At first I thought it had to be stress. The patient was in her early forties, and she had been coming to my clinic for several years, complaining of weakness, stiffness when walking, numbness in her hands, occasional falls, and headaches. I ran tests the first year, including an extensive check for diabetes, anemia, and internal-organ dysfunction. All were normal. I ordered nerve-conduction studies to see whether her numbness might be from carpal tunnel syndrome, which is caused by pressure on the median nerve in the wrist. They were normal. I did an echocardiogram. It was normal. I discovered that her job would be eliminated in a downsizing, and I suspected that played a major role in her complaints.
Then one Friday night, she noticed the vision in her left eye had become a bit hazy, so she came to the clinic that evening. The doctor on duty found no abnormality in either eye but thought she might have a detached retina, a true emergency and one of the few things that could get the on-call ophthalmologist to come see a patient late on a Friday night. Her retinas seemed fine, though, so he decided to see if she might have an inflamed optic nerve or a problem in her brain and ordered an MRI of her head and eye for the coming week.
