As we mentioned earlier, the 1950s was really an influential decade on fandom. Fanzines became less sercon in content. As a result, fan humorists such as Bob Bloch, Walt Willis, Bob Shaw, and John Berry became celebrities in fandom. Since we think that, above all, a fanzine should be entertaining to read, you've probably noticed that we publish a lot of articles by fan humorists. One of the best of them in present-day fandom, in our opinion, is Sharon Farber, who currently resides in our old stomping ground of Chattanooga. Here is the latest installment of her "Tales of Adventure and Medical Life" series. This is the tale of how I healed the blind, the deaf, and the hale all in one blow. When the emergency call caught up with me I was in clinic and my senior medical student, if I recall correctly, was making paper airplanes from prescription blanks. "Hey," I told him. "Got a stat consult for you to see." He unfolding an airplane and got a pen ready to take notes, ready but apprehensive. I knew he could handle it; he was a competent and invaluable student. Why, only last week, he'd managed to corner the clinic mouse and catch it in a styrofoam cup. "ENT (ear, nose and throat or otolaryngology. It's much simpler to say ENT) at Jewish Hospital. They've got a woman in her 20's, blind, epileptic. Must be one of those genetic syndromes. Anyway, she's in with an ear infection and now she's started losing her hearing." "Uh oh," he muttered. It sounded awful, a real emergency for once, as opposed to our usual stat consult: "We've got a guy here with syncope, he's been completely worked up, we want to send him home this morning, but want a neuro consult first." The poor girl, struggling through life unable to see, having seizures, and now she was going to be deaf too, totally cut off from life. Not to mention that the way an ear infection would make you bilaterally deaf was by causing meningitis, which can of course lead to brain damage and death as well. No, this was a true emergency and my student snatched up his black bag and sprinted for the door. After clinic the attending neurologist and I traipsed over to Jewish Hospital, several blocks away, and let the student present the case to us. It was even worse than ENT had described -- she was not only blind, epileptic and soon to be deaf or dead, but she was also paralyzed on one side, and allergic to half the drugs in the PDR. We entered the room. The patient was an overweight bleached blond with an unconcerned expression. She was reading a book in Braille, and a white cane leaned against the bed. "It's me again," said the student, and introduced us. They he began to question her, and further describe her history, as the attending and I watched. And began to furrow our brows. And began to exchange glances. Because the patient was not blind. The way her vision flickered about from doctor to doctor...She was pretending to be blind, and not doing a very good job of it either. I stepped forward, interrupting the case presentation. "How many fingers?" "I can't see anything," she replied. So I pulled out my OKN strip. Optico-kinetic nystagmus takes advantage of reflexive following and refixating on a series of moving stripes. I think of a way a person's eyes rhythmically flick side to side as she watches telephone poles pass the car window. If OKNs are present, it means the eyes and the parietal and occipital lobes of the brain are functioning. It's a way you can test vision in kids and other uncooperative sorts. She had some OKNs, but not great. She obviously was unfocusing her eyes, deliberately non-fixating. (A friend of mine had a brain damaged young male patient who wouldn't look at the OKN strip. So he then pasted tiny Playboy nudes onto a long piece of paper, and got excellent eye movements.) "Ahh," said my attending, more sophisticated than I, a mere resident. He took the bedside mirror, held it at arm's length before her, and began moving it closer. A mirror has an infinite plane of focus, so matter how deliberately you avoid looking at it, your eyes will find some target. If the target is moving, your eyes will then involuntarily converge and accommodate. (Accommodations refers to the way pupils get smaller as you focus upon a near object. The famous Argyle-Robertson pupils of neurosyphilis are said to be like a prostitute -- they accommodate but don't react.) "Mmm," said the attending, observing the predictable results. "Uh hunh," I agreed. The medical student, realizing what was going on, wore an expression that alternated between stupefaction and worry. Stupefied as he realized that if she wasn't blind, she probably wasn't epileptic, paralyzed, or deaf either. (She wasn't.) Worried because she'd duped him, and he thought we'd think he was an idiot, rather than just inexperienced. Medical training is designed to make you paranoid. Let's say medical students were toddlers. The first time the kid pulls up, takes a step, and falls down, the attending physician or supervision residents wouldn't say, "Oh, poor thing, did um hurt umself? Let's try again." They'd say, "You fool! You fell! Don't you know how to walk? Your ignorance could have killed someone! You're hopeless -- I hope you weren't planning to attend day care at Mass General." For some reason, the attending and I decided to send the patient to neuro-ophthalmology clinic. Partly it was that she seemed to be getting a lot of charitable benefits for being blind (Braille school, the while cane, god knows what else) and this annoyed our tax-paying souls; more, it was that I thought she might amuse my friend the neuro-op fellow. There are, after all, few amusing things in the practice of neurology. It's pretty hard to derive laughs from the sufferings of the demented, the disabled, the depressed. (Though every once in a while a confused patient will say something hilarious and I'll break up; very unprofessional. Like the gentleman with lymphoma all over his brain, who had great comic timing so that his friend and family thought he was just joking around more than usual until he ran into another car and came to medical attention. "Who's the president?" I asked. He stared at me, utterly amazed I didn't know. "Irving Berlin!" he replied. (Then he told me he was in an airplane. "Now look, sir," I said, beginning to point out that other occupants of the neurosurgery ICU. "See that guy in bed with the intravenous fluids? And all those nurses? Do you still think this is an airplane?" ("Huh. Well,"he answered, shaking his head disparagingly at my ignorance. "This isn't any ordinary airline." We put up a sign -- The NICU: Not Just nn Ordinary Airline.) One of the few pleasures, then, in a depressing specialty, is to watch someone pretend, say, to be paralyzed, and be able to trick him into demonstrating normal strength. (Though a friend of mine tried to avoid the draft during Vietnam -- and I think it was a perfectly appropriate to attempt this my any means possible -- by faking carpal tunnel syndrome. He soon found out that his condition is properly diagnosed by an uncomfortable nerve conduction test, and he disliked neurologists for the next decade, until making an exception in my case.) The neuro-op fellow gave me a blow-by-blow account of our patients's clinic visit. He filled the examining room with stray stools and tables, and this supposedly blind woman threaded her way through the obstacles, walkíng to the chair. When his med student checked her reflexes, he casually held up his hammer and said, "Hold this for me a minute, okay?" and she reached out and took it. Okay, so it's not all that challenging when the patient is highly unintelligent. After the fellow and his student wasted a lot of time and had a lot of fun doing all the highly sophisticated tests that a subspecialist has at his disposal, they presented her to the neuro-opthomology attending. We'd thought he'd enjoy the case too, and maybe demonstrate some new and even more subtle ways to fake out a faker. Evidently, though, he was in a bad mood that day. He scowled, walked into the examining room, didn't even say hello. He just picked up a copy of Time, flipped it open at random, and waved the page before her face. As with the OKN strip, her eyes made tiny involuntary movements as she momentarily focused on the print. "20/40," the attending snapped, tossed the magazine over his shoulder, and stalked out of the room. The medical legal situation is such that, even though we knew the lady was faking the deafness, my attending felt I should do a spinal tap to rule out any possibility of meningitis. One of the problems with patients who fake things, after all, is that sometimes they actually get sick, and you can totally miss the real illness underneath all the nonsense. I wasn't happy about doing a lumbar puncture, as the patient was overweight, which makes an LP very difficult. (The test is done by feeling the backbone, kind of difficult if you're liberally padded.) Also, I was tired. I let the patient know that it wasn't really necessary and it would be painful, but rather than refuse the test, she announced her decision to leave the hospital that day -- but only after the spinal tap! This was going to ruin the little that was left of a very bad day for me. "Fine," I sighed, calling the nurse and requesting an LP tray. "And now," I said, pulling a syringe of salt-water from my pocket, "I have here a medicine that will cure your blindness." "What?" she cried, suddenly very upset. "No! You can't so that!" I jumped forward and shot the salt water into her IV line. "Too late, I have. You're cured." She wailed in despair. Revenge can be sweet. Next: Who are these people faking illness, and why do they think they can get away with it? All illustrations by Teddy Harvia