Dr. Martin got to the nuisance part of the task right away: The phone call to the resident (he was there but the floor nurse had to wake him up) and to the Radiology Department. And not just he had to find out if the MRI was possible then, but also to see if a known neuro-radiologist there would be available to read it as it came out. And then he had to write his note in the chart, the transfer order from one hospital to the other and he had to fill out a transfer formality form. The Nurse would take care of the transportation arrangements by ambulance and the copying of the chart to go along with the patient and his mom.
They did have a bed in the neurosurgery floor of the other hospital and the resident accepted the boy. And Nick would be having an MRI of his spine (actually two, one for the upper, one for the lower part) as soon as he got there…
By the time it was all done, it was just about 5 o’clock so Dr. Frank Martin did not bother going back home for a short nap. Instead, he followed the ambulance across town to the University hospital, parked his car by the ‘short term ER’ and sat in the radiology reading room as the MRI was being done and the films were coming out. He was taking a peek too at the MRI console screen over the tech’s shoulder.
And yes, it was very abnormal: The boy had a long, amorphous soft mass all around his spinal cord filling the canal between the vertebrae from mid cervical to the bottom of the dorsal spine. His awful hunch, his dream, his bad nightmare, had pointed the way. Amazing! He had not even done a spinal tap as in the previous “Eddy’s” case where his hunch had been not of a mass, but of meningitis. The neurosurgeons would be doing a biopsy of the mass, probably with a limited open surgery, instead of a ‘transcutaneous,’ blind tap.
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Dr. Martin would later hear, with Nicolas still in the neurosurgery floor, of the results of the open biopsy with the tissue diagnosis: A nasty, Non-Hodgkin’s’ Lymphoma. The pediatric hematologist-oncologists would take from there and brought him down to the pediatric floor as the long mass, insinuated around the boy’s spinal cord and around so many nerve roots, was quite inoperable. He would have instead radiotherapy and aggressive chemo. The clinical process by which they had arrived at a diagnosis -just Dr. Martin’s overnight dream, a nightmare, a ‘hunch’- was never acknowledged, praised or discussed by his ‘academic’ colleagues.
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And as nasty -yet curious- complication for Dr. Martin, potentially dangerous to his record, even possibly lethal, a few weeks later, he heard that he was being investigated by the FBI, true -and the State Health Department- as prescriptions (Rx scripts) ‘signed by him’ in the University Hospital format had appeared in several pharmacies in the Brooklyn area! He was startled when he was interviewed by an FBI officer about the matter. When three, old style scripts ‘filled out’ for opioids with his name were shown to him, he immediately recognized his signature as being a fake.
Apparently, he learned, Nick’s mother, a druggy, had stolen from the nurses’ stations counter at the University Hospital Neurosurgery floor, when Nick was there, a whole pack of blank prescriptions that had been left out there over the counter. She knew how to fill them and put Dr. Martin’s name at the bottom. When she was found, she still had in her purse a pack of blanks she had not tried to use yet… Phew!
Dr. Martin later would also learn that the fact that his prescriptions for opioids had been found all over Brooklyn had reached the State Office of Professional Conduct (OPC), The Wolves – even though he had been cleared of any wrong doing by the FBI… He also learned that a note to that effect ‘would always stay in his file’ [Even fake accusations they don’t throw away! He’d later learn].
CHAPTER 4
Oh well…
Dr. Martin was not very popular with the pediatric staff at the University Hospital. It was the days of Dr. Frank O. This guy was known nation-wide for a controversial ‘how-to’ book on ‘what to and not to feed kids.’ His fame soon got him a celebrated high position in the D.C area (only his life to be cut short by a deadly illness; ha!). The young, upstart Dr. Martin had been in private practice for just a couple of years. He was an easy target for scrutiny -and critic- by his fellow colleagues in academia, across the street, especially by the tough Peds boss Frank O. Dr. ‘O’ had a slew of med students, interns and residents, and had underneath a fairly large group of general pediatricians and specialists. He was to many of them a god-like authority.
Dr. Martin had been called to the Irving Hospital ER to see a young brittle diabetic boy who presented from another, 30 miles away hospital ER with ‘a probable stroke,’ unable to move his right side or to talk. He had been fine till he went to bed the night before. By the time Dr. Martin got there the boy, Jack Durham, already had had a CT scan of his brain -which was normal- and had been seen by the upstairs peds resident. The nurses were about to wheel him to the ward when Dr. Martin got to see him. He confirmed the neurological findings and saw no need to add anything to their assessment as the boy’s diabetes did not seem in acidosis -or hypoglycemia-, he was alert, though not talking yet and was beginning to move his right hand. The pediatricians, as the ER attending, blamed the diabetes as the cause of his stroke, which fortunately was rapidly improving.
By late morning little Jack was perfectly well. Dr. Martin was able to snick out of his office during his scheduled lunch break, came to see him and suggested an early discharge since he was fully recovered neurologically, up walking and talking, and his blood sugar was fine. So it was done. The boy went home after 6 hours in-patient.
In the next three months Dr. Martin got to see Jack Durham three more times, each with an identical story. In those times the blood sugar was NOT an issue though the pediatricians still considered his diabetes the culprit. The boy’s case was so unusual that it was formally presented in their departmental weekly Grand Rounds. The possibility that ’the boy may be having unwitnessed seizures in the middle of the night -facilitated by his brittle diabetes- and his stroke-like picture be just a post-ictal phenomenon,’ was ventured by Dr. O., the big guru. Yet ‘his Electroencephalogram (his EEG) has been normal ‘times 3,’ had argued Dr. Martin. But he was willing, as per Dr. O., to give little Jack a try with phenobarbital daily as a preventive of seizures… [medical malpractice Lawyers in a parallel case at later time, would argue against him that he should never have given the patient ‘anticonvulsants’ if he did not think the patient was having real seizures! What an irony!].
But the phenobarbital did not work as little Jack had one more identical episode while on that drug. And so it happened again when he was next tried instead, on Dilantin, and later on Tegretol against Dr. Martin’s own judgment. It was all happening within the span of 10 months. From the beginning, and after his first normal EEG, Dr. Martin was beginning to think that ’this was not due ‘to unwitnessed nocturnal seizures’ but to recurrent ‘hemiplegic migraines,’ a few cases of which he had seen during his fellowship down in the big City. One such hemiplegia, he recalled, quite prominent, he had seen in a young man in his late teens when after a just won race in Central Park, his happy coach had poured a bucket of ice water on his head; he remembered how the young man had immediately ‘stroked out’ – and then Dr. Martin saw him in the nearby ER. He remembers having suggested the diagnosis of benign, hemiplegic migraine ‘that will resolve by itself in about six hours.’ He had been right. His chief neurologist there was impressed with the young Dr. Martin, but was still incredulous about his diagnosis.
By the time Dr. Martin tried Jack on that last drug, Tegretol, he was already planning to try the young boy next on a fairly new drug then Inderal (=propanolol, a beta blocker) that was beginning to be used by neurologists as a preventive for migraines (and not of seizures). So after his last, 8th or 9th episode, when he discharged little
