22. The Uncle


There are a couple of reasons why a doctor shouldn’t have family or close friends as patients. I believe most of the time is one of the two: you either think your loved one always has the worst-case scenario or that he probably has nothing serious. I’m part of the second group. And I learned that the hard way.

Uncle Billy was one of my favorite persons in the world. He was my mom’s brother, but almost twenty years older than her. So I always told my friends in school I had three grandpas since I called him Gramps Billy. It was not until I turned twelve that I finally started calling him uncle.

During my second year of residency, my mom called me on a Sunday to tell me she was worried about him.

‘Why mom? What happened?’ I asked alarmed. 

‘He’s not making sense anymore, honey. You know your uncle, he is always so smart and sharp. Now he seems confused frequently, forgetting some things.’

‘Oh, right.’ I said a bit relieved. ‘It happens mom. Uncle Billy is seventy-something, right? Seventy-four?’

‘Seventy-five.’ She said on the other side of the line. ‘Still… I know my brother is getting old, Liz. But I don’t know, something fells off.’

I smiled thinking of how mom always took care of everybody. ‘I see. Maybe we could take him to the doctor then.’

‘So, when are you coming, Liz?’

‘Oh mom, I wish I could but my vacations are still a couple of months away.’

We talked some more until she had to go for groceries. I didn’t tell her cause I wanted it to be a surprise. I managed to change my schedule in residency and took a week off to visit mom. Little did she know I had been speaking to her from the airport on my way to Chicago.

A couple of hours later I knocked on her door. She was so surprised and happy to see me that it made me wish I had done this sooner. We spend the rest of the day catching up and I felt so homesick I almost cried. 

The next day mom and I went to visit Uncle Billy. I walked into his living room feeling like a little kid all over again. He was sitting in his chair like he always used to.

‘Hi, uncle!’ I said excitedly hugging him.

‘My Little Lizzie!’ He said tapping my back.

Aunt Judy, his wife, brought us all some coffee and biscuits. During our talk, I could see what mom had meant. My uncle wasn’t as sharp as he used to be. It was like he spaced out during our conversation and then came back a bit confused. He laughed if off and Judy reminded him of what we were talking about. Still, I wasn’t worried. It was probably his age right.

While I was washing the dishes, Judy told me she had set an appointment with a neurologist for Uncle Billy. I nodded silently.

‘It’s not only his mind, Liza. He’s walking so slowly too. It’s like he’s aging all at once.’

‘I’m sorry, auntie.’

‘Anyway, could you come with us? His appointment is on Wednesday.’

‘Of course. I’ll be there.’

In the waiting room of Dr. Jain, I saw Uncle Billy struggling to walk towards the chair. I helped him sit beside me when I noticed something coming out of his pants.

‘Are you wearing diapers, uncle?’ I asked.

‘He’s having a hard time holding urine, Liz. For almost a year now. When we go out he prefers to use them to avoid trouble.’ Aunt Judy told me.

That hurt me in a different way. Auntie was right, he was aging. But even then, I didn’t make anything of it. That was all I could think of, normal aging. 

After 10 minutes of waiting, we were called in. Dr. Jain was a renowned neurologist specialized in the elderly. She came from India and kept a low-profile office in the city. Word said she was the best.

‘Good morning, Mr. Herrera.’ She said when we entered the room. ‘I’m Dr. Jain. How are you doing today?’

Uncle Billy started telling Dr. Jain what had been bothering him, which to my surprise was the difficulty to walk. Then auntie Judy proceeded to talk about his mental difficulties lately and the struggle to hold his urine, which was bothering her the most.

The interview went on for a while with some back and forth about Billy’s previous state of health. In the physical, Dr. Jain started with his gait evaluation, which I quickly identified as a wide-based gait. The rest of the evaluation was pretty normal from where I was standing except for his cognitive function. After everything was done she sat back on her chair and asked us all to do the same.

‘So, from what I’m seeing so far, Mr. Herrera started having urinary incontinence about a year ago.’ Aunt Judy nodded and Dr. Jain continued. ‘Then four months later he was struggling to walk. Finally two months ago came the confusion and mental difficulties, is that right?’

Before Aunt Judy could answer I finally understood what was happening. How could I not see it before? Urinary incontinence, gait abnormalities, and cognitive disturbances. I had seen those three together so many times before, in books and even in real life. But when Uncle Billy had all three right in front of me I couldn’t connect the dots.

‘I believe Mr. Herrera has a condition called…’

‘Normal Pressure Hydrocephalus.’ I completed her thought.

Dr. Jain smiled. ‘Yes. I’ll explain to you all about it, but let me start by saying that if that’s the case, there’s a treatment for it.’

I looked at auntie Judy and I could see her eyes filled with tears but also a hopeful smile. 

After a while, we left the office and scheduled a brain MRI for him. Unfortunately, I couldn't wait for the imaging and had to go back to residency. Aunt Judy sent me his results not long after and sure enough, they showed ventriculomegaly and white matter changes.

Weeks later, Uncle Billy underwent a lumbar puncture followed by ventricular shunting. When I saw him at Christmas again, he was like his old self. Smart, funny, and independent.

That’s how I found out that I belong to the second group of doctors who can’t see their loved ones. I’m the one who thinks they have nothing serious.

Want to know more about Normal Pressure Hydrocephalus?


Want to read a real case of Normal Pressure Hydrocephalus?


Clinical Board
Incont.: incontinence; Dx: diagnosis; Tt: treatment.

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