История онемевшей на два года правой руки Майкла Крайтона и как "оно само прошло"
Ранее о книге Крайтона "Путешествия": https://cube-wan.livejournal.com/389005.html
Вступительная Глава "Medical Days (1965-1969)"
"(...) A few weeks after I decided not to continue, I developed numbness in my right hand. Over several days, the numbness extended up my arm to the shoulder. I thought perhaps I’d slept on my arm and had compressed the nerves a little. The numb sensation was mild, and I ignored it.
I had every reason to ignore it. During all the clinical rotations I had developed convincing symptoms of every disease I had studied.
In dermatology, I was sure my moles were growing; I went home each night and used a hand mirror to check my back, where I was convinced melanomas were popping out like beads of sweat.
During surgery, I developed bloody stools, symptomatic of a hemorrhagic ulcer, a true surgical emergency-although one of the residents said disdainfully that I had just developed hemorrhoids, and welcome to the club.
During genitourinary, I developed pain on urination and would spin down my urine in the lab each day, looking for micro-organisms that I felt sure were there, although I could never find them.
In each instance, the day the clinical rotation ended, the symptoms mysteriously vanished-only to be replaced by new symptoms, which developed as I began my new rotation. So, no matter how persuasive these new symptoms seemed to me, I had learned, after a year, not to panic. I certainly wasn’t going to panic now over something as peculiar as numbness in my right arm. I chose to avoid thinking about it; I refused even to look up the symptoms in my textbooks.
Then, one day in the cafeteria lunch line, I reached into my pocket for change and realized I could not distinguish the coins I was feeling in my pocket. I had to bring the coins out and look at them in my palm to see which was which. I knew what this was called: asterognosis.
I knew it was definitely abnormal.
Still I ignored my symptoms. Nothing further happened for two weeks, but the numbness did not go away, either. One day I asked a classmate who was a superb diagnostician, “What can give you numbness in your right arm?”
He thought about it for a while, shook his head. “The only things I can think of are spinal-cord tumor and multiple sclerosis.”
I thought, What does he know, he’s only a medical student. I still did nothing. I expected the symptoms to go away. They didn’t. I worried more and more about my arm, until finally I looked up the symptoms of spinal-cord tumor and multiple sclerosis.
It was immediately clear that spinal-cord tumor was highly unlikely. If I had anything wrong with me, it would seem I had multiple sclerosis.
Multiple sclerosis was a progressive degenerative disease of the nervous system, which tended to afflict young people. It was an autoimmune disease, in which the body’s defenses became confused and attacked its own nerve fibers as if they were foreign intruders. The progress of the disease was highly variable. There was no known cause, no effective treatment, and no cure.
According to my reading, MS could first appear in almost any way. The fact that I had numbness without pain in only one extremity, with no prior history of injury, was highly suspicious. But it was impossible to make a diagnosis of MS based on a single set of symptoms. You needed to see a pattern of neurological attack and remission, over time, to confirm a diagnosis.
I stopped reading. I went on to my next rotation, and hoped the symptoms would disappear. They did not. My arm remained numb. By now it had been almost two months.
One day in October, while bending over a patient’s bed, I noticed shooting electrical tingles going down both legs. From the reading I had already done, I knew what this was: Lhermitte’s sign. Technically, paresthesias on flexion of the neck.
Lhermitte’s sign was pathognomonic of multiple sclerosis. I had the disease.
I did more reading-a lot more reading. For a man of twenty-six, the news was not encouraging. Multiple sclerosis was highly variable, but, according to the statistics, I could expect substantial impairment within five years; serious handicaps that interfered with a job within ten years; very severe limitations including loss of bladder and bowel control within fifteen years; and death within twenty years.
I was horrified. The thought of becoming bedridden and incontinent, of undergoing the subtle loss of mental functioning, filled me with dread. But I reminded myself I still had not been examined by a doctor; no objective diagnosis had been made.
Finally I couldn’t keep my worries to myself. The internist at the Health Services listened to my story, did an examination, then named a neurologist he wanted me to see. I said I would call.
“No,” he said. “I’ll call. Maybe he can see you right away.”
The neurologist saw me that day. He was young and brisk. I sweated profusely while he examined me. When he finished, he said I could get dressed and come into his office. I dressed and went to the office.
“Well,” he said briskly, “you have had a demyelinative episode.”
“Does that mean I have it or not?” I asked. I couldn’t bring myself to say the words.
“You mean, do you have multiple sclerosis?”
“Uh-huh,” I said.
“Well,” he said, “you have had a single attack, yes.”
I felt as if a great powerful wave washed over me, knocked me down, spun me around in boiling surf. I felt as if I were drowning in this man’s office, sitting in a chair facing his desk.
The neurologist started speaking very quickly. “But let me tell you how to think about this,” he said. “I assume you have been reading up on it?”
“Yes.”
“Well, the books are wrong. Listen to me, and forget the books.”
Sure, I thought. Try and cheer me up.
“The books are based on old and inadequate data. I’ll tell you how to look at this disease-or, really, this syndrome, because it’s more a syndrome than a disease.”
He spoke fast and loud, realizing that my attention was wandering, that I was withdrawing into myself in panic. He said that a large percentage of people had a single episode like mine sometime during their lives. Most people would never consult a doctor about it, and so doctors had no idea how common a single episode might be. But he thought they were very common, perhaps occurring in as much as ninety percent of people. He told me that several of my classmates had had such single episodes. Only one had had subsequent episodes.
So the question in my case was whether I would have no further attacks at all, or whether I would have occasional attacks and experience some loss of function, or whether I would have frequent and severe attacks and serious difficulty in my life.
“Think of this as a heart murmur,” he said. “It’s a warning of a possible problem, but you can’t say now whether a heart murmur will remain asymptomatic all your life, whether it will give you some trouble, or whether you’ll die of it. You’ll simply have to wait and see.”
“How long do I have to wait to find out what sort of case I have?” I said.
“Two to five years,” he said. “If you have no further attacks for two years, I think you can relax. And if you have no symptoms for five years, I think you can forget about it completely.”
He then discussed what I could do in the meantime. The answer was, basically, nothing. Multiple sclerosis was a disease of unknown cause. There were some helpful treatments during acute episodes, but no cures. Since there wasn’t anything to do, he said I should take care of my general health and avoid stress and mental upset, but otherwise try not to think about it.
This neurologist was so straightforward, so matter-of-fact, that I was able to leave his office and go back to the wards to work. Despite the bad news, I was okay.
(...)
Dr. Corman listened to my story and sniffed. “Actually,” he said, “there is a third possibility besides spinal-cord tumor and multiple sclerosis.”
“What’s that?”
“Conversion hysteria.”
“Oh, come on,” I said. Conversion hysteria was an old psychiatric concept. (...)
“That’s not me,” I said. “I’m not hysterical.”
“Really?”
“Of course not,” I said, insulted. I pointed out that hysterics were mostly women.
“We’re seeing more hysterical men,” Dr. Corman said.
I pointed out that in cases of conversion hysteria patients showed a characteristic indifference to their diseases. They weren’t really worried. My woman who went blind from time to time complained about it, but she wasn’t as upset as you might expect. Whereas I was extremely upset about my case.
“Really?” Dr. Corman said.
He was annoying me. I said so.
“Well,” Dr. Corman said, “if I were you, I’d consider the fact that, of all your possible diagnoses, conversion hysteria is actually the most favorable.”
I didn’t believe that I was hysterical. Later on, other doctors who followed my case mentioned this possibility, too.
Although the numbness continued for several years, I never developed further symptoms. And I learned that it was indeed common to have a single neurological episode. Fortunately, I have never had another. I have learned to knock on wood, and to take good care of my general health.(...)"
Вступительная Глава "Medical Days (1965-1969)"
"(...) A few weeks after I decided not to continue, I developed numbness in my right hand. Over several days, the numbness extended up my arm to the shoulder. I thought perhaps I’d slept on my arm and had compressed the nerves a little. The numb sensation was mild, and I ignored it.
I had every reason to ignore it. During all the clinical rotations I had developed convincing symptoms of every disease I had studied.
In dermatology, I was sure my moles were growing; I went home each night and used a hand mirror to check my back, where I was convinced melanomas were popping out like beads of sweat.
During surgery, I developed bloody stools, symptomatic of a hemorrhagic ulcer, a true surgical emergency-although one of the residents said disdainfully that I had just developed hemorrhoids, and welcome to the club.
During genitourinary, I developed pain on urination and would spin down my urine in the lab each day, looking for micro-organisms that I felt sure were there, although I could never find them.
In each instance, the day the clinical rotation ended, the symptoms mysteriously vanished-only to be replaced by new symptoms, which developed as I began my new rotation. So, no matter how persuasive these new symptoms seemed to me, I had learned, after a year, not to panic. I certainly wasn’t going to panic now over something as peculiar as numbness in my right arm. I chose to avoid thinking about it; I refused even to look up the symptoms in my textbooks.
Then, one day in the cafeteria lunch line, I reached into my pocket for change and realized I could not distinguish the coins I was feeling in my pocket. I had to bring the coins out and look at them in my palm to see which was which. I knew what this was called: asterognosis.
I knew it was definitely abnormal.
Still I ignored my symptoms. Nothing further happened for two weeks, but the numbness did not go away, either. One day I asked a classmate who was a superb diagnostician, “What can give you numbness in your right arm?”
He thought about it for a while, shook his head. “The only things I can think of are spinal-cord tumor and multiple sclerosis.”
I thought, What does he know, he’s only a medical student. I still did nothing. I expected the symptoms to go away. They didn’t. I worried more and more about my arm, until finally I looked up the symptoms of spinal-cord tumor and multiple sclerosis.
It was immediately clear that spinal-cord tumor was highly unlikely. If I had anything wrong with me, it would seem I had multiple sclerosis.
Multiple sclerosis was a progressive degenerative disease of the nervous system, which tended to afflict young people. It was an autoimmune disease, in which the body’s defenses became confused and attacked its own nerve fibers as if they were foreign intruders. The progress of the disease was highly variable. There was no known cause, no effective treatment, and no cure.
According to my reading, MS could first appear in almost any way. The fact that I had numbness without pain in only one extremity, with no prior history of injury, was highly suspicious. But it was impossible to make a diagnosis of MS based on a single set of symptoms. You needed to see a pattern of neurological attack and remission, over time, to confirm a diagnosis.
I stopped reading. I went on to my next rotation, and hoped the symptoms would disappear. They did not. My arm remained numb. By now it had been almost two months.
One day in October, while bending over a patient’s bed, I noticed shooting electrical tingles going down both legs. From the reading I had already done, I knew what this was: Lhermitte’s sign. Technically, paresthesias on flexion of the neck.
Lhermitte’s sign was pathognomonic of multiple sclerosis. I had the disease.
I did more reading-a lot more reading. For a man of twenty-six, the news was not encouraging. Multiple sclerosis was highly variable, but, according to the statistics, I could expect substantial impairment within five years; serious handicaps that interfered with a job within ten years; very severe limitations including loss of bladder and bowel control within fifteen years; and death within twenty years.
I was horrified. The thought of becoming bedridden and incontinent, of undergoing the subtle loss of mental functioning, filled me with dread. But I reminded myself I still had not been examined by a doctor; no objective diagnosis had been made.
Finally I couldn’t keep my worries to myself. The internist at the Health Services listened to my story, did an examination, then named a neurologist he wanted me to see. I said I would call.
“No,” he said. “I’ll call. Maybe he can see you right away.”
The neurologist saw me that day. He was young and brisk. I sweated profusely while he examined me. When he finished, he said I could get dressed and come into his office. I dressed and went to the office.
“Well,” he said briskly, “you have had a demyelinative episode.”
“Does that mean I have it or not?” I asked. I couldn’t bring myself to say the words.
“You mean, do you have multiple sclerosis?”
“Uh-huh,” I said.
“Well,” he said, “you have had a single attack, yes.”
I felt as if a great powerful wave washed over me, knocked me down, spun me around in boiling surf. I felt as if I were drowning in this man’s office, sitting in a chair facing his desk.
The neurologist started speaking very quickly. “But let me tell you how to think about this,” he said. “I assume you have been reading up on it?”
“Yes.”
“Well, the books are wrong. Listen to me, and forget the books.”
Sure, I thought. Try and cheer me up.
“The books are based on old and inadequate data. I’ll tell you how to look at this disease-or, really, this syndrome, because it’s more a syndrome than a disease.”
He spoke fast and loud, realizing that my attention was wandering, that I was withdrawing into myself in panic. He said that a large percentage of people had a single episode like mine sometime during their lives. Most people would never consult a doctor about it, and so doctors had no idea how common a single episode might be. But he thought they were very common, perhaps occurring in as much as ninety percent of people. He told me that several of my classmates had had such single episodes. Only one had had subsequent episodes.
So the question in my case was whether I would have no further attacks at all, or whether I would have occasional attacks and experience some loss of function, or whether I would have frequent and severe attacks and serious difficulty in my life.
“Think of this as a heart murmur,” he said. “It’s a warning of a possible problem, but you can’t say now whether a heart murmur will remain asymptomatic all your life, whether it will give you some trouble, or whether you’ll die of it. You’ll simply have to wait and see.”
“How long do I have to wait to find out what sort of case I have?” I said.
“Two to five years,” he said. “If you have no further attacks for two years, I think you can relax. And if you have no symptoms for five years, I think you can forget about it completely.”
He then discussed what I could do in the meantime. The answer was, basically, nothing. Multiple sclerosis was a disease of unknown cause. There were some helpful treatments during acute episodes, but no cures. Since there wasn’t anything to do, he said I should take care of my general health and avoid stress and mental upset, but otherwise try not to think about it.
This neurologist was so straightforward, so matter-of-fact, that I was able to leave his office and go back to the wards to work. Despite the bad news, I was okay.
(...)
Dr. Corman listened to my story and sniffed. “Actually,” he said, “there is a third possibility besides spinal-cord tumor and multiple sclerosis.”
“What’s that?”
“Conversion hysteria.”
“Oh, come on,” I said. Conversion hysteria was an old psychiatric concept. (...)
“That’s not me,” I said. “I’m not hysterical.”
“Really?”
“Of course not,” I said, insulted. I pointed out that hysterics were mostly women.
“We’re seeing more hysterical men,” Dr. Corman said.
I pointed out that in cases of conversion hysteria patients showed a characteristic indifference to their diseases. They weren’t really worried. My woman who went blind from time to time complained about it, but she wasn’t as upset as you might expect. Whereas I was extremely upset about my case.
“Really?” Dr. Corman said.
He was annoying me. I said so.
“Well,” Dr. Corman said, “if I were you, I’d consider the fact that, of all your possible diagnoses, conversion hysteria is actually the most favorable.”
I didn’t believe that I was hysterical. Later on, other doctors who followed my case mentioned this possibility, too.
Although the numbness continued for several years, I never developed further symptoms. And I learned that it was indeed common to have a single neurological episode. Fortunately, I have never had another. I have learned to knock on wood, and to take good care of my general health.(...)"