Even though I don’t have an outpatient practice, I like to keep in touch with some of my patients after they’ve been discharged from the rehab hospital. Jack is one of my very favorite success stories.
I met Jack in a small regional hospital in rural America. He had been admitted with sudden-onset weakness, and during the intake process, he mentioned enjoying occasional evening cocktails when out for dinner. Unfortunately, this led the clinicians down the wrong diagnostic pathway, presuming that alcohol-withdrawal seizures were the cause of his weakness (i.e., a postictal state).
A brain MRI was unremarkable, and so the hospitalists started a fairly high loading dose of anti-seizure medication. Poor Jack happened to be very sensitive to meds, and reacted with frank psychosis. He was still not in his right mind days later, but he was going to be discharged nonetheless. A concerned staff member lobbied for a second opinion, and a rehab consult was requested for “encephalopathy because of alcohol withdrawal.” The attending physician remarked that the patient was a drinker, and that I’d be crazy to admit him. He believed Jack had long-standing gait dysfunction from alcohol damage.
Finding a better diagnosis
When I met Jack, it was clear at first glance that only the left side of his body was weak. He was very anxious, and was “furniture surfing” in his room with a nonfunctioning left hand. He was obviously highly intelligent, if not completely lucid, and asked me to call his daughter to help straighten things out. Jack knew that something was terribly wrong, and he needed someone to rescue him from the medications that were muddying his thoughts.
His daughter lived far away and was frightened that her father was going to be sent home alone in this condition. She explained that he was certainly not a heavy drinker and that he formerly worked as a leader in trademark licensing for UCLA. He had been playing golf and running a business prior to admission.
I admitted him to the rehab unit and ordered a repeat MRI (which confirmed his stroke) and stopped all the new medicines. Within 24 hours, Jack was calm and back to his usual, reasonable self, albeit with left-sided weakness that required intensive therapy intervention. Over the two weeks that he was under my care, I had the pleasure of meeting his daughter — an empathic novelist from California — in person. Both she and Jack were so relieved to have a clear diagnosis and treatment pathway. Jack’s goal was to get back to his golfing and to continue living independently in his rustic home.
All’s well that ends well
A year later, I returned to the hospital where I’d met Jack and sent him an email to see if he might like to get together for lunch. We ended up meeting for dinner after work, and I was so pleased to observe that it was now impossible to tell he’d ever had a stroke. His movements were fluid and coordinated, and his mind was crystal clear. He told me he enjoyed golfing again and was planning to buy a new home on the West Coast.
When our server arrived to take our order, Jack turned to him and announced that I was his former physician. I smiled and nodded. And then he followed up with something both touching and incredibly insightful: “She didn’t save my life. But she saved my lifestyle, and that’s even more important to me.”
His words took my breath away, and I realized that his success meant the world to us both. People like Jack are the reason I became a doctor, and I’m so glad he took the time to let me know I was making a difference.
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