janitor’s case was more the norm. His history was studded with uncinate seizures, auras of unpleasant tastes or smells; he gave descriptions of a chocolate bar tasting “metallic” and a smell of “rotten flesh” without apparent source. There were also fugues of déjà vu , as well as its opposite, jamais vu –a sense of strangeness in familiar surroundings. These episodes were often preceded by a peculiar smacking of the lips. The consumption of alcohol often triggered them.
Further, there were visual hallucinations, among them micropsia, in which objects seem smaller than they are; and levitation, a sensation of rising in the air, unsupported. The janitor had also had one brief episode of a phenomenon known as “the double.” He had seen his three–dimensional likeness mimicking his every word and action.
The EEG had been especially ominous. Tumors of this nature, if such it was, worked slowly and insidiously for many months, putting upward pressure on the brain stem; but at last it would gather a sudden momentum and in a matter of weeks, if left unattended, compress and crush the medulla.
The result was death.
“Willie, give me your hand,” said Amfortas gently.
“Which one?” asked the janitor.
“Either. The left.”
The janitor complied.
The resident was looking at Amfortas with an expression of mild pique. “I’ve done that already,” he said with an edge.
“I want to do it again,” said Amfortas quietly.
He put his first two left–hand fingers on the janitor’s palm and his right thumb on the janitor’s wrist, and then he pressed and began to move the fingers around. The janitor’s hand grasped reflexively and followed the movement of the fingers.
Amfortas stopped and released the hand. “Thanks, Willie.”
“All right, sir.”
“Don’t you worry.”
“I won’t, sir.”
By half past nine, Amfortas and the resident were standing by the coffee vending machine around the corner from the entrance to Psychiatric. They discussed their diagnoses, wrapping up the new cases. When they came to the janitor, the summing up was swift.
“I’ve already ordered up a CAT scan,” said the resident.
Amfortas nodded in agreement. Only then could they be certain that the lesion was there and probably close to its final stages. “You might want to book an operating room, just in case.’’ Even now, timely surgery would save Willie’s life.
When the resident came to the girl with suspected meningitis, Amfortas grew stiff and withdrawn, almost brusque. The resident noticed the sudden transition, but research neurologists, he knew, had a wide reputation for being introverted, uncommunicative and strange. He attributed the quirky manner to that, or perhaps to the girl’s youth and the possibility that nothing could be done to save her from serious crippling or even a hideously painful death.
“How’s your research coming, Vincent?”
The resident had finished his coffee and was crumpling up his cup before he tossed it into the trash. Outside the hearing of the patients, the formalities were dropped.
Amfortas shrugged. A nurse wheeled a drug cart past them and he watched her. His indifference was beginning to annoy the young resident. “How long have you been at it?” he doggedly persisted, determined now to crack the odd barrier between them.
“Three years,” said Amfortas.
“Any breakthroughs?”
“No.”
Amfortas asked for updates on the ward’s older cases. The resident gave up.
At ten, Amfortas attended grand rounds, a full staff conference scheduled until noon. The Chief of Neurology delivered a lecture on multiple sclerosis. Like the interns and residents packed in the hallway, Amfortas couldn’t hear it, although he was sitting at the conference table. He simply wasn’t listening.
After the lecture came a discussion that soon was diverted into heated debate over interdepartmental politics, and when Amfortas said, “Excuse me just a minute,” and left, no one
Further, there were visual hallucinations, among them micropsia, in which objects seem smaller than they are; and levitation, a sensation of rising in the air, unsupported. The janitor had also had one brief episode of a phenomenon known as “the double.” He had seen his three–dimensional likeness mimicking his every word and action.
The EEG had been especially ominous. Tumors of this nature, if such it was, worked slowly and insidiously for many months, putting upward pressure on the brain stem; but at last it would gather a sudden momentum and in a matter of weeks, if left unattended, compress and crush the medulla.
The result was death.
“Willie, give me your hand,” said Amfortas gently.
“Which one?” asked the janitor.
“Either. The left.”
The janitor complied.
The resident was looking at Amfortas with an expression of mild pique. “I’ve done that already,” he said with an edge.
“I want to do it again,” said Amfortas quietly.
He put his first two left–hand fingers on the janitor’s palm and his right thumb on the janitor’s wrist, and then he pressed and began to move the fingers around. The janitor’s hand grasped reflexively and followed the movement of the fingers.
Amfortas stopped and released the hand. “Thanks, Willie.”
“All right, sir.”
“Don’t you worry.”
“I won’t, sir.”
By half past nine, Amfortas and the resident were standing by the coffee vending machine around the corner from the entrance to Psychiatric. They discussed their diagnoses, wrapping up the new cases. When they came to the janitor, the summing up was swift.
“I’ve already ordered up a CAT scan,” said the resident.
Amfortas nodded in agreement. Only then could they be certain that the lesion was there and probably close to its final stages. “You might want to book an operating room, just in case.’’ Even now, timely surgery would save Willie’s life.
When the resident came to the girl with suspected meningitis, Amfortas grew stiff and withdrawn, almost brusque. The resident noticed the sudden transition, but research neurologists, he knew, had a wide reputation for being introverted, uncommunicative and strange. He attributed the quirky manner to that, or perhaps to the girl’s youth and the possibility that nothing could be done to save her from serious crippling or even a hideously painful death.
“How’s your research coming, Vincent?”
The resident had finished his coffee and was crumpling up his cup before he tossed it into the trash. Outside the hearing of the patients, the formalities were dropped.
Amfortas shrugged. A nurse wheeled a drug cart past them and he watched her. His indifference was beginning to annoy the young resident. “How long have you been at it?” he doggedly persisted, determined now to crack the odd barrier between them.
“Three years,” said Amfortas.
“Any breakthroughs?”
“No.”
Amfortas asked for updates on the ward’s older cases. The resident gave up.
At ten, Amfortas attended grand rounds, a full staff conference scheduled until noon. The Chief of Neurology delivered a lecture on multiple sclerosis. Like the interns and residents packed in the hallway, Amfortas couldn’t hear it, although he was sitting at the conference table. He simply wasn’t listening.
After the lecture came a discussion that soon was diverted into heated debate over interdepartmental politics, and when Amfortas said, “Excuse me just a minute,” and left, no one
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