Wednesday, December 14, 2011

A Latin Beat

Over many years of medical practice this remains my most memorable case.  It demonstrates how knowing the patient well can be pivotal and it is a brilliant reminder that life is not always governed by reason.

My patient, in his early sixties, had an elevated PSA.  He saw a urologist who performed a prostate biopsy.  It was bad news with findings suggesting an aggressive tumor.

Within two days of the procedure, he became acutely ill with fevers and chills and all the markings of a serious infection.  The prostate was doubtless the source of the infection.  Powerful antibiotics were launched but he, nevertheless, worsened with rising temperatures and then very disturbing neck pain.  Even more alarming was the sudden loss of  strength in his arms and legs.          

Consultation with neurosurgery, along with imaging of the neck, indicated that he had a subdural abscess of the cervical spine.  The neurosurgeon performed immediate and urgent surgery hoping to head off permanent damage to the spinal cord by draining the abscess.
While the surgery eliminated the infection, within two days, he was fully paralyzed despite aggressive medical and physical therapies.

After two months, with no changes,  a fortress of immobility, the neurosurgeon and physiatrist (physical medicine doctor) were absolutely sure that he would never regain any independence.  Discussions with the patient and his family regarding institutional care commenced.  As expected he was crushed.

But that is not the end of the story. Against all odds, he actually regained function of his limbs and went on to an independent and fairly active life.   Mystery and magic were thick in the air during his long and  nearly complete recovery.

Here is what happened.

Both the patient and I were, after two months,  still unable to accept his prognosis.  I kept looking for a roadmap to reverse the injury to his spinal cord, but all efforts were to no avail.

With the science of medicine exhausted, it became clear that the last hope was to deploy the art of medicine.  This put us under the jurisdiction of mystery and magic where we would attempt what one of my friends and colleagues (a poet too) calls "leaping over the science."

Knowing "Carlos" for many years, I landed on the compelling idea that music just might be the vehicle to inaugurate the leap.  It made sense.  He was, after all,  a legendary musician in the local Latin jazz scene, and a venerable mentor to many young musicians. 

 Music was a calling for him and the key narrative of his life.   Just watching him walk and hearing him talk in his graceful latin rhythms marked him as a man crazy for music. 

So, I went to his bedside and told him I believed that music could very well improve his condition.  He looked dubious initially but then managed a smile which implied he was on board.  I asked him to tell me  his favorite albums and artists and had the family bring them to the hospital.

I then discussed my plan with the nursing and physical therapy teams who signed on despite some modest rolling of the eyes.

The plan was relatively simple.  Music would be administered at set times, just like medicines, and played for at least thirty minutes per dose, four times daily.

With the tunes of Machito and Paquito D' Rivera pulsing out of his room, the general mood on the ward elevated and some of us seemed to be walking with a subtle but noticeable swing.  Carlos, on the other hand, remained immobile, sleeping through most of the musical treatments.

Just forty-eight hours into  the experiment, however,  a nurse called - he moved.  Come and see.  Arriving at the bedside I saw his right foot sticking out of the sheets with his great toe moving slowly and sensuously to a latin beat.    

The physiatrist seemed to think we had whisked the patient off to Lourdes in the dark of night and considered the toe dancing miraculous.  With just this minimal improvement, he reversed his prognosis and thought that, with intensive and sustained physical therapy, this small sign could be the harbinger of major improvement .

One year later, he walked out of  a rehab center ready to resume his old life.  Do I believe the music cured him?  Of course I do. 

Can some people leap over the science?

You bet.

PS:  Carlos declined any further prostate investigations or treatments and eight years later, he leads an independent life and his prostate tumor remains asymptomatic.