But even before seeing the elderly woman, Nowak told the resident, he already had a diagnosis in mind - he did think she had myasthenia gravis. Richard Nowak, the neurologist who took over the team as the attending physician, it still wasn’t clear what was wrong with her. When Sanmartin presented the patient to Dr. Whatever made it hard to talk could make it hard to swallow too. And she needed a swallowing study because she said she was choking on her food at home. to look at how the blood flowed through her brain. Myasthenia gravis (MG), an autoimmune disease that causes intermittent muscle weakness, was also possible but less likely at her age. Less likely, but possible, she could have a small mass or tumor. Sanmartin thought that the patient probably had a stroke. She seemed a little weaker on the second or third time. He asked her to stick her arms out “like chicken wings,” and he pushed down on them repeatedly, testing her strength. The young doctor held up a finger, instructing the woman to follow it with her eyes as he traced a large box in front of her face. She lived alone, and until all this happened, drove herself to all her appointments and volunteered at a local school for the disabled. Other than the macular degeneration, the woman had only high blood pressure, for which she faithfully took a pill each day. Not just then, but it would come back, she was sure of it. Her last injection was nearly two weeks earlier, and she’d had double vision and the droopy eyelid on and off ever since.ĭid she have double vision now, the young doctor asked? She glanced around the room. She had macular degeneration and had been getting shots in her left eye for more than a decade. The patient’s story was also different from what he expected. She did have a droopy left lid, but her eyes moved in what looked to him to be perfect alignment, and her speech, though quiet, was clear. As he entered the room, he realized he wasn’t sure what 94 was supposed to look like, but this woman looked much younger. He’d already heard about her from the overnight resident: a 94-year-old woman with the sudden onset of a droopy eyelid, double vision and difficulty speaking, probably due to a stroke. Paul Sanmartin, a resident in the second year of his neurology training, met the patient early the next morning. It wasn’t clear what was wrong with the patient, so she was transferred to nearby Yale New Haven Hospital.ĭr. Initial blood tests came back normal so did the CT scan of her brain. And the left side of her mouth and tongue felt strangely heavy, making it hard to speak. Her left eyelid hung lower across her eye than her right. The doctors in the emergency room were also worried about a stroke. He helped her to his car, then raced to the community hospital a couple of towns over. Her eyes were bright but scared, and her voice was just a whisper. He burst into her tidy brick home to find her sitting in the living room, waiting. Had she had a stroke? She was 94, and though she’d always been healthy, at her age, anything could happen. The 15-minute drive from his small Connecticut town to his mother’s seemed to last forever. I’ll be right over, he said into the phone. He recognized the voice, but the words were muffled and strange.
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