hour passed, I could feel my face becoming flushed. My mind churned through all the things that could have gone wrong: a stroke, heart failure, too much anesthesia for her weakened state. I left work early and hurried home.
I called Mayo and was promptly put through to the recovery room where my father, sounding upbeat, said, "She just arrived here; the surgery started late but she came through it well. She's awake but still groggy." My wise and wonderful husband, noticing my bleary-eyed agitation and then relief suggested, "Why don't you go up there? I bet you could still catch a flight this afternoon." This was no small offer. I thought that leaving him alone for more than a day with our three small daughters, aged 4 and under, was just too much to ask.
"Just go!" he said. "You probably should have flown up yesterday." He handed me the phone--an airline reservation agent rattled off departure times. In two hours, I was jetting toward Rochester.
My mother was up and around within a day, although with an even more swollen face, an odd purple bruise in the shape of a Fu Manchu mustache, and a very stuffy, gauze-packed nose. But these were very temporary.
My mother's body is now slender and her skin has healed. She is off all medication except that required to rebuild her bones. She has regained the strength needed to pick up her toddling grandchildren and the energy required for the perpetual commotion of her older grandchildren. Older, in this case, refers to the 3-, 4-, and 5-year-olds. Age is indeed in the eye of the beholder. My mother has a bright future ahead of her--I think she would agree with Walt Whitman:
Youth, large, lusty, loving--youth full of grace, force, fascination,
Do you know that Old Age may come after you with equal grace, force, fascination?
For information on Cushing's syndrome, contact the Cushing's Support and Research Foundation at 617-723-3674 or on the Web at http://world.std.com/CSRF/.
Susan Whiteman is a psychiatrist living in Bethesda.
CAPTION: Despite visits to many physicians and the concern of her family, Janet Mulshon endured the multiple symptoms of Cushing's syndrome for more than a year before it was diagnosed.