The Medical Detectives Volume I

by Berton Roueche

  "I often think about that visit," Mrs. Morton says. "My reaction was so peculiar. I mean, of all the things that Dr. Dodge told me, the most important made the least impression. I'd been living for weeks with the thought of death. It had haunted me day and night. I'd felt literally doomed. I'd been so sure of dying that l'd accepted it as fact. Yet when I learned that my condition wasn't even serious, I hardly reacted at all. It was as if I'd never had a moment's apprehension. What left me simply weak with relief was knowing the truth at last. My trouble was no longer a mystery At least, it had a name. It was astonishing what a difference that made. And I wasn't alone. There were many other people in the same boat—thousands of them, apparently. Labyrinthitis is really quite common, I gathered. Or, rather, I made it my business to find out. I got hold of a medical text and read about its incidence with the most morbid avidity. The old saying is only too true, I'm afraid—misery does love company. As a matter of fact, several people I knew, or people friends of mine knew, turned out to be companions in misery. They'd had the same trouble off and on for years. One of them, poor thing, was a dancer. Another was a concert pianist. He had a recurrent experience, that was truly appalling. It would happen during recitals. He'd be playing along when he'd suddenly have the feeling that the piano was sliding away from him. The only thing he could do when that happened was to concentrate on trying to will the movement to stop. At times it would work and at times it wouldn't, but somehow he always managed to keep going.

  "It was also comforting to think that I would most likely be feeling better soon. I didn't expect it to happen overnight, naturally, or even in a matter of days. Dr. Dodge had merely said it would probably be soon, and the people I talked to—my fellow- victims—said the same. Improvement took time. So at first I wasn't disappointed. I dragged myself along from day to day, and tried to be patient. And I was—through the rest of April and the first part of May. How I did it I'll never know. Those weeks were the ghastliest of all. The stairs, the treadmill, the platform in space, the awful amorphous feeling—everything seemed to be closing in at once. There was hardly an hour that wasn't a total nightmare. By that time, the mornings had become almost the worst—because each one was such a let-down. I'd wake up and lie there and wonder if this would be the day when I'd begin to Improve. And pretty soon I'd get up and start for the bathroom-and then I'd know it wasn't. To be teased like that was torture.

  I went back to Dr. Dodge on May 8, as arranged. When I told him that nothing had changed, he seemed quite surprised. But all he did was renew my prescription for Equanil and repeat what he'd said during my last visit. The only new thing he did was not give me another appointment. It wasn't necessary, he said—although, of course, I could call him whenever I liked. But I never did call him, even though I went home from that appointment about as low as I've ever been in my life. About a week later, I broke down. I'd reached the end of my rope. I couldn't go on any longer. So I decided to go up to our place in the Catskills for a couple of weeks, and rest. The office was very understanding. They told me to go right ahead. But my husband had his doubts about leaving me all by myself in an isolated country cottage for a couple of weeks. After all, I still wasn't able to cook or wash dishes—a problem that hadn't even occurred to me. Frank didn't mention his misgivings to me, though. He called Dr. Dodge and asked him what he thought of my plan. Dr. Dodge said that a change of routine and scenery might indeed be helpful, and he wanted to know if it would be possible to get someone to look in on me once a day—fix my principal meal, clean up, and so on. As it happened, Frank knew just the person—the teen-age daughter of a farmer in the neighborhood. For a couple of seasons, she'd been going over to open and air out the cottage for us just before we went up for our vacation—a nice, quiet, unobtrusive girl. So Frank got hold of her on the telephone, and she agreed to come over for an hour or so every afternoon—while I could be taking a nap. We drove up on Saturday, May 18, and Frank stayed over Sunday. When he left, I was nicely settled.

  "It was a glorious time to be in the country. Everything was beautiful. The weather was perfect and the foliage was bursting out. And the birds—I hadn't seen so many birds in years. I arrived at the peak of the spring migration, and they were there by the thousand. It took me back to the springs when I was a girl in Iowa.

  That's where I grew up. My father was an amateur ornithologist, and we used to go on long bird-watching walks together. It win wonderful how that almost forgotten interest revived. Not that I did any great amount of walking. The least little movement still sent me reeling. In that respect, the country was just like the city It was all I could manage to crawl from bed to a chair out on the lawn. But that was far enough. The birds were everywhere. I just sat on the lawn and watched them. They almost seemed to pose for me. I saw at least a dozen species that I'd never seen before, including a blue grosbeak and a pileated woodpecker, both of which are fairly rare. They probably mistook me for part of the scenery. I guess I was, to all intents and purposes. I spent hours at a time just sitting there. It was all I did, except eat and sleep, but I wasn't bored for a minute. It was as if all my ambition and energy had drained away. I was perfectly content to simply vegetate."

  Mrs. Morton returned to New York on Sunday, June 2. Her husband went up for the weekend and accompanied her home. She felt relaxed and rested, but otherwise much the same. "The thought of going back to work was agony," she says. "I really doubted if I could make it. I was afraid that the traffic and the subway and the tension would be too much for me. And it almost was, those first few days—the first week of work—but I kept going. I felt I had to. It was a matter of pride. I was determined not to collapse again. And, little by little, the strain began to ease. The change I noticed first was in my mental attitude. I don't mean morale. It wasn't a sense of lift or an Equanil tranquility. My mind began to function. It was something like getting over a severe attack of the flu. I began to feel less dull and self-contained—less empty in the head. Things outside myself began to penetrate. They had meaning. I think I noticed it first at home, in my relationship with Frank. Even when I'd felt my worst—in late April and early May—I'd tried not to be an absolute lump. I'd made an effort to talk and listen and seem to take an interest. Not very successfully, I'm afraid, but I'd tried. I wasn't aware of any turning point when I got back from the Catskills. But I kept trying to be something more than a lump, and then, after a while, it gradually dawned on me that I wasn't consciously trying any more. I wasn't pretending. The interest I showed was genuine.

  "That must have been around the middle of June. Then, even more slowly, I began to notice other differences. My sense of self was one—the split I'd felt between my new self and my old grew less and less distinct. I also began to have permanent form and shape. Then, at some point, some week—sometime in late June or early July—I suddenly felt intact again. I don't know what came next. I mean, there wasn't any sequence of change. I simply began to have a firmer control over motion. I could stop the treadmill. I could keep from teetering out in space. I could make the stairs be there and stand up under my weight. And yet there was a sort of pattern. The wildest sensations were the first to go. I had them less often, and then less intensely, and finally not at all—a slow simmering down to normal. By the middle of August, I was back where I'd been in February. The floor gave a lurch every now and then, and I still had a little trouble focusing, but that was all. And then, as well as I could judge, those remnants vanished, too. It's impossible to say exactly when it all ended. But I think it was Frank who really sensed it first. It was after dinner one night in late August, and he suddenly smiled and remarked that I must be feeling much better. I asked him what he meant. 'You never look scared anymore,' he said."

  [1958]

  chapter 8

  A Swim in the Nile

  The first time Vernon Berry (as I'll call him) took sick on his trip around the world was in a Salvation Army hostel in the Kowloon section of Hong Kong. Berry woke up that morning— it was a Mon
day morning toward the end of February, 1958— with a rocking headache, a sore throat, and the shivers. He wasn't much alarmed. He was young (just twenty-five), his health had always been excellent, and only a week or ten days earlier a doctor back home in Jersey City had immunized him against tetanus, smallpox, typhoid fever, yellow fever, and cholera. What he mostly felt was annoyance. He was traveling on an extremely tight budget (a few hundred dollars in savings, and a recent small inheritance), and he couldn't afford a serious illness. Accordingly, he decided to take no chances. He dragged himself out of bed and down to the Salvation Army clinic, which adjoins the Kowloon hostel. The doctor on duty there heard his unexceptional complaint and made the usual diagnostic soundings. They indicated, Berry was told, a touch of acute bronchitis. The doctor gave him a shot of penicillin and instructions to come back the next day for another. Meanwhile, he was to stay in bed and rest. Berry stayed in bed, except for visits to the clinic, until Thursday. On Friday morning, feeling fully recovered, he left by plane for Singapore.

  Berry spent the weekend in Singapore. He slept at a YMCA hotel on Orchard Road, had his meals at an inexpensive restaurant m the neighborhood, and saw the sights of the port. The next stop on his itinerary was Bangkok, and he chose to go by train—a journey of some fourteen hundred miles through the mountain jungles of Malaya and southern Thailand. He left on Monday morning. That night, somewhere between Singapore and the Thailand border, he took sick for the second time. His feet began to itch and swell. Then he began to itch all over. Then his joints began to hurt. He couldn't imagine what had happened, and he didn't know what to do. There was no one he could even talk to. That alone was unsettling. He began to feel a bit frightened. By morning, he was in a kind of panic, and when the train pulled into Songkhla, in southern Thailand, he grabbed his bag and got off. He found an English-speaking doctor and asked for an explanation. The doctor was noncommittal. It was possible, he said, that Berry had developed a calcium deficiency, and he gave him a restorative injection. It didn't seem to help. The next morning, after another wretched night, Berry resumed his journey, as miserable as ever. He itched and ached, and his feet were so swollen that it was all he could do to walk. Also, he had diarrhea.

  Berry arrived in Bangkok around noon on Saturday, March 1. His first concern was his health. A clerk at a YMCA hostel where he arranged for a bed and left his bag directed him to a hospital operated by the Seventh Day Adventist Church, on Pitsannloke Road. He made his way there, and into the outpatient clinic. The examining physician looked him over, noted his recent history, and offered an opinion. It was his belief that Berry was suffering from two unrelated ailments. One appeared to be a mild attack of bacillary dysentery. That was a common complaint among Western travelers in the East, and it usually responded satisfactorily to sulfadiazine. The other was almost certainly an allergic reaction. There were, of course, any number of possible allergens. The list included foods, drugs, dusts, and pollens. In this instance, however, the circumstances seemed clearly to implicate a drug—the penicillin injections that Berry had been given in Honk Koiik Allergic symptoms, too, could be satisfactorily controlled, wit It cortisone and antihistamines: But Berry must also do his part. He was to rest in bed, drink plenty of water, and report to the clinic daily for treatment and observation until further notice.

  Berry did as he was told. He reported to the Adventist clinic every day for nine days. At the end of that time, he was discharged to convalesce on his own. The following day, he took a train to Rangoon. Except for a little swelling around the eyes, his allergic symptoms had largely subsided, but he still was somewhat diarrheic. He spent the next week traveling by plane and train and bus through Burma and East Pakistan to Calcutta. He reached there feeling tired and apprehensive. He had lost twenty-five pounds in the past two weeks and had had to force himself to eat. He rested for a day in a Salvation Army hostel and then sought out a doctor. The doctor found him nervous and undernourished, and recommended vitamins. Berry took his advice. A few days later, having exhausted the sights of Calcutta, he moved on, by train, to New Delhi. From there, he flew to Karachi. It had been his intention to spend several days in Karachi, but he stayed only overnight. He awoke in a knot of restlessness, threw on his clothes, and caught a plane for Damascus. On the way, he became aware of a leaden ache low in his back and flanks. It smoldered there throughout the rest of the flight. Then, as the plane came bumping down at Damascus, it shifted around to his abdomen and sharpened into a twitching pain. Berry rode uncomfortably into the city with the glum conviction that he was going to be sick again. A French doctor confirmed his fears. Berry had a temperature of just over a hundred, and there was a trace of blood in his urine. Those findings, together with the location of the pain, suggested a kidney infection. Either that or renal colic.

  Whatever the nature of Berry's illness, it kept him in a nursing home in Damascus for a little over a week. He emerged, wobbly but well, on April 14, and had a final consultation with the doctor.

  He was advised to take it easy. The next day, he caught a plane Id Egypt. After a couple of post-convalescent days in Cairo, he traveled up the Nile as far as Luxor. He spent three days in Luxor, wandering among its many antiquities and swimming in the Nile, and then returned to Cairo. From Cairo, he flew to Amman, from Amman to Beirut, from Beirut to Ankara, and from Ankara to Athens. He halted there, at a students' hostel, for two nights and a day. On April 28, he left by plane for Zurich and a tour of Western Europe. In the course of the next six or eight weeks, he visited Geneva, Marseille, Barcelona, Madrid, Paris, Brussels, Amsterdam, Frankfort, Munich, and Vienna. An allergic puffiness around the eyes plagued him off and on, but otherwise he felt encouragingly well. On his second morning in Vienna, he was awakened by a twinge of abdominal pain. It came again while he was dressing, and again on the way to breakfast. Then it went away. Nevertheless, it made him uneasy, and that afternoon he had himself directed to the office of a urologist. The urologist questioned him closely about his Damascus experience, and did a urinalysis. The results, he reported, were entirely normal. Thus reassured, Berry resumed his travels. Between the end of June and the end of July, he visited Berlin. Copenhagen, Stockholm, Oslo, and London. Early in August, he sailed from Southampton on the Queen Elizabeth for New York.

  Berry settled down in Jersey City again, and after a week or two of looking around he found a job as a draftsman with an architectural firm. He lived with his parents and saw his old friends and did as he had always done. It was not, however, as if he had never been away. The allergic puffiness around his eyes persisted, and the itches and swellings elsewhere on his body continued to come and go. In addition, early in September he began to feel a vague and vagrant nausea. The feeling was particularly pronounced just before meals. He told himself that it would soon go away, and when it didn't, he tried to ignore it. At the end of a week, he gave up and called the family doctor for an appointment. The doctor examined him with care, and admitted that he was stumped. In every respect but one, he said, Berry seemed to be in his usual excellent health. The exception was revealed by a blood count. It showed a morbidly significant increase in white blood cells of a kind known as eosinophiles. That tended to suggest the presence of infection. The possibilities were too numerous to mention, but a consultation with a specialist might help to sort them out. he would make an appointment for Berry with an internist of his acquaintance. A few days later, Berry emerged from another thorough examination with another equivocal report. Except for a notably elevated eosinophile count, all tests and soundings performed by the internist had had negative results. The internist, however, was not completely deterred. He had formed, he said, a certain impression—a hunch. Eosinophilia, he reminded the family doctor, is characteristic of trichinosis. So are allergic-like swellings around the eyes, and urticarial itches. He wondered if a mild trichinal infection might not be the cause of the patient's complaint. The family doctor passed this tenuous diagnosis on to Berry, adding that he was generally inclined to c
oncur.

  There is no specific treatment for trichinosis, but in the great majority of cases time will effect a cure. The curative powers of time did next to nothing for Berry. Although the swelling around his eyes subsided, and the occasional hives and itches gradually ceased to recur, the dragging mealtime nausea and the ambiguous eosinophilia continued unabated—for weeks, for months, for a year. Then, one Saturday afternoon in October, 1959, Berry passed in his stool a ten-inch worm. He submitted the specimen, in consternation, to the family doctor. The latter was able to reassure him. The worm was a species of round worm (Ascaris lumbricoides), an intestinal parasite only slightly less common than a tapeworm. It was also, the doctor went manfully on to say, the probable cause of what had seemed to point to trichinosis. Nor was that all. Ascariasis, unlike trichinosis, was readily responsive to treatment. The drug of choice was piperazine citrate, and a single dose was usually sufficient. It was in Berry's case. Within a week, his stomach had steadied and settled, and he felt almost like himself again. The only trouble was his eosinophile count. It had dropped, but it still stood abnormally high.