Читать книгу The Monster Within - Sheldon Cohen M.D. - Страница 7

But was she ready for final exams? Although her symptoms persisted all through her periods of studying, she chose to keep that information to herself, knowing that her mother was such a worrier. Sudden fatigue persisted at about the same level, mild headaches occasionally returned, and twice she found herself unable to verbalize. Her thought again was—I bet this goes away after finals. In the meantime she looked up stress and became fascinated to learn that there was intense physiology involved in the stress reaction: the autonomic nervous system not under conscious control; and a part of the brain—hypothalamus; and the endocrine system especially the pituitary and the adrenal glands.

She became fascinated with the subject of stress and wanted to learn more, but now, during finals, she elected to defer it, especially since she began to have trouble concentrating, things seemed more difficult, and her head felt “funny,” like “something was going on up there.”

She didn’t do as well as she usually did, getting about three points less, on average, than she had in the past, but still good enough not to appreciably affect her overall grade point average. She got mostly B’s, some A’s and a rare C in her four year career, her overall average being about 3.2.

But high school was over finally, and I bet the stress goes away now, she thought to herself. But she didn’t have a chance to find out. The day after the finals, she slept late, rested most of the day and went to a movie with Steve that night. The next day she drove alone to the Golf-Mill shopping center after lunch—and woke up after dark lying on a Lutheran General hospital bed in the Emergency Department with a bandage around her head, an intravenous drip going into her left forearm, a white-coated young doctor at her side, a nurse working at a counter, her hand wringing mother, a sad-faced father and Steve sitting in chairs around her bed.

The enormity of this change was more than she could initially grasp: this is a dream, she thought..., or is this reality? She finally said, “What happened? I’m in a hospital.”

“You were in an automobile accident, you hit a light pole,” said the young doctor as Steve and Ezra stood up while Alvina separated her wringing hands to cross herself.

“I’m Doctor Switzer. The accident caused you to hit your head. You’ve got a large bump up there and you’ve been in and out of consciousness. The good news is we did a CT scan of your head and it’s negative; no fractures, nothing abnormal. I did a general and neurological examination, as best as I could when you were unconscious, and everything seemed normal. Do you remember what happened?” he said as Alvina, listening with bulging eyes crossed herself again and again.

“No I don’t have a clue. All I know is the last thing I remember is driving down Golf Road and then I woke up here.” She shook her head.

At this point in the discussion, Steve who had been fidgeting as if he was anxious to contribute said, “She’s been falling asleep at the drop of a hat lately, doctor, and I’m not talking just about bedtime. She fell asleep on a couch prom night.”

Turning to Betty, Dr. Switzer said, “Do you think you fell asleep this morning when you were driving, Betty?”

“I suppose it’s possible, but I can’t believe I did. Don’t people who fall asleep at the wheel usually do that after they’ve been driving for hours and hours. If I was on Golf Road, I was only in the car a few minutes, and I wasn’t tired, that’s for sure.” But then she had an afterthought and said, “What happened to my car, by the way?”

“Don’t worry, Betty,” said Ezra, “there was some front end damage and we had it hauled away and it’s going to be fixed up good as new. The main thing is that you’re okay.”

Dr. Switzer said, “Well, the fact that you’re awake now is very good news, but when you came in unconscious after the head injury and we did the head scan, even though it was negative we still had to get a bed for you in the Intensive Care Unit because every unconscious head injury patient should be monitored closely for about twenty four hours at least. And we assigned a neurosurgeon, Dr. Kennedy to your case, so he’ll see you probably in the morning. I’ll call him again and give him a progress report. I’m pretty sure you won’t be in the hospital very long, but, as I said, the rules insist on close monitoring for every head injury.”

Betty nodded.

Dr. Switzer continued, “I do need to know if you did fall asleep at the wheel and whether this problem has happened before?”

Betty answered telling the doctor that, “Yes, I have been falling asleep without wanting to lately. I don’t know why.”

Nodding his head, Dr. Switzer said, “That could be an important bit of information. I’ll report that to Dr. Kennedy. Let’s get you to the unit.”

Betty, transferred to intensive care, entered a new world thinking hard about the unusual events of her life recently while her stunned parents and boyfriend left for their homes relieved after the good news, but concerned about what this all portends.

The next morning, after a fretful sleep, Betty was awake when Dr. Kennedy entered her room. Betty estimated this good-looking slim man, about six feet tall with frontal baldness, to be in his early fifties. While washing his hands, he introduced himself and said, “I’ve spoken to Dr. Switzer, so I know what happened to you, Ms. Richards, and I need to get your medical history and check you over.”

“Yes, Doctor,” said Betty sitting up in bed.”

Dr, Kennedy pulled up a chair and sat at the side of the bed, patient chart in hand. “So you might have fallen asleep at the wheel and you’ve had these sleep lapses happen before in other places. Is that right?”

“That’s true, I guess, but I sure don’t have any memory of the car accident, so I have no idea what happened this time, but I have fallen asleep suddenly other places.”

“Can you give me some detail about this sleep problem you seem to be developing?” asked the doctor “For instance, how many times do you think you’ve suddenly fallen asleep and when do you believe it started?”

Betty pondered for a few seconds and said, “Within the last few months, I think, and I found myself going through a sudden sleep three or four times.”

“Any other unexplained accidents resulting from this?”

“No, thank God.”

“Do you suddenly get sleepy for no apparent reason as far as you can tell?”

“Yes I sure do, I’ve fallen asleep on the couch at home and a friend’s house and even once in class when a student had to wake me up,” Betty answered quickly nodding her head.

“Do you have any trouble concentrating on things?”

Betty thought for a few seconds before saying, “Uhh…yeah as a matter of fact. I just took finals and had a hard time studying. My mind wandered…it gets cloudy at times like something’s wrong up there.”

“I see,” said Dr. Kennedy. “Have you ever had slurred speech, had trouble finding words?”

Betty’s eyebrows lifted. “Why yes…a couple of times. My boyfriend heard me once when we were out during a tennis match he was playing. That and my falling asleep is why he brought me home early.”

“Have you ever had a sudden weakness of an arm or a leg?”

Betty thought for a few seconds. “No, I don’t think so.”

“Betty, can you sit up and let your legs dangle? I’ll help you.”

“Sure.”

“Now I’m going to perform a neurological examination. (see appendix 2) Stand please. I’ll be right at your side. And take a few steps forward and a few backward. I’ll hold your arm.”

“Sure.”

“Good, can you walk by yourself four or five steps?”

Betty did easily.

“Betty, can you hold your right hand out to the side”

Betty did so.

“Okay. Betty, now close your eyes and put your index finger on your nose. Okay, now do the same with the other hand. Good.”

“Betty, hold my hand with your right hand and squeeze hard. Good. Now do the same with the left hand. Good.”

After careful observation of these movements, Dr. Kennedy said, “Okay, Betty, now just lie back down.”

Betty did as she was told without difficulty as Dr. Kennedy closely observed her movements. Then he said, “Now, put your right heel on your left knee and run it down your leg to your ankle and do the same with your other heel and run it down your right leg. Very good.”

“Do you have a headache now, or have you had headaches recently?”

“I’ve gotten mild headaches every once in a while, that’s all.”

“Any nausea or vomiting?”

“No.”

“Feel dizzy at all, I mean like the room spinning around your head?”

“Not at all.”

“Okay, Betty, let’s do a few more things. Just relax, it’s perfectly painless.” He proceeded to check arm and leg motor power, strength, sensations of touch and pressure, sharp and dull, cranial nerves, more cerebellar function and reflexes, all done in quick order.

Satisfied, he sat down and said, “That was perfect, Betty. The good news is that you show no MRI or physical examination evidence of any damage to your brain. On occasion, some brain effects could be delayed, so it would be a good idea that I see you again as an outpatient in a week or two just to play it safe and make sure there is nothing slowly developing.”

“Sure, doctor.”

“Now. Betty, your history also suggests a diagnosis that will need some investigation. I believe it is possible that you have a condition known as narcolepsy, where people fall suddenly asleep for no apparent reason, but that diagnosis is best confirmed by a neurologist, because it requires long-term attention and they’re the experts on this condition. There is no easy way to prove that diagnosis such as getting a simple blood test from you. My job as a surgeon is to make sure I did not have to operate on your head, which I don’t I’m happy to report, but the narcolepsy diagnosis is best made by a neurologist or your family doctor. The reason is because narcolepsy is a condition that once diagnosed means a lifetime with the illness. It can be controlled, but there is no definite cure at this time, although there is ongoing research. So, as I said, you need a neurologist in my opinion, or do you have a family doctor?”

“I’ve been to a pediatrician as a kid, but I haven’t seen her in years. Anyhow, I think I’m getting too old for a pediatrician.”

“Well, let me write the name of a neurologist for you that I highly recommend. The nurses can give you her office phone number. And here’s my card, I’d like to see you in a follow-up visit in about ten days.”

“Yes, sir, and thank you, doctor. Can I go home now?” asked Betty.

“I’m going to dictate your report with a copy to the neurologist, Dr. Reiss, and yes, I’ll discharge you for later this afternoon if someone can pick you up. It might be a good idea for you to be driven until you can get this sorted out.”

Breathing a sigh of relief, Betty said, “Yes, my boyfriend or mother could.”