The professor of anthropology from a nearby college could barely contain his irritation. He quickly made it clear that this neurological consultation was for the benefit of his wife alone. She had nagged him for years about what she called his unfitting behavior. After the car accident, his physician suggested they see me to settle the matter.
This was not an auspicious start.
The professor fully looked the part of an old-school academician, in a brown corduroy sport coat with suede elbow patches, wrinkled khaki pants, scuffed Vibram-soled shoes, and thinning white hair brushed back from his temples. In measured phrases tinged with a remnant of a North Carolina accent--held on to despite 40 years of teaching in southern California--he described the accident.
I was backing out into the street from a parking lot, he began. I might have heard a rasping sound, and my wife was saying something, but for whatever reason, I wasn’t paying close attention. So I stopped the car and she drove. I did apparently scrape the passenger side.
His wife pursed her lips and folded her hands on the lap of a pleated tartan skirt. Looking at her white blouse with its Peter Pan collar, I imagined that her wardrobe had changed little from her days as a college student in the 1940s. She seemed to require my permission to speak. I nodded.
Well, Robert, there was more to it than that, she opened cautiously. You drove in reverse down a line of three parked cars and ignored my calls to stop. Then you put the car in forward and drove for two more blocks--and through a stop sign. I was frantic and begged you to stop, but you completely ignored me. After I asked you for the tenth time to pull over, you finally looked at me and turned into the gardening store’s parking lot. When I showed you the damage to our car and said that we had to go back and leave a note for the people whose cars you’d hit, all you could say was, ‘Whatever pleases you.’
The professor sat beside my desk and stared steadily at an ophthalmoscope on the wall above an exam table. Do you recall this? I asked.
He said nothing. I was about to repeat the question when he squinted his eyes, as if weighing whether what she said made any sense. Well, she may be exaggerating my seeming lack of interest, he said.
Did you feel anything unusual at the time, perhaps a bit bewildered? I asked.
After a few more long moments he replied, Well, I might have felt a little lost in space.
I began to probe into his past. Before the accident, had he ever seemed unaware of what he was doing? He said no, but his wife quickly brought up the faculty dinner 17 years earlier at which they’d announced their engagement. At the dinner table, she recounted, he had turned to her and mumbled something, then slowly leaned forward until his face fell into the fettuccine on his plate. No one said anything. She and his department chairman pulled him up by the shoulders; he seemed befuddled for a moment, then told them he felt fine.
What did you make of this? I asked the professor.
She told me about it while wiping some sauce off my face, and I figured that I’d had too much to drink. He shrugged his shoulders.
At the most, he drank two glasses of wine, his wife countered. But no one at the table seemed surprised. And when I took him to see a doctor the next day, his cardiogram and blood tests were normal. The doctor told us that he’d probably passed out from the alcohol.
Next I asked if he’d had any other spells like this, or other car accidents. Again he said no. Again his wife disagreed. What about the time you slammed your foot on the brakes at a cross street, even though you had the right of way, and we were rear-ended? she reminded him with some bitterness. I had pain from the whiplash for months.
I mean that I don’t think I’ve ever passed out like that before, he replied.
No, not exactly, she agreed. But I’ll tell you something, and you either pay no attention or bring up an entirely unrelated subject, as if I didn’t exist. And you do terribly impolite things, and instead of apologizing you insist--not without anger--that I’m misunderstanding or overstating the case.
He had obviously heard this before. I’ve told you that I get absorbed and mean no disrespect, he said. Even the marriage counselor has said we both have to be more patient with each other’s little habits.
So, I thought, there’s more to this than medicine. Domestic squabbling was obviously playing a role here, and this couple wanted me to help their counselor restore goodwill. The real problem might be nothing other than a wife who expects more in the way of decent manners from a scholar who is dedicated to studying the manners of other cultures.
At the same time, the professor’s wife was trying hard not to be personally insulted by his behavior. She mentioned that his previous wife had divorced him shortly after their last child left for college in upstate New York--a bit of information meant to let me know that he had never been easy to live with. Still, no matter how moody, meditative, or aloof he might be or always have been, I needed to settle for myself whether or not a neurological problem existed. And to do that I needed to ask more questions. I started with the wife. Can you give me some examples of what he does that you find out of the ordinary?
Without a pause she said, He’ll repeatedly tap his spoon against the bottom of his soup bowl. I mean, for two or three minutes before even taking a sip, and then he might do it again.
It’s only for a second or two, he interrupted.
No, it’s for minutes, and when I ask you to stop you ignore me. And when you’ve finally stopped and seem more inclined to listen to what I’m saying, you lash out at me.
I then asked him whether he was aware of brief spells when he might lose track of a conversation or falter as he lectured. Did he often experience a peculiar sense of déjà vu or of feeling disconnected from his world? After each question he paused in thought, then gave me a definitive no.
I turned back to his wife. Does he ever stare off into space and repetitively blink his eyes, smack his lips, or do some other stereotyped movement--something like the spoon tapping?
No, I don’t think so. But he’ll walk in front of me or step on the heel of my shoe and trip me and seem oblivious to what he’s done. Her husband looked steadily ahead, offering no defense. And there was the time I was standing on some phone books on top of a wobbly chair trying to dust out a cobweb up on the ceiling. He was holding the chair and had me by the waist. Suddenly, without a word, he let go and walked away and I lost my balance and fell. My leg was killing me. I screamed to him to call 911. He continued to walk toward the bathroom. When I yelled again, he came out and I begged him to call an ambulance. He lifted the phone and, without dialing, said something like, ‘They can’t come.’ Then he stood over me for maybe a minute before he knelt down to help. Finally he went and made the call. My hip was broken and I spent a week in the hospital. It still bothers me, eight years later.
What do you make of this? I asked him.
I recall the situation, but I’m not clear on some of the details, he answered. I mean, I must have had to go to the bathroom and then didn’t think fast enough to realize she was hurt.
His wife wasn’t ready to let him explain it away that easily. But he does do these odd things, and it gets him angry if I make a fuss, she protested. I let most of the incidents go by so he won’t get upset. I waited for her to go on, but she was suddenly busily attending to a loose skirt thread.
It was obvious that she wanted to state her case, but without accusing her prominent husband of being mean, inconsiderate, or even bizarre. And though she seemed to sense this might help me explain his lapses in civil behavior--which she estimated to occur about once a week-- she seemed reluctant to provide me with greater detail. Maybe she didn’t want to add anything that could further threaten their marriage. Maybe her husband had at times acted in a way so offensive she dared not confront him or leak the information to a doctor.
With this suspicion in mind, I encouraged her to push past her strong sense of propriety. When he seems to ignore you, has he ever acted in a way that might embarrass either of you?
She paused, finally touching her hand to his and saying, Robert, don’t take this personally, before she turned to me. Yes. On many occasions over the years, he’ll start to . . . well . . . he’ll pick his nose. I mean, he’ll take one finger after the other, the ring and pinkie on his left hand, and put one in his nose, lick it, then put the other in and lick that and continue this, sometimes for several minutes. If I ask him what he’s doing, he either won’t answer or says, ‘I don’t know.’
I don’t really do that, do I? He looked puzzled.
You do, she answered firmly, and one of the times was when we were at the president’s faculty reception surrounded by friends. No one pays attention, because they all consider you to be so eccentric anyway.
It was this final detail that gave me my diagnosis. The nose- picking behavior was so antisocial, so out of character and seemingly beyond his control, that it fell beyond eccentricity. In ancient times, the professor would have been deemed possessed. Today, he would be called an epileptic.
While most people picture an epileptic seizure as so violent and extreme that it can hardly go unnoticed, I explained to the professor and his wife that he might well be having these attacks of altered awareness due to a type of seizure called partial complex, or psychomotor. A virtual storm of electrical discharges was coming from the neurons of one of the brain’s temporal lobes, where new memories are formed and many of the pathways for emotions reside. In a partial complex seizure, for reasons no one really understands, this outbreak of abnormal brain activity could result in the professor’s unwilled behaviors as well as his amnesia concerning these simple acts. Normally, each neuron’s firing rate is influenced and modified by its neighboring cells, but in the professor’s case, an old head injury, tumor, or stroke could have isolated a particular patch of nerve cells from their neighbors, allowing the patch to occasionally fire without restraint. For the seconds or minutes when such a storm clouded over his awareness, the professor became an automaton who could trip his wife or leave her writhing on the floor, sideswipe three cars without knowing it, or tap, pick, and stare in a maddening fashion. Then, as the seizure ceased, his mind drifting in a confused, amnesiac state, he would lash out at his wife.
Remarkably, the professor readily accepted my tentative diagnosis. He liked its logic, even if he couldn’t offer, or remember, any evidence in its favor. His wife seemed relieved and asked me to talk to their counselor.
I ordered an electroencephalogram for the professor, to monitor his brain’s electrical waves. I hoped it might show us some epileptic activity, though he would have to have a seizure during the EEG in order for it to be detected. A magnetic resonance scan would show us if he had any serious brain disorder.
I quickly assured him, however, that the cause was not likely to be a malignant tumor, since I suspected he’d been having these lapses of consciousness even before he married his present wife. I asked him to discuss the matter with his children and former wife. Was it possible he’d been having these spells for decades?
In the meantime, however, the most practical way to determine whether or not the professor had epilepsy would be to put him on anticonvulsant medication. If he stopped having attacks while on the drug, then my diagnosis would be secure. In addition, I told him not to drive a car until we were certain the seizures had stopped. I would have bet that the only reason he’d never had a really serious accident was that he had walked to work for 30 years and rarely drove on the freeways. Indeed, if the diagnosis proved correct, we could all be thankful that no greater harm had come to the couple while he was under the influence of the electrical demon.
The professor and his wife returned several weeks later. His tests had all come back normal, which was not surprising since he didn’t have a seizure during the EEG. In some instances, a patient can be continuously monitored by an EEG and simultaneously videotaped in an attempt to tie his behavior to a spell. For the professor, that didn’t seem necessary. The drugs