King of Organs (2)
In fact, to be honest, there was no need to pinpoint the exact type of autoimmune encephalitis. The treatments were all pretty similar anyway. There was a clear fix for autoimmune encephalitis: one that would show symptom improvement! I looked at Professor Kaplan.
"Anyway, it's an immune response without a pathogen, Professor. That means this encephalitis can be controlled—it's potentially reversible."
A clear solution existed.
"Ah...."
"High-dose steroids. If that doesn't work, we can inject them directly into the cerebrospinal fluid."
Professor Kaplan couldn't shut his mouth.
The moment that young Asian medical student had walked into Professor Berg's lab, Stanford Medical School had been harboring one burning question.
That resident who'd snagged a Lasker Award and published multiple papers in top journals—what the hell was his deal?
The answer only seemed to drift further away.
Professor Kaplan sat in the cancer ward, surrounded by patient charts, journals, and textbooks spread out before him. Flanked by the others.
"What do you think?"
On either side of him, the Neurology Professor and the Rheumatology Professor stared gravely at the charts and at Kaplan himself.
"High-dose steroids."
The resident in question had already headed to the pharmacy first. To prepare the high-dose steroid IV for the patient and the lumbar puncture kit.
"Well."
It was an experimental approach. But Kaplan—the man who'd invented chemo and radiation for lymphoma—was a scholar before he was a doctor. He knew how to try new treatments. As long as they had physiological backing.
What the hell was autoimmune encephalitis anyway? The Neurology Professor sighed.
"This is why you can't trust what guys in white coats say. It's just...."
"What do you mean?"
"When you start thinking there's hope, you consider these weird treatments, right, Professor Kaplan? Stuff you never even thought of."
"Just say it—will it work or not?"
The Neurology Professor rubbed his temples.
"There's this disease called Acute Disseminated Encephalomyelitis (ADEM). It hits kids, a type of encephalomyelitis, and you see lesions in the brain and lower motor neurons, just like in this patient, right?"
Acute disseminated encephalomyelitis—what the hell? They'd dragged the Neurology Professor here to solve the mystery, but all he was doing was throwing out more odd questions.
"There's a disease like that?"
The Neurology Professor nodded.
"Treatment's empirical steroids. Mechanism isn't fully known, but some patients improve with them. It's rare, though, so why that resident knows about experimental treatments for rare diseases...."
No time for that chatter.
"Autoimmune?"
The Neurology Professor nodded.
"No clear way to confirm, but ADEM is considered 'inflammation unrelated to infection.' The leading hypothesis there is autoimmunity, yeah?"
"This patient's not ADEM, though."
"No. But if this patient's condition is mediated by an autoimmune process like ADEM, then treating with steroids the same way...."
"Got it."
The discussion dragged on. The Neurology Professor pointed to a page in the textbook detailing ADEM treatment. Steroids, as expected. Experimental since the mechanism was unknown.
"That kid's nuts."
How had that resident made the connection? Were they really raising the Einstein of medicine here?
A patient who was going to die anyway.... Harsh words, but there was definitely a real category: patients who, without aggressive treatment, would die or suffer irreversible damage. You saw them pretty often.
The concept of autoimmune encephalitis wasn't fully established in the 1970s yet. If I hadn't said a word, this guy would've gotten conservative treatment for encephalitis at best. And probably died.
No reason to give steroids, by this era's standards.
I finished prepping the steroid injection as Professor Kaplan walked into the cancer ward station with another doctor.
"All set?"
"Yes."
"Talked to the Neurology Professor. Looks like steroids are the way to go."
The Neurology Professor nodded along. What? They'd been debating that?
I'd thought it was already decided.
"We use steroids for brain edema sometimes. This patient's scan showed a bit of that, right?"
"True enough."
Not exactly revolutionary. We wheeled the cart back to the patient's bedside. The Neurology Professor who'd come with Kaplan eyed me curiously, like I was some marvel.
"How'd you figure it out?"
"Figure what?"
"That it might be immune-mediated. Neurologists don't use steroids for brain diseases all that often."
Because they didn't understand the brain back then. Modern medicine uses them aggressively and frequently for concussions, edema, autoimmune encephalitis, you name it.
The good news? Steroids' effects would be immediate.
"Uh.... I thought about other brain diseases treatable with steroids. Though in this case, it's not just the brain—lower motor neurons look damaged too."
"From autoantibodies?"
"Yes."
"Impressive.... Let's see how treatment goes this time."
We reached the bedside. The Neurology Professor squinted, then lapsed into thought like something had clicked.
We wheeled in. The family was there again. Patient just lying eyes closed; kids must've gone home.
Kaplan stood by the bed.
"How're you feeling now?"
The patient struggled to lift his head. Seemed a bit worse than before, maybe.
"Yes...."
I glanced at Kaplan. Fair enough—steroids weren't as hardcore as chemo. Some chemo melts flesh if it leaks outside the vein. Safe to inject in the vein? Who knows. Compared to that, steroids were pretty safe.
I slowly injected the steroids into the patient's IV line.
"Brain damage is a concern right now, so we're starting a new treatment today."
"He can get better, right?" the caregiver asked me.
"There's a chance he'll improve.... I can't promise for sure yet."
I trailed off on purpose. Not the kind of patient you could confidently say would pull through. Theoretically possible—lung cancer could be cured, certain autoimmune encephalitises resolved. But theory aside.
I figured the odds of everything going wrong were still way higher. Symptoms had progressed too steeply, too severely.
"Ha.... Worried sick."
"Let's wait and see the results. I do expect some improvement."
We bowed our heads in greeting and left the room. I sighed inwardly. Hope it works fast. But I was optimistic.
How soon would we know? Time for steroids to fix autoimmune encephalitis varies by the brain damage or dysfunction's cause.
But if it was edema, improvement could start in hours.
Six hours later. I'd check then.
Sat with a book open, but nothing sank in. Restless wait. Alice walked into the station.
She frowned at me on sight.
"What. You didn't go home?"
She was on duty today. Must've just clocked back in after dinner.
"Waiting for the steroid effect."
She tilted her head.
"Huh? Steroids aren't a cure-all. Check tomorrow."
"Brain edema can start improving hours after steroids. Wanna see if it's working before I go."
She blinked.
"Guess it is a cure-all."
She dragged a chair over and plopped down beside me. No helping it. I closed the neurology textbook I wasn't reading.
"How long you waiting?"
"Till symptoms improve."
Alice didn't ask the obvious follow-up: And if they don't?
Six hours passed. Sun long set, heading back to the patient's room. By now, he should've improved, right?
Alice tagged along.
"Think the steroids worked?"
No idea. Medicine's more art than science. Even if scientifically sound, the drug's effect on that patient came down to reality.
The hospital corridor lay deathly quiet in the night. He's better, right? God, I hope so.