As I drove to fix my tire the other day, after having run over a traffic island in the parking lot of a movie theater a few days before taking a chunk out of my front tire and severely damaging the rim, I pondered on how difficult it would be to give up driving if this sort of negligence continued due to poor visual misperceptions. Remember our Parkinson’s affects our vision by causing problems in depth perception (i.e. judging distances) due to trouble with contrast in lightning and colors. Sometime thing we must be ever so vigilant about. The idea of giving up my driver’s license at this stage in my life caused a slight panic. But the fact is that for most of us regardless of age or station in life being asked to consider handing the keys of your vehicle can be a major life stressor!
Why are we so attached to driving? I wonder?
- Cars are a rite of passage in most develop countries like the US. This means adulthood, independence and freedom.
- Cars/driving are a necessity in most large cities who do not rely on mass transportation as their main way of doing business and getting around from point A to point B.
- Diving is a way to stay connected with our friends and loved ones in an ever expanding social family that goes beyond the neighborhoods we grew up in. (this is important when our closest friends live 20 minutes away by car). Diving is a way to decrease our isolation that may come with aging and having PD.
For these reasons, no one likes to be told they have to give up their driver’s license or can’t drive anymore. I recall my father’s anger and indignation when he was asked to hand in his driver’s license. Although, he had grown blind from his diabetic neuropathy holding on to license meant he was still independent even if he knew he could no longer drive. The same feeling was prominent across the board in all my patients, after I instructed them to no longer drive due to safety reasons imposed by their individual’s illnesses. This recommendation infuriated many to the point of seeking others physicians.
I have since learned a thing or two about human nature as I matured as a professional, individual and now as a patient living with same chronic illness that someday may rob me of the ability to enjoy the freedom of the open road.
When I was in training I was asked to evaluate this nice old lady for dementia. She was pleasant and appeared with it until I started probing deeper. She did not have a clue what a pen was or what it was used for taking it completely apart for me and handing it back to me in pieces. Sadly, she was still “working” or at least leaving home every day and for the past few weeks had come home late and most days had a new indentation to her car from a ‘fender-bender’ incident.
However, the decision to take away or maintain someone’s license is not always as clear cut as my case above.
The 4 C’s to consider in making decision of removing license or taking away car keys:
- CONCERN: like my patient- safety is a concern- driving skills are no longer what they used to be. Having frequent accidents, getting lost, trouble navigating small spaces, trouble judging distances, or reflexes are too slow.
- CONDITION: is patient at end stage or have advance disease, having severe dyskenesias, dystonia keeping neck fixed and unable to turn quickly, falling asleep at the wheel, or blood pressure dropping (I had to give up driving for a year at the beginning of my illness due to medication side effect causing me severe sleepiness), having double vision.
- Crashes: This goes along with concern issues- having trouble with actual ability to drive, having many near crashes.
- Co-Morbidities: depression causing poor attention deficit disorder, sleep disorders, of course severe dementia or cognitive impairments which will result not only in poor judgement as that man not long ago in the news who slipped in ice and panicked after hitting a truck and then ran over it several times again in a panic! Or simply not being able to remember where they are going or how to get home or even how to drive consistently, also having generalized muscle weakness or pain can make driving difficult and even dangerous.
If there are concerns regarding driving which unfortunately as our disease advances all of us will reach an impasse upon which driving is no longer an option or safe for ourselves or for others on the road. When this happens it is best to speak of giving up driving as “retiring” from driving as you would a job. This makes the transition much easier physiologically speaking as it were just another ‘milestone’ in the life of a PD patient to go through.
Certainly the consequences of giving up one’s autonomy and freedom of being behind the wheel cannot be dismissed so easily from a practical view as we stated previously in our society we rely in many parts of the country with poor infrastructure of mass transit transportation on our own means (e.g. state of Texas) nor psychologically as our disease advances we become more depressed and have a tendency to become more isolated so we need ways to be able to connect with the outside world.
There is a downloadable handout called “Getting by Without Driving,” which could prove to be a great resource. This handout can also help to ease transition.
Finally, if you are still not sure after discussing with your physician the pros and cons and reviewing the 4C’s, there are a few places to consider going:
- Occupational therapy- they will assist and watch patients drive and see if they are safe.
- State Department of Public Safety– ask your loved ones to take their driver’s test again. If the state says they pass then you are off the hook.
- Some states / cities have driving schools for chronically ill/neurologically impaired patients – look in the PD support groups or ask the occupational therapists about these.