A New Doctor [Roderich]

"William. William, wake up please." Will opened his eyes and turned his head towards whoever was speaking to him. He'd gotten used to being woken up whenever the nurses wanted something or if it was mealtime. Unfortunately this time the nurse who woke him was a tall purple dinosaur towering over his bed, and thankfully he resisted the urge to scream. He took a deep breath, closed his eyes, and opened them a few seconds later. The nurse by his bed was actually human now, thank goodness, and the dinosaur was gone. "William? Are you all right?"

"Yes, yes I'm all right." He heard a song coming from the TV and realised someone set it on a channel that plays a show with a purple dinosaur, then left the remote well out of his reach on the opposite side of the room. It must've been playing ever since someone shifted the remote, and how long ago was that again? He wasn't really sure.

"Could you please turn off the TV or change the channel?" Will said. "Someone else left the remote on that side of the room, and it's been playing that show with the purple dinosaur for a while."

The nurse nodded then went and picked up the remote, and switched off the TV before coming back over to Will. She gave him the remote, and then she raised the top part of his bed up.

"Thank you so much." Will said. He didn't mention the nurse looking like a dinosaur when she first woke him up. She might think he was crazy or something. "Um, why are you raising the bed?"

"A Doctor is coming in to see you soon, William." She said. "He's been asked to try to find out why you sleep so much."

"I see." Will said. So far the only doctor he'd met was Meilan, and since this new doctor was a guy it clearly wasn't going to be Meilan. With a bit of luck this doctor might figure out the sleeping issues he has. He wasn't sure if this new doctor could do that, but anything that stops dinosaurs appearing in his room would be good. "Thank you for telling me."

"You're welcome," The nurse said as she headed for the door to leave the room. "The Doctor will be here in a few minutes."

---

* Another part of narcolepsy is dreams that intrude on reality in the form of hallucinations like Will seeing the nurse as a dinosaur there.

(Fff, sorry it took so long for me to reply. I blame finals.)

Heading down the hall with the new patient's records in hand, Roderich had a sinking feeling that this was going to be another one of those cases.

Those being the all-too-frequent cases that were passed on to him simply because they involved some strange symptoms and he happened to be a specialist. Never mind that his specialty was infectious diseases and the symptoms pointed towards an autoimmune disease or deformation or injury as the etiology--the general practitioners just had to hand the case over to him when diagnosis started getting difficult. Part of him couldn't be too aggravated, knowing that if the diagnosis did turn out to be outside of his line of work he wouldn't have to deal with the treatment, but the other part was always rather annoyed. He hated having his time taken up by things that technically shouldn't be his problem...

At least he could be grateful for the fact that his first few courses of action had been carried out already for this one. Upon being admitted after his accident, the patient had received a CT scan to check for head injuries and the scan had come out clean. That ruled out various manifestations of trauma, including encephalitis and hemorrhaging. He'd also had his post-accident regimen of analgesics changed a few days ago, which rendered it less likely that the sleepiness was a side effect. His blood had been tested and the possibility of diabetes, as well as various nutrient deficiencies, had been ruled out.

Well. Roderich was currently hinging his bets on either a thyroid condition or sleep apnea. Either would make the case transfer to someone else, a thought which made him slightly more content with the situation. (There was also the possibility of mono, but he was sure he could cross that off the list quickly.)

He stepped into the room, grabbing the chart from outside of the door and glancing over it for any recent developments before setting it and the records aside on a nearby table.

"Mr. Green," he greeted politely. "I'm Dr. Edelstein. I'm going to check for a few things, but would you mind telling me in detail about your sleepiness before I start?"

[[No worries!]]

Will heard the door of his room open again, and saw the Doctor enter. The Doctor then introduced himself, and asked him about his sleepiness. No one had asked him to explain how he felt before, and Will took a moment to think about it before responding.

"Um, sorry in advance if I fall asleep while you're here, and if I do fall asleep just wake me up. I've been feeling constantly sleepy during the day since I was 17, and I'm 22 now so that's a long time. The constant sleepiness I feel every day is an overwhelming urge to sleep that gets stronger and stronger if I don't give in to it. Eventually that urge gets so strong that I can't stop myself from falling asleep at all. I also have a very slim chance of controlling where I fall asleep when that urge to sleep takes over, but that's about it."

Will wondered if Dr. Edelstein could imagine what life was like for him. Maybe an example could explain it properly?

"You've pulled an all-nighter before, right? Now try imagining you've pulled four all-nighters in a row on no sleep at all, and you can't sleep until you get home from work that night. Someone has just given you an urgent task that is mind-numbingly boring and has to be completed right then and there. Is it near-impossible to focus on that task given how tired and sleepy you are?" Will said. "That level of sleepiness and fatigue is how I feel when I'm awake, and that mind-numbingly boring task represents everything I have to do every day. When I wake up after sleeping during the day, I feel a little less tired and a little more awake like I do right now. That feeling only lasts for a short time, and then I go back to fighting off my usual level of fatigue and sleepiness. I'm not sure if that was exactly what you wanted me to explain, but that's how I feel every day. I can explain how it's affected my life as well if you need to know that."

A mildly troubled look crossed Roderich's face. Will had been experiencing excessive sleepiness, to the degree that he would fall asleep mid-conversation, for six years? He'd never before sought treatment to it? Gosh, the kinds of things people were willing to live with...

His initial surprise turned to inward amusement as Will asked him whether he'd pulled an all-nighter. He'd been through medical school--of course he had. Three scattered through one week had been his maximum, however. Four, from what he'd witnessed, tended to invite symptoms of delirium.

Hmm, it looked as though he could safely rule out mono, if only due to the sheer span of time. Sleep apnea remained possible, though the severity of the symptoms pointed towards other possibilities. A thyroid problem was still possible as well, and would require tests that the initial blood analysis would have missed...

"Yes, that will be adequate," he said, folding and unfolding his hands thoughtfully. "Have you experienced anything besides sheer sleepiness? Any cramps, pain, trouble breathing, chills or fever..?"

Will listened to the list of symptoms Dr. Edelstein rattled off, and he hadn't experienced any of those. Given the level of pain relief he was being given for his injuries pain would be non-existent, and he really hadn't experienced any of those other things.

"Thanks to the doses of pain relief I'm not feeling any pain at the moment. I haven't experienced any of the other things you mentioned either." Will said. "I do experience something different to that though. If I'm holding something and someone startles or scares me by saying or doing something unexpected I end up dropping the item. It's not merely me being clumsy since my hands just don't move or grip anything for a minute or two. For example, you could take the TV remote when that happens, try to get me to hold it, and it'd just fall out of my hand."

"I can't prove it, but I think that could've happened on a bigger scale when I got hit by the truck." Will said. "Its horn was one of the most unexpected and scariest things I'd ever heard."

That theory was a weird one, but Will had no doubts that it could be possible. If losing control of his hands could happen, surely losing control of his body (scary as that sounds) is possible, right?

Well, of course he wasn't experiencing pain now that he was on medication. But the fact that the other symptoms weren't present pushed thyroid problems off the table. There was sleep apnea, then, and...hmm, what was Will describing there? A temporary loss of motor control...it sounded like a minor atonic seizure. Moreover, it sounded as though Will had been having such seizures prior to the accident, which took out the possibility of them being post-traumatic--well, if his medical records were correct in indicating that he'd had no head injuries in the past.

Actually, that was a decent question. Will hadn't checked into a hospital for his constant sleepiness before, so he could very well be the type that had suffered some form of brain injury and decided it'd go away with some asprin and rest. Perhaps something small enough that it had mostly healed over and escaped the eye of the physician who did the scan?

Such an injury could link back to his sleepiness, too--but then again, it could be entirely separate. He really ought to go check a few details and find a few more possible disorders...

"With that reaction to being startled, did you begin experiencing that around the same time that your sleepiness began?" he asked. "And do you happen to remember being injured beforehand--maybe a few weeks, months, even a year before the onset of your symptoms? Anything that involved you hitting your head, especially if it resulted in dizziness or a headache?"

Those two questions Dr. Edelstein asked were good questions, and Will had to really think about them for a moment before answering. Had he ever had any head injuries? He wasn't sure. He could definitely answer the first question though.

"That reaction to being startled can happen when I laugh too, and to be honest I'm not entirely sure when that started happening because I used to put it down to clumsiness when stuff like cups, glasses and plates seemed to slip out of my hands. It could've been around the time the sleepiness began because I remember both the sleepiness and things slipping out of my hands affecting my rugby playing. I finally quit playing rugby a couple of years ago when I started having trouble getting through training. I didn't want to let down the team by not being able to handle training or a full game. I guess if I built up my fitness again after getting out of here I could go back and be a referee or a coach."

He paused before answering the second question. He didn't remember ever getting a concussion in all the years he's played rugby although other members of teams he's played in had.

"You mean a concussion, right? In all the years I played rugby I don't remember ever getting a concussion. Some of my team-mates had had them, but I don't think I ever did."

Okay then. Post-traumatic head injury was out. That removed one possibility from the equation but didn't bring him much closer to a conclusion. Sleep apnea? Still a fair explanation for the sleepiness. The central kind involved a neurological imbalance, rather an obstruction (an obstruction, of course, would have likely manifested as snoring and been noted by a night nurse by now.)

Well, he might as well run after that possibility. He scribbled a few notes on Will's charts.

"I'm going to run a sleep study on you," he told him. "Your problem is likely neurological, so I'm going to have you go down to the lab and have your brain activity measured, along with a few other factors. It's a non-invasive procedure--you're just going to have a number of electrodes and sensors placed on you and you'll get to sleep for a while. Would you mind having it done right now?"

"That's fine with me!" Will said. The sleep study sounded really interesting to him. They could test for stuff while he sleeps? Awesome! He wondered if there was anything he needed to do for the testing aside from being there and then sleeping.

"What sort of stuff does the test measure?" Will said. This sleep study was something interesting in what had been a boring week so far. He was genuinely curious about this, and wondered what Dr. Edelstein might find out from it. Good things? Bad things? Interesting things? Whatever it was, Will wanted to know partly for curiosity's sake, and partly to ease the boredom that he'd been feeling from being stuck in his room.

(Fff, latereply. Sorry.)

"A lot of different things," Roderich replied. "Electrical activity in the brain, eye movements so we can tell when you enter REM sleep, muscle tension to check for excessive limb movements, heart rate, breathing and blood oxygen levels. It's basically a diagnostic test where we try to cover all possible symptoms."

"All right, let's go." He stepped out through the doorway, returning shortly with a nurse that helped him wheel Will's bed out of the room and down the hall. A short elevator ride took them to the floor the sleep lab was on and aided by the technician there, Roderich outfitted Will with the multitude of electrodes and sensors required. He lingered briefly, jotting notes from their conversation and watching Will drop off to sleep in the course of only a minute, his breathing and pulse slowing on the monitor.

He was an interesting case, honestly--enough of an enigma to be more interesting than annoying. The study would take hours, though, so he neatly placed Will at the back of his mind for the moment and headed off to fetch the records of his cryptosporidiosis patient.

*

It was the following morning, when he was sitting at his desk and sipping green tea from a travel mug, that the results came in through the network.

He scrolled through them, brow furrowed. Hmm. Apparently Will had entered REM very quickly and awoken three times during the test. His breathing had been normal and his blood oxygen levels hadn't dropped much below expected values. His heart rate had also stayed steady during sleep and no notable involuntary limb movements had been reported. There was no perceptible evidence of seizure activity.

It wasn't apnea--his breathing would've been interrupted and there would likely have been some oxygen desaturation, were that the case. Helpfully, the technician had thumbed through Roderich's notes and offered a suggestion.

Ah. Yes. That made sense--what Roderich had thought were a type of epileptic seizure were actually attacks of cataplexy. He didn't know too much about the diagnosis in question, but he probably would have thought of if he'd managed to identify that symptom for what it was.

He went back to Will's room, mug in one hand and phone in the other, pulling up studies about the disorder and reading them as he walked and stood in the elevator. He'd been right on two counts--that it'd been neurological and that it wasn't within his specialty. Its basis was autoimmune. He'd be able to hand this back to Will's primary doctor and not have to do any follow-up.

He inquired with a nurse as to whether Will was currently awake, then stepped inside the room, smiling a bit in satisfaction. "Good morning."

Will woke up the next morning and thankfully there'd been no purple dinosaurs in his room this time. Now that he had the remote he was able to switch off the TV before going to sleep, and seemingly avoid such things appearing out of nowhere. He thought back to the sleep study as he ate breakfast and wondered if Dr. Edelstein had found out what he wanted to know from it. Will had had some dreams during the sleep study, and that was about all he knew about it from his perspective.

Speak of the devil, soon after he finished his breakfast Dr. Edelstein walked in! He seemed to be in a good mood though, so maybe he found out something good? Perhaps something that explains everything? Will certainly hoped so.

"Good morning!" Will said. "Did you find out what you wanted to know from the sleep study?"

---

[[Sorry for the shortness of this. D: Will'll definitely be more talkative once Roderich starts explaining things!]]

(Heh, it's fine. I didn't give you a ton to work with. XD)

"Yes," he said, setting his mug aside on a table. "It seems you have a disorder called narcolepsy. It's neurological--likely a genetic problem that causes disruptions in sleep patterns. Your excessive sleepiness and losses of muscle control are both symptoms of the disorder, and the time you started experiencing them is consistent with when narcolepsy tends to set in."

He glanced down at his phone, thumbing open a page in a medical database about treatment. It was a bit rude to have the thing on in front of a patient, he supposed, but he didn't exactly know that information off the top of his head, though he had read up on a number of sleep disorders before.

"You're just on acetaminophen and ibuprofen right now, aren't you? If you don't mind taking liquid medicine, I think I'm going to try and order you some Xyrem--that's a narcolepsy-specific medication. If you want something else or end up having side effects, I'll leave a note on your chart about putting you on a stimulant and antidepressant, which should lessen the sleepiness and instances of muscle weakness, respectively."

[[Sorry about the late reply. ^^;]]

Will listened as Dr. Edelstein explained the diagnosis and what it was. Everything suddenly seemed to make sense! He'd always thought it was just a cheesy saying, but it really did feel like a weight had been lifted off of his shoulders as the diagnosis sank in.

"So not being able to stop myself from falling asleep at unexpected times and places, dropping stuff, breaking stuff, falling over, being called clumsy, lazy and accident-prone by other people, and even the accident that put me in here was all because of narcolepsy?"

Now that he was thinking about it, his narcolepsy had affected every area of his life and yet he'd put up with it all thinking if he just gets through this day and the next and the one after that his health might improve. He then listened to Dr. Edelstein explain that there was medication that can help ease the symptoms.

"Thank you for figuring all of this out, and I'd like to try Xyrem. If it does what it's supposed to life will be a bit easier for me."

Will liked the sound of life being easier after coping with everything for so long. He'd be able to do a better job at work, and he could even go back to playing sport if he felt like he could handle it. He just has to get better first.

(Heh, it's okay. </late too>)

"Xyrem it is, then." He took Will's chart, which had been left by the nurse on the counter, and jotted down a note about the medication and its alternatives, ending with a decided SEP ("somebody else's problem.") Yep, he was done with this one. Awesome.

Stowing his phone in his pocket, he extended a hand for Will to shake. "Good luck, Mr. Green. Hopefully you won't contract anything unusual enough for me to be called to see you again."

He meant it in the friendliest way possible, of course--seeing that, at this point, the sort of thing that would put Will again under his care would be dangerous complications or nosocomial infections, them not running into each other in anything more than a passing way would be good indeed.