Symptoms of Unknown Origin: A Medical Odyssey

Chapter 15. The Woman Who Would Not Talk

114 15 The Woman Who Would Not Talk I was asked to see Adelaine because of her diabetes mellitus. When I first saw her, she was a patient on the psychiatric unit in a state of severe depression. She had talked very little since admission and was about to receive electroshock therapy. I was asked to evaluate her medically prior to the electroconvulsive treatment. Adelaine was fifty-five years old, a widow, and the mother of one daughter, who lived nearby. When I walked into her room, she was curled up in bed facing away from the door toward the window. I walked to the other side of the bed, pulled a chair to the bedside, and sat down facing her. She did not move but lay there with her eyes closed. I tried to get her to talk to me, but she did not move or respond in any manner. There was mention in the admission history of severe headaches of unknown duration but very little other detail. The daughter, who would later play an important role, had not yet come in to give the clinical history. Adelaine had mild diabetes mellitus that was under fairly good control, with only mild blood-sugar elevations. Her physical examination was within normal limits, as were the remainder of her laboratory work and a chest x-ray. Skull x-rays and a spinal tap had been normal. A thorough neurological examination was within normal limits. I completed my physical examination, which was within normal limits except for her flaccid, withdrawn, and unreMeador ฀pagesFeb15.indd฀฀฀114 2/17/05฀฀฀5:35:12฀PM The Woman Who Would Not Talk 115 sponsive state. She kept her eyes closed. During my examination, she did not say one word. I suspected she was more conscious and more present than she appeared. She winced with pain but did not withdraw when I gently pinched her arm. I came back later that day. Puzzled by her withdrawn state and wanting to be sure I was not missing some other treatable internal disease, I sat and watched her for several minutes. I was trying to think through the situation. I could find no explanation for her clinical state from the laboratory or physical examination. The diabetes was not playing any significant role. I was confounded by the extreme state of her withdrawal and my continued belief that she was more conscious than she appeared. It somehow seemed too much or exaggerated. Depressed people are withdrawn but rarely to this degree. To get a better look at her, I turned my head horizontally so that we were face to face. I bent slightly forward and put my head down on the mattress beside her pillow. I was trying to see if her face or her eyes were asymmetrical. I was still wondering if she had had a stroke. I stayed in this awkward position for a moment. Suddenly she opened her eyes and looked back at me. The sudden movement startled me. There I was with my head almost on the bed next to this curiously silent patient now staring back at me. I did not move but held the position. I said, without moving my head, “Hello. How are you?” She closed her eyes and slowly moved her head from side to side as if to say “no” or “not well.” I was not sure what she meant. She said nothing, and the movement was ever so slight. I would have missed it if I had not been looking very closely. It was the kind of headshake that people who are very sick or nauseated make when they do not want to be bothered. She remained silent. Again I lay my head down on the bed beside her pillow. I wanted to see what would happen if I just stayed there. She looked directly at me and then moved her eyes down and away from me as if to avoid my eyes. Still holding my head sideways and on the bed, I took my Meador฀pagesFeb15.indd฀฀฀115 2/17/05฀฀฀5:35:12฀PM 116 Symptoms of Unknown Origin finger and moved it in front of her eyes and she followed it in all the cardinal directions. All the complex neurological circuits that control eye movements were intact. There is a world of information in those six basic eye movements. I had noted out of...