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January 3, 2005 Internship Journal

It has been a while since my last entry because a virus deleted my hard drive. It was very upsetting because I had been spending a lot of time on my Journal. Oh well.

Mrs. Fox is a 40-year-old woman I took care of on neurology. Her neurological symptoms date back to 2001 when she developed right leg numbness and blindness in her right eye. She had originally been diagnosed with multiple sclerosis. She remained blind in her right eye, but she had several other transient neurological symptoms, until January 2003. At this time, she had progressive leg weakness that prohibited her from walking on her own. She also began to lose the use of her right arm. Despite all of this, she continued to work for the Postal Service as a mail carrier. Towards the end of the year, she was not able to drive anymore, so she borrowed the help of a friend and continued to work. Finally, by December 2003, she was no longer able to do her job. I could hear the heart ache in her voice when she told me this story. Her determination to keep working definitely had earned my respect.

Around this time, her diagnosis of multiple sclerosis was replaced with a diagnosis of cerebral vasculitis. Vasculitis is a blanket term for inflammation caused by the body's own immune system causing all sorts of different problems. Common examples of this are Lupus and rheumatoid arthritis. Unfortunately, we don't have a good treatment for any of the autoimmune diseases. We treat them all the same way; steroids. Not the steroids that some athletes take, but steroids that act as anti-inflammatories.

From December 2003 until August of 2004, her symptoms held pretty stable. She was able to walk with assistance from her son or husband. She was able to fold laundry and perform some other tasks around the house. Chores like this would take her much much longer than it used too, but she was able to do them. From August until the middle of November, when I met her, she had continued to decline. Now, she cannot perform any activities of daily living nor do anything around the house. She has a power wheelchair at home to help her get around, but they do not have a van to transport her in her wheelchair. Depression sets in more and more everyday.

After I took her history, she was eager to speak with me. I am the first person that she has met that can relate to her. I told her my story and she was quite amazed. She asked me how I have dealt with everything. I told her that because I thought I was going to get better it made the adjustment period much easier. Then, by the time I realized that I was not going to get better, I had been seeing patients and seen the impact that I could have on them. I told her how seeing patients has given me a sense of value. It happened to be the day that my story was on the Today show. The local channel was rerunning it, so I told her about it and left to do some other work.

When I lied down that night, I wondered if I had made her more depressed by sharing my entire story with her. She did not have anything to give her a sense of value. Her situation was just the opposite. She was no longer able to perform tasks around the house or work. It was after two in the morning, and I had gone nonstop all day, so luckily I fell asleep before spending too much time worrying about it.

When I saw her in the morning, I expressed my concerns. She said that speaking to me only helped her. She was just so happy to speak to someone who could relate to her frustrations.

Mrs. Fox had been admitted to further evaluate something that had been seen on an MRI. Her MRI at our hospital did not show this lesion, but it did show severe inflammation throughout the upper part of her spinal cord. This bought her five days of high dose IV steroids. As far as her acute management, it doesn't really matter if this is part of multiple sclerosis or cerebral vasculitis. Like I said before, despite all of our advances in medicine, this is the best thing that we have to offer people with diseases that are characterized by inflammation and are caused by the body's own immune system. Sometimes these patients get better from the steroids, and sometimes they do not.

Mrs. Fox improved some during the five days, buying her two more days of steroids. She regained the use of her right hand, but her right arm remains so weak that it isn't that functional. She was discharged to rehab, where I continued to keep in touch with her. Every time that I saw her in the hospital as well as in rehab, I tried my best to be positive. I really didn't know what to expect from the steroids, but I wanted her to get better. I knew that she would have to regain more function than I have to have the same quality of life because my work as a resident gives me so much satisfaction and a great sense of value.

The last time I saw her she was feeding herself and performing some other basic tasks with her right hand. I know that she will continue to work hard and maximize whatever function she has. I will certainly keep her in my thoughts and try to keep in touch with her.

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