Symptoms of Unknown Origin: A Medical Odyssey

Prologue

1 Prologue The double doors of the amphitheater swung open. A nurse and physician rolled a patient in a wheelchair into the bottom of the amphitheater. A white-haired fiftyish-appearing woman in a bathrobe and nightgown sat slumped to one side of the wheelchair. She was the most pitiful person I had ever seen. Her mouth was half open, with drool dripping from one corner. She struggled to raise her head from its dangling position but could not. Her eyes drooped half closed. It was obvious that the woman was paralyzed. The rows of seats of the amphitheater slanted upward in an acute angle for nearly two stories. Students sitting in the top rows looked almost directly down into the pit below. Dr. William King, professor of physiology, stood at the bottom of this well with the patient and her physician. Dr. King had just finished his lecture on the biochemistry of the neuromuscular junction. Approaching the end of our physiology course and nearly at the end of our first year of medical school, we were seeing our first patient. We were completing our study of the nervous system. During the first year of medical school, all the focus is on the normal human body—its anatomy, tissues, organs, physiology, and biochemistry. So naturally , as the courses went by, we became more and more interested in seeing live patients—more accurately, we were hungry for clinical contact. The year was 1952. Dr. King introduced the class to Dr. Sam Riven, the patient’s Meador฀pagesFeb15.indd฀฀฀1 2/17/05฀฀฀5:34:51฀PM 2 Symptoms of Unknown Origin physician and a member of the clinical faculty. Dr. Riven had a busy practice of internal medicine in the community and was widely known as an excellent physician. He looked like a nineteenthcentury child’s impression of what a doctor should look like. Absent the beard, he reminded me of the physician at the bedside of the sick child in Luke Fildes’ classic painting “The Doctor.” He wore buttoned suit vest under his long white coat. A Phi Beta Kappa key dangled from a small gold chain that ran from one vest pocket to another. He stood tall and erect and exuded confidence. His hair was graying. There was a trace of a Canadian accent as he spoke in a soft but distinct voice. Dr. Riven introduced Mrs. Gladys Goode to the class and told us this pitiful woman had myasthenia gravis. Dr. Riven said that Mrs.Goode had agreed to omit one dose of her medicines so we could see how she appeared untreated. The woman made a feeble effort to smile with an ever-so-slight movement of the corners of her mouth; she made a hoarse whispery sound when she tried to speak. He then asked her to perform several tasks. He held up an arm and then let go. The arm flopped back into her lap. She could not move her legs or arms, could not raise her head, could not completely open her eyes. She could barely swallow and could not speak, at least in a voice we could hear. Dr. Riven kept patting her on the head and reassuring her. He repeatedly asked her if she could tolerate a few more minutes. She made a barely noticeable nod of her head. It was more as if she raised her head a fraction of an inch and then let go as her head wobbled a few times on her chest. Dr. Riven then took a filled syringe from his black bag. He held the syringe high in the air and squirted a small spray from the needle, swabbed the patient’s upper arm, and injected the clear liquid into the patient. We sat there in complete silence for several minutes. Slowly the woman began to come alive. There was a science-fiction aura about it—as if Riven was creating life right before our eyes. First she was able to fully open her eyes, then she could close her mouth, then she raised her head to an upright posiMeador ฀pagesFeb15.indd฀฀฀2 2/17/05฀฀฀5:34:52฀PM Prologue 3 tion. The drooling stopped. Slowly she adjusted her position in the wheelchair. And then, like a pure miracle, she sat upright, stood up, spread her arms out to each side, and made a small bow as if to say, “Here...