Blog # 171: Excerpt from Dr. Fogan’s medical mystery novel, DINGS Chapter 26 Part A

 

 

Conner shuffled over to a shelf. His lithe, four-foot frame was draped in an over-sized adult patient gown that floated around his ankles. He wore it open in the front rather than in the back.

He picked up a plastic, multi-colored model of the brain. He turned it over and sideways, and then started to pull apart its components. A piece fell onto the thinly carpeted floor.

“Don’t do that, Conner!” I said sharply.

Sam turned and winked at him. “Aw, I’m sure that’s what it’s there for, Sandra. He’s okay.”

When the doctor returned I saw him focus on Conner’s underpants. We exchanged glances and grins about the tan-and-olive camouflage motif. Conner had begged for them because they were military like his dad. I bought him a dozen.

Sam and I sat beside each other along one wall. I started to get up. “Would you like me to reverse the gown, Doctor? Conner insisted on tying it in front.”

“No, no. It’s fine. Okay, Conner, let’s see you just walk back and forth, normally.”

“Like this?”

The neurologist nodded. He evaluated Conner’s arm swings, balance and how he walked. “Perfect. Now, walk on your tiptoes. Like this.” Dr. O’Rourke rose onto the balls of his feet and demonstrated what he wanted Conner to do.

“Good. Now, walk on your heels like this.” The doctor rocked back onto his heels as he leaned forward and elevated the toes of his shiny, black shoes to take a few awkward steps. Once again, our boy mimicked him. I covered my mouth with both hands to conceal a smirk at their awkward postures.

“Fine! Your legs are equally strong. Now, I want you to walk as if you are on a tightrope. Put one foot in front of the other and touch the heel in front with the toes on the other foot. Keep the feet real close together.”

Conner took five perfect in-line steps.

“You’ve got great balance.”

“This is easy, Dr. O’Rourke!” Conner beamed.

The neurologist returned Conner’s broad, toothy grin. “I knew you’d like this part of our visit. Now, hop up and down on your right leg like this.” Dr. O’Rourke put his hands over the side pockets of his white coat to prevent papers and tools from popping out as he hopped a couple of times. Conner imitated him. “Now switch legs. Excellent!”

“Okay, now put your feet together like this so that they touch ankle to ankle, side by side.” The doctor stood with the side of each of his shoes touching the other. “Yes, just like that! Now, stand like that and don’t move.”

“This is so easy!” Conner exclaimed. Sam smiled at him and then looked at me.

The neurologist nodded. “Now, stay just like that and close your eyes. Don’t move.”

Conner stood ramrod straight and squeezed his eyelids extra tight in that exaggerated way that little kids do. A few seconds later, the doctor said, “That’s great, Conner. Your balance centers could not be better. Now turn around so I can check your back.”

He lifted Conner’s gown and bunched it up around his shoulders. “I don’t see any spinal curvatures or birthmarks that sometimes accompany degenerative nervous system diseases that are associated with epilepsy.”

That was good to hear. All doctors should interact with patients and their families: educate us, for crying out loud! Dr. Choy did that, too.

“Okay, now climb onto the exam table, young man.” He felt Conner’s wrist pulses and then inspected Conner’s hands and fingernails. “There can be telltale clues of diseases here.”

Then he picked up a thin, cloth measuring tape and wrapped it around Conner’s head. “Your head circumference is fifty-three centimeters.” He looked at a chart and declared, “Normal head size.”

“Oh, that’s good!” I felt my heart thump and then, just as suddenly, a sharp gloom settled over me. I had become so distracted by their interactions that for a precious few moments I had actually forgotten why we were here.

Conner looked at us and giggled. He seemed to be enjoying himself.

The doctor smiled and began to wrap a pediatric-size blood-pressure cuff around Conner’s left upper arm.

“No! That gets too tight!” Conner yanked his arm away.

“This is a very important part of the evaluation, Conner. It’s a small cuff made for children. I don’t think I’ll have to make it too tight, and the pressure will only last for a few seconds. I promise.”

“Let the doctor do it, Conner,” Sam commanded.

Conner cast a sober glance at his father and slowly extended his arm. He grimaced every time Dr. O’Rourke rhythmically squeezed the large black bulb that slowly tightened the cuff around Conner’s arm.

The doctor placed his stethoscope in his ears: “Seventy-eight over fifty. That’s fine!”

Dr. O’Rourke moved the stethoscope to the boy’s chest. “No heart murmurs.” Then he moved the stethoscope over both sides of the boy’s neck. “No abnormal ‘whooshing’ sounds here, either. That suggests no blockages in the arteries leading to the brain. I wouldn’t expect to hear any in a child.”

Conner nodded and looked into the neurologist’s eyes. Dr. O’Rourke smiled at him.

“I appreciate how you’re explaining what you’re doing, Dr. O’Rourke. It’s like we’re all in medical school.” I laughed and gave Sam’s hand a gentle squeeze.

Finally, the neurologist placed the end of the stethoscope on top of Conner’s head and closed his eyes.

“I’ve never seen a doctor do that before—listen over the top of the head, I mean. Do you hear something up there?”

“I’m just being thorough, Mr. Golden. If there’s an abnormal blood vessel or increased pressure inside the skull, sometimes we can hear a telltale sound.”

“Well, did you hear anything?” Sam and I exchanged a worried glance.

“No, and that’s normal. I shouldn’t hear anything.”

This examination was turning out to be quite a performance. My doctor never did any of these things.

He told Conner to lie down on his back. Then, he quickly moved his hands over Conner’s belly as Dr. Choy had done, stopping here and there, pressing softly and moving his hands again. Conner looked uncomfortable once or twice, then erupted into giggles. “That tickles!”

“If an abdominal organ is enlarged, that could be a clue of a neurological-associated disease. Conner is normal.” He pulled out the waistband on Conner’s undershorts and took a quick look at his privates. “No evidence of a developmental or genetic disturbance here. Okay, you can go ahead and sit up now, Conner.”

The neurologist walked over to a shelf and picked up a dark vial. He shook it a couple of times, unscrewed the cap and sniffed. He returned to Conner, who was swinging his dangling legs over the edge of the exam table. Our boy appeared quite comfortable being the center of attention.

The neurologist gently pressed Conner’s left nostril closed and waved his other hand with the open vial under his right nostril. “Can you smell this?”

Conner jerked his head back and contorted his face. “Ahhhh! Nooooo!” He covered his nose and mouth with his hands.

“No, Conner. You don’t have to do that,” Dr. O’Rourke reassured him. “This one’s a good smell. Can you tell me what it is?”

Cautiously, Conner bent forward and took another sniff. Before he could answer, Dr. O’Rourke repeated, “Can you smell that?”

“Yes.”

He tested the other nostril.

“It’s good,” Conner pressed. “Is it gum?”

The neurologist turned around and held the vial under my nose. I sniffed. “It smells like something, uh…is it, uh, some spice? No. Cloves! It’s cloves.”

“Right! That’s what it is.” Then he placed it under Sam’s nose.

“Yeah. It smells good. You’re right, son. It did smell like chewing gum.”

The neurologist replaced the cap and placed the vial back on the shelf. Then he picked up a handheld eye chart. Conner tested twenty-twenty in each eye.

“Good job. Now, keep your right eye closed and look into my eye.”

The doctor stood three feet in front of Conner. Dr. O’Rourke closed his own left eye and pointed to his open right eye. “Keep looking right here in my eye,” he instructed. The neurologist stretched out both of his hands to the sides. “Look only into my eye, Conner. I want to out find how well you can see out of all of the corners of your left eye.” Dr. O’Rourke wiggled a finger off to the side and had Conner say “now” when he saw the movement.

After the exam the doctor explained, “You did great, Conner! The fact that he sees my fingers move when they’re off to the sides means that the visual nerve tracts between Conner’s eyeballs and the visual cortex at the back of his brain are working well. All of that function takes up a lot of space in the brain. My visual field testing suggests that there are no hidden abnormalities where these pathways are. That’s very important.”

I sat back and shook my head. My mind churned with his explanation and trying to visualize what he was talking about. I had never seen a neurologist at work, and I was so proud of Conner’s mature cooperation.

“He’s doing great, Sandra!” Sam whispered.

The neurologist switched off the overhead lights and lifted a cylindrical instrument off its perch on the wall behind Conner. “You’re doing very well. Now I am going to shine a light into your eyes so I can check the area where the retina and nerves are. Keep looking straight ahead and try not to move your eyes. Just stare at the X on that wall. Keep looking at it even if my head gets in the way.”

The doctor aimed a beam of light at Conner’s right pupil and moved within a couple inches from our son’s face. As Dr. O’Rourke peered through the instrument, he told us he could see where the optic nerve entered the back of Conner’s eye and the little veins pulsating around it. Then he examined the other eye. “There’s no sign of abnormal pressure inside Conner’s head,” he announced and replaced the cylindrical device on its wall holder.

“That’s a relief,” I sighed. Sam and I looked at each other. We chuckled. Conner’s face had a quizzical expression, but he smiled, too.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.