Joan Paul

The ED tonight wasn't so exciting until the end. There was one child who had a seizure and fell to the floor, with several nurses then occluding the doorway to his room. This brought to mind my epilepsy project. I went through my head trying to find out what type of seizure he had, if this would be classified as epilepsy, etc. The doctor had decided on a spinal tap with the child, although he would have to be restrained so that the procedure could be performed smoothly without complications.

Later on...

A nurse had asked me for a favor. She wanted me to take care of this patient's husband, who had a mild case of Alzheimer's, at least that's what I thought she told me.

He walked very slowly with us to Radiology, where the nurse and PCT wanted me to sit with him and his wife's purse in order for her to get her x-rays done. Because of his Alzheimer's, I sat there to have a conversation with him, while reminding him every once in a while where his wife is.

Every 5 minutes- as I stared at my watch- the worried husband asked where his wife was. I wasn't sure if this was because of the Alzheimer's, or his impatience with the duration of the procedure. We must have been sitting for over 15 minutes, and I had inadvertently kept asking him questions about his past. After each question, the thought, "Dope!" kept springing up in my head. I asked him if he were a professor in economics, where he lived in the city, where he was originally from. I probably should have put some effort into thinking about how my questions would sound before they came out of my mouth.

Anyway, I tried to distract him with the signs on the wall, telling him repeatedly that his wife was in the room behind us- not the one in front, not the one to the side nor the one down the hall. She was behind us, and we were not allowed to walk into the room, else they might have to retake the x-rays, which would then prolong their stay in the hospital. His hands were shaky, ears full of hair, skin littered with liver spots. He reminded me of that judge in Ally McBeal, the one who liked good dental hygiene for those that watched the show. Halfway through the wait he wanted to stand up and walk around, except he only made one or two paces before his wife came out from the room.

A smile brimmed on his face, and his wife was very eager to talk to me about him. She let me know that he used to be a professor of political science at UC Davis. However, his past was much more interesting. I walked her back to the urgent care room as she was explaining how they met. She worked in foreign exchange, with regards to Eastern Europe, and he happened to show up at a convention. Although they were vastly different in age, they somehow ended up together in the end. Born in Czechoslovakia, he had moved to the states. Playing tennis, and learning English on the side, he was able to obtain an athletic scholarship that sent him to Tufts. The war broke out, and proud of being in America, wanting to serve his country, he joined the army, halting his education. He had a stint in the war with the OSS, the agency leading up to what is now the CIA. After serving our country, he attended Harvard, where he was able to obtain his degree in political science. He was in California, she in New York. However unlikely it was to her that she would date this fellow, she eventually married him, for better or worse.

I was very surprised at how much information patients are willing to divulge about their past and how freely they answered my probing questions. She had come in because of a fall, having had cataracts surgery the week before. The feeling of dizziness and headaches compounded with blurred vision may have resulted in this accident. She revealed that it was usually her husband who was the reason for their hospital visits. By the way, she appreciated the speed at which doctors took care of her during this stay tonight. She had only been in the ED for 2 hours, and when I left, she was merely waiting for the results from the CAT scan.

Her husband's health history is somewhat tragic. I had asked her how mild his Alzheimer's was, and she said not very. 5 years ago, the doctors diagnosed him with having moderate AD. In addition, he had lymphoma and was catheterized for some time. The catheter filled with blood or something, and they spent 6 hours in the ED before any doctor had attended to them (this conversation was introduced when she was comparing the expediency of this visit to previous ones). She then said that he also has congestive heart failure and doesn't drink enough fluids, which could explain his kidney problems. Reflecting on this, it's quite hard to remember everything that happened; the amount that went on in their lives... I could not remember all that information in the brief time that I spent talking with them. One thing I noticed, though, was how the wife kept apologizing to the husband, saying it was her fault that they were staying in the hospital, and that hopefully it won't take too much longer. She attempted to offer him her cranberry juice, but he wouldn't drink it because it was hers. She responded by saying that she's okay with him taking a sip of her drink. I could imagine how difficult it must be to care for someone with AD- the husband constantly gets agitated, according to the wife.

The wife also asked me what I was doing down there. I told her a little about my past in Texas, where I went to college, that I was volunteering in the ED, moved to SF to take classes and find work. I mentioned to her about my work in adult neural stem cell research, explaining to her one of my projects concerning epilepsy. She seemed very interested, which I hoped she would be. I tried to simplify my research as much as possible, telling her that epilepsy is caused by dysfunction in the brain. A certain region of the brain loses neurons, a result of cell death. My project involves isolating and purifying adult neural stem cells- I emphasized adult, since she asked whether I used embryonic stem cells or otherwise. I told her that even throughout adulthood, stem cells persist in all tissues. So I continued, saying that in most epilepsy surgeries, the neurosurgeons take out a piece of their brain. Not ALL of their brain, but a portion of their brain- the piece that generates the seizures, which is discovered by electrically mapping the brain before surgery is performed. I kept explaining to her that they tried to remove as little as possible, so that other brain functions are not compromised. Once this tissue is removed, if the patient consents, I am then allowed to take this tissue and try to culture the progenitor cells. I also provided simple details about neural stem cells, that stem cells are theoretically able to generate all cell types in the brain. After growing up these stem cells, I would then attempt to drive these cells down a certain lineage. That is, I would try to turn them into a specific cell type, the type that is lost in the temporal lobe of the brain, in order to replace the neurons that have degenerated or died off.

In the end, I think she understood, because she was very amazed with the project, and I told her that this therapy had implications in restoring cells lost in a variety of neurodegenerative disorders. She hopes that people are doing the same for Alzheimer's disease. She said that it was a nice pleasure talking to me, she thanked me for taking care of her husband while she was preoccupied, and she hoped that we would see each other again. I shook her hand, then I unexpectedly held the husband's hand before shaking it with two, saying it was a pleasure to meet him, and that I hope he has a good night. The wife responded with something like, "Such a nice boy." I was slightly embarrassed, but this interaction made my night.

My narrative sounds a little busy, but I tried to fill in as much information as I could remember from 4 hours ago. I am nearing a food coma from the spaghetti and bing cherries I had for dinner after volunteering. My eyes are also drying out, so I think I will call it a night.

Clare and Nants are now in town. Yay?