Read Online Reaching Down the Rabbit Hole by Allan H. Ropper - Free Book Online
Authors: Allan H. Ropper
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did he know who he was, where he was, what day it was, did he know how to get home? Satisfied that Wally was indeed “oriented times three,” he told him to return the next day. As the couple walked back to the car, Wally’s wife started to cry, not for herself, but for her husband.
At the age of seventy-eight, Wally had reached a breaking point. His wife’s chances of beating the cancer were merely fair, his daughter’s marriage was falling apart, and his business—a party supply store—had just failed. He now had to run a household, care for his wife, cook the meals, manage his stock portfolio, all while dealing with his own health issues: diabetes, hypertension, COPD, obstructive sleep apnea, and congestive heart failure. The last straw that sent him to a local hospital, not for his wife but for himself, was the confusion. After a complete medical examination revealed the respiratory and cardiac problems, it was decided that Wally would need the resources of a larger facility. In addition to his confusion, it seemed, Wally would occasionally stare into space and blink in clusters. It was thought that he might be having small seizures, so he was sent to us, and we fitted him with a twenty-four-hour EEG monitor.
Wally Maskart was placed in a room next to Gordon Steever, two doors down from Mrs. Gyftopoulos. Wally and Gordon, although in the throes of acute confusional states, were a study in contrasts. Wally engaged the world, while Gordon hid from it. Wally witnessed Mrs. Gyftopoulos’s code blue and wrote about it in his journal, while Gordon kept to his room and stared at the floor. They had a few things in common. The first, which was speculative, was that Gordon had been Wally’s daughter’s seventh-grade basketball coach. The second, which was unfortunate, was that both of their spouses were battling cancer. The third, which was definite, was that I had no idea what was wrong with either one of them. The fourth, which was obvious to even the most casual observer, was that something was very, very wrong with both of them. We couldn’t rule out the possibility that their confusion was not a neurological phenomenon, but a psychiatric one. We also couldn’t rule out the possibility that in both cases it was life-threatening.
Callie, the second-year resident with the idiosyncratic word selection, presented Wally’s workup in the conference room on the morning of Mrs. G’s code: “Mr. Maskart is a seventy-eight-year-old right-handedman who was recently admitted for episodes of confusion. He has a history of coronary disease, the usual slew of hypertension, hypo-adrenal whatever, diabetes, obstructive sleep apnea. He’s presenting again after persistent episodes of confusion: just wacko, per the family. He’s been getting lost while driving, he’s been having episodes of what he describes as d é j à vu. His son says he seems to be a little more confused in the mornings. He seems at times to be unable to work the television remote. He’s really into toy trains . . .”
“Model railroading,” I corrected.
“. . . whatever, but it seems that recently he bought the wrong kind of train things, which his family says is just not like him.”
“What things?”
Callie looked through her notes. “A tinplate locomotive, whatever that is.”
“Continue.”
“He was admitted to medicine [the medical ward] on the twenty-fifth. He had three days of continued déjà vu, increased sleepiness, and increased confusion. Then he was readmitted and sent here. The other thing that’s complicated this is that he seems to be playing around with his medications at home.”
“What do you mean?”
“He has psoriatic arthritis and is on prednisone. He seems to be getting his meds confused. Apparently he likes to tinker with them, and he might be taking his wife’s medications. She has cancer.”
“Has he had a tox screen?”
“I truly hope so.”
The presentation took longer than most because the history
At the age of seventy-eight, Wally had reached a breaking point. His wife’s chances of beating the cancer were merely fair, his daughter’s marriage was falling apart, and his business—a party supply store—had just failed. He now had to run a household, care for his wife, cook the meals, manage his stock portfolio, all while dealing with his own health issues: diabetes, hypertension, COPD, obstructive sleep apnea, and congestive heart failure. The last straw that sent him to a local hospital, not for his wife but for himself, was the confusion. After a complete medical examination revealed the respiratory and cardiac problems, it was decided that Wally would need the resources of a larger facility. In addition to his confusion, it seemed, Wally would occasionally stare into space and blink in clusters. It was thought that he might be having small seizures, so he was sent to us, and we fitted him with a twenty-four-hour EEG monitor.
Wally Maskart was placed in a room next to Gordon Steever, two doors down from Mrs. Gyftopoulos. Wally and Gordon, although in the throes of acute confusional states, were a study in contrasts. Wally engaged the world, while Gordon hid from it. Wally witnessed Mrs. Gyftopoulos’s code blue and wrote about it in his journal, while Gordon kept to his room and stared at the floor. They had a few things in common. The first, which was speculative, was that Gordon had been Wally’s daughter’s seventh-grade basketball coach. The second, which was unfortunate, was that both of their spouses were battling cancer. The third, which was definite, was that I had no idea what was wrong with either one of them. The fourth, which was obvious to even the most casual observer, was that something was very, very wrong with both of them. We couldn’t rule out the possibility that their confusion was not a neurological phenomenon, but a psychiatric one. We also couldn’t rule out the possibility that in both cases it was life-threatening.
Callie, the second-year resident with the idiosyncratic word selection, presented Wally’s workup in the conference room on the morning of Mrs. G’s code: “Mr. Maskart is a seventy-eight-year-old right-handedman who was recently admitted for episodes of confusion. He has a history of coronary disease, the usual slew of hypertension, hypo-adrenal whatever, diabetes, obstructive sleep apnea. He’s presenting again after persistent episodes of confusion: just wacko, per the family. He’s been getting lost while driving, he’s been having episodes of what he describes as d é j à vu. His son says he seems to be a little more confused in the mornings. He seems at times to be unable to work the television remote. He’s really into toy trains . . .”
“Model railroading,” I corrected.
“. . . whatever, but it seems that recently he bought the wrong kind of train things, which his family says is just not like him.”
“What things?”
Callie looked through her notes. “A tinplate locomotive, whatever that is.”
“Continue.”
“He was admitted to medicine [the medical ward] on the twenty-fifth. He had three days of continued déjà vu, increased sleepiness, and increased confusion. Then he was readmitted and sent here. The other thing that’s complicated this is that he seems to be playing around with his medications at home.”
“What do you mean?”
“He has psoriatic arthritis and is on prednisone. He seems to be getting his meds confused. Apparently he likes to tinker with them, and he might be taking his wife’s medications. She has cancer.”
“Has he had a tox screen?”
“I truly hope so.”
The presentation took longer than most because the history
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