The Medical Detectives Volume I

by Berton Roueche

  The terror that mounted in Mrs. Morton during those weeks of inconclusive consultations was excited by more than uncertainty. Suspense merely sharpened its edge. Its substance was the growing vigor and variety of her hallucinations. The chronology of their proliferation is no longer very clear in Mrs. Morton's mind. Her memory of their nature, however, is cruelly complete. "I can still feel them," she says. "I can close my eyes and feel myself standing in the apartment or the office and the waves of movement rolling under my feet. At first, it was only in the afternoon or evening. Then—within a couple of weeks, I think—it began to happen earlier and earlier in the day. And more frequently. I have a mental picture of myself lying in bed on a cold morning—which would probably make it early March—and knowing what would happen the minute I stood up. It was never as pronounced in the morning, though, as it was later in the day. My vertigo seemed to build up hour by hour. To accumulate. Or, possibly, sleep and rest gave me a certain amount of resistance that gradually wore off.

  But the bathroom was always an ordeal, at any time. Any small room, I should say—my closet, the kitchen, a narrow hallway. I particularly dreaded taking a bath. It was bad enough to close the door and feel the room begin to tip. But when I got into the tub —it was like being in a tiny boat in a heavy swell. Even in the morning.

  "I never bathed at night—after the first time. No power on earth could have made me go through that again. In fact, everything was a trial at night. By the end of the day, I seemed to fall apart. It wasn't only vertigo. There was the problem of focusing. I got so I couldn't judge the spatial relationship of things with any kind of precision. I was especially baffled when it came to anything close at hand. Sewing, for example. I had to give up darning and mending. And cooking. Frank finally took over in the kitchen. I simply couldn't cope. By the time I'd finished peeling a potato, there'd be practically no potato left. I'd break an egg—I mean, I'd try to. But instead of just cracking the shell, I'd smash the egg all over the stove. I couldn't even wash the dishes. I'd finish with a plate and stick it in the drying rack. Crash! A complete miss. I'd dropped it on the floor. I broke more dishes in the month of March than I had in the whole of my life before. I also did more walking. At first, I spent every evening just walking—outdoors, where I didn't feel closed in.

  "Outdoors and bed—those were the safe places. For a while, at least. The outdoor phase didn't last long, but I was always comfortable lying down. At the office—I don't know how I managed to keep on working, but I did—there was a couch in the rest room I could use when things got too much for me. Although the act of lying down was sometimes distinctly unpleasant. I would stretch out on the rest-room couch or the sofa, or get into bed, and instantly feel myself falling. The distance I fell always varied. I might fall three or four inches. Or it might be a drop of ten feet. Then I'd slowly drift back up. But sometimes there was more to it than that. I'd bounce, for what seemed like several minutes. One of those times, it went on and on, and all of a sudden I recognized the rhythm. The fall and rise was in exact synchronization with my breathing. Maybe that explains the whole lying-down phenomenon—I mean the getting-into-bed part. The relief I got from lying down was something else, of course. When you're flat on your back, I suppose, there's no strain on the equilibrium.

  "The relief I got from walking the streets—I don't know how to explain that. But, as I say, it was only temporary anyway. It didn't last much beyond the middle of March. Then the buildings started to lean and sway, and the sidewalk began to tilt, and it was almost as bad as being indoors. In some respects, it was worse. The sense of motion was somewhat less violent. I think it was less wild and erratic, too. But the scale was so much bigger. Every block was a downhill slide or an uphill climb, and the intersections looked two miles wide. Crossing a street took all the courage I had. I didn't dare glance to the left or right. Any sudden movement of my head and the world turned upside down. My system was to fix my eyes on some distant object. That usually kept me on balance. Then I'd make a dash for it. It was always better to keep focused on something in the distance. At close range, everything blurred. Perhaps I should never have gone out alone. I imagine some people would have refused to. But I'm not like that. I was determined not to be an invalid. I'm glad to say that Dr. Dodge agreed with me. And so did Frank. All either of them ever did was caution me to be careful—to cross with the light, to use the handrail on the subway stairs, and so on. Of course, they didn't have much choice. They knew very well that my mind was made up. But, even so, I had some really horrible experiences. At least, they seemed awful then. I remember one evening coming home from work. I was walking north on Lexington Avenue when I noticed a man at the end of the block. He was one of those derelicts, reeling drunk, and he was headed my way. There were just the two of us—nobody else from where I was to the corner. The minute I saw him, my system collapsed. I couldn't seem to focus my eyes on anything, and I began to reel right with him. If he lurched toward the curb, the sidewalk tilted toward the curb. When he caught himself and staggered back across the sidewalk, it tilted in that direction. I was sure we were going to collide. I could almost feel the impact. But we didn't. We came face to face —so close I could smell his breath. And then I lost him. Everything blurred. The next thing I knew, he was gone—dancing on down the street. I had only one real collision. And it wasn't with a drunk. It was with a perfectly innocent young man, and I was entirely to blame. I was on my way to lunch. The sidewalk began to drop away from under me, and down it I went, practically at a gallop—straight for the front of a store. Fortunately, there was this young man standing there. If I hadn't toppled into him, I might have gone right through the window. He didn't say anything. Neither of us did. I was too numb. I just slunk away. But it wasn't hard to imagine what he thought.

  "The most horrible experience I had of that kind wasn't actually on the street. It happened in that underground passage that runs from Grand Central Station to the Roosevelt Hotel. The time was about six o'clock one evening in early April. A woman who had been a classmate of mine at Radcliffe was in town, and we had arranged to meet at the Roosevelt for dinner and go on to a concert at Town Hall. I suppose it sounds odd for someone in my groggy condition to plan a long, unnecessary evening like that, no matter how determined I was to keep going in my day-to-day routine. Well, I wanted to see my friend. I hadn't seen her for several years. That was only part of it, though. The basic reason was me—my state of mind. It didn't seem possible that anyone could be as sick as I was and live. There were times in March and early April when I was absolutely certain I was going to die. But my reaction to death was peculiar. I don't remember feeling afraid. All I remember is an overwhelming sense of urgency. So little time. So little done. So much I wanted to do. I've almost never read imaginative literature, but one Saturday morning I rushed out of the house and bought two recent novels—Rebecca West's The Fountain Overflows and The Lost Steps, by Alejo Carpentier. It didn't matter that I could scarcely see. I devoured them both. It was like being possessed. I craved every kind of diversion. I dragged Frank to the theater more than once, and I never thought of refusing when he suggested the Philharmonic or the Metropolitan. My response to music had never been so complete. I spent hours listening to records. I'd play some old favorite —like Beecham conducting Haydn's 'London' Symphony—and it was amazing. It seemed to me that I could hear the inner structure more clearly than ever before. It was the same with food. I'd always been a rather casual eater, but I began to understand how gourmets must feel. Good food was pure delight.

  "So the idea of dinner and a concert wasn't at all unusual. My only mistake was deciding to take that dreadful underground passage. It was raining and I was in a hurry, but even so I should have realized. When I did, it was too late. The passage was jammed with commuters, shoving and pushing and surging toward me. But I didn't dare turn back. The floor was beginning to wobble, and I knew if I tried to swing around, it would tip me head over heels. All I could do was go on. The traffic wa
s still all against me. People kept looming up—towering up. They came charging at me like giants. I don't know whether it was my eyes or the way the passage was rocking or the murky glare of light down there, but they really looked like giants. Their heads were brushing the ceiling. And then I felt something right out of a nightmare. It began with a sensation I'd often had—the feeling that the floor was lifting to meet my foot and, at the next step, sinking under my weight. I was almost at the end of the passage when I felt the movement change. It was as if someone had pulled a lever. There was a little jolt, and the floor was moving very slowly backward down the passage. I was walking on a treadmill. Only for a minute, though. Then I reached the stairs. I drove myself up to the lobby and collapsed in a chair. I was jelly.

  "I thought the treadmill must surely be the end. I didn't see how I could possibly stand anything more. It had to be the end. I didn't see how there could be anything more unearthly than that. But it wasn't the end—far from it. The treadmill was only another beginning. From that point on—from early April—I began to move in a different world. Two worlds, rather. In a way, it was like a personality split. I felt more and more removed from everything and everybody. I knew they existed. I lived and worked among them, but always at one remove. I stood apart. Actually, it was more of a triple split. There was me. There was the rest of the world. And there was the me of the past, when reality had been real. It wasn't a schizoid split—not as I understand that term. I never lost touch with reality. I always knew the difference between what actually was and what was wild illusion. Also, my two selves were never coexistent. The me of the past existed only in memory. The feeling I had was metamorphic. I'd moved into a new self. In a sense, of course, I had. My personality did change. I wasn't the same person then that I'd been before and that I am now. The craving I had for diversion was wholly out of character, and when that wore off, as it did in a very short while, I was even less like my normal self. I never had a pleasant thought. I lived to sigh and grumble. I couldn't read. I was too restless, too self-absorbed, too empty. My ability to focus on print dropped to practically nil. My limit was the absolute minimum my job required. And that was painful—physically painful. It was the same with music. Music, especially recorded or broadcast music, began to hurt my ears. The upper partials literally felt like needles. I gave up the piano very early. It required a coordination of eye, ear, nerves, tendons, and muscles that I no longer had, and besides, it just plain bored me. The only thing that interested me was me, and most of the time I felt too dull to even concentrate on that. I was nothing. I just sat in my shell and sulked.

  "But that was only part of the new sense of self I had. The change was more than a matter of mind or emotion. It was a total metamorphosis. I was conscious of a new dimension—a new plane. I had a new relationship to space. My legs, my arms, my face, my whole body felt different. I suppose everyone remembers the Hall of Mirrors at Coney Island. That's the way my body felt. It had no permanent shape. It changed by the minute. I seemed to be completely at the mercy of some outside force—some atmospheric pressure. I was amorphous. Whatever form I had was determined by the contractions or expansions of the force that confined me. And its pressure was never evenly distributed. I mean, I never simply grew or shrunk. My left leg would seem to lengthen. Or my right arm. Or my neck. Or one whole side of me would double or treble in size. And yet that doesn't fully describe it. There were times when the force seemed to be the rotation of the earth. I would have the feeling that I was vertically aligned with the earth's axis. I could feel a sort of winding movement start up inside me. Then one of my legs would begin to shorten, as if it were an anchor being drawn slowly up by a winch. The other leg would dangle. Not for long, however. After a minute, the winch would shift. It would engage the dangling leg, and just as slowly bring it up to match the other. Sometimes the movement alternated back and forth. One leg would be raised perhaps a foot and then gently released, and as it sank back, the other would rise. The only analogy I can think of is treading water. That was exactly the sensation. But my relation to the rotation of the earth took other forms, too. I often moved in opposition. The problem then was to somehow resist—to hold on. It took every ounce of strength I had to keep from being spun off into outer space. At such times, I was always teetering on the edge of space. One sensation I had on innumerable occasions was of floating in space on a tiny platform. I was somewhere between the earth and nowhere. If I was standing still, or had just stood up, the platform bounced. If I was actually moving, it tipped or tilted. Or slid away behind me—like the treadmill. The only sensation more terrifying than the platform was what happened when I had to go down a flight of stairs. It meant stepping off into space. But I don't want to talk about that. I can't even bear to think about it.

  "The only person I ever attempted to tell what it felt like going downstairs was Dr. Dodge. That was on April 10. I hadn't seen him for over two weeks, and he wanted to know exactly how I felt. So I told him. I told him all my symptoms, all my experiences, all my fears and worries—everything that had happened since our last meeting. How glad I was that I did. I still am. Because, for once, his reaction was more than merely sympathetic. He actually did something. He picked up his pen and wrote out a prescription. It was for Equanil, he said, one of the tranquilizing drugs, and the dose was three four-hundred-milligram tablets per day. Then he added that there was one more specialist he wanted me to see. Another physiologist, whose particular field was electroencephalography. Dr. Dodge would make the arrangements, and let me know. He was very offhand about it. Deliberately so, I realize now. He made it seem like just another routine test. I'd heard of electroencephalography—vaguely. I knew it had something to do with recording electrical currents in the brain. But that was all I knew —or cared. My mind was fixed on Equanil. I'd heard a great deal about tranquilizers. Who hasn't? I knew they had helped and saved so many people—people much worse off than I was. I was really prepared for something not far from a miracle. What happened was not quite that. Equanil had no effect on anything fundamental. But it did something for my morale. It made me feel less like screaming. It kept my shirt on.

  "Dr. Dodge phoned me the following day. My EEG test—as he called it—was set for the next afternoon, April 12, at four o'clock. Our next appointment would be on April 15. He would have my EEG report by then. I don't remember much about that test. I arrived in such a state of confusion. The doctor's office was in a huge block of buildings, and everything went wrong. I misread his name on the directory. I took the wrong elevator. I got lost in a maze of corridors. And when I finally got straightened out, I had to wait in a dim little box of a foyer that reduced me to a pulp. But apparently that didn't matter. The doctor gave me the test, and he must have been satisfied that the findings were accurate, because his report reached Dr. Dodge on schedule. He was reading it when I walked into his office. Or so it turned out. I knew he was reading something that had to do with me. Something important, too. His expression told me that. Then, as soon as I sat down, he told me so himself. He was really in a most communicative mood. He said he was more relieved than it was possible to say. Our talk at my last visit—some of the more outrageous things I'd described—had made him uneasy. It had led him to suspect that the root of my trouble might be a brain tumor. The EEG test, as perhaps I knew, was diagnostic for that. Some doctors, he said, might have ordered one earlier, but he had held off, because he wanted to see the results of other tests first. A brain tumor was a rather outside possibility. Well, anyway, here was the electron cephalographist's summary of his findings. He read it off—Impression: Essentially normal.'

  "You can imagine the chill that ran up my spine. Even the thought of brain tumor is frightening. For a moment, I was cold to the bone. I just sat there. So did Dr. Dodge. Then he tucked the report away in my folder and leaned back in his chair. He said he was sorry to have kept me in suspense so long. I realized, he hoped, that his noncommittal stand had been unavoidable. My case had presented certain
problems. It still did. But, in his considered opinion, the basic outline was now sufficiently clear to justify a diagnosis. And one that held no cause whatever for alarm. My trouble was a disturbance of the internal ear called labyrinthitis. He explained it to me in some detail. Enormous detail, in fact. He couldn't have been more considerate. But I'm afraid that at the moment I didn't grasp much of what he said. Except at the end —and this was very encouraging—that it wouldn't be necessary for me to come in again for several weeks. May 8, he said, would be soon enough. Meanwhile, of course, I was to continue taking Equanil."

  Mrs. Morton's recollection of that diagnostic discussion, though limited, is entirely correct. The explanation that Dr. Dodge considerately gave her was a thorough review of the subject. It was also, he told me during a recent talk I had with him in his office, a thoroughly candid one. He began with a few words on the nomenclature of middle-ear disorders. Labyrinthitis, he informed her, was only one of several more or less synonymous names by which such disturbances are known. Another was Meniere's syndrome. It takes its name from Prosper Meniere, a nineteenth- century French otologist, who first described the condition. Until 1861, when Meniere published a revolutionary paper entitled "Maladies de l'Oreille Interne Offrant les Symptomes de la Congestion Cerebrale Apoplectiforme," vertigo had been considered an invariable symptom of brain damage or disease. His paper, which was based on definitive clinical findings, demonstrated that the true seat of the phenomenon was the internal ear. Other names for Mrs. Morton's condition included aural vertigo, vestibulitis, and, of course, labyrinthitis. Dr. Dodge preferred—at least in this instance—the last. The suffix "itis," as he supposed she was aware, meant "inflammation." So the meaning of labyrinthitis, as a word, was simply an inflammation of the aural labyrinth. The specific nature of the disturbance in her case was something that neither he nor his colleagues had been able to determine. As she knew, the results of her various examinations had all been essentially normal. In other words, they were negative. That didn't mean that no disturbance existed, though. Quite the contrary. It simply meant that none of the techniques available to medicine had been able to detect it. Labyrinthitis is a slippery thing. Its possible causes are extremely numerous. The triggering mechanism can be a tumor or a cyst. It can be a bacterial or a viral infection. It can conceivably be a metabolic abnormality. Some investigators believe that it can be traced—in part, at any rate—to psychogenic factors. Or even to an allergy. And there may be other factors, still unknown to science. It was at this point, Dr. Dodge told me, that he informed Mrs. Morton that she could put her mind at rest. She could be quite sure that he had eliminated all the more serious possibilities. But he then went on to make it clear to her that the condition was considered chronic. It was also accepted, he felt obliged to add, that no known treatment was effective. Nevertheless, he felt justified in suggesting that in all probability she would soon begin to feel more like herself again. Long remissions were frequent, and there was some reason to believe that the condition was often self-limiting. In some instances, the symptoms simply vanished and never recurred. That, he told Mrs. Morton, in conclusion, had been his experience with several cases closely resembling hers. It was not, however, as it turned out, a prognosis whose accuracy was immediately confirmed.