A fellow doctor recently referred a patient to me for a second opinion. My colleague had observed this patient, named Ukraine, since birth without noting any serious concerns, until a few years ago, when the patient began to manifest the symptoms of a strange unknown disease.
In earlier life, the patient contracted all the illnesses one would expect in a child—allergies, flues, and even chickenpox. When the patient reached puberty, in 2004, his body began to show the signs of successfully rebelling against its past. The patient manifested all the signs of growing into a mature, healthy, and independent adult.
Then, about three years ago, the patient began to show worrying symptoms. He was suffering from flashes and his hands were swollen. He began to act irrationally, and stopped eating regularly.
My colleague sent the patient abroad, referring him to a consilium of twenty-seven highly respected European doctors for examination. However, he received a rather confusing response. The consilium put the patient through a series of standardized tests, the last of which was held on October 28 of this year. All of the tests, however, had negative results. The consilium reported that the patient had tried to cheat on the tests, and had even attempted to manipulate the results by threatening and blackmailing some of the doctors.
The consilium was split. One group of doctors maintained that the patient’s symptoms were normal, and that his slight irregularities would disappear as he grew older. This group did, however, raise concerns about the potential for contagion from the patient’s eastern neighbor, whom they considered seriously ill. The other group of doctors maintained that the patient was seriously ill, and would have to be put in quarantine to prevent an epidemic. With no possibility of consensus, the consilium sent the patient home with vitamins and a new test to be carried out in 2015.
It was at this moment that the patient was referred to me for examination.
Examination
When the patient came to see me, I could no longer recognize the healthy young man I had once seen at my colleague’s. Despite his youth, he looked pale, tired, and distracted. I began to examine him, but he protested that nothing was wrong. He claimed not to care about his health, and instead asked for something stronger than a vitamin to stop the rash on his hands.
However, the patient’s demeanor rapidly changed. His facial expression changed and he began screaming at me. He was demanding that I write to the consilium and ask them to prescribe him a magic pill, also known in Europe as ‘association’ or ‘membership’. This therapy had been prescribed to his western neighbors fifteen years earlier. It has worked so well that they had been able to join the consilium themselves.
Then, suddenly, his demeanor changed rapidly yet again. He smiled crazily and whispered that he knew he was seriously ill, but if I would let him stay as an outpatient of my clinic, he would agree not to run away with his contagious eastern neighbor.
The patient was clearly in pain and deserved an in-depth examination. His condition couldn’t be healed with just vitamins, or even with the consilium’s special treatment.
So I started with the basic battery of tests.
The Hands
I first turned to the patient’s swollen hands. My colleague’s initial diagnosis suggested that they were the source of the patient’s illness. In case of a healthy adult, the hands are usually the guarantors the body’s wellbeing. For almost three years, my patient’s hands had been covered in a rash. They were also prone to erratic movements—constantly grabbing other people’s belongings, threatening to beat them, and clutching on, refusing to let go of the patient’s chair. The patient’s facial expression also suggested that his hands were acting independently from the rest of his body, and that he did not approve of their behavior. This was definitely not just a simple rash.
The Legs
I continued my examination, checking the patient’s legs. In a healthy patient, the legs would provide balance to the body, acting in opposition to the hands. However, these were also covered in a rash. One of them was swollen, and the other looked as if it had recently been broken.
I asked the patient what happened to his legs. He sighed and told me about a serious car accident that he had been involved in in February 2010. As a result, his driver was unbraided and unjustly imprisoned, and he himself was almost handicapped.
The patient’s legs were supported by a borrowed walking stick. Since then, his legs had been in pain, he could not keep his body straight, and sometimes felt as if his legs would go forward while they were moving him backward. The patient had felt a slight relief on October 28, only to relapse a few days later.
Hearing and Vision
Following the accident, the patient also began to experience increasing problems with his hearing and vision. He was still able to watch some television channels and read some newspapers, although his hands kept grabbing for the remote control and throwing the papers in the trash bin.
Part of him felt pretty comfortable with this situation, as he could now relax and finally watch all those crime series. The other part, however, rebelled and even considered going to a specialist and having his ears and eyes fixed. However, he failed as the doctor could only see him on the October 28, when he had to be examined by the consilium of 27.
The Stomach
The further my examination progressed, the more troubling the patient’s prognosis looked. Yet, the patient began to relax and finally confided in me that his stomach was also causing him trouble.
It looked as if his stomach had initially been acting in coordination with his hands, so that it could be fed constantly. This condition had evolved, however, and the patient’s hands now seemed to be attempting to starve the stomach by depriving it of food. The stomach of any healthy adult always looks for profit, and tries to engage with the hands and other body parts to this end. However, it looked as if my patient’s stomach was attempting to assume the functions of his brain, and control his hands and legs at the same time. That looked abnormal to me.
The Brain
Pursuing my examination, I moved on to the patient’s brain. I was very surprised not to find any trace of brain tests in my colleagues’ report. It seemed that he had ignored all of the patient’s 46 million brain cells.
I discovered serious damage to the brain. It was as if the brain had experienced a period of normal development which had suddenly stopped. It was being deprived of oxygen and blood and was supported by a rather weak spinal cord . It was no wonder that the brain could not control its own hands and legs.
Not surprisingly, the brain appeared to refuse to believe the messages that the eyes and the ears of the patient conveyed to it. The brain was only capable of fulfilling one function—allowing the patient’s hands to satisfy the appetite of his voracious stomach. Fresh, younger brain cells were trying to stimulate the brain to recovery, but this was not enough to restore proper function to the entire body.
I observed that the patient’s brain seemed to be in a state of denial. It seemed to believe that the patient’s hands were still giving rather than taking, his legs walking straight and opposing the hands’ behavior when needed, his mouth saying what he saw clearly and his ears hearing clearly. According to his medical history, the patient’s parents had suffered from the same kind of denial for 70 years. I therefore concluded that he was suffering from a hereditary condition.
Diagnosis
My diagnosis was therefore clear—the patient’s brain was the main problem. The state was not yet terminal, but if not treated quickly and with the right medicine, the patient risked becoming comatose by 2015. A mix of brain stimulation, shock therapy, and deep psychoanalysis was needed to get the patient out of this state. Although, if the consilium absolutely insisted, vitamins could be prescribed as a supplement.
Treatment
The first task was to restore the supply of oxygen and blood to the patient’s brain, and revitalize his neurons. A number of short visits to a better climate somewhere in Europe could facilitate this. Communication with other—healthier—people could also help the patient’s brain recover. Therapy, on the other hand, would help the brain understand that it alone was responsible for what was happening to the patient. The patient’s brain would have to learn that it could and should control the patient’s body.
If the patient followed my prescribed treatment, full recovery would take a minimum of ten years. However, worse cases have been observed, and I would not rule out a speedier recovery.
I communicated my diagnosis to the patient. Although he could not hear me well, I promised to send him a letter that could be read to him by one of his kind western neighbors. He shook my hand and finally left.
On the one hand, I felt relieved. Ukraine was one of my most difficult patients and I had managed to diagnose my patient correctly. However, it still left me feeling sad. How many similar patients, who are diagnosed with a rash instead of serious brain damage, and prescribed vitamins instead of serious therapy, are among us?
