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‘THE DIAGNOSIS’ OFFERS HORRIFIC MESSAGE FOR NEUROLOGISTS

Brust, John C.M. MD

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Dr. Brust is Professor of Clinical Neurology at Columbia University College of Physicians & Surgeons and Director of the Department of Neurology at Harlem Hospital Center in New York City.

From Sophocles to Thomas Mann, our great writers recognized the symbolic power of physical loss. In King Lear, the newly blinded Gloucester declares, “I have no way, and therefore want no eyes. I stumbled when I saw.” In two recent novels, blindness becomes a political parable. James Kelman's How Late It Was, How Late describes a Glasgow lowlife, blinded in a brawl, as he half-comprehendingly tries to deal with his disability. Jose Saramago's Blindness describes an epidemic of blindness in which everybody sees white rather than black and nearly everybody behaves badly.

In Einstein's Dreams, a collection of brief fantasies, Alan Lightman described a city whose inhabitants have no memory, even for their own identity. Each person “… is a snapshot, a two-dimensional image, a ghost.” In his altogether different novel, The Diagnosis, Lightman, a physicist at MIT, switches to chilling realism in describing amnesia and neurological disintegration in Bill Chalmers, a 40-year-old junior executive who lives with his wife and teenage son in suburban Boston.

Heading to work on the subway, Chalmers suddenly cannot remember where he is going, where he lives, or who he is. Panicking, he strips off his clothes and is taken by the police to Boston City Hospital. He soon escapes and wanders through a series of nightmarish encounters – most notably a Fellini-esque church bingo fest – before his memory returns. A different kind of deterioration then ensues, with symptoms that baffle a phalanx of physicians, including even a neurologist at the Massachusetts General Hospital.

Figure. The Diagnosi...
Figure. The Diagnosi...
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TIME-OBSESSION

From the first page we are aware that Chalmers is time-obsessed. “It was 8:22. Twenty-three minutes to his stop, a nine-minute walk to his building, two minutes on the elevator, and he'd be at his desk by 9:00.” We are again and again given absurdly precise indications of the time. “It was 1:32.” “It was 1:42.”“It was 7:36.” We also learn that at home Chalmers communicates with his son by e-mail and that his wife is carrying on a virtual affair by e-mail with someone she has never met.

Chalmers' company sells “efficiency management,” and the information-driven and technology-ridden world he inhabits evokes scenes worthy of Heironymous Bosch. “The long snake of traffic on Waltham Street stretched for two miles from Mass Ave. to Route 2 and crept along at an average speed of five miles per hour, stopping and starting, winding slowly around turns and over hills, honking at smaller snakes that attempted to intrude from side streets, shedding pieces of itself on the side of the road, excreting clouds of thin bluish exhaust. At least once a week, a car plowed into a telephone pole, its driver having been preoccupied on his phone, and to the poisonous gases and shouts were added the screams of ambulances and fire trucks pushing their way to the accident.”

Counterpoint of a sort is provided by installments of an Internet course,“Plato Online,” describing events related to the death of Socrates. (A study question from the Plato software program: “How did people send messages and communicate with each other in ancient Greece? Compare with the methods of communication today.”)

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PHYSICIAN'S ROLES

Amidst such a debased culture, Chalmers' physicians, not surprisingly, neither heal nor comfort. A radiologist decides to perform, without the pa-tient's consent, a “microbiopsy” on Chalmers' brain, using the hospital's newly purchased computer-guided aspirator. “Just come with me and take a look at this machine. It's state of the art. It's beautiful. It's a goddamned miracle.” Chalmers' primary care physician orders an MRI, explaining to his patient, “MRI is a relatively recent technique that uses short bursts of powerful radio waves and magnetic fields to get the patient's hydrogen atoms to emit other radio signals. Next time you come, I'll show you some of the images from the MRI. They are really splendid.”

A neurologist performs an EMG and then tells Chalmers, “Nerve conduction velocities are around fifty meters per second. Distal latencies are between three and four milliseconds at seven centimeters. Amplitudes are satisfactory…. My apologies but I cannot find any problem.”

A psychiatrist tells him, “Illnesses are vague and ambiguous, omnipresent, interminable, often without any cure. But problems… problems are definite. Problems have beginnings and endings…. I like your word problem.” In the meantime, Chalmers' symptoms relentlessly progress.

Confined to his room, he takes to tracing the shadows of a leaf on the floor. “… it occurs to him that he is drawing a history of a sort. It is a history of the earth, a map of the movement of the earth…. The earth moves, shadows move. Earth mother, the giver of leaves, the paradise, the blessing.” Catharsis is interrupted, however, by a distracting hum – “the ubiquitous hum, the low hum beneath everything else” – continuing even after he closes the windows, turns off the television and computer, and covers his ears. “Damn you, he shouts. Damn you…. The hum only increases in volume, an electrical vibration, a moaning in his brain. He slams his chair into the TV. I'm going to break every machine on this planet. The billions of cell phones and fax machines and computers and automobiles and other machines without names. I'm going to rip the phones out of the wall.”

Physicians, and particularly neurologists, will bring their own perspective to this ironically entitled novel, but professional insight will not spare them the brunt of its horrific message.

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WEB SITES ON AMNESIA

Neil A. Busis, MD, Chief of the Division of Neurology and Director of the Neurodiagnostic Laboratory at the University of Pittsburgh Medical Center-Shadeyside, and author of Neuroguide-Neurosciences on the Internet, suggested these among other Web sites for background reading related to amnesia:

www.u.arizona.edu/∼pdavidso/amcog.html: This home page of The Amnesia and Cognition Unit of the Department of Psychology at the University of Arizona, headed by Elizabeth L. Glisky, PhD, contains information about its ongoing investigation of the relationship between source memory and the frontal and temporal lobes of the brain, funded in part by the National Institute on Aging(NIA).

http://fido.cpmc.columbia.edu/kandel/: The homepage for the laboratory of Howard Hughes Medical Institute investigator Eric Kandel, MD, University Professor of Physiology and Psychiatry at the Center for Neurobiology and Behavior at Columbia University College of Physicians & Surgeons, contains information about the lab's current research on learning and memory.

www.fmsfonline.org/: The home page for the False Memory Syndrome Foundation — which was started in 1992 to document and study the phenomenon of adults recalling “repressed memories” of childhood sexual abuse and its devastating effect on families — offers legal, political, and scientific updates about false memory syndrome.

©2001 American Academy of Neurology

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