21 November 2012


If you are in fact what this man says,
God have pity on you! You were born to misery.

Oh! Oh! All come to pass, all true!
I find Oedipus Rex tough to read, because everyone but Oedipus sees where things are headed. Oedipus doggedly investigates the death of the king. He is blindsided (and blinded) by the sudden revelation (see above) that he had unknowingly killed the king (his father) and wed his mother. Throughout the play, Oedipus is a step behind everyone else. He's the last to know the truth.

A patient came in with rapidly progressive weakness of recent onset. In his usual state of health just months ago, he could hardly walk without falling and could barely summon the strength and dexterity required to button his shirt. He wanted to know why.

At the start of the visit, the physician and I assembled differential diagnoses in our minds. The physician obtained an excellent patient history, eliciting answers that ruled out some of the diagnoses on our lists. Pretty soon, all of the potentially reversible illnesses on my differential were ruled out. Nothing much seemed to fit the patient's symptoms, except for amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's Disease). It is an awful disease, progressively paralyzing the body's muscles while leaving one's mental faculties intact.

We moved on to the physical examination. The doctor performed tests specific to ALS, and our findings increasingly supported that diagnosis. I was filled with a horrible sense of foreboding. I could tell that within minutes the diagnosis would be confirmed. Given the rapid progression of his disease, he didn't have many more months to live. I steeled myself for the wrenching moment when the patient would be informed.

Our medical training confers upon us some prophetic powers. In making diagnoses, we interpret signs on the body that are inscrutable to most. With our medical knowledge, we can sometimes accurately predict the course of a disease. Like Cassandra and Tiresias of ancient Greece, we issue dire warnings ("if you don't quit drinking, it will kill you!") that often go unheeded.

But as neat as it is to see the future, I now understand that this faculty can be a burden. Like those prophets of old, we were condemned to foretell this patient's tragic fate yet powerless to alter it.