Medical Mystery: Doctor's diagnosis drew laughs, but it saved woman's life
Tuesday, December 7, 2010
As the all-too-familiar number flashed on his cellphone shortly before 9 p.m., Dan Landri-gan reflexively braced himself for bad news. The caller was one of the doctors treating his wife, Donna, who had been in a coma for four months. "She sounded pretty choked up," Landrigan recalled.
"I think we've found out what's making your wife sick," the specialist at the University of Rochester's Strong Memorial Hospital told him, as a wave of relief flooded his body. "I was completely shocked," said the telecommunications executive, now 37. "My hope for so long was that this was the phone call I was going to get."
Doctors at three Upstate New York hospitals had been stymied by Donna Landrigan, whose case was unlike any they had seen. The previously healthy 35-year-old mother of three had initially become so psychotic she had to be tied to her hospital bed to keep her from hurting herself or attacking others. A few weeks later she had been placed in a medically induced coma to protect her from the continuous seizures wracking her brain, spasms that could have killed her.
Every promising lead had seemed to turn into a dead end, and the dangers of prolonged coma, including severe brain damage, were mounting. Things looked so hopeless that doctors had begun discussing whether to suggest terminating life support.
That phone call on April 29, 2009, was the first good news in months. It represented both a turning point for the Landrigans and vindication for the second-year neurology resident who had closely followed Donna's case since December 2008, when she was initially hospitalized. The startling diagnosis that Nicholas Johnson proposed, he recalled with understatement, had been met with "a little bit of laughter" by senior physicians, amused by the exotic and sometimes outlandish diagnoses made by residents.
This time Johnson's spot-on deduction, and his persistence, not only solved the mystery but also saved Donna's life. Her case, which made medical history, was recently described in the journal Neurology.
"For someone to beat this is amazing," said neurologist James Fessler, director of the Strong Epilepsy Center, who also was involved in treating her.
The first sign of Donna's illness occurred shortly before Halloween 2008, when she complained of severe headaches, then a stiff neck. A spinal tap revealed viral meningitis, and she spent three days in the hospital; once home, she got progressively worse. Most noticeable was her increasingly strange, often paranoid, behavior, which involved the couple's twin sons, then 11, and their daughter, who was 4 at the time.
A stay-at-home mother whose life revolved around her children, Donna recalled what happened the day she forgot to bring a snack for her daughter's preschool class. "You would have thought someone had died, I was that emotional," she said recently, summoning one of the memories she retains from that time; the next seven months are a blank.
Doctors counseled patience and warned that recovery might be bumpy. "We would chalk up any weird symptom to her just getting better," Dan recalled.
The night of Dec. 4, while talking on the phone, he realized that Donna had not returned from the garage. He found her face down on the concrete floor beside her minivan; she was unresponsive and her mouth bore foam from an apparent epileptic seizure.
Donna regained consciousness in the ambulance but was incoherent and combative. After a day or two of tests at a hospital, a psychiatrist was summoned. He told Dan that Donna was a secret alcoholic in the throes of withdrawal. Dan said the psychiatrist flatly dismissed his protests that Donna was strictly a social drinker.