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The woman burst through the emergency room doors shouting: “Where’s my son?”

“Over here,” I blurted, startled by her entrance. Short and wiry, she flew past the paramedics to her motionless, well-built 25-year-old. Then, turning to me, she rose on the balls of her feet and hissed, “I told those doctors he needed an MRI!”

“Does he have epilepsy, ma’am?” I asked carefully. “Any type of seizure disorder?”

“He did this once before,” she continued, as if not listening. “Those idiots upstate couldn’t tell me what was wrong. Three months ago he had this…event. Same as today. They told us to see a neurologist. But the damn insurance company wouldn’t approve the MRI.”

Trying to take control of the situation, I pulled aside the lead paramedic. “Tell me again—why did you intubate him?”


“He was comatose,” the burly man in the blue uniform said. “Didn’t respond to Narcan,” an antidote to overdoses of opiates, like heroin. “Then he started seizing.”

“Full-blown seizures?” I asked.

“Hard to tell,” the paramedic replied, wiping his forehead. “Jerking his arms back and forth, not breathing well. We decided not to wait, so we sedated him—that stopped the seizures—and then we put the tube in.”

Comatose patients have a tendency to vomit stomach contents into their lungs. A cuffed breathing tube prevents that. “Sounds reasonable,” I said. “And when the family called 911, what exactly did they say?”

“Mom found him in bed, couldn’t wake him up.”

The young man on the gurney looked utterly peaceful—except for the plastic breathing tube arcing out of his mouth. I turned back to the mother and asked, “Did he have a CAT scan that first time?”

She smirked. “It came out normal.”

A young woman came over to where we were standing. “I’m the sister,” she said.

Seeing a new opportunity for information, I asked, “Any drugs that you know of? Medications?”

Mother and daughter’s heads both shook an emphatic no. “He’s a good boy. No drinking, no craziness,” Mom cut in.

“He had some friends over last night. They hung out upstairs,” the sister added. “Maybe a few beers. Nothing more.”

The young man’s physical exam offered no clues. His vital signs were perfect; his pupils were small but reacted well to light; his arms and legs barely moved when pinched, but they had good tone, not the flaccid splay of paralysis. I went down the differential diagnosis. Drug overdose? That would have been detected three months earlier, the first time this happened. Brain bleed or meningitis? Obviously these were the nastiest contenders, but my alarm bells weren’t going off; coma aside, Doug looked too good. Persistent seizures? He lay inert as a statue (although it is possible for a brain to have epileptic electrical activity yet cause no visible muscle contractions).

The best clue I had was that this event was a repeat. But a repeat of what? Relapsing encephalitis? Narcolepsy? A degenerative neuronal disorder? A new form of mad cow disease? I envisioned the answer buried in some thick tome titled Neurological Disorders You Can’t Even Imagine.