“I am having a very weird experience. I feel confused.”
That text was a reply to my text wishing my friend Camilla a good trip to the Oregon Shakespeare Festival, the following day.
I was obviously bothered by these words but hoped that maybe this was a sign of stress over another friend’s imminent arrival at her house and the upcoming trip. But several texts went unanswered for several minutes.
Then I read, “Where are we right now?” And I thought two things: first, I needed to drive across town to see her and figure out what was happening and two, I had the glimmers of a diagnosis, which wasn’t bad for a guy more than 30 years out of practice, assuming I was right.
I drove across town, not an easy task with some rain and another call from Camilla which I took hands free on the wheel. This was the second time in two months I had a medical advice phone call in the car that I had to answer hands free. Camilla couldn’t tell me the date, the president, when she last saw me, anything recent. She had no pain, but she kept saying she was confused.
When I got to her house, she was downstairs and outside. She gave me a long hug, longer than usual, and I knew I needed to examine her, so we went upstairs to her room. She could walk fine, even upstairs. Her motor, coordination, and sensory examinations appeared just fine. We sat on the couch where I could ask her specific mental status questions, and observe her, which didn’t appear to show any improvement or worsening from my time on coming over. I gave her several nouns to say (parts of the body work well), and she did fine. That is my screen for aphasia. She wasn’t aphasic. I examined her cranial nerves, motor, sensory, coordination, and plantar responses. They were all normal.
At this point, Lisa, Camilla’s friend and driver for her upcoming trip, appeared, and I apprised her of what was happening. I now mentioned the term “transient global amnesia,” which I had seen, looked like this, and when I saw it decades ago had no specific cause, no treatment, resolving in the matter of several hours. Camilla still needed to have a CT Scan or an MRI, blood work and be seen by someone more up to date than I, who might have some other thoughts. We needed an ED, not urgent care. So Lisa and I tried to find Camilla’s medical cards and driver’s license, which we did, and Lisa would drive Camilla and follow me. They had known each other for years.
After we arrived at the ED, and checked in, Camilla’s vital signs were taken at the front desk and she then sent to triage where I went as well, explaining that I was a friend, a retired neurologist, thought I might be able to help explain what she was going through and mentioned the diagnosis, “transient global amnesia.” As a retired physician, I need to tread a narrow line in hospitals. I want to be helpful without getting in the way. I am out of date with both workups and treatments, but I have decent if long unused clinical skills, and in some instances, such as this one, I have historical information that the patient cannot provide. I found nothing that went against my diagnosis of transient global amnesia.
Camilla was given a room in the ED and when she had changed into a gown, Lisa and I went in to sit beside her. She had an ECG and blood drawn, and a few minutes later, the physician came in, with a booming, “who is the retired neurologist?” I sheepishly raised my hand and gave him a fairly rapid summary of her story. He quickly examined her and turned to me, questioning, “Transient global amnesia?” To which I, sitting, nodded vigorously like a bobble headed dog. Camilla then had an MRI and a CT scan. I read the ECG, the first one I have read in a few decades, enough to know that it was normal. I left the room to make way for two other visitors, since at this point my job was mostly over, and the other two wanted to see her. I had treaded the fine line well. I spoke when I needed to, was quiet the rest of the time. I went for dinner then waited for some time in the waiting room, hoping my message that I wanted to come back into the room would be delivered. I did hear that Camilla would be discharged, but knowing discharges can take time, waited until one of the doors was open and then quietly followed one of the workers through. When he turned right, away from my direction, I hoofed it quickly down to her room, knocking on the wall, since the curtain had been pulled. My diagnosis was right; Camilla was perhaps slightly better. Lisa would need to stay with her this night.
We left and walked to the Lisa’s car, where I made sure Camilla would safely be inside. She and Lisa would travel to the Shakespeare Festival the next day and stay two nights there, seeing four plays.
I felt like a physician again, for the first time in a long, long time. I was proud of what I did, how I carried myself in a medical facility, doing exactly what needed to be done in this situation. I diagnosed the patient on the basis of a phone call and confirmed it with an appropriate workup a few hours later. Not a bad job at all.
Boreal B[l]og 
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