Not my Leg

Not My Leg

Original Title: Nicht mein Bein

Radio Play by Klaus Fehling

Translation: Sarah M. Richter

All rights reserved

Luftschiff-Verlag 2011

Personnel

He, male in his mid- to end-thirties

Doctors 1-4, male/female experts of different specialties, different ages

Old Person

Situation

Outside, busy, e.g. in a pedestrian zone, in motion

Or atmosphere as described in text (open-plan office, party, café, waiting room, hospital, etc.)

 

HE:

I can’t
Explain it yet
But
I still remember the beginning.
Looking at it from today
It is clearly visible.
Eight years ago
Suddenly
For a short period of time
I didn’t understand
My own leg anymore.
I thought:

[Atmosphere: open-plan office]

This is not my leg.
It doesn’t behave like it.
It doesn’t want to keep still.
As if it had its own will, that leg.
But it is one
Of my two
legs.

The left one.

Clearly, it belongs to me. No doubt.
But at the moment
It doesn’t listen to me
Unlike every other day
Unlike the other one,
The right one.
Strange.

[Atmosphere off]

It trembled.
If I concentrated
It stopped
Under protest
And started again
As soon as I thought of something else.
I wasn’t familiar with that.
My legs had never done anything like that before.
I remember thinking:

[Atmosphere: open-plan office]

How am I supposed to work like that?
Fortunately
No one can see me.
I’m taking a break
Drink some coffee
Relax a little.
I expected too much of myself
Lately.
Sure enough.
I can’t put away with that anymore.
I’m going on thirty after all.
Too little sports
And maybe too much beer,

I thought.
I stopped smoking
Without any problems
From one day to the next.
More than six months ago.
That can’t be it.

I thought:
I’ll have to check on my posture.
Rest more.
Take care of myself.

[Atmosphere off]

Then it had calmed down again,
That leg.
Soon I didn’t think of it anymore
And I went on living my life.

The drivers of the buses,
Who got me to work every day,
Took less and less time
To close the doors.
Sometimes I barely
Got in.

The daily office work
Became less and less easy
Week by week
In this summer
Eight years ago,
Which seemed to me
Unbearably hot.
The colleagues.
My boss.
The customers at the trade fair.

I was so happy, I didn’t have
To share my office with anyone.
Behind closed doors
I realized,
I wasn’t as good at
Persuading people
As in the past
Anymore.

But back then
At the beginning
I thought this would pass.
After all one knows one’s skills.
And you don’t forget how to bicycle
Suddenly

Just like that.
I often make
An unfriendly impression.
Arrogant.
Sometimes afraid.
Though on the inside I am courageous
Most of the time
And amiable.

I live in a part of this city
Which has many kebab shops
And fitness centers
Where the tone in the streets
Is often rough,
One,
Who won’t stand a staring-contest
Is rather looking down
Taking care no one
Taps on his shoulder.
I’ve got my body with me at all times.
Like a wet cloak.

[Atmosphere: Party]

Dancing?

No. I don’t dance.
I don’t feel like it.
Sorry.

[Atmosphere off]

 

DOCTOR 1:

It won’t be stopped.

HE:

No one is able to read my handwriting.
Even though I’m trying really hard.
What’s that scrawl supposed to mean,
People are asking.
Are you actually able to read that?

Yes. I am.
That’s the main point, isn’t it?
It got worse, my handwriting.
To be honest,
Sometimes not even I can
Decipher my scrawl.
Always getting smaller.
Got to practice more
Exercise
Never let go.
Then it is going to improve,
I thought so
for a long time.

 

DOCTOR 1:

It starts between the age of 50 and 60, concerns more men
Than women.

 

HE:

It had come quietly
And probably been with me for a while
When I noticed it bit by bit.
Like a couple of years ago
When I was getting coffee.
I still see myself:

[Atmosphere: Café, many customers]

Two full cups.
One in each hand.
I offered her myself
To bring her a cup of coffee.
That goes without saying.
This way, not both of us have to stand in line before the counter.
I can do this.
Already on my first meters I’m spilling something.
Boy, those cups brimmed.
With steaming hot coffee.
But everybody’s gawking anyway
That’s what it feels like to me.
Don’t loose your head
Because of a little hot coffee
Dripping from my fingers.
The more I concentrate on my hands
The more they’re trembling.
Although they’re usually so reliable.

Why now …?

It’s not working.
I have to

Cut this off.

[Atmosphere off]

Everybody’s staring, for sure.
I put both cups down
Cautiously.

A tremor goes through my body.
I lift one for starters
And leave the second one.

 

DOCTOR 1:

The destruction of nerve cells within the pat of the brain controlling muscle movement causes a decrease in the production a brain chemical called dopamine. This leads to alterations in the activity of the neural circuits within the basal ganglia and therefore within the cerebral cortex. There may be multiple reasons for the destruction of these cells.

HE:

The other people on the street are walking ever faster.
Often I can hardly keep up,
They are that fast.
And one is more and more frequently being bumped into.

[Atmosphere: waiting room]

Well I don’t always show,
What is inside me.
Sometimes I force myself
Inside out
To make a friendly face.
Just like I sometimes force myself
To swing my arms while walking.
In front of a mirror I even …
But it is too exhausting in the long run.
And not everybody can handle it.

[Atmosphere off]

[Pen on paper]

 

HE:

List of things that don’t work anymore:
Jumping on one leg.
Hula hooping thigh-high for more than five seconds.
Skateboarding.
Standing still.
Drawing straight lines.
Running fast.

The doctor says not to worry.
I could have thousands of reasons, he says.
Maybe too much stress.
I have a lot of stress.
Yes.

The doctor wants to know, if I do sports
Pretending an earnest glance as I negate.
Also he suggests psychotherapy.
Another hands me a prescription.
Two, thrice daily,
He says.
And wishes me good luck.

[Atmosphere: Pharmacy, opening of a box, unfolding of package insert]

(Reading)

»Clinical specifications:

Indications: Depressive psychoses, if treatments with other anti-depressants were unsuccessful.”

I notice
For example while brushing my teeth
The unnatural posture of my left arm
And my toes keep hurting in my shoes
They are that cramped.
But depressions?

Nothing seems as easy as before.
And the troubles are multiplying
contact with the neighbors,
Landlords,
Nurses,
Cashiers,
At the hairdresser’s
And in the kebab shop,
At the post-office, the stairway,
With my sister’s kids
And at work.
At the opera
Or at the movies
I can’t keep my legs still.

[Pen on paper]

List of things that won’t work anymore:
Carrying a full glass without spilling anything.
Jackstraws.
Hitting the bull’s eye .
Dancing?
I was never able…

 

DOCTOR 1:

The affected nerve cells are responsible for the control of physical movements like walking, running, jumping or swimming – and upright posture.

 

HE (reading):

»Contraindications: Hypersensitivity to active ingredient …, acute alcohol-, sleeping pill-, analgesics- and psychotropic drug-intoxications…«

One of them once asked me
If I drank.
Alcohol that’s what he thought.
He saw my tremor
And nothing else crossed his mind.
Of course I thought that was rude.
No,
I said.

I said that in a very friendly tone.
More resistance wasn’t possible.
I almost apologized
For not drinking
And trembling nevertheless.
At least he did ask.
Others just go ahead and assume.

(reading)

»…alternating psychosis…, neurological disorders, Parkinson’s disease, …«

The thought of me drinking
Is actually even one of the least harmless.
Others could think,
I’d been up to something,
Hence being nervous.
Or maybe angry.
Or insane.
Though on the inside I’m always calm
And never aggressive.
I am not like that.
Different that’s what I am.

(reading)

»Side-effects: nausea, dry mouth or hypersalivation, transpiration, head ache, dizziness, fatigue and reduced physical activity are common… Occasionally increased appetite, weight gain, extrapyramidal disorders which include acute dystonia, e.g. tremor, rigor and akinesia of the extremities and facial area, palatoglossus-, eye and jaw muscle spasms, wry neck, back stiffness……«

[Medicine box being thrown into trash can]

I’ve developed strategies
To not attract attention.
To not arouse suspicion
I had something to hide.
So no one can see the tremor
I sit on my hands.

[Typing on keyboard]

Continuation of list:
Standing on one leg.
Writing with a pen.
Cycling without fear.
Mixing cocktails.
Concealing agitation.
Passing a job interview.

[typing stops]

Depressions are not the problem.

[Atmosphere: Party]

I haven’t been asked
in a long time
if I wanted to dance.

[Atmosphere off]

 

DOCTOR 1:

It is about a selective, progressive destruction of those cells.

 

HE:

Once I even let a bus
Take off
Rather waiting for the next one.

 

DOCTOR 2:

A disconnection and ongoing destruction of those cells.

 

HE:

Weird.
Growing old happens so much faster
Than one might think.
I don’t feel like
Being in my mid-thirties.
I even understand those grim old people,
You always see in town or on the subway –
Those with the bad-mood-faces,
Which in my twenties, I would have taken as a personal offence.
After all, we hadn’t done any harm.
Now I often happen to be standing
In the subway’s light barrier,
To wait for those, just walking over from the escalator,
To board the train.

 

OLD PERSON:

Thank you, young man.

 

HE:

Sure.

 

DOCTOR 2:

The three main symptoms are rigor, tremor and akinesia.

 

HE:

Sometimes I want to tell you something.
Something important.
I spit it out
Letting it run free
As if it were puppies,
Which, as soon as let loose,
Don’t listen to me anymore
And just run away.
And you are confused,
Because of something so afraid
Came something so courageous.
That’s hard to evaluate.

[Atmosphere: Party]

Sure.
I like to dance.
But I prefer to dance
By myself.

[Atmosphere off]

It is hard,
To be convincing
With shivering legs.
Things can’t go on like this.

[Typing on keyboard]

List of things that won’t work anymore:
Peeling potatoes.
Walking backwards.
Tripping without falling down.

[Atmosphere: another waiting-room]

Even the experts have no advice
Handing me a prescription for anti-schizophrenia medication

which I don’t take-

or letting me dance:
pointing at my nose with my finger, eyes closed,
jumping on one leg
walking through the room.
Loosen up
They tell me.
Relax.
There’s no need to be scared.
I’m not too sure about that
But I’m not scared anyway.
Then they give me beta blockers.

which I do take-

I’m in my mid-thirties after all.
Much too young for…

[Atmosphere off]

 

DOCTOR 2:

Muscular rigidity, tremor and akinesia.

 

OLD PERSON:

I say!
You may as well make a friendly face,
Young man.

 

HE:

The beta blockers are helping with the tremor a little.
It is something that is helping me.
But ever more frequently I fail at everyday encounters,
So I rarely leave home
And take care, to always have enough cash on me,
To not be forced to pay with my ATM card;
Because often enough
People don’t even believe
My signature.
I don’t want to endure it,
This suspiciously scrutinizing look
From my signature to my face,
to my ATM card to my face,
my signature,
my face,
my trembling fingers,
legs, ATM card, face …
I try to smile.
I arrange answers
To the questions I will be asked.
I grow a beard.
Also, because shaving isn’t working out so well anymore.

[Slow typing on keyboard]

Continuation of list:
Shaving.
Nail-cutting.

 

DOCTOR 2:

Buttoning-up your shirt?

 

HE:

Still working.
Playing the guitar, too.

[ Johnny Cash playing „Rusty Cage“ (LP: Unchained) from first chords to second chorus]

You wired me awake
And hit me with a hand of broken nails
You tied my lead and pulled my chain
To watch my blood begin to boil
But Im gonna break
Im gonna break my
Im gonna break my rusty cage and run
Too cold to start a fire
Im burning diesel burning dinosaur bones
Ill take the river down to still water
And ride a pack of dogs
Im gonna break
Im gonna break my
Im gonna break my rusty cage and run

 

HE (quietly):

I am gonna break
I am gonna break my
I am gonna break my rusty cage and run

My face is dismissing our friendship
And refuses to smile for me.

 

DOCTOR 3:

Pardon?
When you’re speaking so quietly
I can’t understand what you’re saying.
You’ll have to speak louder.

 

HE (in normal volume):

It’s getting more clearly.
And uphill is getting steeper.

 

DOCTOR 1:

The lack of dopamine results in a relative surplus of acetylcholine and a lack of serotonin and noradrenalin, nerve-signalling substances needed for proper impulse-transmission between nerves. Their unavailability in sufficient quantity results in massive limitations of motor-, psychic-, sensory and vegetative areas.

 

HE:

For one turn I need thirteen little steps.
I’m going on a quest to find the cause.

(reading)

„Does your hand shake although you’re sitting quietly with arms in the lap?
Is one of your arms bent or dangling when you walk?
Do you have a stooped posture?
Do you have a shuffled walk or drag one leg behind?
Do you have a small-stepped walk and do you frequently trip or fall down?
Do you suffer from listlessness and a lack of initiative?
Are you frequently experiencing back pain in your neck-shoulder-girdle?
Did you notice your withdrawal from friends and relatives, your avoidance of contacts and general listlessness?
Did you notice alterations in your voice? Has it become monotonous and quiet, or does it sound hoarse?
Did you notice your handwriting getting smaller?

Yes.
Yes.
Yes.

(reading)

„If your answer to more than three of those questions is yes…“

Yes, goddammit.
I’ve got to do something.

[Atmosphere: doctor’s room]

 

DOCTOR 3:

The highest concentration of dopaminergic neurons can be found within the basal ganglia system and the frontal lobe. Within the circuits of the basal ganglia 18F-DOPA PET is able to define the dopaminergic neurons of the nigrostriatal pathway. The nigrostriatal pathway is a neural pathway consisting of the dopamine-producing nerve cells of the substantia nigra and neuronal connections with the dopamine-containing nerve endings of the central striatum.

The 18F-marked DOPA is a blood-brain barrier passable precursor molecule of the neurotransmitter dopamine which is metabolized to dopamine by DOPA decarboxylase, an enzyme of dopamine synthesis.

This part of synthesis takes place mostly takes place within the striatal nerve endings of the nigrostriatal pathway. Therefore, the dopamine metabolism of these neurons can be inferred from the 18F-DOPA PET signal detected within the striatum. The measurement of the 18F-DOPA PET signal results from the prior identification of the 18F-DOPA reference standard calculated after multiple sequential scans using the Patlak plot.

 

HE:

What does that mean?

 

DOCTOR 3:

To clarify the diagnosis you will be injected with a fluorine-isotope-marked L-DOPA solution. The marked L-DOPA will be assimilated by the brain and metabolized into dopamine. It will be accumulated within the so-called striatum.

ER:

A bag of nerves.

 

DOCTOR 3:

And then we’ll take a look into your brain.

 

HE (Typing on a keyboard):

Buying in a ticket from a machine on a moving train.
Eating spaghetti. Without making a mess.
Lying on my back and keeping my legs still.
Having the courage to approach the matter.

[Atmosphere: hospital, MRI-sounds]

 

ER:

Having the courage to approach the matter.
Three times ninety minutes
With a fast decaying isotope.
Don’t move.
Every few minutes somebody takes my blood sample.
The head is fixed with adhesive tape.
So later on the experts
Will get to see something on the images
About what’s going on in my head
The pictures are blue
And yellow
And red.
And unsteady.

The doctors are asking
Whether I had depressions –

That would have been typical at the beginning of the disease –
And let me play piano in midair.
The nurses are asking
Whether I had any bowel movements –
That would be very important, something one had to look after –
And take my blood pressure.
Once in a while the resident physician
And a pack of medical students
Come to my bed.
The social therapist is asking,
Whether I need any household appliances for my housekeeping, or
Maybe a walker.
My case is interesting for everybody
On ward five I am
Aged 36
The youngest.

[Atmosphere off]

[Dictating machine switched-on]

 

DOCTOR 4:

Concerning the medical history it is to be reported that eight years ago the patient felt a tremor in the area of his left leg. In the course it spread progressively to the right leg and both arms. In addition, the patient reports distinctive stiffness of his extremities, complains about muscle cramps, increasing tremors with agitation as well as an alteration of his handwriting.

In the psychological examination the patient showed himself alert, aware and overall orientated.

[Dictating machine switched-off]

[Atmosphere: ward 5, Neurology]

 

HE:

But here in the clinic, people at least seem to take me seriously.

[Dinner is being brought]

For dinner I get two sandwiches, already cut in halves.
Yesterday, when I was admitted, I was allowed to make them myself.

[Atmosphere off]

[Dictating machine switched-on]

 

DOCTOR 4:

The neurological examination found a right-handed patient without meningism. The state of the cerebral nerves is inconspicuous. The muscle stretch reflexes of the upper extremity are normal and symmetrical those of the lower extremity are brisk and symmetrical. No indication of spasticity. No paresis. Both upper and lower extremities show a rigor pronounced on the right. Dysdiadochokinesia pronounced on the left. Finger-nose test and heel-knee test proper. Pronounced rest and holding tremor. Reduced swinging of both arms. Hypomimy as well as postural instability during the tensile test. Positive cogwheel phenomenon. Manners of standing and walking unstable. Romberg’s and Unterberger’s test without directional tendency to fall. Micrography.

[Dictating machine switched-off]

 

HE:

Finally, the problem has got a name.

[Dictating machine switched-on]

 

DOCTOR 4:

The PET with 18F-DOPA shows considerable decrease of the dopamine metabolism in both putamina, noticeably more pronounced on the left side. In synopsis with the performed Raclopride-PET, findings argue for an idiopathic Parkinson’s syndrome.

 

HE:

And a prognosis.

 

DOCTOR 4:

As an inpatient the patient was treated with beta blockers, a dopamine agonist and monoamine oxidase inhibitors. Hereunder the pathology improved noticeably.

 

HE:

But no effective solution.

[Dictating machine switched-off]

 

DOCTOR 1:

So far no treatment of the cause is possible. Available medication will mitigate symptoms and slow down progression.

[Atmosphere: busy market, cramped and loud, many languages]

 

HE:

An agonist is a substance able to imitate the effect of a certain transmitter.

[Atmosphere off]

 

DOCTOR 3:

The agonist occupies the respective receptor and activates the cell’s signal transduction.

 

HE:

All of a sudden I feel invincible.
I manage to sit still
And my poker face is able to smile until further notice.

 

DOCTOR 4:

Monoamine oxidase inhibitors block monoamine oxidase-B, an enzyme which degrades dopamine. This way dopamine is accumulated within the brain, even though the general deficiency remains. Undesirable side effects are fatigue and light-headedness, head ache and dermatological reactions. The medication has a slightly stimulating effect, which may lead to sleeping disorders. Hence it should not be ingested at night.

 

HE:

My sleep is good.
Thankfully.
I take good care
To always have my pills at hand.
Once I forgot.
That was worse,
Than in the past,
As I didn’t yet take them.

 

DOCTOR 1:

It won’t be stopped.

[Atmosphere: pedestrian precinct]

 

HE:

My first walk, post-hospital –
Sounds and smells, and the whole day
Is just like in the past,
Eight years ago,
When I could just have my body with me,
Walking through the city.
Now I’ve returned.
You can pat my back.
I did it.

[Atmosphere off]

 

DOCTOR 4:

Systematic therapy, in the beginning may even lead to a total freedom from symptoms. This stage of illness is called the “honeymoon”.

 

HE:

I forget it, sometimes.

 

DOCTOR 4:

Some patients feel like they’re “cured”.

 

HE:

I got in fights
With “friends”, who wanted to talk me into believing,
I had nothing.
As fit as a fiddle.
A fake.
Same old story.
It’s only mental,
You need to work out more,
Eat healthy.
The
Don’t make such a fuss”
It’s like a knife.
And the blade hasn’t been getting a bit blunt.
One, who knew me for a long time,
Actually said,
I had,
As in I myself had,
Elected to
Get this disease.
We had a huge fight
And the anger went straight into my legs
And I remembered the way it was
Those last years,
Which are so unreal to me,
As if someone else had experienced them
And told me about it.

 

DOCTOR 2:

If the patient reduced the dose rate or discontinues medication, symptoms and ailments will return.

 

HE:

It’s better now. Why is everybody still gawking?
I feel rare.
There have to be others.
At least statistically.
I would know it if I saw them.
Maybe even before they knew themselves.
And then what?
Address them?
Excuse me, I just noticed you too have …”
Impossible.
In Hollywood there’s a rich boy,
With him it started at 29 as well.
He’s putting all his money into a foundation.
Medical research.
Because he intends to
Dance at his kids’ weddings.

[Atmosphere: Party]

No.
I don’t dance.
I’m satisfied
Tapping a leg.

[Atmosphere off]

[Atmosphere: doctor’s room]

 

DOCTOR 1 (reading a letter):

Thank you very much for sending blood samples of above-named patient who is under suspicion to suffer from Parkin-associated Parkinson’s disease… We made a molecular genetic analysis for mutations… Sequencing of entire coding region and the exon-intron-structure, gene dosage analysis of all 12 exons… By means of sequencing point mutations and small deletions are detected… Said analysis identified a mutated allele (heterozygous deletion of exon 4)…”

Did somebody explain anything to you?

 

HE:

No.
I received the fax today without commentary.
What does that mean for me?

 

DOCTOR 1:

I’m no geneticist.
But this says
There’s a chance for other relatives to as well be carriers of this mutation. Therefore, we would like to ask you, to point out the possibility of human genetic counseling for him and his relatives, to the patient.”

Did you plan on having children?

 

HE:

No.

[Atmosphere off]

List of things that won’t …
In the clinic they gave me a book.
It describes gymnastical exercises,
To maintain one’s flexibility.
It actually says:
Do these exercises together with your grandchildren.”
You’re getting old much faster
Than you think.
Most of the time I’m okay.
Sometimes,
On the bad days,
When the medication doesn’t want to work,
I’m different.
Then even the punks
Consider me a drunk.

Maybe I am different
Than those,
Who want
to be different
on purpose.

List of things that deeply touch me:
When an old man can barely scale the curb,

When kids run away from their mothers on the street,
When somebody hauls up his furniture into a van.
But also the brittle voice of Johnny Cash
And the actor Bruno Ganz, playing Adolf Hitler in cinemas, with
The trembling hand behind his back.
Then I want everything
To be still for just one moment
To take a rest.

 

DOCTOR 4:

It won’t be stopped.

 

HE:

I want everybody to know
And to understand it.
But I only tell a few people.
I don’t want to apologize.
Those last years were
Like a misunderstanding
To whose clarification
This one important information
Was missing.
It changed everything
That once was.
I stayed the same.
Even if I still can’t really explain it.