A sacrifice greater than lunch

Abstract

Our initial clinic visit had run long, as usual, spilling over into the traditional lunch hour. (I have yet to meet a cognitive neurologist who runs precisely on time or a physician who has the luxury of adhering to a timely lunch break.) His was a complicated case: Mr. X was a 51-year-old white right-handed engineer with cognitive deficits persisting almost a decade after a prolonged ICU stay secondary to septic shock from an injury sustained at his work, further complicated by ARDS and pulmonary emboli. He developed ICU delirium and ICU psychosis, ranging from hallucinations that a black couple visited him in the hospital and told him they were his real parents to thinking he was in a war zone. He subsequently suffered PTSD, reliving those hallucinations, which at times felt more real to him than his everyday life. He also had spells of “zoning out” of unclear etiology. I spent a long time talking to him and his wife, trying to cobble together an outline of events without the benefit of any of his hospital records, although I was thankful I did not have to weed through more than the 1-inch stack of notes from his psychiatrist. He had never seen a neurologist before, so his psychiatrist made the referral to me after years of working with him to determine if there was a neurologic reason for his cognitive deficits.