Abstract
She was sobbing. Her husband, eyes lowered, turned his head slowly in disapproving judgment. With his tan-colored hat affixed tightly to his tan-colored head, he slouched further in his seat. David, also slouched on the patient table, seemed completely uninterested in the parental affair. He had his own tension. Head bowed, he desperately clutched his flexed right hand with his left. This was my first visit. These were the Almadys. “How are you feeling?” I asked, hoping to break the tension. David only shrugged his shoulders. “All right, I guess,” he replied, his impossibly oversized t-shirt draped over his bony, 14-year-old shoulders. Six months ago, David had suffered a left basal ganglia stroke related to an internal carotid artery dissection. Three months later he arrived at the emergency department complaining of severe arm pain. Imaging suggested a possible second stroke. One month ago he developed a significant dystonia in his right arm. And on the day of the sobbing, I began a longitudinal program at my medical school which paired medical students with physician mentors and their patients. David's examination was revealing. As he …
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