Brainstorm. Sheldon J.D. Cohen

and kids.”

      “Any problems sleeping?”

      “None at all.”

      “Any problem concentrating?”

      He paused. “I don’t think so.”

      “What about appetite?”

      “Good.”

      “Any headaches?”

      “No.”

      Burt noticed him beginning to fidget. George got up, walked over to the window, and stared outside. When he returned to his seat, his expression had changed. Burt had seen this failure to concentrate before. He knew it was time to stop. This was a different patient from the man he met on their first visit.

      “It’s a big waste of time—right?” asked George.

      “Your wife’s worried, so I’m glad you came. I’ll step out of the room, and while I’m outside I want you to strip down to your shorts so I can examine you. As soon as you’re ready, open the door a bit and I’ll come right in.”

      Burt did a brief examination, a repeat of the last time, before concentrating on George’s neurological exam. He evaluated his motor abilities and did a full sensory exam. He checked cranial nerves and reflexes. He checked the strength of George’s arms and legs. He looked into George’s eyes with an ophthalmoscope. There were no localized neurological deficits. In short, his examination failed to reveal any evidence whatsoever of neurological change.

      “All right, George. Everything looks good. May I call your wife in?”

      “Sure.”

      When she returned, Burt informed her of the results. “Your husband’s examination was normal. I don’t find any evidence of a brain tumor, or any other brain disease for that matter. In fact, I find nothing wrong. But normal findings can sometimes register even when there’s a severe illness. What I’m saying is that everything is fine so far, but for a complete evaluation I’m recommending an MRI brain scan.”

      “What would that show?” asked Gail.

      “It would eliminate any possibility of a tumor or other brain disease. I don’t find such evidence on his physical exam, but we must look into every possibility.”

      “Brain tumor?” repeated Gail. George flashed a look of disbelief.

      “I don’t think there’s a tumor, but I want to be thorough,” said Burt.

      George was staring out the window again, no longer paying attention.

      “Anyhow, that’s number one,” said Burt. “Number two could be some psychological dysfunction: anxiety or depression to be exact. Not that George fits the exact mold of these diagnoses, but if there is any significant changes as you suggest we’d better check out that possibility. In fact,” he paused to look at George. “I would like to recommend you see a psychiatrist for a second opinion.”

      He bolted straight up. “A shrink? No way. Never.”

      “Well, then my final suggestion is that you watch and wait.” Turning to Gail, he directed the next comments to her. “Because of your husband’s occupation, I’d rather not prescribe medication considering he works with nail guns, hammers, power tools, and climbs ladders. We need to get this all sorted out first.”

      From the corner of his eye, Burt saw George jump up to leave. “Thanks for your time, doctor.”

      “Hold it, George.” The tone of the doctor’s voice took both Gail and George aback. His facial expression was stern. “This brings me to number three. It looks like you never took the tests that I ordered the last time.” Burt placed himself in front of the closed door. George got the message and stepped back.

      “Right. You said I had an ulcer, and the medicine took care of it,” lied George.

      “I said I thought you might have an ulcer, but for a final diagnosis I needed those tests I ordered.”

      “I’ll see to it that he takes them,” said Gail.

      “It could be too late, Gail. If the ulcer healed, and that’s a possibility because the pain’s already gone, then the X-ray might now read normal. I mention this only because the time to take tests is when symptoms are present. I hope you’ll learn from this experience and go from here.”

      George was noncommittal, but Gail soaked up every word.

      “Here’s a slip for the MRI of the brain, a full set of blood chemistries a blood count, and a stomach X-ray. Get them right away and I’ll have the results in a few days. There’s a lot of unusual things going on here and I need the help of these tests before I can pinpoint a diagnosis. You listened to my advice and ignored it after your first visit. I have no idea why you did that, but it made no sense. I’ll never order a test unless it’s necessary, George, and in your case there are some unusual things that could cause all your symptoms and they can’t be ignored and I must, I repeat, must have these tests.”

      Gail promised, and she and George departed in complete silence. They did not speak in the car on the way home. Gail prayed for a quick and simple diagnosis and cure.

      When Gail raised the subject of medical tests George said, “I have no brain tumor, and I’m sure as hell not going to some shrink.” When she offered opposition, George left the room. Her only hope was that he might change his mind. But why was he being so resistant? His whole mindset was not rational Why was he refusing to do what the doctor ordered? It’s as if he never heard what the doctor was saying. What was happening? Things have gone on too long.

      CHAPTER 10

      George’s emotional lability, fueled by his changing internal biochemistry, could not alter the inevitable. His work showed signs of deterioration, not because of any difference in physical prowess, but because of the storm that raged inside his brain. Like a hurricane born off the coast of Africa, the storm was heading westward toward Florida and gaining turbulence, speed, and momentum. This was the cause of his confusion and forgetfulness, both of which affected his performance at work. Jobs were left unfinished, shoddy work had to be redone and he failed to remember assignments. His mental state changed so fast that his coworkers, and even the foreman, could not miss the signs. Andy Simpson summoned him into his office.

      “Sit, George. We gotta talk. Sorry, but you have to know, if there ain’t any improvement pretty fast, you’re outta here. You always did great work, but it’s different now and the boss knows everything. He told me to fix this problem either way. I got no choice. I’m under the gun, and I’m gonna watch you like a hawk. Understand?”

      George was confused, but he knew enough to recognize that his job was at stake. He had all he could do to hold back and not vent. “I’ll do okay,” he said, trying with all his strength to muster the necessary control to keep his voice steady. “You’ll see.”

      Andy, hoping for the best, dismissed him with a stern and unchanged expression.

      The small talk between George and Gail had turned into silence. In fact, any meaningful conversation between them became more difficult. He mixed up the children’s names, and even they began to notice something wrong with their father.

      Megan cried whenever he raised his voice. He spent most days staring into space, and even stopped working in the basement. Gail, reaching the breaking point, had had enough. She feared he was having a nervous breakdown, or worse. Could it be a brain tumor, she wondered? The unmistakable truth was that his condition was deteriorating. At times, he would respond to questions with answers that made no sense. She decided the time had come to give him an ultimatum: that he return to Dr. Crowell and level with him, or she would leave and take the children to her parents.

      By evening, Gail heard a loud groan. She left the kitchen and went to the living room where she saw George sitting on the edge of the couch, doubled over and shaking. He had his arms crossed over his abdomen.

      “Good God, what’s