The Cavewoman of Ardingly
Monday
In my first hour as a consultant at Mid Sussex Hospital, Haywards Heath, I was thrust in front of room 57 on Zebra ward.
Chloe Woods, daughter of ward matron Lizzie Woods may have had a stroke. Dr Donaldson, ward consultant wanted my urgent neurology opinion. The ward was on tenterhooks.
My demons were vocal that morning. ‘An Indian doctor would be a failure unless proven otherwise here. This is not Manchester teeming with Asians. You are treading on egg shells.’ They said.
I read through the notes and asked the juniors. "15 year old girl presenting with left sided paralysis and fits. Causes? ….Lets discuss after we see the patient".
I stretched my ID to the scribing registrar who struggled with my name. “Dr A-n-a-n-d M-o-h-a-n” I anglicised it to a point, my father would surely have felt cross.
Lizzie Woods was not in her uniform but was fully in charge.
After introductions, she told me the story.
“Chloe has been perfectly healthy. The strongest of my 3.
Predicted straight As at Ardingly, talented painter, likely to make it to UK gymnastics team"
‘Ardingly’ -Bollywood actor Shahrukh Khan's daughter went there. I remembered.
I clearly wasn’t big enough. Pressure.
"She was going upstairs to her bed as usual. She said I am feeling dizzy. Then she goes ‘ I can't move my left side mummy’. And fell to the floor like a log. Then she had a fit"
She was brought to our A/E just past midnight. Sleepless blue vampires sucked both blood and urine from her. All clean.
I made Chloe do this that and the other with her limbs.
"Grade 0 to1 on the left upper and lower limbs” I spoke out loud for the registrar to document. Chloe's left side was pretty much dead.
"Do we have a time for scan?” Lizzie was impatient.
“We’ll get that sorted ASAP. Leave that with me.” I needed to score every brownie point.
"Can you video if she has more fits please" I said to Lizzie while leaving.
The juniors listed the causes.
"Excellent - very likely a stroke. Tumour ,infection, multiple sclerosis etc all very unlikely " I wrapped up the teaching to speak to the scan specialist (radiologist).
The scan happened around 12 pm.
I pushed through the hour with unnecessary coffees and wee wees and finally at 1 the radiologist called . “Brain looks pristine” he said.
Did someone punch on my chest? I should feel happy that my patient didn't have a stroke or brain tumour. But no. I was up against worse. An invisible, impalpable disease.
I went back to the ward.
“Brilliant news! Your brain is absolutely normal "I revved up my failing engine as I walked into 57.
Chloe had a straight face. Lizzie's relief changed to disbelief in seconds. “Whats going on then? She just had another fit" She said, shoving her phone towards me. A video buffered for a few seconds and came to life.
The penny dropped. The demons giggled.
"Well from your scan, we know you haven't got a stroke, tumour or anything. The brain looks healthy" I moved the words around like chewing gum.
"It’s like a computer that doesn’t work. Hardware looks fine but the software is not”
Lizzie hardened “Can you explain this in plain English?”
"We call it functional neurological disorder. Symptoms caused by severe psychological distress. Psychosomatic illness " I stopped for the reaction.
Lizzie shook her head side ways. "No ways. Chloe is not such a girl. She can't be making this up"
“Correct. Just like my heart is racing away now. I am not making it up. A trick my brain is playing on my body” I didn’t say this.
Chloe's face reddened and her eyes welled up "I am not faking this."
"I know Chloe, I didn’t say you are …. ……….” before I could complete, she went into another fit. Eyes closed, loud grunts and thrashing limbs violently. Oxygen monitor, the habitual drama queen false alarmed because of the shaking.
"Oh my goodness this is the worst it’s been" Lizzie pressed the emergency buzzer. Two staff nurses rushed in.
"Shall we get some Midazolam?" One of the nurses asked.
"No" I said.
Their eyes popped out.
“This is a pseudo seizure. No medications please "My voice not as loud as I wished.
"We should call Dr Donaldson ". The nurses judged me. Understandable I thought.
Dr Donaldson, ward consultant luckily agreed with me. The fit fizzled out after 15 minutes but Lizzie complained to the ward manager who escalated it promptly to Dr Rachel Hamilton clinical director. Lizzie demanded a second opinion from Great Ormond Street Hospital for Children, London.
Dr Hamilton texted me .Tuesday morning we would hold a multidisciplinary team meeting (to suss out Dr Mohan)
Confident that I will be screwed, my demons left me alone for the rest of the day.
Tuesday
The multidisciplinary meeting was a court room. Perhaps the judgment the demons said was coming.
I explained my findings. Dr Donaldson kindly weighed in with her powerful “I agree” nods throughout.
Lizzie fought with sideways head shakes. The physiotherapist supported my diagnosis. This tilted it in my favour.
Dr Hamilton, delivered the masterstroke. We should keep Chloe on Zebra ward, but if she didn’t improve by Friday we should refer her to London. Everyone would have won and lost by Friday.
Lizzie was asked for final thoughts. “Dr Mohan was too insensitive”. She commented.
When I came to the UK 10 years ago, my cousin told me to practice three magic words liberally.
I said ‘thanks’ to Dr Hamilton for her time; ‘sorry’ to the parent and ‘please’ to the offer of allocating a psychologist to the case.
The physio caught me in the corridor. She said Dr. Heather Jones senior psychologist was the best with teenagers.
I agreed thinking “whatever”. I had never seen a case like this get better for months forget in 4 days.
A mixed race woman in mid-forties; Tattoos from shoulder to finger; Lip piercing; Extra chewing gum and Issey Miyake trying hard to cover up tobacco. Was Heather really the best psychologist here? I was confused but hopeful for my brown skin. The prejudiced demons jumped off my head and disappeared under Heather’s cupboards.
For self defence, I decided to join Heather’s sessions with Chloe.
In Chloe’s room Heather addressed people “love”, “lovely” and “puppet”. I saw the case slipping through our hands. This was not how psychologists spoke.
Chloe was painting with her right hand. Left still profoundly dead.
A kingfisher with a used condom in its beak. Climate change. Teen rebellion.
“ Aah Puppet. That’s amazing. Wonder if you could help me with MY project” Chloe said.
“I have been asked by the Uni to write a chapter on Evolutionary psychology”. She explained.
This woman worked on her own timeline. No mention of therapy, stress or anxiety yet .I fiddled my fingers.
“Yeah it’s a bit boring isn’t it Puppet. But there is a way YOU can help me make it fun” Heather said.
“Me?” Chloe frowned.
“Yes you! Your picture just gave me a cracking idea. Can you draw me some small picture cut outs?”
“Can try.” said Chloe.
“I want a picture of a caveman or better, let’s make it a cavewoman. Girl power” Heather said looking in my direction and winked. I laughed to play along.
“Then …… a picture of a few animals in one frame- may be a lion, gorilla and rhino; then one of modern world. Same cave woman’s face but in modern world” Heather clarified.
“Wow! That’s quite a bit.” said Chloe.
The girl power reached a deal that Chloe will make those pictures by Wednesday morning. She had no more fit that day. She was busy making the cut outs for Heather. No plans for therapy yet.
Wednesday
Lizzie was less visible on the ward now.
Chloe laid out her cut outs.
A cave woman with flowing curly hair standing on a rock with backdrop of orange sky. A stunning self portrait. The animal picture showed a Lion pouncing in the air, gorilla growling and a rhino charging head on. Plumes of dust created an illusion of movement.
The modern life cut out was Chloe’s mom and dad dropping her at Ardingly School and Chloe looking back at them.
“ I – am – floored . I cant believe this. Thank you so much ”. Heather said hugging Chloe. I didn’t know if that was professional. But I noticed Chloe’s left arm flicker to rise. Unfortunately it fell back as if reminded of its paralysis.
“ Lemme show you what I had in mind.” Heather sat down on the bed. An overbed coffee table separated them.
“Imagine this scene Puppet. On a fine Wednesday morning, in the prehistoric jungle, the cavewoman stood on her rock”. Heather’s eyes widened.
She stopped to put a youtube video on her mobile for sound effect. A djembe tune played. I could not believe it. I moved a step back pretending I wasn’t part of that.
Heather’s throaty lion roar broke my chain of thoughts “Suddenly the wild animals burst in”. “What will our cavewoman do?”.
“Run for life or fight?” Chloe said partly as a question.
“Yes puppet! Run or fight back. We call it flight or fight response” Heather agreed.
“Their brain was designed for fight or flight. That’s how they survived. Or else they would have been eaten by wild animals. Human race wouldn’t have made it without that reflex”
“The brain asks the body to pump stress hormones all around. Cortisol and adrenaline. Heart beats faster. Breathing becomes heavier collecting all the oxygen. Muscles get ready to run or fight”
Chloe twisted her lips contemplating that.
“But the cavewoman became a modern woman.” Heather put the modern day cut out on the coffee table and declared a music change.
“shala lalla….. shala lalla……” . I stretched and saw the title – Little mix’s Love me like you …….
She continued her voice over “ But the brain didn’t change. We got rid of physical threats and made the brain believe it was safer. But the brain was just the same…… Ready for fight or flight if needed.”
“Look! modern day. Everything safe and civilised but for some little threats”
“Remember the brain is still the same” saying that she brought back the cavewoman picture.
Little mix played on giving a benign cover to the whole thing. But I was waiting for a fit.
“Now puppet. What threats can a Year 10 girl at Ardingly have?” Heather pushed on.
But Chloe played along “Stress of GCSE , sports competition, boyfriend girlfriend issues and …………….. mommy daddy problems……”
She then looked through the pictures, through the floor, through the abyss below the hospital.
But Heather persisted “Sometimes little threats pile up and the cavewoman brain breaks. It does a flight or fight. But people outside don’t get it, they don’t see any animals. Social threats are invisible. They call it panic attack, psuedoseizure , anxiety and so on”
“When it cant do fight or flight there is a third response – Freeze” Heather said, turning the cave woman cut out horizontal. “Body just cant move”.
There was a rising siren. It was Chloe’s wail. She made incomprehensible sounds. “I will fail. Don’t want gymnastics. Want mommy and daddy. Don’t want Craig………”
A sudden pause and she kicked the coffee table and Heather away.
She fell onto the floor and had another violent fit. The cavewoman cut out jerked in her arm.
The oxygen alarms did their deed. Nurses rushed in to the room. Little mix continued to play in the background.
Heather pacified everyone saying “It was an exhausting session. She needs rest” She paused Little mix and walked out of the room.
In the corridor Heather asked me. “What is your caveman story, Love? You seem like you are walking on egg shells”. It jolted me. She was talking exactly like my demons. How did she know?
But I covered up “Now ….that’s getting a bit personal Heather.”
Thursday
Heather called me to do a repeat examination on Chloe with Lizzie video recording it. She had specifically asked me to use tests to show that subconsciously Chloe could still move her left side fine.
For the rest of the day she did joint sessions with Lizzie and Chloe without me around.
Late afternoon she called me to her office for a briefing over coffee.
“We have done our bit Anand. Chloe has seen the videos. She may accept psychotherapy or not”
Heather filled me in with the cavewoman jigsaw.
Lizzie and Martin Woods’ separation was the lion. Gymnastics and GCSE were the Gorilla. On the evening before hospital admission, Lizzie’s new boyfriend Craig had come home. When Lizzie went into the kitchen to make tea, Craig commented to Chloe that he was confused who was hotter, Lizzie or Chloe. This was the rhino. That was it. The cavewoman did a fight, flight and a freeze.
We agreed for a joint review on Friday morning to decide if we refer her to Great Ormond Street or discharge her home.
Friday
The demons woke me up at 5.30 am. They were gobby and excited.
At 7.30 I got a whatsapp message from Heather.
“ Late night with the girls from dance group. G n T +++. Headache ++++. Cant make it in today. Good luck with CW. xx”
I thought “what the fuck”. How could someone be so unprofessional? That was almost a reportable offence.
Swearing at Heather I reached the ward.
Chloe did not have any seizures from the previous afternoon.
A student nurse chaperoned as Chloe was on her own.
I knocked on Chloe’s door. I was going to open the door slightly to ask if it was ok to go in.
But pulling my jaw open and driving all my demons away permanently, Chloe herself swung open the door. She was stood there holding the door with her left hand, brushing her teeth with the right. She said “ maawning” with a mouth full of foam as if nothing ever happened.
She asked me when she could go home.
After discharge formalities, I went down to put a thank you note in Heather’s office.
I thought I would slip it through her door. But there she was, typing away on her computer.
“You said you were calling in sick?” I asked.
“I was, ... but what if you reported me for unprofessional behaviour” She said.
“Just kidding. The deadline for this was bugging me.” She swirled her chair around and showed me her manuscript.
‘Evolutionary Psychology and Anxiety’ – a folder with Chloe’s drawings clipped to it.
“Do you work on demons?” I asked.
She went back to her screen and said “Yesss! Rumination fancies bad experience. Demons are born when rumination fucks bad experience repeatedly. Bad experience is unstoppable. But we can neuter rumination.”
