Right Brain: The Strangeness of a Good Diagnosis

Coffee, black with a spritz of milk. I enjoyed routine, and today was no different. We were on the 12th floor of the "tower", as our hospital is lovingly called. It was my second year of residency, and I was charged with admissions to our neurological ward. Sighing with the expectation of a long day, I walked over to our patients. The first was a woman in her sixties. She complained of trouble swallowing for the past 2 months that was getting worse. She was otherwise healthy. Asked about her social background, she looked over to her husband with an impish grin and replied: "happily married for almost thirty years." Physical examination was next. There was no apparent muscle weakness, but, strangely enough, the Babinski sign was clearly positive. Looking at her tongue, I noticed a single, delicate strain of muscle twitching. It was subtle, but impossible to miss. The twitching was adamant. It was not rhythmic, but it was unrelenting. I could not help but stare, and eventually, the patient closed her mouth, looking at me puzzled. I did not make the connection at first. But, walking back to our room, I realized that the concert of neurological dysfunction was spelling out the diagnosis. I caught myself feeling excited despite my knowledge of the potential outcome. Reporting my findings to my consultant, I remember him saying: "Sure sounds like amyotrophic lateral sclerosis, but we still have to complete our work-up." And so we did, dutifully.