Читать книгу Who's Killing the Doctors? II - Alex Swift - Страница 17

Deidra Bell was 16 and very pretty. For several days she had been noticed in school to act very strange. In the middle of the day she appeared to be… not just herself, as if she was not with it. Her classmates finally brought the matter to the attention of the teacher while it was happening. Her teacher, thinking that she had ‘taken something,’ brought her to the school nurse. She also thought that she was probably on drugs. By the time they called her mother thinking of taking her to the nearest Emergency Room, she had snapped out of it. So they stopped.

But they still told her mother that something really strange was happening with Deidra, and that mom had to watch her better as for whom she was with after school hours, and that she‘might be using speed, or perhaps acid’… Then nothing happened for the next week. But after that, similar episodes of not acting herself started again. Finally in one of her longer episodes of ‘spacing out’ the nurse was contacted again, mom picked her up and she took her to the E.R. She was still out of it so the nurses and doctors had plenty of time to see what was going on. She was ambulatory but non verbal. Her exam was normal and so was her blood work; her drug screen in blood and urine was negative. She was OK again by the time they were done. The next day the same thing happened and mom took her back to the E.R. And as before, nothing abnormal was found and again her toxicology screen was normal; she was not on drugs; after 3 hours or so she again snapped out of it. Someone suggested that she be seen by a pediatric neurologist who was in private practice and who was known for seeing most new patients with a rush within a day or two. So they called Dr. Martin who, yes, could see her in a couple of days. He even offered to see her that very same day, but they told him that she was already fine. The next day would be fine.

Mom and daughter showed up for their scheduled appointment and Deidra was ‘normal.’ She was not acting strange or out of it. Her EEG was normal and so was her neurological examination including a mini-mental assessment. Dr. Martin felt that perhaps she had experienced brief ‘lapses’ of consciousness -along the lines of the much talked but still poorly understood ‘transient global amnesia,’ perhaps ‘auras’ of unusual migraines, perhaps some sort of seizure or trance though her EEG was not showing anything of such. He reassured mom that whatever those lapses had been that the issue did not seem to him awfully serious to her health. But suggested that as it was likely some sort of identical, repeated event, that mom be prepared to bring her back to his office -NOT to the hospital E.R.- for an immediate exam and an EEG to be done as it was happening. He gave mom his home phone number. ‘Call me WHILE her lapse takes place. Not after. The greatest chance to make the diagnosis is by catching it.’

Deidra did not have any more ‘spells’ in the next several weekdays. But then it happened again on a weekend: Mom called Dr. Martin on a Sunday morning as Deidra all of a sudden did not seem herself. ‘Both of you meet me in my office right away,’ he told her. Dr. Martin, with his wife Isabel -an R.N. and his EEG technician- arrived in their office just minutes before the Bells did, dad included.

Deidra was walking normal, looking straight, but brought in by her mother who was holding her by her hand and was pulling from her like a puppy dog. They were brought immediately to the doctor’s EEG room and Isabel hooked Deidra to the machine with its many strategic wires while Dr. Martin talked to dad. From a good 20 feet away, as the EEG recording started, they could hear the shk-shk-shk-shk-shk-shk-shk-shlk-shk loud thumping of the pins at the pathognomonic 3-Hz speed (= 3 cycles per second) so classical and diagnostic of Petit Mal Seizures: Yes, a tall spike followed by a big domed wave occurring 3 times every second! That went on non-stop as the doctor and Mr. Bell came right in and they could watch it as it was happening.

“It is unbelievable!” Dr. Martin said.

“Why” Mr. Bell asked. “Is this the first time you see it?”

“Well, no. I see it all the time in cases of Petit Mal seizures, but normally we can’t ‘catch’ the spells when they are happening; and then their EEG only shows this type of recording briefly, for a few seconds at a time, off and on, when the youngster seems acting perfectly normal. We never see it occurring continuously without interruption for this long.”

The doctor brought Mr. Bell back to his consultation room as mom stayed with Deidra and the full length EEG was completed within 45 minutes. Dr. Martin told Mr. Bell that he had seen only one other young lady, about 14, when he was the only child neurologist in a large New York City hospital; that girl, he recalled, had similar EEG findings -“the EEG in these cases is identical, though usually not for so long- girl who in spite of such spells was a straight A student (both girls happened to be!).

The doctor talked at length to Mr. Bell and then to his wife as she joined them. Dr. Martin quickly wrote a prescription for a tablet of 20 mg of Valium and sent Mr. Bell to a nearby pharmacy, just 3 blocks away, as he grabbed the phone and called the pharmacist in person so the pill would be ready immediately when he got there. Mr. Bell was back in the office within no more than 10 minutes. Soon Deidra’s EEG was completed. Dr. Martin ripped off several pages of the tracing and gave them to the Bells to keep. Though the girl was still ‘not quite with it,’ her mother was able to have Deidra take the Valium pill with some water.

They talked for a long time especially as Dr. Martin wanted to see if and when Deidra snapped out of it – which she did exactly after 20 minutes of having taken the pill. Dr. Martin also learned during that time a new bit of information he hadn’t heard when he had seen her a few days earlier and had a normal EEG; that a first cousin of hers, now a grown up and perfectly normal, with college education and a good office job, also had had ‘some form of seizures’ when he was young.

Dr. Martin gave them a prescription for Deidra to take regularly, daily, Sodium Divalproate (= Depakote), He told them about its reported possible side effects, they felt comfortable with the information given and they left. It was Sunday, nearly noon time. Deidra never had any more ‘trances’ in the next several years that Dr. Martin followed her.

In the next Thursday afternoon after that amazing EEG, in the regular conference of the Neurology Grand Rounds of the University Hospital, a different case and issue as scheduled, was presented. But it ended a few minutes short of the hour, so Dr. Martin, sitting quietly in the audience, and prepared with his long paper tracing in his attaché, came to the podium, asked everybody to remain briefly seated and gave in a nut shell the recent history of Deidra. Then he asked everybody to come up front, gave one page to hold to a resident, and he pulled the rest of the long tracing all across the auditorium on the floor to the opposite wall. They were all amazed to see such constant 3-Hz spike-and-wave recording, diagnostic of ‘Petit Mal Status Epilepticus.’ They would never need to see it again (and most of them never would!). It was a good teaching demonstration for all.

Dr. Jethro Finkel, the chairman of the Department of Neurology, told Dr. Martin:

“Frank, this is so unusual. Why don’t you send this for publication to Neurology?”

“Yes, it is unusual. The longest bouts of uninterrupted 3-Hz spike-and-wave activity I’ve ever seen were practically never longer than a page. I was already thinking about sending it to a Journal, but I’ll see.” And they left things there.

After a few months, Deidra’s mom, concerned about the advertised side effects caused by the drug her daughter was taking, asked Dr. Martin if it could be changed. He obliged. He placed her then on Lamotrigine. He told her in a next visit, of the side effects also possible with this newer drug and to be alerted to any possible ‘skin rashes.’ Mom and Deidra felt comfortable with the drug as it was promoted by the pharmaceutical as the safest for teenage girls with seizures. But after a couple of months Deidra reported to her mother ‘a rash,’ so again Dr. Martin switched her, this time to the oldest drug ‘for maintenance’ for Petit Mal seizures, Ethosuximide. To this writer’s knowledge, Deidra remains on it to this day and doing well with it.

As for publishing a brief communication of Deidra’s case with pages long of the amazing recording, Dr. Martin did send it… only to be shocked when the journal reviewers chastised him ‘for not having admitted her to the hospital on the spot when he saw her in his office that Sunday and her EEG was such.’But she was just in the Hospital E.R. (twice!) and she was sent home still ‘out of it’!… And she did for me so well after I treated her on the spot with oral Valium… Plus a kid with Petit Mal seizures never needs to be in the hospital as far as I am concerned!… Am I in another world?…

Needless to say, with such a negative reception, Dr. Frank Martin was turned off from ever trying to publish it and he never attempted to send it again either to the same or to another medical journal. The heck with them!

The criticism -he thought utterly stupid and unfair- and rejection of his paper by the most widely read medical journal by neurologists in the US, cemented his becoming more and more distant from official medicine and from its accepted establishment; even though he would continue for some time being a contributing member of a couple of medical speciality academies, of the state and county medical associations and of the local pediatric society. Ah well!…

[When one day he would really need them legally, besieged by the State Health Department, by OPC, The Wolves, none of those ‘associations’ would help him anyway! The case of this girl, Deidra, handled then by Dr. Frank Lee (name changed here), is that of the print and text #14 of the non-fiction picture book “FRANKLY” to which this is a prequel. “FRANKLY” shows, on page 56, a piece of her actual EEG with the classical 3 per second spike-and-wave discharges!”).