Radical Awakenings

Abstract

Radical Awakenings Pringl Miller WTF is going on with my mother?" I thought. My mind was racing; my heart sank deep into my gut, knocking the wind out of me as I struggled to breathe. Just breathe. Stay calm, don't panic. This isn't a trauma code activation … or is it? My observations and cognitive interpretations were being rapidly internalized as stressors, which led to a series of visceral responses because I knew they portended badness. I was experiencing a real-life reflex arc and entering the slippery slope of being a daughter who is also a medical doctor. Navigating the personal with the professional is often a challenge for clinicians. There was going to be a reckoning ahead; however, immediately, I found myself fighting back the emotions and impending sadness to diagnose the problem. I was on vacation in my mother's home and I had some serious work to do. Reflecting on my last visit with her, everything seemed fine … normal. "At baseline," as we say. But now, in retrospect, these new observations would explain her recent comment to me that she was dropping things and didn't know why. How could I have blown off her comment? Why hadn't I realized this SOS was significant? I had failed the test of being on high alert as a doctor for my aged mother, and now I was learning that she was seriously ill, and it all felt so ominous. While absorbing my mother's new state of affairs on the first day of my visit, I noticed subtle differences in her behavior and personality as well as dramatic changes in her physicality. For example, she was less engaging. It was as though her disposition was muted. The vibrant and inquisitive, in-your-face, "I want to know everything that's going on with you" mother was MIA. Similarly, when I looked into her beautiful grey-green eyes, they cast an absent quality that was eerie. I associated this void with what I imagined a zombie projects because it was as though my mother was no longer present in her own body. Also disturbing were uncontrollable subconscious upper extremity jerking movements that occurred in synchrony with a weird facial grimace, giving the appearance of being possessed. Later, I would learn these spells were faciobrachial dystonic seizures or FBDS, a pathognomonic feature of Voltage-Gated Potassium Channel (VGKC) autoimmune encephalitis. It was noteworthy and somewhat reassuring that these FBDS and everything else that was disease-related went seemingly unnoticed by patient number one except for her report that she was dropping things, which didn't seem to faze her. Another profoundly abnormal sign that she was not herself—she was no longer as vigilant about order and control. This 180 was unsettling to observe and accept in a woman who had always been highly aware, independent, and in control of herself and her surroundings. I felt strangely alone and uncomfortable holding onto this new information because nondisclosure didn't feel respectful, and yet I reasoned there was mercy in her not knowing to spare any associated distress. The red flags kept accumulating and had me concerned, but I felt relieved that she was actually "ok" living in her body and in a safe place. Nothing catastrophic had occurred during the interim of time between the onset of these symptoms and my visit. I continued my assessment and started to formulate my management plan while she was pleasantly busy with something to read. It's always important to provide a complete history to the doctor, so I started inspecting the house looking for more evidence of trouble while also hoping to assuage my fears. Unfortunately, what I discovered suggested that her disability had been longer-lasting than I might have otherwise thought. [End Page E14] Multiple entries in her checkbook dating back several months were illegible because of a combination of micrographia and incomplete notations. How long had this illness gone unrecognized? Were her bills paid? So many questions and the answers felt increasingly unwelcome and overwhelming. Upon confirming something was terribly wrong, I phoned my brother and relayed my concerns. I suspected we were about to embark on...