On Medicine: What Can Odd, Interesting Medical Case Studies Teach Us?

by Siddhartha Mukherjhee

NY Times,  July 17, 2018

“Late one evening in the medical library of the hospital where I work, I opened The Lancet, the medical journal, and came across a case report written by the neurologist-writer Oliver Sacks and colleagues. ‘In July 2011, a 52-year-old woman presented to our psychiatric outpatient clinic in The Hague with a lifelong history of seeing people’s faces change into dragonlike faces.’*

Hooked, I continued: ‘She could perceive and recognize actual faces, but after several minutes, they turned black, grew long, pointy ears and a protruding snout and displayed a reptiloid skin and huge eyes in bright yellow, green, blue or red. She saw similar dragonlike faces drifting toward her many times a day from the walls, electrical sockets or the computer screen.’ ”

Osler wrote: To talk of diseases is a sort of Arabian Nights entertainment.   This is frequently quoted, but the full sentence actually reads “To talk of diseases is a sort of Arabian Nights entertainment to which no discrete nurse will lend her talents.” Nurse and Patient Chapter IX, Aequanimitas.

Oliver Sacks certainly was never discrete, and all physicians have a fascination with weird clinical tales.  Mukherjee’s reflective  essay  NY Times is worth reading.  It indirectly comments on the many patients we see with “medically unexplained symptoms” and the importance of reporting these since in the future their true nature may be elucidated. Case reports are not readily published in our major journals because they reflect badly on the Impact Factor.  And so, the boring and predictable grind us down as we slog like penitents through our professional journals.

* Prosopometamorphopsia and facial hallucinations. Blom JD, Sommer IE, Koops S, Sacks OW. Lancet. 2014 Nov 29;384(9958):1998. PMID: 25435453