A strange dream

On a late summer day in 2020, Johan and his youngest teenage son bike down to the harbour. Their family lives in a Swedish suburb close to the sound, a narrow strait that separates southern Sweden from Denmark. They cast their fishing lines out and catch some perch, which they either throw back or give away. A little later, Johan’s wife, Rebecka, shows up to take a swim.

Johan is sitting close to his son’s side. When one of them gets a bite the other comments, if the size of the fish merits the catch.

The water sparkles in the August sun. Rebecka joins them after her swim.

Five years earlier, Johan googled the terms PD and honeymoon. He has a PhD in molecular psychiatry, but it wasn’t in his capacity as a neuroscientist that he was refreshing his knowledge of Parkinson’s disease. A few days before his forty-seventh birthday, a neurologist had provided him and Rebecka with an explanation for why Johan was having difficulty moving his right wrist. Why his fingers tingled. Why he’d been using his left hand to help his right in controlling his mouse.

In a certain small area of a healthy brain, neurons produce dopamine, a neurotransmitter. Dopamine regulates a variety of functions, including movement, motivation and reward. In a brain with Parkinson’s, these neurons start dying off.

They die quietly and painlessly. Typically, the patient’s dopamine producing cells will already have decreased by 50% by the time symptoms of Parkinson’s disease are present.¹ For a period, drugs can compensate for the dopamine that the brain can no longer make. This time is known as the disease’s “honeymoon”.

As a researcher, Johan has studied the role of dopamine in numerous contexts. He tells of how he now can observe – in his own body – what a powerful substance it is. How seamlessly it integrates him with his sense of self. In the absence of medication, he starts feeling “low, slow and clumsy” he explains. He illustrates by becoming a rag doll, drooping in its chair. The medication makes him “himself” again, and the feeling is immediate. “Ah,” he says, “this is how it should be.” And the rag doll shakes and straightens up in its seat.

Increasingly, Johan has started to experience dips, the so-called OFF periods, when the medication temporarily stops working. He describes how he deals with these dips: whenever he feels like someone’s turned off a switch inside him, he takes an extra dose of dopamine – and waits.

Then he is switched on again.

Medication isn’t the only thing that helps. One way that Johan strengthens his constitution is with an exercise bike. And his physiotherapist has shown him how to counter the effects of muscle stiffness by exaggerating his movements. And by e-nun-ci-a-ting his words. Johan flings his arms wide and demonstrates how a Johan who’s adjusting for Parkinson’s might comport himself. Then a wry smile lights his face. “Though I was always somewhat of a mumbler.”
 

At Johan’s house, the past and present interweave. There’s a record player and walls of vinyl LPs. A red Fender Jazzmaster in the corner of the dining room and countless other guitars in the cellar. Shelf after shelf of essays, Scandinavian novels, photography books. Travel guides, graphic novels. A large David Bowie poster over the stairs.

And on the door of the guest bathroom, Johan has taped up a comic strip.

First frame: a diminutive male figure dreams that he enters a bathroom. Next: he brushes his teeth vigorously, spattering toothpaste everywhere. Then: he rinses out his mouth and flashes a big toothy grin at the mirror. And finally: the little man wakes up. He wakes to a world of palm trees and ocean, and he’s riding a hippo and waving a flag as the hippo swims off into the horizon.

Johan has held onto this little tale for thirty years. The paper is yellowed and brittle.

There’s a lot of his past that he’s been able to carry with him into the present. But what about his future?

When healthy people talk about their plans and worries for the future, Johan tends to keep silent. His own future is something he prefers not to think about. Instead he just says, “So far, so good.” He sums up his situation like this: when he was young, he wore his hair long and with a fringe, like the Ramones. There’s little trace of that full head of hair these days. A glimmer of a smile crosses Johan’s face. If he’d lost his hair overnight, he says, it would have been traumatic. He’d feel the same way if his Parkinson’s symptoms all showed up at the same time. But they appear gradually, and he adjusts.

What he has is the present – but how is he going to fill it? A couple of years ago, he and Rebecka saw a one-man show by a Swedish performer who also has Parkinson’s. The performer addressed that exact question. He said that he wasn’t going to climb Mount Kilimanjaro. He’d rather ask his wife if they could make some grilled cheese sandwiches and sit together on the couch to watch a few episodes of a TV series.

That answer moved Johan deeply.

As long as he can, he wants to keep living life as usual: working, playing music, cooking weekend dinners. Trying to persuade his boys to hang out with their parents, and amused that they’d prefer to hit the town. For the time being, he manages to function as before, albeit a bit more slowly now and then. And his limbs haven’t started to twitch and writhe – those involuntary movements that often are a side effect of taking dopamine medication for an extended period.

Every day, he encounters the comic strip on the bathroom door. It’s entitled “A strange dream.” He has no idea what reality he might one day wake up to, but when healthy people say, “So far, so good,” the words signify something different than when Johan says them.

For his fiftieth birthday, he had the face of the little comic-strip man tattooed on his arm.