Today's Reading
It was not at all clear to me what we were dealing with here. As I spoke with Jane in her hospital bed that morning, the police were searching her apartment for signs of forced entry. It was an obvious and troubling possibility: that Jane had been the victim of some kind of abduction. But that alone would not explain her blackout.
Certain drugs could have done it, of course: alcohol, obviously, or Rohypnol, the infamous date rape drug, or any number of other hypnotics, none of which is understood in any kind of depth. Even general anesthesia continues to mystify, and in fact, its main effects may be only amnesia and paralysis.
Jane reported that she had not ingested any such substances that morning, as far as she knew, and that she had been alone in her apartment in those last remembered minutes.
When I asked her if anything like this had ever happened to her before, she shook her head.
She took a small sip of orange juice. I noticed, again, the way she picked the skin around her fingernails.
I then asked her the question I'd been wondering about since the start: Did this have anything to do with why she had come to see me the week before?
I could tell that the subject made her uncomfortable.
"No," she said, quietly. "That was about something else."
I've learned to second- guess statements like that. One thing can always mean another, and a doctor learns early the law of what is known as Occam's Razor: The simplest explanation is the likeliest to be true. On that day in the hospital, it seemed to me that the two events— Jane's short visit to my office and this unusual amnesiac episode— were linked, somehow, perhaps two consequences of the same source of internal distress.
An MRI had shown no signs of stroke or brain injury. A series of blood tests had been sent to a lab.
Even then, though, I sensed that this might be something else. There are a great many psychiatric conditions that can disorder the mind without leaving any trace in the brain or the blood.
The emergency room physician had made a preliminary diagnosis of the least medically serious possibility: transient global amnesia, which is defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders as an episode of brief, unexplained memory loss. The chief evidence for this condition, however, is the absence of any other explanation. And so it is a diagnosis that fails to satisfy.
When I was a medical student, I was trained to leave extraneous details out of patient histories, but with Jane, I was having trouble determining which were the important facts and which ones were not. I had the suspicion, as I often do, that small details might turn out to be relevant.
For example, during our conversation in the hospital, Jane continually touched her left wrist in the place where a watch would be if she were wearing one. Some in my profession might argue that this motion should have signaled to me that Jane was a person unusually preoccupied with the passage of time. But I've always resisted such universal symbols. To twist Tolstoy's famous phrase: In my experience, every unhappy patient is unhappy in their own way.
By taking Jane's history, I learned that day that she was an only child, that her parents were still alive and lived on the West Coast, that she'd grown up in Southern California and now worked as a librarian at the Fifth Avenue branch of the New York Public Library. She lived with her one-year-old son in the Park Slope neighborhood of Brooklyn, about a mile from the patch of grass where she'd been found that morning. Her son, I was relieved to hear, was at that moment in the care of his daycare provider—in Jane's absence, this woman had kept the child overnight. The first sign that anything was wrong had been when Jane failed to pick him up from daycare the day before. On that day in the hospital, I detected no signs of mania or psychosis in Jane. Her thinking seemed rational and coherent. She was slightly agitated, perhaps, a bit anxious, but nothing that would rise to the level of diagnosis.
...
