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A chronicle from Sweden

Contributor: Catrin Seth Grundsten

Origin/affiliation: Geriatrician, Geriatric clinic SUS, Malmo, Sweden

This municipality rehabilitation section is placed in Malmoe, the third biggest city in Sweden (320,000 inhabitants). The building is grey and it has a small garden in the front with flowers and some green trees. But inside every room looks alike, with no personality. Outside the house in the entrance two of my patients sitting in their wheelchair smoking. I meet them there every morning and every afternoon when entering and leaving the section this week. It is my first and probably the last week for a couple of month, thou I am substituting one of my older colleague that is home sick. It is me and a younger colleague and together we have 26 patients. Most of the patients have had an acute neurological disease or an orthopaedic disease or trauma and are transferred from the hospital, but some of them comes from their homes having troubling walking, and there are both younger and older patients. They come to this place for rehabilitation and stays for a couple of month.

The nurse is presenting my first patient called Inga-Lisa, a 75-year old woman. She is sitting in a wheelchair, and her sister wants me to call her because she is worried about Inga-Lisa. Reading the notes from last week, they describe a woman with COLD, Bipolar disease, Diabetic type 2 and Hypertension. In total she is taking 11 pills daily, including antipsychotic drugs against her bipolar disease. A couple of month ago, she could walk with support and now she can hardly stand up. Today her blood-samples, blood pressure and pulse are normal.

Before I go to see the patient, the nurse tells me she is isolated because of the instruction of covid-19, every patient is for two weeks after they arrive to this department. Before coming here everyone needs a negative corona test, and after a week we take a new test. If both are negative and they have been at our department for 2 weeks we take away the isolation, but still they are not allowed to have visitors.

In the meeting with the patient she is smiling, looks well nutritional and her hands shaking. She tells me everything is fine, she has no pain, she eats, drink, her stomach is working and she can pee. But she cannot tell me why she cannot walk anymore. She has hard time remembering. Neurological she is stiff in the limbs and trunk and she is slowly moving. The trembling disappears pointing her finger to the nose. Talking to the sister she is worried and impatient for the doctors to do something. I tell her that I suspect Parkinsonism, or possible a side effect of an antipsychotic drug she has been using for over 30 years. My plan is lowering her antipsychotic medication, doing MMSE, sending her to brain x-ray and planning on starting her in Parkinson-medication. We agree in monitoring by telephone in two weeks and ends the conversation.

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