Day 4

Day four I was able to work from 12 to 4 and I have to say the first two patients I saw contained perhaps the most bizarre set of incidents ive seen all week. The first patient was an African American female 60 years old accompanied by her husband. At first she seemed completely normal as I shook her hand and introduced myself. But as our forty five minute session went on it was very clear something was very off about the patient. She was extremely shy and quiet, looked around suspiciously, could not make eye contact, or make anything resembling a decision. To the average person she would simply come off as extremely "crazy". We were barely able to convince her to come in and do the sleep study. She had been referred to us by a neurologist named Womack who spent a 130 minute session with her. Upon her departure I shut the door and me and dr. Lee exchanged dumbfounded glances, we immediately sat down at the computer and started reviewing notes from the neurology visit etc. Upon further review of her notes the neurologist had written he had never seen anyone quite like this patient. She failed several parts of her brain cognition test memory, ability to make decisions etc. At the end of the session he wrote a referral for her to see a psychiatrist. Which we asked her about she seemed very reserved and not at all excited about the psych appointment. She had been admitted to the hospital before brought in by her sisters who said she was extremely paranoid, thought her mess were poison could not make even the simplest of decisions etc. So it would have been possible to conclude that she was schizophrenic, psychotic etc. If not for the kicker: this lady had a masters degree was on a high level of thinking a short few years ago and had seen dr lee and 09 upon which he did not remember her having her symptoms this bad. Also as weird as it sounds during our session with her she did not give off the air of someone who had. A psychiatric disorder, it was almost as if she was autistic. Upon further discussion with dr. Lee we both come to the same decision: this was not something psychiatric but rather some sort of neurodegenrative disease. This lady did not need a psychiatrist but rather a brain biopsy, because very clearly her physical brain was in decline. So anyway that was an extremely interesting case especially for someone who was referred for sleep apnea. The second gizzard incident was shortly after a man with post polio came into the clinic for a referral, sat down in the exam room and was subsequently bitten by a spider, and sent to the er, both unprecedented and hilarious