People say "never say never" sometimes to give hope, sometimes to give warning. A week in neurology taught me just how real and painful "never" can be.
I first saw this patient while walking outside to grab a quick bite to eat from the corner store. Food fell from his mouth and his hands looked to stiff to clean himself up. His mother was next to him helping him out. Stroke? I asked myself. Seems too young. And why did he tremble?
When I called out the name on the chart passed to me by the senior resident, I was pleasantly surprised to see him raise his hand and identify himself. So the interview began. One year history of uncontrollable mouth opening, followed by TMJ pain, inability to close his mouth, muscle spasms of the jaw, spreading down his neck to the right arm and then his left leg. I looked at his old photo, his cheeks were not sunken then, the muscles not as prominent. Now his hyperactive muscles have hypertrophied, his inability to eat carved his body of much fat, further enhancing the muscular outlines. When the resident came to discuss the case with us, I could sense the look of apprehension on his face. He was clinging on to the hope he had contracted an infection, something a 2-week course of antibiotics could cure. Yet the verdict was final and clear. The problematic gene most likely ran through his family tree, DYT3 of Panay island. It was something he knew, probably looked it up on the internet. From his research he would have understood, he might never find stillness again.
My next patient wobbled into the OPD. Her sister holding her by the waist. Eighteen month history of progressive loss of balance with associated dizziness. Her speech slurred, her body shook with small almost imperceptible tremors. I used to run, she recalled. Now I can't run, I can no longer jump. All signs point to a neurodegenerative disease. Pancerebellar syndrome, etiology yet unknown. After the requisite diagnostics, she will be told, she might never find balance again.
In the two days I shadowed our consultant doing her rounds, I witnessed three patients code. None were revived.
If only "never" could really be obliterated in the spectrum of possibilities.