Читать книгу Brainstorm - Sheldon J.D. Cohen - Страница 11

When they arrived for their scheduled appointment, they waited more than an hour before Burt could see them. Gail had difficulty keeping George in his seat. Several times, he threatened to get up and leave. When it was their turn, a sullen George walked into the doctor’s examining room.

Burt greeted them both before scanning George’s chart and questioning his patient. He asked, “This visit is for you, Mr. Gilmer, is that right?”

“Yes,” said Gail, before her husband could speak, “and I had to beg him to come.”

The doctor glanced back at the chart, reviewing for detail. Burt recalled the abdominal pain syndrome most likely attributed to an ulcer. He noted that George had failed to follow through with the previous post-exam tests he had ordered during the last visit.

Burt stepped within inches of his sulking patient who was sitting on the examining table with hands folded in his lap. “Tell me what happened,” said the doctor in a calm voice

“The wife dragged me here.” he said. “She thinks something’s happening to me, but I feel great. In fact, if you’d like the truth, I’m just trying to satisfy her. This is all a big waste of time.” Burt nodded and turned his gaze to Gail.

“Doctor, it was like pulling teeth to get him here,” she said. “He’s like a stranger. It’s all so sudden, and I’m sick with worry. He loses his temper, he forgets things, and he even got lost driving home the other day.”

George shook his head in defiance, but failed to get a word in while Gail continued. “He’s nervous and irritable and barks at the children. We’re all scared to death. Worst of all, the other day at the supermarket some guy bumped into him with a cart, and he started swinging and punching. The store manager called the police, and we’re praying that the man won’t press charges.”

“That’s quite a lot of complaints, George,” said Burt. “How do you feel about all this?”

“Nothing’s wrong with me,” he countered. “I’ve been busy at work, and took on some extra jobs. Just lost my temper in the supermarket, but I didn’t hurt the guy.”

“Hmm,” replied Burt,” sounds like two different stories.”

“Sure does,” said George, with a wry smile.

“Gail, if you don’t mind, I’d like to question your husband alone. Soon as I finish, I’ll call you back in. Is that okay with you, George?”

“Yeah, sure.”

Gail nodded and left the room.

“Okay, George, let’s concentrate on what brought you here. I’ll ask you questions and check you over again. Have you ever been in a fight like this before?”

“No. Well, maybe when I was a kid.”

“Do you think you’ve been getting more nervous as time goes on? Is your wife right that there’s been some change in you?”

“No, I don’t think so.”

“Has anything changed at work; any recent pressure?”

“Sure. Lots of deadlines, and my own work like the side jobs I take care of on Saturdays and my day off.”

“Your wife thinks you’re forgetting things. Is that true?” A distracted George did not respond. Burt waited, permitting him extra time before repeating the question.

“Well, one day at work I was going to frame in some doors until the foreman told me I already did it. I was sure I didn’t, but I checked to see and he was right. I just think he was putting me on because I know I never worked on those doors.”

“Is the extra work adding to your stress?”

“No, like I said, I like it. The money’s good, and I get the chance to do my own thing.”

Burt paused, making sure he had eye contact before going on. “Are you happy in your marriage, George?”

“Sure, why not? I got a great wife and kids.”

“Any problems sleeping?”

“None at all.”

“Any problem concentrating?”

He paused. “I don’t think so.”

“What about appetite?”

“Good.”

“Any headaches?”

“No.”

Burt noticed him beginning to fidget. George got up, walked over to the window, and stared outside. When he returned to his seat, his expression had changed. Burt had seen this failure to concentrate before. He knew it was time to stop. This was a different patient from the man he met on their first visit.

“It’s a big waste of time—right?” asked George.

“Your wife’s worried, so I’m glad you came. I’ll step out of the room, and while I’m outside I want you to strip down to your shorts so I can examine you. As soon as you’re ready, open the door a bit and I’ll come right in.”

Burt did a brief examination, a repeat of the last time, before concentrating on George’s neurological exam. He evaluated his motor abilities and did a full sensory exam. He checked cranial nerves and reflexes. He checked the strength of George’s arms and legs. He looked into George’s eyes with an ophthalmoscope. There were no localized neurological deficits. In short, his examination failed to reveal any evidence whatsoever of neurological change.

“All right, George. Everything looks good. May I call your wife in?”

“Sure.”

When she returned, Burt informed her of the results. “Your husband’s examination was normal. I don’t find any evidence of a brain tumor, or any other brain disease for that matter. In fact, I find nothing wrong. But normal findings can sometimes register even when there’s a severe illness. What I’m saying is that everything is fine so far, but for a complete evaluation I’m recommending an MRI brain scan.”

“What would that show?” asked Gail.

“It would eliminate any possibility of a tumor or other brain disease. I don’t find such evidence on his physical exam, but we must look into every possibility.”

“Brain tumor?” repeated Gail. George flashed a look of disbelief.

“I don’t think there’s a tumor, but I want to be thorough,” said Burt.

George was staring out the window again, no longer paying attention.

“Anyhow, that’s number one,” said Burt. “Number two could be some psychological dysfunction: anxiety or depression to be exact. Not that George fits the exact mold of these diagnoses, but if there is any significant changes as you suggest we’d better check out that possibility. In fact,” he paused to look at George. “I would like to recommend you see a psychiatrist for a second opinion.”

He bolted straight up. “A shrink? No way. Never.”

“Well, then my final suggestion is that you watch and wait.” Turning to Gail, he directed the next comments to her. “Because of your husband’s occupation, I’d rather not prescribe medication considering he works with nail guns, hammers, power tools, and climbs ladders. We need to get this all sorted out first.”

From the corner of his eye, Burt saw George jump up to leave. “Thanks for your time, doctor.”

“Hold it, George.” The tone of the doctor’s voice took both Gail and George aback. His facial expression was stern. “This brings me to number three. It looks like you never took the tests that I ordered the last time.” Burt placed himself in front of the closed door. George got the message and stepped back.

“Right. You said I had an ulcer, and the medicine took care of it,” lied George.

“I said I thought you might have an ulcer, but for a final diagnosis I needed those tests I ordered.”

“I’ll see to it that he takes them,” said Gail.

“It could be too late, Gail. If the ulcer healed, and that’s a possibility because the pain’s already gone, then the X-ray might now read normal. I mention this only because the time to take tests is when symptoms are present. I hope you’ll learn from this experience and go from here.”

George was noncommittal, but Gail soaked up every word.

“Here’s a slip for the MRI of the brain, a full set of blood chemistries a blood count, and a stomach X-ray. Get them right away and I’ll have the results in a few days. There’s a lot of unusual things going on here and I need the help of these tests before I can pinpoint a diagnosis. You listened to my advice and ignored it after your first visit. I have no idea why you did that, but it made no sense. I’ll never order a test unless it’s necessary, George, and in your case there are some unusual things that could cause all your symptoms and they can’t be ignored and I must, I repeat, must have these tests.”

Gail promised, and she and George departed in complete silence. They did not speak in the car on the way home. Gail prayed for a quick and simple diagnosis and cure.

When Gail raised the subject of medical tests George said, “I have no brain tumor, and I’m sure as hell not going to some shrink.” When she offered opposition, George left the room. Her only hope was that he might change his mind. But why was he being so resistant? His whole mindset was not rational Why was he refusing to do what the doctor ordered? It’s as if he never heard what the doctor was saying. What was happening? Things have gone on too long.