I am a world-renowned diagnostician. I’m the person doctors call when patients are sick, remain sick, and fall on the path of complete deterioration. I’m the person that figures out why nothing the doctors do prevents the downwards slide of their patients. I should note I am autistic. I rarely have a facial expression other than serious or annoyed. Being serious and annoyed is essential for my job. I don’t like being touched. I do not have a good bedside manner. I speak like a robot and patients, loved ones, and many doctors get annoyed with me. But this isn’t about my autism.
My first plan of action is to remove patients from all medications. Medications often mask symptoms. Symptoms are critical for diagnosing. It is possible to be asymptomatic for diseases – like COVID-19 or Chicken Pox, but doctors don’t reach out to me about that. No symptom, little concern. Well, no symptoms, no hospital. Let’s be clearer. I’m the doctor that finds the rare disease. The one in a million disease. The one in five million disease. Do you know about Occam’s Razor? Basically, if you’re sleeping in your suburban home with a picket fence very near a major city and you hear hoofs in the middle of the night, think horses, not zebras. I always think of zebras. Occam had a limited imagination or else a narrow world.
I live in Baltimore, Maryland, and work out of a very claustrophobic office filled with books. Believe it or not, you can’t get everything from the internet. Last week, I was called to Dubai. A seventeen-year-old female presented with tumors. She had thirty tumors removed in London. All benign. She had ten tumors removed in Dubai – three were malignant. Her father was a prince or something. I wasn’t quite sure. I only cared about his medical history and he dictated it to a male doctor. He was uncomfortable talking to me. A woman. When I saw the girl she had five benign tumors and two impinged on her spine. Not so easy to remove. She was also in pain. I insisted all medications be removed. It wasn’t long before she began screaming in pain. Other symptoms began surfacing. I retreated to a room and did Zoom conferences with two residents at John Hopkins. I left the hospital for my ridiculously lavish hotel room and slept.
It came to me. In the morning with coffee and a croissant. Von Hippel-Lindau. Growth of mostly benign tumors made of blood vessels. There is no cure. It may result in blindness, brain damage, or death. I ordered medications to ease the pain, consulted with a neurosurgeon, and recommended that the girl receive an MRI once per month. If the tumors were caught early they could be excised easily and prevent the worst. It wasn’t really good news for the girl. A lifetime of hospitals and surgeries. A lifetime of being different. I knew what that was like. I am autistic. Remember?
I boarded the plane home. When I got to John Hopkins, I collapsed. Symptoms? Shallow breathing, racing heartbeat, the feeling that the world was squeezing me, panic, weakness. I set my residents to work. What was wrong with me?
Doctor McGill came to me sheepishly after nine hours. “Panic attack,” he nearly whispered.
“No. No. Look some more. Zebras. Zebras.”
Doctor McGill stood still. “Horses.”
I blinked and fell into a dreamless sleep. Horses for now. Zebras tomorrow.