The Two Kinds of Decay

The New Neurologist

After examining me and listening to me for less than five minutes, my new neurologist said I didn’t have Guillain-Barré syndrome but a rarer, chronic form of the disease, called chronic idiopathic demyelinating polyradiculoneuropathy. He was right.

He recited a list of the treatments I’d have instead of apheresis, in chronological order of necessity. If steroids don’t work, he said, we’ll try gamma, and then we’ll try interferon, and since azathioprine didn’t work, we’ll try cyclosporine, and if that doesn’t work, we’ll try cyclophosphamide, and if that doesn’t work, there are lots more drugs we can blast your immune system with.

He said some of the drugs had bad side effects, but that a twenty-one-year-old person could handle a few side effects, and that a twenty-one-year-old person should not waste time with any treatments but the most aggressive.

He didn’t approve of plasma exchange, which just tidied up the immune system’s spill of poison into the blood without stopping up the leak that caused the spill.

He was like a Black Panther of pharmacology. By any means necessary. I loved him immediately.

I never saw my old neurologist again, and in a few years I heard that his partner, who’d covered my case for him sometimes, had lost his license after being convicted of having had sexual relations with a number of his elderly patients. Their practice was shut down, and I don’t know whether my old neurologist moved to another hospital or quit practicing entirely.