Laugh to Death: My Rx for Dying Well With ALS

By Martin F. Welsh

Laugh to Death: My Rx for Dying Well with ALS, a collection of personal vignettes, chronicles a doctor's end-of-life journey with ALS, also known as Lou Gehrig's disease. Welsh's unique outlook as a doctor-turned-patient, while at times serious and somber, is more often hilarious, if not irreverent. Throughout—from the time of his self-diagnosis until his passing six years later—Martin F. Welsh, M.D., reveals how a terminally ill person's attitude can profoundly affect their quality of life.

• Language: English
• Publisher: BookBaby
• Release date: Sep 13, 2018
• ISBN: 9780966942750

Book preview

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ONE

I Diagnose Myself, and No One Believes Me

Ever since I was a child, I wanted to be a doctor. I was the oldest of six children—there were seven next door and another handful up and down the block. I was somehow drawn into becoming the neighborhood medic. My mother died when I was twelve years old, and my dad worked long hours to support us; consequently, whenever my brothers, sisters, or a neighbor kid got a scrape or bruise, they came to me. I remember enjoying bandaging them up after making them cry. I used a lot of tincture of Merthiolate—remember that stuff? It stings, and Bactine was for sissies! But they kept coming to me. Then there was the influence of the Marcus Welby, M.D. show on TV. I won’t tell you about the trouble I got myself into when I found a bunch of insulin syringes and needles in the gutter one day. You can just imagine.

Lucky to inherit the intelligence required, I was focused and persistent enough to achieve my goal. I got my M.D. from UCLA in 1980. I spent three more years becoming board certified in family practice. I moved to a small town in the Northern California Sierra foothills to work and raise a family. It was a script I had written at age seven.

I had a good career going in Placerville with lots of patients who loved me—many became good friends as well. My two kids were A students, and I managed to make enough free time to satisfy my addiction to playing sports over the years: basketball, tennis, water-skiing, long-distance running, and golf. Appointed chief of staff at the local hospital in 1990, I’ve been a respected member of the community, blah, blah, blah.

Fast forward.

There’s a saying among the medical community about family practice, and it’s true: good family practice is the first ten minutes of every specialty. In other words, a family practice doctor studies all the medical specialties and knows a little about each one. I found this to be especially true in the following incident. In May 2004, I conducted a full neurological exam on a patient (I’ve since completely blanked on who it was or why). Depending on the patient’s symptoms, I did this exam anywhere from once a week to once a month. Anyway, part of it calls for rapid, alternating movements. I face the patient and start by tapping my thumb and index finger rapidly together. As I demonstrated this movement on my left hand, he mimicked with his right. Then, when I did the same on my right hand, I noticed my movements were definitely slower than my left. The patient didn’t notice, but I was puzzled as I finished the exam.

The rest of that day as I sat at my desk, I periodically rechecked myself, and it stayed the same. Later on, I collared Mark Kal, my friend, partner, and also a family practice doctor, and said, Hey Mark, look at this. He asked if I had any wrist pain. I didn’t, so he checked me for cogwheel rigidity, a sign of Parkinson’s disease. He then looked at me and said, I want you to go see Rajiv (Dr. Rajiv Pathak, our local neurologist). Mark got right on the phone, and, two days later, there I was sitting in Rajiv’s