15. The John Doe
It was a holiday. I am not sure which holiday, but I know it was one, cause the staff was smaller and the schedule was crazy. I was responsible for a million patients and any admission that could happen on my floor that day.
‘How is it going, Dr. Diaz?’ Jake, one of the nurses on the night shift asked me when I walked in.
‘Everything well, thank you. How was your night? Anything new with my patients?’
‘Not really.’ He shrugged. ‘Except… Your John Doe woke up during the night.’
‘Really?!’
‘Yes, but don’t get too excited yet. He was very drowsy and unable to communicate properly. But if I heard him right, I think his name is Frank.’
‘Frank.’ I repeated. ‘No last name?’
He nodded no. ‘Have a good day, Lisa.’ Jake said before leaving.
John Doe had been my patient for three days already, and we didn’t know anything about him. Well, I guess I could call him Frank now. Frank had been found by strangers on Dumbo, in Brooklyn. He was alone, unconscious, and without any documents or cellphone. The people who found him called 911 and Frank was brought to the hospital. He was a white man in his late twenties and he was notably well-dressed, like someone who works in a law firm or Wall Street. Or who knows, maybe even a hospital.
Initially, the ER doctors thought he could be on a drug overdose. He was hypertensive on presentation but the other vital signs were relatively stable.
Since he couldn't give any history, he got the full workup. Blood tests were fine except for kidney function, which was slightly off. And then they put him into a CT scan: hemorrhagic stroke. Now they knew why he was blacked out. The neurosurgery team evaluated his case but no surgical intervention was planned. His case, they said, didn’t meet surgical criteria. They were satisfied he was stable and hoped he could slowly recover with time.
'He probably had some aneurysm or other anatomical problem which ruptured.' The neurosurgery resident explained to me. 'Unlucky I guess.' He shrugged and left.
Even though I didn't know much about John/Frank, every day I saw him I would hang by his bed for some time, talking to him. Since med school, I had learned that even when we think they are not listening, a surprising number of patients have memories from the time they were unconscious. I noticed he had a cross tattoo on his chest, so I also prayed the Lord’s prayer at his bedside. Still, no sign of him waking up until that night, with Jake.
I checked on my other patients first and left him for last.
'Good morning, Frank.' I said shaking his arm a bit. He opened his eyes and looked at me. That was the first time I saw him there, looking awake. I couldn’t help but smile.
'I hope you're name is Frank indeed. I am sorry if it's not. Shall we pray today?'
So I started the prayer as I used to. When I finished, it was weak, but I could hear his amen.
'Frank? Can you speak?'
'Gere. Frank Gere.' He whispered forcefully.
'Thank you.' I said with a hand on his shoulder.
Then I spend a good part of my day tracking down Frank Gere's family. We found out he was a lawyer, his family was from Arizona so they had no idea he was missing. As soon as I called them, his mother got on a plane on her way to New York. I was still on call when she arrived.
'Hi, Mrs. Gere. I am Dr. Lisa Diaz, the one who spoke with you over the phone.' I motioned for her to take a seat.
I started by gathering the information she had about her son’s previous health conditions. The only thing she knew was that recently he had gone to a health fair and he was told his blood pressure was high. Other than that, Frank was healthy as a bull.
‘He never even caught a cold.’ Mrs. Gere told me with eyes full of tears.
I took her to see Frank. He was still unable to communicate much, but the look on his face and the tears that rolled down when he saw his mother were enough. I had to excuse myself from the room. I found a nearby bathroom and hid inside a stall. Some patients get to you in a different way, in a way no book can prepare you for.
How come such a young healthy guy, probably my age, was in such a bad place? In one split second, his whole life fell apart. I gave myself a couple of minutes to take in what was happening and to silently pray for his mother. May God help her.
I left the bathroom and sat on the first computer I found. Maybe if I could find at least what caused Frank’s stroke, I could give some comfort to his family. Or, to be honest, to myself. I reread everything there was on his chart, mostly physical exams and blood tests since we didn’t have any history before.
All I found were the things I already knew: significant hypertension and kidney dysfunction. Wait. Maybe that was it! What if the kidney problem was the first thing, which caused hypertension and then hypertension caused brain bleeding! But still, what caused the kidney dysfunction? And the blood pressure was high but not that high to cause a brain bleed on its own. Damn.
Feeling restless I decided to call Peter. I’m not sure why, but I thought he could help me in some way. I didn’t tell him often, but I actually trusted him. He is a hell of a doctor.
‘Lisa?’ He said when he picked up.
‘Hi! I need your input on something.’
‘I’m good too, how are you?’ He said laughing.
‘Shut up.’ I answered laughing too. ‘Hear me out.’
I told him everything I had, which wasn’t much, and waited for his response.
‘Are you there?’ I asked biting my lip after a silent time.
‘Yeah Yeah. You know, what if the problem is in his vessels? You told me neurosurgery is thinking of aneurysms or anatomical abnormalities, right?’
‘Yes.’
‘So what if his arteries are bad in the kidneys and bad in the brain?’
‘Huh. Interesting. Elaborate.’
‘Remember that disease with string-of-beads arteries?’
‘Yeah, fibromuscular dysplasia.’ I answered and then it sank in. ‘Wait. That’s perfect! Thank you, Peter.’
‘Anytime, Lisa. See you around.’
‘Hey.’ I stopped him before he hung up. ‘You’re very good.’
‘Thank you, Liz.’
Peter was right. Imaging showed the classic alternating pattern of narrowing and dilation in renal, carotid, and intracranial arteries. Unfortunately for Frank, his disease had formed a rare brain aneurysm that ruptured in a catastrophic way.
I explained what we had found to Mrs. Gere, and she thanked me even though we couldn’t do much but about it.
‘That’s not true. We can still pray.’ She smiled.
Frank was in the hospital for 6 weeks and I kept going there to see him every day until he was discharged to a rehab facility. His mother joined me every day for morning prayer. And near the end of his hospital stay, Frank did too.
…
Want to know more about Fibromuscular Dysplasia?
https://journals.viamedica.pl/kardiologia_polska/article/view/KP.a2021.0040/64025
Want to read a real case of Fibromuscular Dysplasia?
https://www.cureus.com/articles/32307-a-case-of-isolated-intracranial-fibromuscular-dysplasia
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