I am in the coffee shop this evening. I was planning on writing clinic notes, but the EMR is down so I will write a blog instead about an interesting patient I saw last weekend.
On my last 24 hour Saturday call shift I was consulted to see a 30 year old woman with known abnormalities in her brainstem and whitemater on prior MRIs who comes in with balance problems, and clumsiness. She told me she had trouble walking and she felt like she was drunk (I hear that a lot from people who really aren't drunk). She also had difficulty with simple motor tasks like buttoning her shirt and writing. She lived on the Crystal Coast; the outer banks of North Carolina about 4 hours away. About 2 years ago she came to UNC with symptoms of left sided weakness and her MRI showed brainstem and whitematter abnormalities. She has seen at least 3 neurologists previously; the first told her she had MS. We told her that she didn't the last time she came...
In the ED we repeated her MRI brain and it showed a round concentric onion shaped lesion extending through her parietal, occipital, and temporal lobes that is brand new along with her prior abnormalities. Her deficits were minimal on exam. She had subtle left sided facial droop and left sided weakness. She was able to walk but she was unsteady. But she knew something was wrong. Based on her imaging; I felt like she has Balo's variant MS; a condition with large circular whitematter lesions. Everyone agreed with me the next morning (which is relatively unusual). We would have to tell her that she likely does indeed have MS and that what she was told previously appears now to be incorrect.
The above case is interesting, but the person sitting next to the patient captured my attention. It was her father. He worked in Charlotte; about 2 hours west of Chapel Hill. His daughter lives on the outerbanks coast, about 4 hours east of Chapel Hill. She clearly was in no position to drive, so she called him and he made the drive 6 hours east to the outer banks to pick her up, and then 4 hours back west to Chapel Hill for us to see her that evening.
This reminds me of the time I broke my wrist ice skating when I was a college sophomore. I had a hunch somthing wasn't right. I wanted to see a doctor. Who was going to take me to the hospital? Who else; I called my dad at around 6 in the morning the next day and told him I think I broke my wrist. He got up out of bed and took me to the hospital. A splint was given to me and later I wore a cast for about 6 weeks (No one signed it; I didn't want that. I was 20 years old and too mature for that nonsense).
When you know something is wrong medically, it can be scarey and lonely. The question becomes who will be there to hold your hand when you're struggling; to drive you to the hospital; to make you food and do your laundry if you need some time to recover? For me and the patient I saw last Saturday, it was dad, and I am thankful I have that support system even if I live many miles away from my parents.
