This afternoon, I spent an hour interviewing a 70-year-old retired lawyer who had been brought to the hospital for "confusion" and "unpleasant vivid daydreams." When I first met him, he said to me, "Well, it's been a fascinating trip so far. I didn't know that all this stuff is going on, that delusions like this can happen to people." He then elegantly launched into a nonsensical explanation of recent events, from being lost in the snow in Vermont with only strange innkeepers in sight, to being kidnapped and brought to Japan, where he was given hospital socks. As I struggled to keep him on track and progress with the interview, I felt frustrated with his verboseness. Listening closely, trying to make sense of his eloquent speech, I realized that his words added up to nothing more than nightmarish delusions. He, too, has been struggling to make sense of these experiences: "I've been trying to analyze why these things are happening to me... I feel better since they've mapped out a game plan, [which is] to bombard people with reality." Later, he failed a simple neurocognitive assessment. A picture emerged of an intelligent, educated man using those reserves to compensate and mask a significant decline.
As the interview seemed to be going on forever, we paused for a neurology resident to do her exam. I watched as numerous Parkinsonian features were revealed: bradykinetic hand movements, perseveration, increased muscle tone, shuffling gait. After, I stepped out of the room to ask the resident her thoughts. "We're thinking Lewy body dementia," she said, a diagnosis that goes along with Parkinsonism. I felt excited at discovering something new, the chance to diagnose, glad to have stumbled upon a neuro exam for a disease I hadn't seen before. A hypothesis shared only between the resident and me, not yet voiced to the patient himself.
I stepped back into the room to finish my interview. Towards the very end, I asked the patient to describe his mood at present. "One hundred percent better!" he said, and smiled. "I actually think I have a chance now of being able to do things again, of going back to how I was. I was really worried about Alzheimer's, but the CT and MRI came back totally benign!" I choked up. Minutes later, I stood up, thanked him, shook his hand, and left the room.
As the interview seemed to be going on forever, we paused for a neurology resident to do her exam. I watched as numerous Parkinsonian features were revealed: bradykinetic hand movements, perseveration, increased muscle tone, shuffling gait. After, I stepped out of the room to ask the resident her thoughts. "We're thinking Lewy body dementia," she said, a diagnosis that goes along with Parkinsonism. I felt excited at discovering something new, the chance to diagnose, glad to have stumbled upon a neuro exam for a disease I hadn't seen before. A hypothesis shared only between the resident and me, not yet voiced to the patient himself.
I stepped back into the room to finish my interview. Towards the very end, I asked the patient to describe his mood at present. "One hundred percent better!" he said, and smiled. "I actually think I have a chance now of being able to do things again, of going back to how I was. I was really worried about Alzheimer's, but the CT and MRI came back totally benign!" I choked up. Minutes later, I stood up, thanked him, shook his hand, and left the room.
No comments:
Post a Comment