June

Montana

Dad and I left for Montana on the last day of May 2006. Mom didn’t come because she had to work, but Dad had retired from the Post Office about six months earlier. He was a mailman for 38 years. About half way there, we stayed overnight in American Falls, Idaho. He and I had dinner at Pizza Hut that night. I spilled sunflower seeds all over the floor at the salad bar because I couldn’t hold the spoon level. And when I took a shower in the hotel, he was worried because he thought I might fall. I refused to take a bath in a hotel bathtub. Gross. I didn’t fall, but Dad had a cause for concern.
We were in Billings on time the next day for our 4:00 appointment. Dr. Coneman did tests for neurological symptoms. I would eventually become very familiar with these. The tests provide information to the doctors about the state of the nervous system. They are simple tests that require patience from the doctor and cooperation from the patient.

The Neurology Exam

The doctor tests for cognition. He determines if you are alert, he asks questions about time and place to see if you are oriented. If a family member is around, they may be asked if there is any change in your personality. As you speak to the doctor, they are secretly listening to the character of your speech and observing your behavior. Is your speech smooth? Are you making sense? Are you acting strangely? How do they know if you weren’t strange to start with?
There are eye tests. They shine a light in your eye and then the other one. They ask that you watch their finger with your eyes only as they move it around, don’t move your head, just your eyes. They check your peripheral vision: how many fingers am I holding up? You are not to look directly at the fingers.
They look for symmetry on your face, do both sides look about the same? Smile big. They ask you to move your tongue and lips. They ask if there have been any changes in your smell, taste or hearing. They touch the left and right sides of your face and ask if it feels the same on both sides. They make a noise by each ear and ask if it sounds the same on both sides.
Strength is tested in your arms and legs. Push against me with your arm. Now pull. Push out with your leg, now pull in with your leg. Push down with your foot like a gas pedal. They prick around on your body to make sure you can feel everything.
They scrape the bottom of your foot with something sharp to see if your toes curl up or down. If you are older than two years, they are supposed to curl down. Mine went up. They test to see if you can feel vibration and temperature. They test reflexes in your knees, elbows, ankles and wrists. I was hyper-reflexive. Stand back if you touch my knees.
They ask you to touch their finger with your finger and then touch your nose. They move their finger to a new spot and you touch it again. Touch your nose. Move the finger, touch it, touch your nose. Repeat. Tap your fingers in a coordinated motion, smoothly. Faster. Now move your heel up and down the opposite shin, other side. Now let me see you walk.
Dr. Coneman did not do all of these tests. He asked me to walk heel-to-toe, like in a drunk test. I gave it a quick try. Impossible. He ordered blood tests for West Nile virus and Epstein-Barr virus. He also ordered an MRI scan of my brain and a lumbar puncture (I prefer the term ‘spinal tap’ to lumbar puncture). He said it looked like an “inflammatory process,” and we needed to wait it out. It would pass.
In his notes from that day, Dr. Coneman wrote:
“Nina is a 32 year old woman who has had a bout of the flu, suggesting an underlying viral process followed by elements of ataxia along with hyper-reflexia.” Ataxia is unsteady and clumsy movements in the limbs and trunk due to a lack of coordination. Think of it as not being able to taxi smoothly. Although my reflexes, especially in my knees, have always been a bit brisk, they were really crazy now.
“The patient is a healthy-appearing, well-nourished woman who has some slight speech slurring.”
“Well-nourished.” Gold! Pure Gold!
Dr. Coneman’s statement that the illness would pass stayed with me. I believed it would pass, I just had to pass through the illness, however long it took. I never doubted it. I don’t know why I believed this, I just did. Not believing was not an option.