A Medical Economics Web Exclusive

Living with terror

World events and personal crises often play off each other, this doctor found.

By Daniel M. Slutzker, MD
Interventional Cardiologist/Knoxville, TN

While growing up I knew a kid whose birthday fell on December 25. He always felt a little bit cheated because he had to share his special day with everyone else who celebrated Christmas.

During the week that the World Trade Center and the Pentagon were attacked, I was diagnosed with multiple sclerosis. In comparison to our national tragedy, my disease was small potatoes. For me and my family, though, it was a huge sack of small potatoes.

For about a month I'd been limping noticeably, and I was no longer able to jog. I gathered cafeteria consults in the hospital from an orthopedic surgeon and a physiatrist. They asked about back pain or injury, and I'd had none. They advised me to wait and see.

A couple of weeks passed, and I was having trouble lifting my foot to put on a sock. I saw a neurologist. He asked about other symptoms, and I recalled that a year before, my right arm had tingled for a couple of weeks as if it were sunburned. He promptly ordered a spinal tap and an MRI.

When I emerged from the scanner, a neuroradiologist was waiting with the films. He didn't mince words.

"It looks like MS."

"Is there anything else it could be?" I asked.

"No."

Since that devastating week, our nation has been living with the fear of the next terrorist attack. Since my diagnosis, I've also been living with the terror of another attack on my nervous system.

My neurologist immediately put me on a short course of high-dose steroids, and I've been injecting myself every other night with interferon. To me, those subcutaneous injections are not unlike our sending special forces to unearth hidden Al Qaeda. Both efforts may be partly in vain, but they have to be better than waiting for the next shoe to drop or, to use a more appropriate metaphor, waiting for the next sword to strike.

When my neurologist looked at my MRI, he pointed out a small black hole. I asked what that meant, and he said that with enough such holes, I could lose some intellectual function. I asked him why my leg was getting better. He explained the pathology behind the battle between oligodendrocytes and astrocytes.

"Kind of like good versus evil? How ironic this week," I said.

He told me to avoid extreme heat but encouraged me to exercise, so I began jogging again.

Over the course of the year, I've gone from thinking about the disease every five minutes to thinking about it now only during the time it takes to prepare and inject the interferon.

I joked with my neurologist that MS was thought to be a crippler of young adults and so, being 44, I didn't qualify. He didn't buy my argument. There must be thousands of people with MS who don't even know they have it because they're doing so well.

I've heard from a few people about friends and relatives who died of MS, but I've convinced myself that they were the exceptions. I think about the stories we hear from patients about someone who dropped dead after a normal stress test, or about the grandfather who smoked like a chimney yet lived to be 90. People talk about those things because they're exceptions and, therefore, remarkable.

For the first couple of weeks after our nation was attacked, every billboard at every restaurant, church, and store displayed some message about hope, faith, and prayer. Then one afternoon I saw the marquee outside Taco Bell blaring a different message: "CHICKEN FAJITAS ARE BACK!"

I had to smile. To me, this resumption of business as usual was akin to a groundhog poking his head out of his hole after a violent storm. In fact, it was right about then that I began to come to terms with my illness.

Life has continued, and I've yet to miss a day of work. My patients don't know about my illness—not because I'm hiding anything from them, but because my plan is to continue as I always have until I have no choice.

Neither our nation nor my nervous system has yet suffered another attack. We Americans are told to continue doing what we've always done. I'm a doctor, and now I'm a patient too. I can do both. Like my friend who was born on Christmas, I'll play the cards I was dealt the best I can.

Daniel Slutzker. Living with terror.

Medical Economics

2003;1.