"There's nothing wrong with your pons," says my neurosurgeon. "I'm not going to order another MRI. They can talk to you about that later if they want one." I've had six already. And he has ordered up nine of the vials of blood they want. He rolls his eyes. "But I'm not ordering that one. Nothing in your history indicates that kind of vitamin deficiency. They're reaching."
"They" are the neurologists, who have been brought in to consult on my case. When the ambulance brought me in, the first worry was stroke, so they called Dr. O., the neurosurgeon on duty and I became his patient. The CT was negative for stroke so he sent me down to the tube. That's when they first saw the inflammation of the spinal cord. O. was still ready to cut if need be, but he wasn't satisfied with what he was seeing. "I'm going to run a contrast MRI so I can get a better look at this." He sent me back to the tube.
Two hours later. "You don't need surgery yet. I'm checking you into the hospital."
By the middle of the 2nd day he was sure he didn't need to cut. There were still four MRIs, a spinal tap and a variety of other tests to go to try to figure out where the swelling was coming from. "But this is out of my area now, so I'll need to call in the neurologists." It was apparent that he was trying to decide whether or not to transfer me to their service or just bring them in to consult. He decided to keep me. "You're an easy patient." He smiled.
But he doesn't have the same kind of curiousity as the neurologists. Like my primary care guy, he mostly wants to figure out what he needs to do to save my life and make me feel better. He knows he doesn't need to cut and he knows that whatever the cause is, massive infusions of steroids give the best of odds of reducing my symptoms in the short term. He'd be interested in knowing why my immune system is gnawing at the myelin sheath, but he's due in surgery this afternoon and that's where his focus is. He's done as much as he can do for me.
For the neurologists, however, my current status is just the beginning. Now their professional curiousity is up. Why is my body doing this? Is it the vitamins after all? Is there some other kind of deficiency? How long has this been happening? Did I have a viral infection at some point? Is it tied into my optic nerve somewhere? Why is it mostly in the cervical area rather than further down -- isn't that unusual? Why is the swelling diffuse along the cord rather than bunched up? Is there another test we can run?
I'm amused by the competitive tension -- the different perspectives of these very calm, but very intense professionals. And it occurs to me that this split may occur, to some degree, throughout the medical professions. There are those, like Mike and like O., who are principally therapists -- they want to fix the problem and get their patients back into their daily lives as quickly and completely as possible. Then there are the diagnosticians like Dr. A. and Dr. S., who really want to know what's going on. We know so little about the nervous system. This is a chance to learn a little more. And then maybe to find a way to treat me a little bit more effectively than their last patient.
Bless them all.